[Show abstract][Hide abstract] ABSTRACT: Cardiac events associated with congenital coronary abnormalities are rare but potentially life-threatening in a young population. Most of these patients are not diagnosed before their initial cardiac event. Amongst such coronary artery anomalies, sudden death is frequently seen in an anomalous origination of a coronary artery from the opposite sinus. We herein present the case of a patient who presented with sudden cardiac arrest associated with an anomalous right coronary artery originating from the left sinus of Valsalva. Surgical treatment was selected because there was evidence of reversible ischemia based on the findings of a stress test.
[Show abstract][Hide abstract] ABSTRACT: While the incidence of endograft infection is very low, the treatment is difficult when it occurs. We herein present the case of a 52-year-old male who had undergone a graft replacement in the proximal descending thoracic aorta for dissected aortic aneurysm (DA) 6 years previously and hybrid surgery 2 years previously, which consisted of an abdominal graft replacement, visceral and renal debranching surgery and endovascular surgery for a ruptured abdominal DA and residual thoracoabdominal DA. Following collapse from septic shock due to an endograft infection, we performed an in situ reconstruction of the entire thoracoabdominal aorta following intensive antibiotic therapy and 2 preoperative CT-guided percutaneous interventions. He was discharged 4 weeks after the surgery without any complications.
[Show abstract][Hide abstract] ABSTRACT: Objectives: Although valvuloplasty for mitral insufficiency has been established and achieved favourable outcomes, valvuloplasty
is not generally applied for aortic insufficiency. In this study, we investigated aortic valvuloplasty for aortic insufficiency.
Methods: Of 130 patients who underwent aortic valvuloplasty at our department between August 1993 and July 2012, 81 patients
with aortic insufficiency without lesions in the aorta or aortic root or infection were investigated. Seventy-two patients
were male, the mean age was 52.8 years, and 30 patients had a bicuspid aortic valve. NYHA class before and after surgery,
the left ventricular dimension (LVD) on echocardiography, left ventricular ejection fraction (LVEF), grade of aortic regurgitation,
re-surgery avoidance rate, and mortality rate were investigated.
Results: The mean NYHA class and aortic regurgitation were 1.8 ± 0.7 and 3.6 ± 0.5, respectively, and preoperative LVDd, LVDs,
and LVEF were 6.5 ± 0.8 cm, 4.3 ± 0.8 cm, and 62.2 ± 9.9%, respectively. On discharge, the NYHA and aortic regurgitation were
improved to 1.0 ± 0.1 and 1.2 ± 0.9, respectively. LVDd and LVDs were significantly improved to 5.2 ± 0.8 and 3.8 ± 0.9 cm,
respectively, and LVEF was 63 ± 10.2%, showing that the contractility was retained. The re-surgery avoidance rate was 97.2%,
86.9%, 82% and 69.8% after 1, 5, 10 and 15 years, respectively.
Conclusion: After aortic valvuloplasty, the left ventricular dimension was relatively retained, but the improvement of aortic
regurgitation and re-surgery avoidance rate were not satisfactory, indicating the necessity for further modification and investigation
of the surgical procedure to improve the outcome and generalise the surgery.
Preview · Article · Oct 2014 · Interactive Cardiovascular and Thoracic Surgery
[Show abstract][Hide abstract] ABSTRACT: A 62-year-old man with past history of chronic atrial fibrillation, congestive heart failure, and pneumonia was referred to our hospital for further workup of pulmonary sequestration. Enhanced computed tomography revealed intralobar pulmonary sequestration (IPS) of the lower left lobe, as well as aortic aneurysmal dilation at the origin of the aberrant feeding artery. We performed a hybrid operation consisting of thoracic endovascular aortic repair and excision of the IPS and left lower lobe by video-assisted thoracic surgery. The patient was discharged 5 days later without complications.
No preview · Article · Jul 2014 · The Annals of Thoracic Surgery
[Show abstract][Hide abstract] ABSTRACT: A 34-year-old man was admitted to our hospital because of sudden respiratory failure caused by massive pulmonary embolism. After arrival in the hospital, the patient experienced cardiopulmonary arrest, and we promptly initiated percutaneous cardiopulmonary support, in addition to sternal compressions for cardiopulmonary resuscitation. Computed tomography revealed massive pulmonary embolisms and intraperitoneal bleeding due to liver injury. After interventional hemostasis of the hepatic arteries, we performed emergent pulmonary embolectomy and hemostasis of the liver with gauze packing. Absence of further intraperitoneal bleeding was confirmed 2 days later on a second look. The patient was discharged 2 month later without neurologic sequelae.
No preview · Article · Jul 2014 · The Annals of Thoracic Surgery
[Show abstract][Hide abstract] ABSTRACT: We describe here an initial successful case of valve-sparing surgery using reimplantation technique in a 24-year-old male with aortic root dilatation with truncal valve insufficiency after common arterial trunk repair. Concomitant right ventricular outflow tract reconstruction with expanded polytetrafluoroethylene was also successfully performed. He was discharged home on postoperative day 10 without stenosis or regurgitation of repaired valves. He is in New York Heart Association class I condition without any anticoagulant agents 6 months after operation. Of course, careful follow-up will be needed though our early result is acceptable.
