Editor in Chief:Takashi Nitta Vol.51, No.1, January 2022 CONTENTS

Preface

  • Recommendation for Defensive Pessimism ―Surgery does not Create a Surgeon above or below Another Surgeon―　H. Izutani

Case Reports

  • ［Congenital Heart Disease］
  • A Rare Case of Cornelia de Lange Syndrome Achieving Intracardiac Repair of Tetralogy of Fallot Following Ectopic Patent Ductus Arteriosus Banding　K. Tanaka et al.…1
    A Rare Case of Cornelia de Lange Syndrome Achieving Intracardiac Repair of Tetralogy of Fallot Following Ectopic Patent Ductus Arteriosus Banding
    Keisuke Tanaka* Yuzo Katayama* Sho Isobe*
    Kota Kawada* Yoshio Nunoi* Masanori Hara*
    Hiroshi Masuhara* Noritsugu Shiono* Takeshiro Fujii*
    Yoshinori Watanabe*

    (Department of Cardiovascular Surgery, Toho University Omori Medical Center*, Tokyo, Japan)

    We describe the case of a 1-year and 7-month-old girl who was born at 36 weeks and 6 days of pregnancy weighing 1,351 g. In addition to the diagnosis of Cornelia de Lange syndrome and Tetralogy of Fallot, we confirmed shunt blood flow from the lesser curvature of the aortic arch to the main pulmonary artery. Thus, we additionally diagnosed ectopic patent ductus arteriosus (PDA). Ultrasonography showed interruption and retrograde flow of the diastolic blood flow in the anterior cerebral artery. Therefore, we made a diagnosis of blood stealing due to an ectopic PDA, and we performed surgical intervention via a median sternotomy at 25 days. When we ligated the shunt blood vessel, the percutaneous oxygen saturation decreased from the high 90% range to the low 70% range, thus we temporarily released the ligation. We narrowed the ectopic PDA so that the percutaneous oxygen saturation could be maintained the high 80% range. Postoperative ultrasonography showed improvement of the pressure waveform in the anterior cerebral artery. After discharge, oxygen demand increased gradually with weight gain, and we performed intracardiac repair using a monocusp valve patch at 1 year and 7 months. We report a rare case of Cornelia de Lange syndrome wherein we achieved intracardiac repair of Tetralogy of Fallot after ectopic PDA banding in the neonatal period.

     

    Jpn. J. Cardiovasc. Surg. 51 : 1-5 (2022)

    Keywords：Tetralogy of Fallot ; patent ductus arteriosus banding ; Cornelia de Lange syndrome


  • A Double Connection of Mixed Total Anomalous Pulmonary Venous Connection:Successful Patch Closure of Residual Shunt　N. Miura et al.…6

    Japanese Journal of Cardiovascular Surgery Vol.51, No.1

    A Double Connection of Mixed Total Anomalous Pulmonary Venous Connection : Successful Patch Closure of Residual Shunt
    Norito Miura* Tomohiro Nakata* Maiko Tachi*
    Shoichi Suehiro* Kensuke Imai* Koji Shimizu*
    Hiromi Wada* Teiji Oda*

    （Department of Cardiovascular Surgery, Shimane University Faculty of Medicine*, Izumo, Japan）

    Double drainage sites from a common venous confluence of the pulmonary veins of a mixed total anomalous pulmonary venous connection is a rare condition that is called a “double connection.” There have been very few reports of reoperation for minor drainage of a double connection. A 28-year-old male with double connection type （Ia: major drainage ＋ IIa: minor drainage） mixed total anomalous pulmonary venous connection （TAPVC） was referred to our institution. He had undergone TAPVC type Ia （major drainage） repair at the age of 1 year. Postoperative enhanced computed tomography showed residual TAPVC IIa （minor drainage） at the age of 15 years. Therefore, the definitive diagnosis was double connection-type mixed TAPVC. Residual shunt gradually increased, and cardiac catheterization revealed an increased pulmonary blood flow/systemic blood flow ratio. Echocardiography showed enlarged shunt vessel and mild tricuspid regurgitation. Catheter intervention was considered too risky and, therefore, we performed patch closure of the residual shunt through a right atriotomy. The postoperative course was uneventful, and follow-up computed tomography showed shrinkage of the shunt vessel without any thromboembolic events.

