Left atrial myxoma mimicking papillary fibroelastoma.

A 67-year-old woman was referred to our hospital with a diagnosis of deep vein thrombosis due to surgery for left patellar fracture. Deep vein thrombosis resolved with thrombolytic therapy. Transthoracic echocardiogram revealed a mobile left atrial tumor.

Preoperative computed tomographic diagnosis of an aortocaval fistula associated with aneurysm of the abdominal aorta.

Aortocaval fistula is a rare but life-threatening complication of ruptured abdominal aortic aneurysm. We present a case of an aortocaval fistula with acute right heart failure. The condition was accurately diagnosed before operation by physical examination, echo, and especially by computed tomography (CT), thereby enabling proper planning of the operative strategy.

Gas-containing pericardial abscess in a type 2 diabetic patient.

A 63-year-old male with type 2 diabetes mellitus was admitted to our hospital with fever and chest pain. An echocardiogram, chest CT and MRI showed the gas-containing pericardial abscess located posteriol to the right atrium. He was initially treated by thoracoscopic pericardial fenestration to set a drainage tube in the pericardial abscess.

Graft replacement for massive mobile embolic source in brachiocephalic artery.

A 76-year-old woman presented with multiple brain infarctions in the right middle cerebral artery and vertebral artery area. Carotid sonography revealed a large mobile pedunculated mass in the brachiocephalic artery, which showed rapid growth despite treatment with heparin and aspirin. Graft replacement of the brachiocephalic artery was performed under selective cerebral perfusion with deep hypothermia.

Transcranial Doppler study to assess intracranial arterial communication before aortic arch operation.

Background: The assessment of intracranial arterial communication is important to prevent a stroke from occurring during an aortic arch operation. Bilateral axillary artery perfusion was used with the left common carotid artery perfusion for selective cerebral perfusion. A preoperative left carotid artery compression test with measurement of the left middle cerebral artery (LMCA) flow was performed to determine how safe it was to interrupt the perfusion to the left common carotid artery.

IgG4-positive plasma cells in inflammatory abdominal aortic aneurysm: the possibility of an aortic manifestation of IgG4-related sclerosing disease.

Inflammatory abdominal aortic aneurysm (IAA) is associated with autoimmune disease. However, the precise mechanism of IAA remains unclear. There is increasing evidence that IgG4 is involved in the autoimmune mechanism of various idiopathic sclerosing lesions, including sclerosing pancreatitis and retroperitoneal fibrosis.

Aortic valve replacement with 17-mm St. Jude Medical prostheses for a small aortic root in elderly patients.

Background: There are few reports about the optimal prosthesis for elderly patients who have small aortic roots with an aortic annular size of less than 19 mm.

Methods: From October 2004 to October 2006, 11 women aged 70 years or older (mean age, 74.9 +/- 3.

[Inflow cannula direct insertion into the true lumen of the ascending aorta for an acute aortic dissection patient with intraoperative malperfusion after aortic clamping].

A 47-year old woman, who was diagnosed as Stanford type A acute aortic dissection, underwent an emergent operation. Because of obesity and bleeding, it was impossible to find the right axillary artery. Only we could have for inflow line was the femoral line.

Non-occlusive condition with the Better-Header roller pump: impacts of flow dynamics and hemolysis.

Purpose: Impacts on hemolysis and backflow using a non-occlusive setting with the Better-Header (BH) roller pump were investigated.

Methods And Results: Pump flow of a non-occlusion setting was measured with a pump speed of 3 L/min and 5 L/min against various after-loads. With the non-occlusive setting (BH-NO350), backflow was less than 10% if the pump pressure head was <300 mmHg.

Replacement of an aortic Starr-Edwards ball valve prosthesis 28 years after implantation.

A 53-year-old woman who had undergone aortic valve replacement with a Starr-Edwards (S-E) valve (Model 1260) and open mitral commissurotomy 28 years previously was hospitalized with cardiac failure. Echocardiography showed mitral stenosis, mitral regurgitation, and a normally functioning S-E prosthesis. At reoperation, the mitral and aortic valves were replaced with St Jude bileaflet mechanical prostheses.

Usefulness of a multidetector-row computed tomography scanner for detecting pannus formation.

Background: Prosthetic valve dysfunction (PVD) as a result of pannus or thrombus formation is an infrequent but serious complication. Currently available diagnostic tools, however, are insufficient to detect a minute pannus and thrombi. The use of a more advanced diagnostic image, multidetector-row computed tomography scanner, may enable us to determine the anatomic and functional causes of PVD.

Obstruction of St Jude Medical valves in the aortic position: histology and immunohistochemistry of pannus.

Objective: This study aims to reveal the morphological, histological, and immunohistochemical mechanism of pannus formation using resected pannus tissue from patients with prosthetic valve dysfunction.