No preview · Article · Feb 2014 · The Annals of thoracic surgery
[Show abstract][Hide abstract] ABSTRACT: Recently, several new anticoagulants have been used instead of warfarin for preventing thromboembolism. In the RE-LY (Randomized Evaluation of Long-Term Anticoagulation Therapy) trial, the direct thrombin inhibitor dabigatran etexilate was as an effective and safe as dose-adjusted warfarin for prevention of stroke in high-risk patients with atrial fibrillation. However, the safety and efficacy of thromboprophylaxis after mechanical valve replacement is uncertain. We report a 57-year-old man with a mechanical heart valve who experienced acute upper limb thromboembolism during dabigatran intake. Dabigatran might be inadequate for thromboprophylaxis after mechanical valve replacement.
No preview · Article · Nov 2013 · The Annals of thoracic surgery
[Show abstract][Hide abstract] ABSTRACT: A 20-year-old man with fever and chest pain was referred to our hospital, where purulent pericarditis was confirmed by various examinations. Hemodynamic collapse and acute pulmonary edema occurred 1 week later, caused by acute severe aortic valvular regurgitation (AR). Emergency surgery revealed that the AR had been caused by avulsion of the aortic valvular commissure, which seemed to have resulted from penetration of the pericardial inflammatory process to the aortic root. We report this case because purulent pericarditis is now relatively uncommon and resultant aortic commissure avulsion is even rarer.
[Show abstract][Hide abstract] ABSTRACT: Objectives:
Cerebral complications of infective endocarditis (IE) [particularly, mycotic aneurysm, visualized as a hypointense spot on T2*-weighted brain magnetic resonance imaging (MRI)] are associated with a high incidence of postoperative cerebral or subarachnoid hemorrhage. We have adopted a policy of performing elective open heart surgery after performing a MRI enhanced by gadolinium in such patients whenever possible after improvement in inflammatory findings around a cerebral aneurysm.
Fifty-six patients (35 men and 21 women, mean age 56 years) diagnosed with active-phase IE between January 2000 and December 2010 were analysed retrospectively.
Six patients who had not undergone MRI were excluded. The remaining patients were classified into four groups according to preoperative brain MRI findings-Group A (n = 13): cerebral haemorrhage, cerebral infarction, abscess and encephalitis; Group B (n = 7): simple or multiple black dots ( = hypointensive spots) with cerebral haemorrhage or cerebral infarction; Group C (n = 15): simple or multiple black dots alone; Group D (n = 15): no abnormal MRI findings. None of the 12 patients who successfully underwent elective surgery in Groups B and C developed postoperative cerebral complications.
Brain MRI is an important tool for the detection of asymptomatic intracranial abnormalities associated with IE and evaluation of the preoperative bleeding risk of patients. Patients with contrast enhancement around black dots are at high risk for bleeding, and performing open heart surgery in such patients whenever possible after the improvement of inflammatory findings reduces the potential risk of cerebral haemorrhage.
Full-text · Article · Mar 2013 · European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery
[Show abstract][Hide abstract] ABSTRACT: We describe the case of a 17-year-old boy with bicuspid aortic valve with two raphae, for whom subvalvular circular annuloplasty and adjustable cusp suspension procedures successfully terminated severe regurgitation.
No preview · Article · Aug 2012 · Asian cardiovascular & thoracic annals
[Show abstract][Hide abstract] ABSTRACT: Septal hyper-contractility is thought to be the principal cause of significant left ventricular outflow tract obstruction (LVOT) and systolic anterior motion (SAM) of the mitral valve by making the distance between the mitral valve and papillary muscle shorter. A seven-year-old patient with severe hypertrophic obstructive cardiomyopathy underwent direct interventricular septal myectomy/myotomy using the resection/crush method to modify hyper-contractility. The procedure successfully reduced the pressure gradient from 180 mmHg to 7.6 mmHg, and systolic anterior movement of the mitral leaflet disappeared. Mitral regurgitation improved from grade 2 to grade 0. Postoperative echocardiographic vector velocity imaging (VVI) study revealed a reduced twist angle, depicting attenuated ventricular contraction power from a maximum twist 17.9° to 7.9°. Perioperative VVI revealed that interventricular septal myectomy/myotomy is useful, not only in reducing LVOT obstruction, but also in reducing hyper-contractility, which increases the distance from the mitral valve to the papillary muscle and relieves SAM.