     

    Jpn. J. Cardiovasc. Surg. 51 : 6-10 （2022）

    Keywords：mixed total anomalous pulmonary venous connection ; double connection ; residual shunt


    Copyright ©2022 By Japanese Society for Cardiovascular Surgery All rights reserved.

  • ［Acquired Cardiovascular Surgery］
  • A Case of Left Ventricular Free Wall Rupture with Suspected Posterior Papillary Muscle Necrosis　M. Matsuyama et al.…11
    A Case of Left Ventricular Free Wall Rupture with Suspected Posterior Papillary Muscle Necrosis
    Masakazu Matsuyama* Katsuya Kawagoe* Kunihide Nakamura*
    Koji Akasu**

    （Cardiovascular Surgery, Miyazaki Prefectural Nobeoka Hospital*, Nobeoka, Japan, and Cardiovascular Surgery, Nobeoka Kyoritsu Hospital**, Nobeoka, Japan）

    We report a case of arbitrary delayed surgical repair for left ventricular free wall rupture （LVFWR） after acute myocardial infarction with suspected posterior papillary muscle necrosis. The case was a 67-year-old woman who had chest and back pain in the morning, and relapsed in the evening, and was urgently transported. She had an acute lateral wall myocardial infarction on an electrocardiogram and pericardial effusion on transthoracic echocardiography （TTE）. She was found to have an obstruction at the origin of the left circumflex branch on coronary angiography. TTE showed low-intensity findings on the head of the posterior papillary muscle, suggesting necrosis of the papillary muscle. For LVFWR, conservative treatment was prioritized and IABP （intra-aortic balloon pumping） management was performed for the purpose of reducing after load because there was concern about papillary muscle rupture （PMR） due to cardiac manipulation and because it was an oozing type and did not disrupt respiratory of circulatory dynamics. On the 7th day after the onset, TTE showed improvement in echo-luminance of the posterior papillary muscle head and gradual increase in pericardial fluid, and a non-suture procedure was performed. She withdrew from the IABP on the third day after surgery and was discharged home on the 12th day.

     

    Jpn. J.Cardiovasc Surg. 51 : 11-15 （2022）

    Keywords：mechanical complications of acute myocardial infarction; left ventricular free wall rupture （LVFWR）; papillary muscle rupture （PMR）; sutureless technique


  • A Case of Pulmonary Embolism Caused by a Large Thrombus Attached to a Chiari Network, Which Required Thrombectomy　Y. Tabayashi et al.…16
    A Case of Pulmonary Embolism Caused by a Large Thrombus Attached to a Chiari Network, Which Required Thrombectomy
    Yuka Tabayashi* Satoshi Kawatsu* Masayuki Otani**
    Katsuhiro Hosoyama* Keisuke Kanda* Koki Ito**
    Katsuhiko Oda*

    （Department of Cardiovascular Surgery, Iwate Prefectural Central Hospital*, Morioka, Japan, and Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine**, Sendai, Japan）

    A 57-year-old man presented with a one-month history of dyspnea. Computed tomography revealed a pulmonary embolism, and echocardiography revealed multiple linear floating thrombi in the right atrium. An urgent surgical thrombectomy was performed, and most of the thrombi in the right atrium and bilateral pulmonary arteries were removed under cardiopulmonary bypass. The thrombi in the right atrium adhered to the linear Chiari networks. The patient was treated with rivaroxaban uneventfully and subsequently discharged on postoperative day 26. Herein, we report a case of right atrial thrombi and pulmonary embolism likely augmented by the Chiari network, which was successfully treated with surgical thrombectomy.

