A Case of Spontaneous Aortic Root Rupture / 日本心臓血管外科学会雑誌

The patient was a 74-year-old man who was brought to the emergency room with severe chest pain and shock. Transthoracic echocardiography showed moderate pericardial effusion, and contrast-enhanced computed tomography (CT) showed a dilated ascending aorta with hematoma. However, no evidence of an intimal flap in the aorta was found. Bloody pericardial effusion was suggested by the CT attenuation value ; therefore, type A aortic dissection was highly suspected. At surgery, an extramural hematoma was observed on the ascending aorta. An 8-mm dehiscence that had penetrated the adventitia was identified just above the commissure between the right and left coronary cusps of the aortic valve, without dissection in the ascending aorta, and thus spontaneous aortic root rupture was diagnosed. The dehiscence was closed directly with a mattress suture from outside of the sinus, and the dilated ascending aorta was replaced. The patient's postoperative course was unremarkable, and he was discharged 14 days after surgery.

Primary Papillary Fibroelastoma in the Left Ventricle / 日本心臓血管外科学会雑誌

A 76-years-old woman was admitted with a left ventricular tumor that was accidentally found by a transthoracic echocardiogram. The tumor was located in the papillary muscle near the apex, had an irregular surface, and was well mobile. The urgent operation was planned because the tumor might have caused of embolism. A cardiopulmonary bypass was established with distal ascending aortic cannulation and bicaval venous cannulations. The resection of the tumor was performed by a transaortic approach. Pathological examination confirmed the tumor as primary papillary fibroelastoma. During the operation, a thoracoscope was used to assist the resection of the tumor. It was useful for a good visualization in the left ventricle. In this case report we describe a rare case of primary papillary fibroelastoma in the left ventricle and a technique of resection using a transaortic approach with an assistance of a thoracoscope.

Surgical Procedures and Long-Term Results of Intraoperative Re-do Mitral Valve Repair / 日本心臓血管外科学会雑誌

We examined the surgical procedure and long-term results in patients who underwent intraoperative re-do for the completion of mitral valve repair. Between March 1993 and July 1996, 81 patients underwent mitral valve repair for pure MR using TEE evaluation. Of these, 12 patients that were judged to have more than mild residual regurgitation (MRA≥2.0cm² or MRL≥1.0cm) underwent intraoperative re-do. All of the patients were type 2, according to Carpentier's classification. Seven patients had degenerative disease and 2 had infective endocarditis. If the cause of residual MR was localized discoaptation, 5-0 suture plication with beating heart that increased the coaptation zone and resulted in decrease in the residual MR was useful. If the cause of residual MR was leaflet prolapse or dehiscence, intraoperative re-do was performed the cardiac re-arrest. Two patients of billowing valve underwent MVR and the other needed additional resection of leaflet, artificial chorda or suture. After intraoperative re-do, every procedure resulted in a reduction of MR except for 2 patients underwent MVR during the early postoperative stage, and of those all but one remaine no-to-mild MR in the late term (mean follow-up 26.2 months). In conclusion, 5-0 suture plication was effective for intraoperative re-do procedures, and basic mitral valve repair modification was necessary in about half of the cases. Intraoperative re-do was safely performed with no mortality or morbidity and it yielded good long term results. Intraoperative TEE evaluation was considered to be important.

Acute Abdominal Aortic Occlusion: Two Cases of Successful Prophylaxis of Myonephropathic Metabolic Syndrome / 日本心臓血管外科学会雑誌

We report two cases, a 58-year-old male and a 60-year-old female with acute aortic occlusion probably ascribable to intracardiac thrombosis associated with atrial fibrillation. Thrombectomy was performed at about 5.5 hours and 4 hours respectively, after the onset of occlusion, and revascularization was successful. To prevent MNMS after revascularization, about 2, 000ml of blood was taken from the femoral vein of the male patient, and 1, 000ml of blood from the female patient, and this blood was returned in the form of abluted erythrocytes in transfusion through a cell saver to the patients. We suspected slight myoglobinuria after the operations, but they did not develop MNMS because a urine volume of about 3, 000ml was maintained by administration of infusion solution and diuretics and by replenishment of electrolytes and correction of acidosis. It was concluded that the technique involving the removal of a large volume of blood from distal veins and its transfusion through a cell saver was effective in preventing MNMS.