[Mitral Valve Infective Endocarditis Caused by Parvimonas Micra].

We encountered a rare case of infective endocarditis caused by a common Gram-positive anaerobic coccus Parvimonas micra, originating from colorectal cancer. The patient was a 78-year-old female, presented with fever, speech disorder, and right hemiplegia resulting from stroke. Transthoracic echocardiography revealed mitral regurgitation and a mobile vegetation on the mitral valve.

A case of cardiac strangulation following epicardial pacemaker implantation.

An 8-year-old boy had undergone permanent epicardial pacemaker implantation with a Y-shaped bipolar ventricular lead on day 6 after birth for treatment of congenital complete atrioventricular block. He was found to have pulmonary stenosis and mitral stenosis by follow-up echocardiography. Further studies including computed tomography and cardiac catheterization revealed that the pacemaker lead had completely encircled the cardiac silhouette and was in a state of "cardiac strangulation".

Atypical Hemolytic Uremic Syndrome following Acute Type A Aortic Dissection.

Atypical hemolytic uremic syndrome (aHUS) is a thrombotic microangiopathy (TMA)-related disease that manifests as a triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury (AKI) and is caused by uncontrolled activation of the complement system. We report the case of a 61-year-old woman with acute type A aortic dissection that subsequently developed into aHUS. The hematologic disorders underlying aHUS improved after treatment with the complement inhibitor eculizumab.

Use of computed tomography-guided biopsy to detect -induced mycotic abdominal aortic aneurysm after endovascular repair.

Mycotic aortic aneurysm (MAA) is rare but lethal. Detection of the causative bacteria is important for successful treatment. In some cases, however, no micro-organisms are detected by repeated blood cultures.

Endovascular Repair for Ruptured Axillary Artery Aneurysm Proximal to Hemodialysis Access.

Axillary artery aneurysms are uncommon and potentially high-risk lesions threatening the upper extremities. In hemodialysis patients, arteriovenous fistulae creation rarely triggers aneurysmal degeneration and arterial aneurysms in inflow arteries. These aneurysms are usually treated by surgical repair.

Size and Stiffness of the Pulmonary Autograft after the Ross Procedure in Children.

Progressive dilatation of the pulmonary autograft is one of the greatest concerns after the Ross procedure. Increased stress in the arterial wall may cause changes in the elastic properties of the pulmonary autograft, and thus lead to pathological dilatation. The present study aimed to investigate the changes in the autograft diameter and stiffness during follow-up after the Ross procedure.

Tricuspid regurgitation resulting from acute type A aortic dissection.

Proximal extension of acute type A aortic dissection can affect the aortic valve but seldom affects the tricuspid valve. We report the case of an octogenarian who underwent successful surgical repair of an aortic dissection that was accompanied by tricuspid regurgitation. We believe that the tricuspid regurgitation was attributable to displacement of the valve resulting from aortic dissection.

Aortic valve replacement in a porcelain aorta using endo balloon occlusion.

Aortic valve surgery carries increased risks in patients with an extensively calcified aorta. We describe a technique in which we maintain systemic perfusion via bilateral axillary artery perfusion in conjunction with endoaortic balloon occlusion, and limit the circulatory arrest time.

Repair of a ductal aneurysm using a hemi-clamshell incision in an elderly patient.

Spontaneous ductal aneurysm is rare in adults, although it is diagnosed sporadically, even in the elderly. Commonly, patients with a ductal aneurysm undergo an aneurysmectomy followed by patch-plasty through a lateral thoracotomy. However in older patients, more extensive surgery is often required due to more developed atherosclerotic lesions, requiring total arch replacement.

Cor triatriatum repair to eliminate suffering from paroxysmal atrial fibrillation.

Development of atrial fibrillation is one of the primary indicators of cor triatriatum in adults. Here we describe a case of a patient suffering cor triatriatum coexistent with frequent paroxysmal atrial fibrillation. Paroxysms of arrhythmia were not encountered after surgical correction.