[Show abstract][Hide abstract] ABSTRACT: We report two cases of non-obstructive mesenteric ischemia (NOMI), a rare but potentially lethal complication after cardiovascular surgery, which was successfully managed. In both cases (a 74-year-old chronic hemodialysis patient who underwent emergency aortic valve replacement and coronary artery bypass graft (CABG), and a 74-year-old patient who underwent emergency abdominal aortic aneurysm operation), NOMI occurred early postoperatively (on day 8 and 22, respectively). They suffered from severe abdominal pain, confusion, and metabolic acidosis. Contrast-enhanced multi-detector CT (MDCT) scan and subsequent selective mesenteric angiography revealed characteristic signs of NOMI, for which selective papaverine infusion through the angiography catheter was performed. It was effective in both cases to halt progressive bowel ischemia and bided our time to perform a hemicolectomy of the necrotic segment. Contrast-enhanced MDCT scan and subsequent selective angiography are vital for diagnosis. If the condition does not improve after selective papaverine infusion, exploratory laparotomy and resection of necrotic intestinal segment should be performed immediately.
[Show abstract][Hide abstract] ABSTRACT: A 28 year-old man without any heart disease suddenly fell down in a train and was admitted to our hospital after complete resuscitation by automated external defibrillator. Various cardiac examination were performed to clarify the cause of cardiopulmonary arrest. Coronary angiography showed normal coronary artery, and acetylcholine provocation test and exercise stress test were negative. No structural heart disease was revealed by cardiac MRI and echocardiogram. Brugada syndrome was suspected because of mild ST-segment elevation in the right precordial leads, however intravenous pilsicainide did not elicit typical coved type pattern. On a continuous electrocardiogram monitoring, there were frequent monofocal premature ventricular contractions (PVCs) originating from right ventricular outflow tract (RVOT), and some of them developed into nonsustained polymorphic ventricular tachycardia. Considering from these results, he was highly suspected having idiopathic ventricular fibrillation (VF) triggered by PVC of RVOT origin. Radiofrequency catheter ablation (RFCA) was performed and no polymorphic ventricular tachycardia was induced by any stimuli after RFCA. An implantable cardioverter defibrillator (ICD) was also implanted, and no shock has been delivered after hospital discharge. We experienced malignant type of idiopathic VF triggered by PVC from RVOT, and combination therapy of RFCA and ICD would be effective in this case.
No preview · Article · Jan 2011 · Journal of Arrhythmia
[Show abstract][Hide abstract] ABSTRACT: For a 75 year-old man with extensive aortic aneurysm, who had undergone a previous infra-renal abdominal Y-graft, a staged replacement of remaining segments was performed. A hybrid procedure of open-laparotomy debranching of visceral branches and endovascular stentgraft insertion in the thoracoabdominal aorta was performed first, followed by subsequent direct replacement between the proximal ascending and distal arch using cardiopulmonary bypass. Three months thereafter dissection of enlarged proximal descending aorta occurred, for which we performed an emergent endovascular stentgraft deployment which bridged "elephant trunk" of the arch graft and the previous stentgraft. Consequently total aortic replacement was successfully accomplished without any neurological sequela.
Full-text · Article · Jan 2011 · Annals of Vascular Diseases
[Show abstract][Hide abstract] ABSTRACT: To elucidate the effects of prosthetic valve sound on a patient's quality of life (QOL).
We compared the valve sounds of ATS, SJM, and Carbomedics (CM) based on assessments by 248 patients who underwent mechanical valve replacements from January 2000 to August 2003 at seven facilities in Japan. We used a self-administered questionnaire for evaluating patients' assessments of valve sounds and the Japanese version of SF-36 for measuring their health-related QOL.
With respect to the valve-sound level perceived immediately after surgery, we considered the ATS and SJM valves quieter than the CM valve, but others have considered the ATS valve quieter than the SJM and CM valves. Regarding the time when the valve sound stopped bothering patients, a significant difference was observed between the ATS and CM valves and between the SJM and CM valves. The logistic regression analysis on patients' perceptions of valve sounds indicated that the influences of age, gender, and valve position are significant. Furthermore, a survey with SF-36 indicated that a long valve sound will affect a patient's health-related QOL.
The present study suggested that the ATS valve surpassed the other two valves on the whole in audibility of valve sound and patient health-related QOL. However, further studies, including the ongoing prospective study, are necessary for a more comprehensive and accurate evaluation of the ATS valve.
[Show abstract][Hide abstract] ABSTRACT: A 74-year-old woman with exertional angina was diagnosed with occlusion of the left coronary ostium associated with a rudimentary aortic valve cusp. A transesophageal echocardiogram, a multi-detector computed tomographic scan, and a coronary angiographic scan revealed the rudimentary aortic cusp covering the small left coronary aortic sinus leading to occlusion of the ostium of the left coronary artery, despite the intact coronary arteries. After excision of the rudimentary left coronary cusp, the left coronary ostium appeared intact. An aortic valve replacement with annular enlargement using a bioprosthetic valve was performed. The patient uneventfully recovered without angina.
No preview · Article · Dec 2010 · The Annals of thoracic surgery