[Aortic root replacement with a freestyle stentless valve for prosthetic valve detachment caused by aortitis syndrome; report of a case].

A surgical case of a 65-year-old man with aortitis syndrome is presented. The patient had undergone aortic valve replacement for aortic valve regurgitation with a mechanical prosthesis, followed by a re-do operation (valve fixation) for prosthetic valve detachment 6 months after the 1st operation. Three months after the 2nd operation, perivalvular leakage due to valve detachment was detected again.

[Stepwise technique of the proximal anastomosis with the new proximal anastomotic system for the prevention of kinking of the graft].

In using the proximal anastomotic system, the anastomotic site should be carefully selected to prevent the kinking of the graft, because the angle of the graft and the aortic wall is perpendicular. There recommended anastomotic sites are the left lateral aortic wall adjacent to the pulmonary artery for the left coronary system grafting and the lower aortic wall adjacent to the right atrium for the right coronary system grafting respectively. When the selection of these sites are difficult because of the atherosclerotic lesion of the aorta, the short vein graft (2-3 cm) was first anastomosed with PAS-Port device to the site free from atherosclerosis.

Re-do mitral valve replacement using the valve-on-valve technique: a case report.

We report a repeated mitral valve replacement (re-do MVR) using the valve-on-valve technique for a degenerated bioprosthesis. A 49-year-old female, who had had a 29 mm Carpentier-Edwards mitral bioprosthesis for mitral regurgitation 20 years previously, was referred to our institution for dyspnea. She presented with pulmonary edema secondary to severe mitral bioprosthetic valve regurgitation.

A technique of snaring method for fitting a prosthetic valve into the annulus.

Background: Tourniquetting technique to fit a prosthetic valve (PV) into the annulus in valve replacement surgery has been previously reported. We modified the previously reported method and designed a simpler tying technique.

Patients: We performed 11 aortic (AVR: including four cases for calcified aortic stenosis (AS) with a small annulus and one cases for infective endocarditis with intramuscular abscess cavity), eight mitral valve replacements (MVR), and one tricuspid valve replacement (TVR: for corrected transposition of the great arteries).

Off-pump quintuple coronary artery bypass grafting for situs inversus totalis.

Dextrocardia associated with situs inversus totalis is a rare condition. A 49-year-old man with dextrocardia and situs inversus totalis underwent off-pump quintuple coronary artery bypass grafting using bilateral internal thoracic arteries and bilateral radial arteries. The operative technique was similar to that of off-pump coronary artery bypass grafting for situs solitus.

Concomitant mitral valve repair and left ventricular reconstruction in a patient with chronic ischemic mitral regurgitation and inferior left ventricular aneurysm.

The surgical approach to ischemic mitral regurgitation with concomitant inferior left ventricular aneurysm remains uncertain in terms of the indication for operation and the short- and long-term outcomes. We performed concomitant mitral valve repair, left ventricular reconstruction, and aortic valve replacement on a 71-year-old male with severe ischemic mitral regurgitation, inferior left ventricular aneurysm, and degenerative aortic regurgitation. Postoperative status was in New York Heart Association functional class I without mitral regurgitation 8 months after operation.

Feasible pericardiotomy for off-pump coronary artery bypass.

Pericardiotomy is the first essential step for the exposure of the coronary artery in off-pump coronary artery bypass (OPCAB) via a median sternotomy. After the dissection of the pericardium from the pleura, a longitudinal pericardiotomy from the apex to the aortic reflection was employed. The pericardiotomy was extended transversely to make a trapezoidal flap.

Concomitant transabdominal MIDCAB and abdominal aortic aneurysm repair.

We present 2 patients who underwent transabdominal minimally invasive direct coronary artery bypass with the right gastroepiploic artery combined with abdominal aortic aneurysm repair. The surgical procedures, both performed through a median laparotomy, proved safe and of limited invasiveness. The one-stage surgical intervention prevented catastrophic complications, such as acute myocardial infarction or rupture of abdominal aortic aneurysm.

Does skeletonization compromise the integrity of internal thoracic artery grafts?

Background: There are few reports that demonstrate the chronologic changes in the functional integrity of the internal thoracic artery (ITA) wall after skeletonization. We investigated the impact of skeletonization on ITA wall integrity by immunohistochemical analyses in acute and chronic phases.

Methods: Nine mongrel dogs underwent bilateral ITA dissection with one skeletonized vessel and the other pedicled.

Surgery for cardiomyopathy with mitral regurgitation and dyssynchrony.

We present a case of dilated cardiomyopathy with medically intractable congestive heart failure, which was improved by surgical intervention including mitral valve repair and biventricular pacing. This strategy is effective against dilated cardiomyopathy with interventricular dyssynchrony and mitral regurgitation.