Surgical Management of Infective Endocarditis Complicated by Budd-Chiari Syndrome.

Budd-Chiari syndrome (BCS) is a relatively rare comorbidity, particularly in patients undergoing cardiac surgery. The difficulty arises when we try to drain blood from the obstructed lower body circulation to establish extracorporeal circulation. Herein, we describe a patient who developed a persistent fever after undergoing neurosurgery for a head arteriovenous fistula, wherein blood cultures confirmed infection.

Localized dissection of the sinus of Valsalva mimicking spontaneous coronary artery dissection.

A 56-year-old man, suspected of having ST-segment elevation myocardial infarction due to spontaneous coronary artery dissection, underwent emergency percutaneous coronary intervention. Although he had moderate aortic regurgitation with aortic root dilation and mild heart failure, it was controlled with medications. Two weeks after discharge, he was readmitted with severe heart failure due to severe aortic regurgitation and underwent an aortic root replacement.

Contemporary Management of Stable Coronary Artery Disease - Implications of the ISCHEMIA Trial.

Coronary artery disease (CAD) remains a leading cause of mortality and morbidity in developed countries. Although urgent revascularization is the cornerstone of management of acute coronary syndrome (ACS), for patients with stable CAD recent large-scale clinical trials indicate that a mechanical 'fix' of a narrowed artery is not obviously beneficial; ACS and stable CAD are increasingly recognized as different clinical entities. We review the perspectives on (1) modifying the diagnostic pathway of stable CAD with the incorporation of modern estimates of pretest probability, (2) non-imaging evaluations based on their availability, (3) the optimal timing of invasive coronary angiography and revascularization, and (4) the implementation of medical therapy during the work-up.

Optimal phase analysis of electrocardiogram-gated computed tomography angiography in patients with Stanford type A acute aortic dissection.

Objective: To determine the phase that facilitates flap observation of the ascending aorta in Stanford type A acute aortic dissection with perfused false lumen.

Methods: We reconstructed retrospective Electrocardiogram-gated Computed Tomography Angiography images of the ascending aorta of all 20 patients to 20 phases of curved-multiplanar reconstruction in 5% increment. One radiologist created and randomized 10 cross-sectional images of each phase for every patient and two radiologists scored these images on a 5-point scale depending on the degree of flap stoppage.

Hemodynamic performance and incidence of patient-prosthesis mismatch of small-sized Trifecta pericardial aortic valves.

Objectives: Small-sized bioprosthetic valves are sometimes associated with suboptimal hemodynamic performance, leading to a patient-prosthesis mismatch. Trifecta pericardial valves are designed to improve hemodynamic performance. The purpose of this study was to investigate the hemodynamic properties of small-sized Trifecta valves and their efficacy in preventing a patient-prosthesis mismatch.

Safety and efficacy of a simple cardiotomy suction system as a blood salvage procedure during off-pump coronary artery bypass surgery.

The ideal blood-salvaging strategies for off-pump coronary artery bypass graft procedures have not been determined. We developed a new blood-salvaging system that uses a cardiotomy suction. The purpose of this study was to examine the efficacy of this novel method.

Unexpected intraoperative coronary malperfusion after primary repair of acute type A aortic dissection with surgical glue.

In the surgical treatment of acute aortic dissection, the attachment of the dissected wall using surgical glue can be an effective procedure to stabilize the fragile dissected wall. A 42-year-old man underwent aortic root replacement for acute type A aortic dissection. However, after aortic declamping, he experienced severe myocardial impairment, which required an additional procedure of coronary artery bypass grafting.

Management of systolic anterior motion of the mitral valve: a mechanism-based approach.

Although the mechanism of systolic anterior motion (SAM) of the mitral valve is unknown, it is known to have a multifactorial pathophysiology. Echocardiographic analysis of the mitral leaflet revealed the step-wise progression of SAM, and intraventricular flow analysis revealed the contribution of drag force generated by the misled flow below the posterior leaflet. Although several diverse clinical features of SAM are already known, some key features need to be abstracted from among them to understand the regulation of SAM establishment.

Radiation therapy for recurrent cardiac undifferentiated pleomorphic sarcoma after three operations.

