A surgical case of infected cardiac myxoma.

A 60-year-old woman presented with a fever of unknown origin. Echocardiography revealed a large left atrial tumor protruding into the left ventricle during diastole. Laboratory investigation showed an elevated white blood cell count, C-reactive protein concentration, and interleukin-6 concentration.

Comprehensive Pain Control Strategy in Minimally Invasive Mitral Valve Repair.

Purpose: The effect of our comprehensive strategy to reduce pain after minimally invasive mitral valve repair through a right mini-thoracotomy was assessed retrospectively.

Methods: Our comprehensive strategy constituted the following: planned rib cutting to avoid rib injury, sufficient intercostal muscle division to mobilize the cut rib, limiting the number of intercostal ports, avoiding nerve entrapment, continuous extra-pleural intercostal nerve block, and regular use of oral non-steroidal anti-inflammatory drugs. We compared patients treated with this comprehensive strategy (Group S, n = 13) and patients before this strategy was implemented (Group C, n = 13).

Utility of Ultrasonographic Assessment of Distal Femoral Arterial Flow during Minimally Invasive Valve Surgery.

Purpose: To evaluate the utility of ultrasonographic assessment of blood flow to the lower limb below the cannulation site in minimally invasive cardiac surgery (MICS).

Methods: Twenty-two patients who underwent ultrasonographic assessment in MICS were reviewed retrospectively. In all patients, the right femoral artery was used for arterial cannulation.

Trunk Muscle Cross-Sectional Area as a Predictive Factor for Length of Postoperative Hospitalization after Surgical Aortic Valve Replacement.

Purpose: We investigated the utility of trunk muscle cross-sectional area to predict length of hospitalization after surgical aortic valve replacement (AVR) for aortic stenosis (AS).

Methods: Adult AS patients who underwent isolated AVR at a single institution were studied. The cross-sectional area of the erector spinae muscles (ESM) at the first and second lumbar vertebrae and that of the psoas muscle (PM) at the third and fourth lumbar vertebrae were measured on preoperative computed tomography (CT).

Commissure enhancement technique in aortic valve repair.

Sinotubular junction enlargement is one of possible causes of aortic valve regurgitation. However, there is no appropriate technique for sinotubular junction diameter reduction in aortic valve repair in a patient without disease of the ascending aorta or sinus of Valsalva. Herein, we report a simple commissure enhancement technique comprising the placement a horizontal mattress suture buttressed with felt at the sinotubular junction level in the commissure area.

Usefulness of Left Atrial Volume as an Independent Predictor of Development of Heart Failure in Patients With Atrial Fibrillation.

Left atrial (LA) volume is known as a robust predictor of heart failure (HF) development in patients with sinus rhythm. However, among patients with atrial fibrillation (AF), the utility of LA volume for prediction of HF development has not been determined. The objective of this study was to investigate the utility of LA volume for prediction of HF development in patients with AF.

New Flexible Internal Annular Fixation Rings for Tricuspid Aortic Valves.

Objectives: Although aortic annulus repair has a long history, there are still no ideal devices to control an aortic annulus. We have developed a new method involving the use of an expanded polytetrafluoroethylene graft with the support of a metallic ring holder during implantation from inside an aorta, with no dissection of the surrounding aortic annulus.

Methods: We used aortic annular rings of 18 to 24 mm made of Gore-Tex tubed grafts (W.

Infective Endocarditis on Caseous Calcification of the Mitral Annulus Involving Both the Anterior and Posterior Annulus: A Rare Case Report.

A 72-year-old man with end-stage renal disease and who was on dialysis was admitted with fever and chills. Two years previously, he had been diagnosed with caseous calcification of the mitral annulus (CCMA). Blood cultures revealed Staphylococcus aureus, and echocardiography revealed vegetation attached to the CCMA lesion, progressing to both the anterior and posterior annulus.

Posterior leaflet reconstruction using autologous pericardium in mitral repair.

A 75-year-old woman experienced recurrent mitral regurgitation caused mainly by a shrunken and tethered posterior mitral leaflet with a dilated left ventricle. Posterior leaflet motion was severely restricted. We successfully resolved the tethering and restored valve coaptation and competence using posterior leaflet reconstruction, which is a modified method of posterior leaflet augmentation using autologous pericardium.

Challenging mitral valve repair for double-orifice mitral valve with noncompaction of left ventricular myocardium.

Double-orifice mitral valve (DOMV) is a relatively rare cardiac anomaly. Although usually associated with various cardiac anomalies, co-presence of DOMV and noncompaction of left ventricular myocardium (NCLVM) is extremely rare. Here, we present a 24-year-old male who underwent mitral valve repair using artificial chordae and annuloplasty at the posterior commissure for severe mitral regurgitation (MR), resulting from flail anterior leaflet of the larger postero-medial orifice and dilatation of left ventricle with NCLVM.

Anomalous Right Coronary Artery Arising from the Left Sinus of Valsalva in a Young Athlete.

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.

Endograft infection after hybrid surgery for chronic Stanford type B aortic dissection: endograft infection and treatment.

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.

Tricuspidization and reimplantation procedure for unicuspid aortic valve with annuloaortic ectasia.

Unicuspid aortic valve is a rare anomaly. We report 2 cases of successfully treated unicuspid valves with aortic dilatations by using a tricuspidization and reimplantation procedure. Two men, 35 and 39 years old, with severe aortic regurgitation and stenosis received this procedure.

Hybrid surgery for intralobar pulmonary sequestration with aortic aneurysm.

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.

Massive pulmonary embolism with liver injury associated with chest compressions during cardiac resuscitation.

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.

Valve-sparing root replacement surgery for the truncal valve in an adult: report of the initial successful case.

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.

Thromboembolism in a patient with a mechanical mitral valve during anticoagulation with dabigatran etexilate.

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.

Commissure avulsion of the aortic valve caused by purulent pericarditis: report of a case.

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.

Management of infectious endocarditis with mycotic aneurysm evaluated by brain magnetic resonance imaging.

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.

Methods: 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.

Successful repair of bicuspid aortic valve with two raphae.

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.