     

    Jpn. J. Cardiovasc. Surg. 51 : -0 （2022）

    Keywords：Chiari network ; pulmonary embolism ; right atrial thrombus ; thrombectomy


  • Coronary Artery Bypass Grafting in a Patient with Situs Inversus Totalis　Y. Takahashi and T. Niino…21
    Coronary Artery Bypass Grafting in a Patient with Situs Inversus Totalis
    Yu Takahashi* Tetsuya Niino*

    (Department of Cardiovascular Surgery, National Hospital Organization Disaster Medical Center*, Tachikawa, Tokyo, Japan)

    A 75-year-old man with situs inversus totalis, presented to our hospital complaining of chest pain. ECG showed ST depression in the leads of Ⅰ, aVL, V5, and V6. Blood tests showed cardiac enzyme (Troponin I)elevation. Coronary angiography revealed severe calcification and stenosis of the anatomical left anterior descending artery (LAD), and the anatomical right coronary artery (RCA). The Patient underwent coronary artery bypass grafting (CABG) using the right internal thoracic artery and saphenous vein graft. The postoperative course was uneventful. CABG in a patient with situs inversus totalis is very rare. We present this case with a review of the relevant literature.

     

    Jpn. J. Cardiovasc. Surg. 51 : 21-24 (2022)

    Keywords：situs inversus totalis ; dextrocardia ; coronary artery bypass grafting (CABG)


  • Successful Mitral Valve Repair for Papillary Muscle Rupture Caused by Coronary Spasm Induced by Myocardial Infarction　Y. Wada et al.…25
    Successful Mitral Valve Repair for Papillary Muscle Rupture Caused by Coronary Spasm Induced by Myocardial Infarction
    Yohnosuke Wada＊ Homare Okamura＊ Yuichiro Kitada＊
    Tomonari Fujimori＊ Hideo Adachi＊

    (Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital＊, Tokyo, Japan)

    Papillary muscle rupture, a complication of acute myocardial infarction, causes acute mitral valve regurgitation. However, to date, only a few articles have reported PMR associated with coronary spasm. In this article, we report the case of a 64-year-old woman who suffered posteromedial papillary muscle rupture caused by coronary spasm or Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA), and was successfully treated with mitral valve repair.

     

    Jpn. J. Cardiovasc. Surg. 51 : 25-30 (2022)

    Keywords：papillary muscle rupture ; coronary spasm ; myocardial infarction ; mitral valve repair ; MINOCA


  • A Case of the Left Atrial Appendage Perforation with the WATCHMAN Device Implantation Rescued by an Open Heart Surgery　T. Yazawa et al.…31
    A Case of the Left Atrial Appendage Perforation with the WATCHMAN Device Implantation Rescued by an Open Heart Surgery
    Tsubasa Yazawa* Koshi Yamaki* Aoi Kato*
    Yuki Goto* Ryota Yamamoto* Junya Sugiura*
    Keisuke Tanaka* Wataru Kato*

    (Department of Cardiovascular Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital*, Nagoya, Japan)

    The transcatheter left atrial appendage occluding device, WATCHMAN, can be used to prevent thromboembolism in patients with nonvalvular atrial fibrillation who are at high risk of bleeding during anticoagulation. We report an emergent surgical case of cardiac tamponade due to the left atrial appendage perforation with the WATCHMAN device implantation. An 83-year-old woman with recurrent paroxysmal atrial fibrillation (CHA2DS2-VASc score 4, HAS-BLED score 3) after catheter ablation was scheduled for the WATCHMAN device implantation. During implantation, the patient developed cardiac tamponade and underwent emergent surgery with cardiopulmonary bypass for active bleeding despite pericardial drainage. The bleeding was caused by the left atrial appendage perforation, and suture exclusion of the left atrial appendage was performed.