Multiple infected aortic aneurysms repaired by staged in situ graft replacement.

The development of multiple infected aortic aneurysms is extremely rare, and treatment remains challenging. We report here a 72-year-old man with multiple infected aortic aneurysms in whom a staged in situ graft replacement for the aortic arch and pararenal abdominal aorta was successfully performed. A rifampicin-bonded graft seemed to be effective in preventing postoperative infection.

Bilateral axillary artery perfusion to reduce brain damage during cardiopulmonary bypass.

Background: Theoretically, a multiple perfusion approach, reducing detachment of atheromatous debris from the aortic intima and its flow into the cerebral circulation, should contribute to lessen a stroke, and may be applied to complex cardiac surgery with extensive aortic disease. The aim of the present study was to examine the value of bilateral axillary artery perfusion during thoracic aortic and cardiac surgery, and to evaluate the clinical results with a particular focus on cerebral damage.

Methods: From March 2002 through December 2007, 24 patients (16 male and eight female; age range, 43 to 84 years) underwent bilateral axillary artery perfusion through side grafts during cardiopulmonary bypass.

Missing left atrial thrombus: dislodgement or artifact?

Patients with a left atrial thrombus are considered at high risk of thromboembolism. Surgical treatment is generally recommended. We experienced a case of a patient with a history of cerebral embolism related to chronic atrial fibrillation in whom, unexpectedly, no thrombi were found at thrombectomy.

Aortic valve replacement in a patient with a brain tumor.

We report a case of aortic stenosis with a brain tumor in a 67-year-old man. Although he showed no clinical neurological abnormality, a computed tomography scan revealed a brain tumor. We performed aortic valve replacement under several management techniques to avoid cerebral injury.

Coronary artery bypass grafting in cerebral palsy with severe contractures of extremities.

We report on a 76-year-old man suffering from cerebral palsy who underwent coronary artery bypass grafting. Limitation of available bypass grafts and the approach of intra-aortic balloon pump insertion are of great concern because of his specific posture resulting from multiple articular contractures. We describe our planning to survive coronary surgery in this specific situation.

An unusual manifestation of brain tumor: development of delayed hemiplegia after cardiopulmonary bypass.

Cerebral swelling after cardiopulmonary bypass might trigger a critical cerebral consequence resulting from intracranial space-occupying lesion. We experienced a 75-year-old woman who suffered from a delayed left hemiplegia after mitral valve replacement. Urgent diagnostic imaging revealed the presence of a brain tumor with perifocal cerebral edema.

Bilateral axillary arterial perfusion in surgery on thoracic aorta.

Bilateral axillary arterial cannulation for selective cerebral perfusion might minimize cerebral embolic complications during surgery on the ascending aorta and aortic arch. From March 2002 through February 2004, bilateral axillary arterial perfusion was applied in 12 consecutive patients (mean age, 61.3 years).

Acute volume reduction with aortic valve replacement immediately improves ventricular mechanics in patients with aortic regurgitation.

Objectives: Few data have been available regarding the immediate response in ventricular mechanics to acute volume reduction caused by aortic valve replacement for aortic regurgitation.

Methods: We studied 9 patients in the operating room immediately before and after the institution of cardiopulmonary bypass. Left ventricular pressure and cross-sectional area (a surrogate of left ventricular volume) were measured with a catheter-tip manometer and a transesophageal echocardiographic system equipped with automated border-detection technology.

Evidence-based infection control in thoracic surgery.

Objectives: Methicillin-resistant Staphylococcus aureus (MRSA) continues to pose a major threat to the lung and cardiovascular surgery patients. We propose evidence-based infection control (EBIC) against MRSA.

Methods: We conducted a basic study comparing genotyping to cluster analysis using minimal inhibition concentration on 17 drugs for 21 MRSA strains.