We report the case of a 57-year-old female suffering from recurrent malignant undifferentiated pleomorphic sarcoma of the left atrium. Metastasis to the posterior mediastinum was detected upon first presentation. Incomplete resections were carried out twice before mitral valve replacement was finally performed.

Proposal of a novel index for selection of optimal annuloplasty ring size for tricuspid annuloplication.

Background: Optimal ring size in tricuspid annuloplasty (TAP) surgery to treat functional tricuspid regurgitation (TR) was investigated because optimal ring size remains undefined.

Methods And Results: Sixty seven patients who underwent TAP at our institution were retrospectively studied. Tricuspid Annuloplasty Ring size Index (TARI) was defined as implanted tricuspid annuloplasty ring size divided by body surface area (BSA).

Do semi-rigid prosthetic rings affect left ventricular function after mitral valve repair?

Background: After reports of cardiac impairment caused by mitral annuloplasty with rigid rings, several prosthetic rings with semi-rigidity were introduced. The influence of semi-rigid rings on postoperative cardiac function remains unknown. This study compared postoperative cardiac function between patients receiving a semi-rigid prosthetic ring and those receiving a flexible ring or band.

Influence of left ventricular function on development of systolic anterior motion after mitral valve repair.

Objective: A hyperkinetic heart has been suggested as a risk factor for systolic anterior motion (SAM) after mitral valve repair, but the influence of preoperative left ventricular (LV) function on the development of SAM has not been elucidated.

Methods: Transthoracic echocardiographic data were retrospectively reviewed in 441 patients who underwent mitral valve repair for degenerative mitral regurgitation. Comparisons were made between patients with and without SAM (SAM cases vs noncases).

Morphological analysis of systolic anterior motion after mitral valve repair.

Objectives: The systolic anterior motion (SAM) of mitral valves occurs at a certain rate despite the introduction of several preventive procedures. The purpose of this study was to investigate its mechanism by analysing the change in mitral valve morphology associated with operative procedures.

Methods: Components of mitral valves were measured before and after operative procedures by transoesophageal echocardiography in 179 patients who underwent mitral valve repair.

Impact of papillary muscle approximation on mitral valve configuration in the surgical correction of ischemic mitral regurgitation.

Background: Efficacy of papillary muscle approximation (PMA) has not been well defined.

Methods: Mitral valve configuration was assessed using echocardiography before and 1 week after the surgery in 27 consecutive patients undergoing surgical correction of ischemic MR. Comparisons were made between patients undergoing restrictive mitral annuloplasty (RMAP) alone (n = 13, RMAP group) and those undergoing PMA in addition to RMAP (n = 14, PMA group).

Efficacy and pitfalls of transapical cannulation for the repair of acute type A aortic dissection.

Background: Selection of a cannulation site for the repair of acute type A aortic dissection remains controversial. Several cannulation sites have been introduced, but each is associated with a risk of adverse complications. Transapical cannulation is a simple procedure to restore antegrade blood flow during ECC.

Mechanisms of recurrent regurgitation after valve repair for prolapsed mitral valve disease.

Background: We assessed mitral valve (MV) function using serial echocardiography as an indicator of the durability of MV repair. The aim of this study was to analyze the mechanisms of recurrent regurgitation after MV repair for degenerative disease.

Methods: From 1991 to 2007, 736 patients had valve repair for mitral regurgitation caused by leaflet prolapse: 346 patients had posterior and 390 had anterior leaflet prolapse.

New uncoated vascular prosthesis reduces mediastinal tube drainage after thoracic aortic surgery.

Purpose: A new vascular graft (Triplex [Vascutek Terumo, Tokyo, Japan]) has a three-layer structure and no biologic coating material. We assessed inflammatory reaction and mediastinal tube drainage after thoracic aortic surgery using this graft.

Description: Between January 2009 and September 2009, 127 patients underwent open ascending aortic or arch repair.

Extensive reconstruction of the left anterior descending coronary artery with an internal thoracic artery graft.

Background: Revascularization of the diffusely diseased coronary artery is a big challenge for both cardiologists and cardiac surgeons. Long reconstruction of the diffusely diseased vessel may be a useful surgical option. The aim of this study is to assess clinical and angiographic outcomes of extensive reconstruction (≥4 cm) of the left anterior descending coronary artery (LAD) using an internal thoracic artery (ITA) graft with or without endarterectomy.