Fracture embolization of an Edwards-Duromedics valve with asymmetrical closure.

We report a case of sudden leaflet fracture of an Edwards-Duromedics mitral valve 17-years after its implantation. The patient had a history of an asymmetrical motion of the valve, five months earlier. A computed tomography scan showed two fragments that had embolized to the right brachiocephalic artery and left common iliac artery.

Gastrointestinal complications in patients undergoing coronary artery bypass grafting.

Purpose: Gastrointestinal complications (GICs) such as gastroduodenal ulcer, enterocolitis, and ischemic colitis after coronary artery bypass grafting (CABG) are rare, but are associated with high mortality and morbidity. The present study was performed to detect risk factors and to investigate outcomes following GICs after CABG.

Methods: Between January 1992 and December 2001, 17 of 549 patients (3.

Long-term outcome after mitral valve replacement with preservation of continuity between the mitral annulus and the papillary muscle in patients with mitral stenosis.

Background And Aim Of The Study: The effect on left ventricular performance of mitral valve replacement (MVR) with preservation of continuity between the mitral annulus and papillary muscle was studied in patients with mitral stenosis (MS).

Methods: Forty patients with MS who underwent MVR between 1986 and 1995 and had long-term echocardiographic follow up were studied retrospectively. Eighteen patients had conventional MVR (CMVR group), and 22 (PMVR group) had either preservation of autologous chordae tendineae (n = 6) or replacement of the chordae with expanded polytetrafluoroethylene sutures (n = 16).

Increased vascular endothelial growth factor in patients with cyanotic congenital heart diseases may not be normalized after a Fontan type operation.

Background: To determine the change of serum concentration of vascular endothelial growth factor (VEGF) in patients with cyanotic congenital heart disease (C-CHD).

Methods: Patients comprised four groups: group A, 19 patients without cyanosis; group B, 24 patients with C-CHD; group C, 17 patients who had C-CHD and underwent biventricular repair; and group D, 15 patients who had single ventricle and underwent a Fontan type operation. Blood samples were obtained from upper arm veins and serum VEGF was determined.

Surgical treatment of five patients with aortobronchial fistula in the aortic arch.

Aortobronchial fistula (ABF) is a rare condition that is almost always fatal in the absence of prompt and proper treatment. However, treatment remains challenging, particularly in the aortic arch. We present six operations for 5 such patients, in which no in-hospital deaths occurred.

Successful repair of an aortoesophageal fistula caused by a thoracic aortic aneurysm: report of a case.

Aortoesophageal fistula occurring as a complication of a thoracic aortic aneurysm is difficult to repair because of the contaminated surgical field. We report the case of a 67-year-old man in whom an aortoesophageal fistula developed secondary to a dissecting thoracic aortic aneurysm. We performed in situ graft repair of the aneurysm, then covered the site with omentum and resected the esophagus to prevent graft infection.

Long-term results of reoperative mitral valve surgery in patients with rheumatic disease.

Background: Reoperative (redo) mitral valve surgery is still a continuing challenge to surgeons. The aim of this study was to detect the factors that affect late mortality or morbidity after redo mitral valve surgery in patients with rheumatic disease.

Methods: Between May 1983 and February 2003, 92 patients who underwent redo mitral valve surgery for rheumatic disease were enrolled.

Acute type B aortic dissection complicated with a mycotic aortic arch aneurysm.

A successfully-treated case of acute type B aortic dissection associated with a mycotic aneurysm is reported. A 69-year-old man had a history of febrile illness and a high CRP level with increased enzyme activity of the hepatobiliary system before the onset. The culture of the abscess in the distal arch aneurysm revealed Bacteroides fragilis.

Vascular surgery using argatroban in a patient with a history of heparin-induced thrombocytopenia.

For patients with a history of heparin-induced thrombocytopenia (HIT) who undergo cardiac or vascular surgery, the optimal anticoagulation substitute for heparin has yet to be established. Recombinant hirudin has been recommended; however, this agent is unsuitable for patients with renal dysfunction. Argatroban was used in the present patient who had a history of HIT and renal dysfunction and required peripheral vascular surgery.

Predictors of residual tricuspid regurgitation after mitral valve surgery.

Background: Whether preoperative tricuspid regurgitation (TR) will regress or progress late after surgery is unknown. The aim of this study was to evaluate predictors of significant TR late after mitral valve surgery.

Methods: A retrospective analysis was performed on a total of 174 patients who underwent mitral valve surgery without tricuspid valve surgery.

Management of asymptomatic aortic stenosis in patients undergoing coronary artery bypass grafting.

This study compared the outcomes of combined coronary artery bypass grafting (CABG)/aortic valve replacement (AVR) and CABG alone in patients with moderate aortic stenosis and determined the possible indications for AVR at the time of CABG. Between December 1988 and January 2001, in Tenri Hospital, 41 patients with aortic stenosis underwent CABG: 26 patients underwent the combined procedure and 15 patients underwent CABG alone. The patients who underwent CABG alone were separated them into 2 groups on the basis of the results of annual echocardiography: the rapid progression group, defined by an increase of deltaP by >/=10 mmHg/year, and the slow progression group.

Mitral valve repair for severe mitral regurgitation caused by endomyocardial biopsy.

Mitral regurgitation (MR) following endomyocardial biopsy is a rare and severe complication. A 70-year-old man with severe MR due to chordal injury caused by left ventricular endomyocardial biopsy is described. In this patient, a few chordae tendineae of the posterior-median papillary muscle were injured by the biopsy forceps.

Anticoagulant therapy in Japanese patients with mechanical mitral valves.

There are no guidelines for the optimal therapeutic range of anticoagulant therapy in Japanese patients with mechanical heart valves. A total of 214 patients were followed retrospectively after mitral mechanical valve replacement (mean duration of follow-up, 4.8 years; total duration of follow-up, 1,027 patient-years).