[Caseous Calcification of Mitral Valve Annulus;Report of a Case].

We report a case of an 80-year-old female presenting with a mitral valve tumor. Postoperatively, pathologic diagnosis was caseous calcification of the mitral annulus. In surgery, she successfully underwent a mitral valve replacement with a 20 mm mechanical valve.

Acute aortic occlusion due to false-lumen expansion after repair of abdominal aortic rupture in type B acute aortic dissection.

We describe a patient with aortic occlusion due to false-lumen expansion after repair of abdominal aortic rupture in acute type B aortic dissection. A 70-year-old man presented to a nearby hospital with severe lower back pain, and was subsequently referred to our hospital with a diagnosis of abdominal aortic rupture. Computed tomography scanning on admission revealed type B aortic dissection with concomitant false-lumen rupture at the level of pre-existing infrarenal abdominal aortic aneurysm.

Repetitive contained rupture of an infected abdominal aortic aneurysm with concomitant vertebral erosion.

We describe a rare case of surgical treatment for a repeated contained rupture of an infected abdominal aortic aneurysm (AAA) with concomitant vertebral erosion. A 59-year-old man presented to a nearby hospital with abdominal pain and fever. On admission, computed tomography (CT) scan revealed a contained rupture of AAA, but the patient declined the offer of surgical therapy.

Right retroperitoneal approach for repair of an abdominal aortic aneurysm involving bilateral iliac arteries in a patient with a left-side stoma after abdominoperineal resection.

A 78-year-old woman, who had a history of abdominoperineal resection with the associated left-side stoma for rectal cancer, was diagnosed with an infrarenal abdominal aortic aneurysm involving both common and right internal iliac arteries. She underwent in situ graft (bifurcated Dacron) replacement through a right retroperitoneal approach because of limited accessibility to the aorta and iliac arteries due to the left-side stoma. The distal anastomosis of the bifurcated graft was placed to the right external iliac artery and left femoral artery, and the left common iliac artery was excluded by ligating the branching arteries.

Ligation-and-bypass technique through the posterior approach for bilateral popliteal aneurysms.

A 56-year-old man with a painful, progressively enlarging pulsatile mass in the bilateral popliteal fossae was diagnosed with a bilateral popliteal artery aneurysm (PAA) and referred to our hospital to undergo surgical therapy. Computed tomographic scanning demonstrated a large, middle-type PAA with a rich mural thrombus in the bilateral popliteal arteries. Following aneurysm exclusion posteriorly, the patient underwent bypass surgery using a ringed polytetrafluoroethylene graft bilaterally.

Leaflet suspension and subvalvular annuloplasty in aortic valve prolapse.

We have utilized the combined techniques of subvalvular annuloplasty and leaflet suspension since 1999 to repair prolapsing aortic valves. We reviewed our short-term results to assess perioperative echocardiographic changes and repair durability. Nineteen patients (15 men and 4 women; mean age, 60.

Individualized off-pump all internal thoracic artery revascularization.

Objective: We developed an individualized off-pump approach in an all internal thoracic artery (AITA) composite graft revascularization (AITACR) program to minimize postoperative neurological complications and to obtain the best long-term results possible. Early results of the individualized approach are reported.

Patients And Methods: The operative method (on-pump or off-pump) was determined based on institutional selection criteria.

Postoperative treatment with carvedilol, a beta-adrenergic blocker, prevents paroxysmal atrial fibrillation after coronary artery bypass grafting.

Background: Arrhythmias following cardiovascular surgery lead to unstable hemodynamics, along with myocardial ischemia and decreased cardiac output. The purpose of the present case cohort study compared the control group with no carvedilol administered and the other group of patients given carvedilol and determined whether postoperative treatment with carvedilol, a beta-adrenergic blocker, prevents paroxysmal atrial fibrillation after coronary artery bypass grafting (CABG).

Methods And Results: Of 160 patients who underwent scheduled isolated CABG, 80 received postoperative carvedilol and 80 did not.

Perioperative changes in dynamic aortic root morphology after Yacoub's root remodeling and concomitant aortic annuloplasty.

We have performed aortic root remodeling concomitant with aortic annuloplasty (subvalvular circular annuloplasty: it tightens the aortic annulus, using Gore-Tex strip (N.L. Gore and Associates, Arizona, USA)) in patients with AAE and AR.

Apicoaortic bypass using a vascular graft with a bioprosthetic valve.

We report a case of 75-year-old man who underwent an apicoaortic bypass for severe aortic stenosis. The patient had a porcelain aorta accompanied by a severely calcified aortic annulus. We used a woven polyester vascular graft instead of a rigid apical connector because the latter material cannot be obtained in Japan.

Aortic root remodeling with aortic annuloplasty: mid-term results.

Background: A retrospective study was performed to determine the appropriateness of aortic root remodeling with aortic annuloplasty (m-Yacoub operation).

Methods And Results: A group of 60 patients with aortic valve disease with concomitant dilated or dissected ascending aorta, who underwent surgery between 1997 and 2003, were evaluated. Nineteen patients whose aortic valves were well preserved (mean age: 57.

Dynamic morphologic changes in the normal aortic annulus during systole and diastole.