     

    Jpn. J. Cardiovasc. Surg. 51 : 31-34 (2022)

    Keywords：WATCHMAN ; perforation of the left atrial appendage ; atrial fibrillation


  • ［Aortic Disease］
  • A Case of Paraplegia after Total Arch Replacement with Frozen Elephant Trunk for Acute Type A Aortic Dissection　R. Nomura et al.…35
    A Case of Paraplegia after Total Arch Replacement with Frozen Elephant Trunk for Acute Type A Aortic Dissection
    Ryuya Nomura* Kojiro Furukawa** Tomofumi Fukuda*
    Yuichiro Hirata* Tatsushi Onzuka* Eiki Tayama***
    Shigeki Morita*

    (Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center*, Fukuoka, Japan, Cardiovascular Surgery, Faculty of Medicine, University of Ryukyus**, Okinawa, Japan, and Department of Surgery, Kurume University***, Kurume, Japan)

    The frozen elephant trunk technique (FET) for the treatment of acute aortic dissection is associated with more favorable remodeling in the descending aorta compared to those patients without FET, but it may also be associated with postoperative spinal cord injury (SCI) and actually,some postoperative SCI cases after FET are reported. Several risk factors for SCI are known and one of them is due to the occlusion of intercostal arteries from false lumen. A 71-year-old woman underwent total arch replacement with FET, but after surgery, she noticed decreased movement in both lower extremities and was suspected of postoperative paraplegia. She went through cerebrospinal fluid drainage but didn’t get better at all. According to the preoperative contrast computed tomography images, seven out of ten intercostal arteries were originating from the false lumen and six of them were occluded after surgery. When most of intercostal arteries are originating from the false lumen and there is no entry inside the descending and abdominal aorta, the intercostal arteries may be occluded due to thrombosis of the false lumen and it may cause spinal cord ischemia after surgery.

     

    Jpn. J. Cardiovasc. Surg. 51 : 35-38 (2022)

    Keywords：acute type A aortic dissection; frozen elephant trunk (open stent graft) ; paraplegia


  • Two Cases of Thoracic Endovascular Aortic Repair Using the Carotid Artery as the Access Route　R. Shimizu et al.…39
    Two Cases of Thoracic Endovascular Aortic Repair Using the Carotid Artery as the Access Route
    Riha Shimizu* Makoto Sumi* Yuri Murakami*
    Takao Ohki**

    (Department of Vascular Surgery, Saitama Cardiovascular and Respiratory Center*, Kumagaya, Japan, and Department of Surgery, Division of Vascular Surgery, The Jikei University School of Medicine**, Tokyo, Japan)

    Thoracic Endovascular Aortic Repair (TEVAR) is widely used for high-risk patients with thoracic aortic pathology. However, access to the thoracic aorta can be difficult because TEVAR requires the introduction of a large a sheath especially in those with aortoiliac occlusive diseases and thoracic shaggy aorta. We herein report two cases of TEVAR in which the common carotid artery was used as the access route. Case 1 : An 86-year-old male patient whose past surgical history was significant for infected abdominal aortic aneurysm with abdominal aortic stump closed and axillo-bilateral femoral bypass. Computed tomography revealed a saccular aneurysm of the descending aorta, which required a carotid artery approach as the access route. Case 2 : A 79-year-old female patient who developed type A thoracic aortic dissection. She was considered to be of prohibitive risk for surgical repair and was treated conservatively. However, an intramural hematoma with an ulcer-like projection lesion in the ascending aorta expanded and definitive treatment was indicated. Because the descending aorta was significantly shaggy, we decided to perform TEVAR via the right common carotid artery as the access route. Both patients’ pathology was successfully treated and were discharged without any complications. TEVAR via common carotid artery access is a useful and safe procedure for patients in whom femoral and abdominal aortic aorta access is not feasible or safe.

     

    Jpn. J. Cardiovasc. Surg. 51 : 39-43 (2022)

    Keywords：stent graft ; thoracic aortic aneurysm ; aortic dissection ; carotid artery access


  • Saccular Aortic Arch Aneurysm with Kommerell’s Diverticulum　M. Ohara et al.…44
    Saccular Aortic Arch Aneurysm with Kommerell’s Diverticulum
    Masato Ohara* Shunya Suzuki* Fukashi Serizawa*
    Suguru Watanabe**

    (Department of Vascular Surgery, Ishinomaki Red Cross Hospital*, Sendai, Japan, and Department of Cardiovascular Surgery, Sendai Medical Center**, Sendai Japan)

