Aorto-left renal vein fistula caused by a ruptured abdominal aortic aneurysm.

Retroaortic left renal vein is a malformation in which the left renal vein courses dorsal to the abdominal aorta. In patients with abdominal aortic aneurysm, an aorto-left renal vein fistula can form if the left renal vein is sandwiched between the aneurysm wall and lumbar vertebrae. The patient was an 84-year-old man with lower back pain.

Opposite effects of SSRIs and tandospirone in the treatment of REM sleep behavior disorder.

Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia defined by intermittent loss of electromyographic atonia during REM sleep with emergence of complex and vigorous behaviors. Although the efficacy of several agents for treating RBD has been reported, a rationale for medication has not been established and the exact pathophysiological mechanisms of RBD are uncertain. We encountered a patient with idiopathic RBD that dramatically improved with selective serotonin reuptake inhibitors (SSRIs) and deteriorated with a 5-HT1A partial agonist, tandospirone.

Nicorandil attenuates reperfusion injury after long cardioplegic arrest.

The cardioprotective efficacy of nicorandil in cardiac surgery was determined using a surgically relevant 4-hr cardioplegic arrest model. Each isolated rabbit heart was parabiotically blood-perfused using a modified Langendorff column. The magnitude of left ventricular developed pressure and rate of change of developed pressure over time were measured before (baseline) and after ischemia.

Safety of perioperative hemodialysis and continuous hemodiafiltration for dialysis patients with cardiac surgery.

Objective: We have routinely used postoperative continuous hemodiafiltration (CHDF) combined with intraoperative hemodialysis (IHD) for dialysis patients undergoing open-heart surgery. This perioperative management could avoid any limitation of potassium concentration in the cardioplegic solution, strict restriction of fluid administration, or blood transfusion.

Methods: To evaluate the safety of this strategy, 22 dialysis patients who underwent open-heart surgery (Dialysis Group) were retrospectively compared with 30 patients with normal renal function selected from the same time period with rigorously matched clinical characteristics such as age, gender, and operative procedures (Matched Group).

Complete rupture of the posterior papillary muscle caused by late reperfusion for acute myocardial infarction.

We describe a patient with acute mitral regurgitation due to complete rupture of the papillary muscle immediately after successful late reperfusion for inferior myocardial infarction. An 81-year-old woman was admitted complaining of mild chest discomfort. Although the electrocardiograms, biochemical test results, and her clinical history showed that several days had passed since the onset of acute myocardial infarction, a late coronary stenting was performed.

Surgical revascularization for acute coronary syndrome: comparative surgical and long-term results.

Objective: The purpose of this study was to evaluate the adequate timing of coronary artery bypass grafting (CABG) for acute coronary syndrome (ACS).

Methods: In our institution, emergency CABG has been avoided when possible for ACS patients favoring stabilization with medical therapies, including intra-aortic balloon pumping or percutaneous coronary intervention. After thorough preoperative examinations, an urgent CABG is performed.

Aortic valve regurgitation in alkaptonuria.

Aortic valve lesions associated with alkaptonuria tend mostly to be due to aortic valve stenosis, while aortic valve regurgitation is only rarely observed. Herein, a case is reported of severe aortic valve regurgitation and a fibrous strand in a patient with alkaptonuria. A 65-year-old male, with a history of inferior myocardial infarction, presented with symptoms of congestive heart failure.

Coronary occlusion using bi-directionally stretched elastic sutures during off-pump coronary artery bypass grafting.

Objective: Off-pump coronary artery bypass grafting may be partly invasive, particularly to the coronary endothelium that is snared. Efficacy of a simple technique to occlude a coronary artery with elastic sutures bi-directionally stretched just beneath the artery was evaluated.

Methods: Test subjects were eighteen adult mongrel dogs weighing 20-30 kg.

Mitral annular reconstruction.

Mitral annular reconstruction using a pericardial patch was performed in 3 cases of atrioventricular disruption. This technique may be useful for atrioventricular disruption in cases of active endocarditis, redo valve replacement, left ventricular rupture after mitral valve replacement, and annular calcification.

Splenic abscess associated with active infective endocarditis.

Splenic abscess is a rare complication in infective endocarditis. Here, we present two cases of splenic abscess associated with active infective endocarditis. Body computed tomography before emergency valvular surgery revealed abscess in the spleen.