Mitral valve nonbacterial thrombotic endocarditis: a rare multi-surgery-tolerant survivor of Trousseau's syndrome.

BACKGROUND: Few previous reports have documented cases of nonbacterial thrombotic endocarditis associated with Trousseau's syndrome for which surgery proved possible for both the primary tumor and the cardiac lesion. The effectiveness of direct oral anticoagulants in patients with Trousseau's syndrome has also received scant attention. CASE PRESENTATION: A 69-year-old man with repeated episodes of cerebral infarction was diagnosed as having nonbacterial thrombotic endocarditis after mitral valve replacement surgery. Stroke recurred preoperatively under apixaban administration. A stomach biopsy also identified gastric adenocarcinoma, and gastric surgery was performed on the 40th postoperative day. The patient was discharged from the hospital and has been free of thromboembolism under a regime of subcutaneous heparin self-injection thereafter. CONCLUSIONS: We have reported a rare multi-surgery-tolerant survivor of Trousseau's syndrome in whom subcutaneous heparin injection was useful for preventing thromboembolic events over a long period.

Platypnea-orthodeoxia syndrome associated with aortic insufficiency and aortic elongation.

An 81-year-old female developed dyspnea only upon assuming a sitting position. Trans-esophageal echocardiography demonstrated left-to-right shunt flow across the atrial septum when the patient was sitting, and right-to-left shunt flow when she was supine, along with severe aortic insufficiency. She was diagnosed as having platypnea-orthodeoxia syndrome and her symptoms were completely resolved following aortic valve replacement, closure of a patent foramen ovale, and shortening of an elongated ascending aorta.

Candidal mediastinitis successfully treated using vacuum-assisted closure following open-heart surgery.

Deep sternal wound infections (DSWIs) are an uncommon but serious complication after open-heart surgery. The reported incidence of DSWIs due to Candida albicans is 0.4%, but these infections have an extremely high mortality of 56%. We herein report a rare case of a 79-year old woman who suffered from Candidal DSWI after repeated open-heart surgeries. We treated her with negative pressure wound therapy (NPWT). This is the rare case report that provides evidence that NPWT is a safe and suitable technique for the management of Candidal DSWIs.

[Distal arch aneurysm and acute aortic dissection with bicuspid aortic valve; report of a case].

A 49-year-old man was admitted to our institution with acute chest and back pain. Chest and abdominal computed tomography (CT) showed type A aortic dissection from the ascending aorta to the bilateral common iliac arteries and a distal arch aneurysm with a diameter of 65 mm. Echocardiogram showed a bicuspid aortic valve with severe regurgitation. We performed total arch replacement and aortic valve replacement. Pathological examination of the aortic wall revealed a typical cystic medial necrosis. After 3 months, we performed the 2nd stage operation for the distal arch aneurysm and descending aortic dissection. Here, we report a rare case of bileaflet aortic valve with aortic aneurysm and aortic dissection.