Method: Eleven patients with prosthetic valve (St Jude Medical valve) dysfunction in the aortic position who underwent reoperation were studied. We used specimens of resected pannus for histological staining (hematoxylin and eosin, Grocott's, azan, elastica van Gieson) and immunohistochemical staining (transforming growth factor-beta, transforming growth factor-beta receptor 1, alpha-smooth muscle actin, desmin, epithelial membrane antigen, CD34, factor VIII, CD68KP1, matrix metalloproteinase-1, matrix metalloproteinase-3, and matrix metalloproteinase-9).

Anomalous origin of the left coronary artery from the pulmonary artery: successful direct reimplantation in a 50-year-old man.

Anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital coronary artery anomaly that is often referred to as Bland White Garland syndrome. Most patients with this anomaly require surgical intervention early in life, and it is extremely rare that patients reach middle age without any symptoms. We present a 50-year-old man with this anomaly, who underwent direct reimplantation of the left main coronary trunk to the ascending aorta.

Anomalous subaortic left brachiocephalic vein associated with tricuspid atresia: a successful bidirectional cavopulmonary connection.

Anomalous subaortic left brachiocephalic vein is an uncommon systemic venous anomaly. Here we report a case of this anomaly in a 3-month-old male infant with tricuspid atresia. The patient successfully underwent bidirectional cavopulmonary connection without cardiopulmonary bypass, although extended dissection of the bilateral brachiocephalic veins was required.

Left atrial thrombus without mitral valve disease in a patient with nephrotic syndrome: report of a case.

Left atrial (LA) thrombi are rarely seen in patients without mitral valve disease. We report the case of a 71-year-old man found to have a large LA thrombus without mitral valve disease. The patient also suffered from atrial fibrillation and nephrotic syndrome (NS), and had a history of transient ischemic attack.

Spontaneous coronary artery dissection causing myocardial infarction and left ventricular aneurysm.

Spontaneous coronary artery dissection (SCAD) is a rare cause of myocardial infarction (MI). A 66-year-old Japanese man, who had had an anterior wall MI caused by SCAD of the left anterior descending coronary artery, developed left ventricular aneurysm 5 years later, with depressed left ventricular function and thrombus observed on echocardiography. Left endoventricular circular patch plasty according to Dor's technique was performed without coronary artery bypass grafting, because of the absense of significant coronary artery stenosis on the preoperative coronary angiogram.

Does off-pump coronary artery bypass grafting really preserve renal function?

It is well known that the use of cardiopulmonary bypass (CPB) influences renal function and occasionally results in renal failure following cardiac surgery. Coronary artery bypass grafting (CABG) without CPB may avoid this and preserve the perioperative renal function. The present study enrolled 52 patients undergoing CABG without CPB (OPCAB group) and matched them for renal function and prognostic variables with 53 patients undergoing conventional CABG (CABG group).

Mitral valve repair in a patient with acromegaly: case report.

A 61-year-old woman had acromegaly associated with mitral regurgitation (MR) resulting from prolapse of the posterior mitral leaflet. At the age of 51 years, the patient was diagnosed with hypertension and a cardiac murmur. She had the characteristic acromegalic appearance, but without visual disturbance.

Treatment of acute massive/submassive pulmonary embolism.

Thirty-five consecutive patients with massive and submassive pulmonary embolism (PE) were reviewed. In 75% of these cases, PE could be suspected on the basis of electrocardiogram alone. Echocardiography was quite useful for diagnosing PE and assessing right ventricle after-load at the bedside.

Thrombolytic therapy with tissue plasminogen activator for the treatment of nonstructural malfunction of bileaflet cardiac valve prostheses.

This study was conducted to determine the effect of thrombolytic therapy with tissue plasminogen activator (t-PA) for nonstructural malfunction of bileaflet cardiac valve prostheses. Twenty-seven patients with bileaflet prosthetic valve malfunction diagnosed by a combination of cineradiography and transthoracic echocardiography were treated with the administration of intravenous t-PA. The treatment resulted in complete success in 55.

Influence of colforsin daropate hydrochloride on internal mammary artery grafts.

The effect of colforsin daropate hydrochloride (colforsin), a water-soluble forskolin derivative, on blood flow in internal mammary artery (IMA) grafts was evaluated in a prospective randomized study of 26 patients undergoing coronary artery bypass grafting. Patients were randomized to receive either colforsin treatment (colforsin; n=14) or no colforsin treatment (control; n=14). Administration of colforsin (0.

Coronary artery bypass grafting in an adult case with Kawasaki disease.

Surgical revascularization for coronary artery lesions secondary to Kawasaki disease has been rarely reported in adult patients. We reported an adult case with few coronary risk factors but with multiple coronary artery aneurysms and obstructive lesions presumably secondary to Kawasaki disease who underwent coronary artery bypass grafting (CABG) with multiple arterial grafts. The postoperative course was uneventful.