[Surgery to Triple Valves for Active Infective Endocarditis Caused by Abiotrophia defectiva:Report of a Case].

We experienced a case of infective endocarditis caused by Abiotrophia defectiva in which aortic, mitral, and tricuspid valve surgery was performed. Even if blood cultures are negative, it is important to treat patients with endocarditis considering the possibility that some organisms are difficult to detect via conventional blood culture. Embolism is a complication that should not be overlooked in cases of infective endocarditis, particularly those caused by Abiotrophia defectiva, which tends to cause embolism. As the patient had splenic and cerebral infarction preoperatively, early surgical intervention was performed to prevent further embolisms, and the patient's postoperative course was excellent.

[Multiple mitral valve aneurysms, mycotic arterial embolism and aneurysms with infective endocarditis].

A 30-year-old woman with a more than 6-month history of fever, weight loss, general fatigue and dysesthesia of lower extremities was admitted to our hospital with a diagnosis of infective endocarditis. Blood cultures revealed Staphylococcus oralis. Echocardiography revealed severe mitral and moderate tricuspid regurgitation, as well as massive vegetations and aneurysms on the mitral valve. Computed tomography revealed an abdominal aortic aneurysm, left common and external iliac arterial aneurysms, and occlusion of the left common iliac, the deep femoral arteries and the bilateral tibioperoneal trunk. The ankle brachial pressure indices (ABI) were 0.94 (right) and 0.61 (left). She initially underwent mitral valve replacement and tricuspid annuloplasty. On postoperative day 24, the affected segments of the arteries were replaced with a woven Dacron bifurcated graft after resection of the mycotic abdominal and the iliac arterial aneurysms. We could not obtain a sufficient amount of omental pedicle to wrap the prosthesis. Her postoperative course was uneventful and mycotic arterial embolism and aneurysm did not recur.

Squamous cell carcinoma of the lung in association with sarcoidosis.

A 76-year-old man who was known to have sarcoidosis, developed a lung tumor. He had previously undergone cardiac and abdominal vascular surgery, at which sarcoidosis was confirmed by lymph node biopsy. A right lower lobectomy was carried out. Postoperative pathology showed limited disease, but cancer recurred 1 year later. Issues regarding the combination of sarcoidosis and a malignant tumor are discussed.

Intermediate type atrioventricular septal defect in the elderly.

A 65-year-old woman with intermediate type atrioventricular septal defect had been undiagnosed until initial presentation with congestive heart failure. She underwent surgery when the ventricular septal defect was found to be restrictive. The atrioventricular valve was similar to the common atrioventricular valve, but was connected to the crest of the ventricular septal defect. Surgery included direct closure of the ventricular septal defect, repair of the cleft in the atrioventricular valve, and ostium primum closure. Postoperative echocardiography indicated successful heart repair. We present a review of rare intermediate type atrioventricular septal defect in the elderly, and we discuss the surgical issues in this case.

Ross procedure for aortic insufficiency due to doubly committed subarterial ventricular septal defect in adults.

A 52-year-old female, with aortic insufficiency due to doubly committed subarterial ventricular septal defect (VSD) underwent a successful surgical repair by the Ross procedure. Preoperatively, she developed congestive heart failure because of less compliance to oral medication, raising concerns regarding life-threatening thromboembolism if she undergoes mechanical valve replacement. Despite the pulmonary autograft being defective, there were no difficulties in completing the surgery. The defect of pulmonary autograft and the VSD was closed by an expanded polytetrafluoroethylene patch. She tolerated the procedure well and now enjoys improved quality of life. We present a discussion of the indication of Ross procedure in the rare presentation of congenital heart disease, as well as several issues raised in this case.

Posttraumatic tricuspid insufficiency successfully repaired by conventional technique.

A 22-year-old man developed exertional dyspnea 2 years after blunt chest trauma due to a horse kick. Preoperative echocardiography showed severe tricuspid insufficiency (TI) caused by chordal rupture and prolapse of the anterior leaflet. A novel repair technique, the "clover technique," was applied, but was unsuccessful in this case. The valve was then repaired successfully using conventional techniques, that is, insertion of an artificial chordae, plication of the prolapsing leaflet, and DeVega's annuloplasty. We present here a brief review of posttraumatic TI, and discuss effective and less expensive techniques for repair.

Ruptured aneurysm of the subclavian artery in a patient with von Recklinghausen's disease.

A vascular manifestation of von Recklinghausen's disease is rare, but may be fatal if it is disrupted. A 39-year-old male with von Recklinghausen's disease presented with a large and tender bruise extending from his left neck to his left shoulder and arm. Computerized axial tomography revealed a ruptured aneurysm of the left subclavian artery. The patient underwent emergency surgery to exclude the aneurysm, and cross-over bypass grafting of both subclavian arteries was performed. We present a brief review of vascular maintestation of von Recklinghausen's disease, as well as a discussion regarding the strategy for treating this rare presentation.

Right ventricle to pulmonary artery reconstruction using a valved homograft.

Although the valved homograft is widely used to establish a connection between the right ventricle (RV) and the pulmonary artery (PA), its durability remains controversial. In the present study, the data on 141 valved homograft implantations in 107 consecutive patients performed from January 1990 to June 2000 were analyzed. The mean follow-up period was 4.6 years (range, 0.2-9.4 years). The clinical data, including clinic records, operative notes, follow-up visits, and letters from referring physicians, were analyzed with particular reference to variables associated with early and late mortality, deterioration of the homograft, and risk factors for patient survival and homograft failure. Early death occurred in 7.5% (n=8) of the cases, and each of these patients died without leaving the hospital. Late death occurred in 2 patients, for whom the cause of death was suggested to be related to arrhythmia. Thirteen patients underwent catheter intervention (ie, balloon dilatation and/or stenting) and 8 of these did not require homograft replacement following catheterization. The overall survival rate at both 3 years and 5 years was 88.9+/-3.4%. Cumulative freedom from total homograft failure was 82.5+/-3.6% at 1 year; 61.6+/-5.0% at 3 years; and 42.4+/-6.2% at 5 years. In comparison with 2 criteria of homograft failure (ie, total homograft failure and homograft failure including catheter intervention), the incidence of freedom from homograft failure including catheter intervention was lower than that of total homograft failure, although the difference was not statistically significant. In the multivariate analysis, significant risk factors with respect to patient survival were homograft replacement and the use of expanded polytetrafluoroethylene (ePTFE); those judged to be significant with respect to homograft failure were total repair with first homograft implantation and diagnosis of truncus arteriosus. The valved homograft was thus considered an appropriate choice of conduit between the RV and the PA, and it provided excellent patient survival. However, this type of homograft did not provide a completely permanent solution for the repair of complex cardiac anomalies. Therefore, the use of ePTFE for homograft extensions should be avoided. Finally, the results suggest that catheter intervention plays an important role in the longevity of the implanted homograft.