[Severe aortic valve stenosis combined with a large brain tumor; report of a case].

We report a case of severe aortic valve stenosis with a large benign brain tumor (meningioma), which was successfully treated with simple replacement with a mechanical valve under extracorporeal circulation (ECC). A large meningioma is considered as a risk in an operation under ECC because it may increase intracranial pressure and cause bleeding. In this case we chose a simple method of aortic valve replacement for the purpose of shortening the ECC time. Under warfarin control, the patient is in a stable condition with good cardiac function and without any neurological symptom at 8 years after the operation.

[Three cases of cardiac tumor; an approach to excise a large tumor in the left atrium].

Tumors originated from the heart are very rare disease and their clinicopathological state has not been fully recognized. Cardiac tumors are most frequently found in the left atrium. An initial treatment is a surgical excision of tumors entirely including their pedicles. And regardless of benign or malignant tumors, it is most important to remove them completely. However, a complete resection of cardiac tumors in the left atrium becomes more difficult in cases of larger sizes or wide expanding of the pedicles. In such cases, we recommend to choose a right-sided approach to the left atrium, so that it enables to be easier to examine all areas of the left atrium for a complete resection of cardiac tumors. We have excised successfully in three cases of larger cardiac tumors originated from the left atrium employing a right-sided left atriotomy.

Left ventricular outflow obstruction after mitral valve replacement preserving native anterior leaflet.

Left ventricular outflow obstruction may result from preserving the anterior leaflet after mitral valve replacement. A 79-year-old woman, who had a mitral valve replacement with the native mitral leaflets left intact 16 years before, was admitted to our hospital with severe dyspnea due to heart failure. Echocardiography showed systolic anterior motion of preserved anterior mitral leaflet, and continuous wave Doppler detected severe left ventricular outflow tract jets during systole without mitral chordal rupture. Surgical incising of the anterior mitral leaflet through the aortic root relieved the obstruction without removing the prosthetic mitral valve.