Background And Aim Of The Study: The three-dimensional motion of semilunar attachment of the leaflet 'annulus' remains obscure. It has been suggested that the aortic root is distensible and moves during the cardiac cycle. In the present study, the aortic root was evaluated using two dimensions.

Risk factors for hypoxemia after surgery for acute type A aortic dissection.

Purpose: Postoperative hypoxemia is a frequent complication of surgery for acute type A aortic dissection. We tried to determine the factors associated with postoperative hypoxemia.

Methods: Between 1997 and 2003, 114 patients underwent surgery for acute type A aortic dissection.

Aortic valve repair for aortic regurgitation: intermediate-term results in patients with tricuspid morphology.

Background And Aim Of The Study: Surgical results after aortic valve repair in patients with aortic regurgitation (AR) of tricuspid valve morphology and with no evidence of aortic root disease have not yet been clarified.

Methods: Between January 1994 and June 2001, aortic valve repair was performed in 40 patients (eight females, 32 males; mean age 61.0 +/- 10.

Magnetic resonance angiography in coronary artery bypass grafting.

An attempt was made to reduce the incidence of perioperative stroke by detecting cerebrovascular disease with preoperative head and neck magnetic resonance angiography and by selecting the coronary artery bypass grafting technique. This strategy was used in 268 patients with ischemic heart disease who had undergone both head and neck magnetic resonance angiography before elective coronary artery bypass in our hospital between May 1997 and April 2001. In patients with significant stenosis or obstruction detected by head and neck magnetic resonance angiography, the findings were evaluated and cerebral blood flow was examined using brain single-photon emission computed tomography.

Three-dimensional recovery time dispersion map by 64-channel magnetocardiography may demonstrate the location of a myocardial injury and heterogeneity of repolarization.

Background: QT dispersion reveals heterogeneities in the repolarization time in the three-dimensional (3D) structure of the ventricular myocardium. In this study, we report on a 3D function map of recovery time (RT) dispersions as measured by 64-channel magnetocardiography (MCG).

Methods: MCG were simultaneously recorded in 29 controls and 21 patients with previous myocardial infarction (MI).

All internal thoracic artery composite graft revascularization.

The aim of this study was to determine the most efficient design of composite grafts and clarify the technical feasibility rate of composite grafting using internal thoracic artery exclusively in patients undergoing triple-vessel revascularization. Retrospective analysis of 104 consecutive patients was carried out. An in situ left internal thoracic artery graft for the left anterior descending artery area, with attachment of the right internal thoracic artery to the side of the left internal thoracic artery to revascularize the circumflex and right coronary vessels, was the most efficient graft design.

Late complications following surgery for type A acute aortic dissection using gelatin-resorcin-formaldehyde glue: report of two cases.

Gelatin-resorcin-formaldehyde (GRF) glue has been widely applied during operations for acute aortic dissection (AAD). At our institution, GRF glue was applied in 40 patients who underwent surgical procedures for AAD from 1995, two of whom needed a reoperation because of the development of a redissection and/or a pseudoaneurysm at the anastomotic sites. The operative findings and histological examinations suggested that the application of GRF glue during the initial operations might be related to the development of a redissection and/or a pseudoaneurysm.

Construction of a three-dimensional outline of the heart and conduction pathway by means of a 64-channel magnetocardiogram in patients with atrial flutter and fibrillation.

Background: Magnetocardiography (MCG) has the potential for collecting three-dimensional (3D) intracardiac electric information, because the magnetic field is unaffected by the shape of the lungs and torso. In the present study, we report on the generation of a 3D heart outline and conduction pathway by means of a current density map using a 64-channel SQUID system, and an evaluation of its significance in patients with atrial flutter (AFL) and atrial fibrillation (AFIB).

Methods: The subjects consisted of 20 healthy volunteers, and 3 patients with AFL and 4 patients with AFIB.

Head and neck magnetic resonance angiography before coronary artery bypass grafting.

Purpose: To evaluate the incidence of vascular lesions in the head and neck by magnetic resonance angiography (MRA), and investigate the factors correlated with severe stenosis.

Methods: Elective coronary artery bypass grafting (CABG) was performed in 413 patients at our center between May 1997 and April 2001. We used MRA to detect head and neck vascular lesions, then evaluated the occlusive lesions and determined their prevalence.

Effective use of fibrin glue for acute aortic dissection.

The use of gelatin-resorcine-formalin (GRF) glue for reconstruction of the vascular wall in the context of acute aortic dissection has become more common. However, anecdotal evidence suggests that use of the GRF glue results in higher rates of postoperative redissection. We describe an alternative method of reinforcing the dissected aorta with fibrin glue that may avoid this complication.

Influence of gelatin-resorcin-formalin glue on mid-term redissection after aortic repair.

Purpose: To determine whether the development of mid-term redissection after surgery for acute type A aortic dissection using gelatin-resorcin-formalin (GRF) glue could be prevented by applying less formalin.

Methods: Between 1995 and 1999, 59 patients underwent surgery with GRF glue to repair acute type A aortic dissection. Forty-one patients underwent surgery before October 1998, and 18 patients underwent surgery after November 1998.