    The patient was a 73-year-old man who was referred to our hospital due to an abnormal thoracic shadow. CT scans revealed Kommerell’s diverticulum and saccular aortic arch aneurysm accompanied by abnormal origins of the right aortic arch and the left subclavian artery. Although there were no subjective symptoms, a surgical operation was planned considering the risk of a rupture of the saccular aneurysm. For the surgery, a median sternotomy approach was employed. Under cardiopulmonary bypass, the aortic arch was detached using the open distal method. Further, an open stent graft was inserted, and the aortic arch was replaced with a four-branched artificial blood vessel. After weaning off the cardiopulmonary bypass, coil embolization was performed on the left subclavian artery, and the site was checked to ensure that there was no endoleak. Although hoarseness was noted postoperatively due to paralysis of the right vocal cord, the patient progressed without any other major complications and was discharged 30 days after the operation.

     

    Jpn. J. Cardiovasc. Surg. 51 : 44-47 (2022)

    Keywords：Kommerell diverticulum ; right-sided aortic arch ; open stent graft


  • A Case of Thoracic Endovascular Aortic Repair for Subacute Aortic Dissection Stanford Type B in a Patient with Marfan Syndrome　S. Nakaji et al.…48
    A Case of Thoracic Endovascular Aortic Repair for Subacute Aortic Dissection Stanford Type B in a Patient with Marfan Syndrome
    Shun Nakaji* Takashi Miura* Ichiro Matsumaru*
    Akihiko Tanigawa* Yutaro Kawaguchi* Shunsuke Taguchi*
    Yugo Murakami* Kikuko Obase* Kiyoyuki Eishi*
    Shinichiro Taniguchi**

    (Department of Cardiovascular Surgery, Nagasaki University Hospital*, Nagasaki, Japan, and Department of Cardiovascular Surgery, Sasebo Chuo Hospital**, Sasebo, Japan).

    A 41-years-old man with Marfan syndrome developed acute aortic dissection Stanford Type B. A new entry was located at the distal aortic arch. Medical treatment was given for a month, but the proximal descending aorta expanded to 50 mm. Because he had undergone partial arch replacement at the age of 36, thoracic endovascular aortic repair (TEVAR) using the synthetic graft as proximal landing zone was performed to close the entry. Six months after TEVAR, the false lumen around the stent graft disappeared. Distal stent graft-induced new entry (d-SINE) did not occur after TEVAR. Three years after TEVAR, we performed thoracoabdominal aortic replacement because of expansion of the residual false lumen without any complication. Endovascular therapy could be useful option for extensive aortic lesion even in Marfan syndrome.

     

    Jpn. J. Cardiovasc. Surg. 51 : 48-52 (2022)

    Keywords：Marfan syndrome ; aortic dissection ; endovascular therapy ; TEVAR


  • ［Peripheral Artery Disease］
  • A Surgical Experience of Popliteal Venous Aneurysm Associated with Acute Pulmonary Thromboembolism　K. Yoshimoto and S. Wakasa…53
    A Surgical Experience of Popliteal Venous Aneurysm Associated with Acute Pulmonary Thromboembolism
    Kimihiro Yoshimoto* Satoru Wakasa**

    （Department of Cardiovascular Surgery, Federation of National Public Service Personal Mutual Aid Associations Tonan Hospital*, Sapporo, Japan, and Department of Cardiovascular and Thoracic Surgery, Graduate School of Medicine, Hokkaido University**, Sapporo, Japan）

    Popliteal venous aneurysm（PVA）is recognized as source of fatal pulmonary embolism；surgical treatment is indicated. A 79-year-old woman presented with acute shortness of breath. A cardiac ultrasound echography showed right heart overload and pulmonary hypertension. A contrast enhanced CT revealed multiple pulmonary artery emboli and right popliteal venous aneurysm. She was immediately started anticoagulation therapy with oral factor Xa inhibitor and her dyspnea improved. As thrombus in venous aneurysm was considered the cause of the pulmonary embolism, we recommended surgical treatment. Tangential aneurysmectomy with lateral venorrhaphy for the saccular venous aneurysm was performed. Postoperative contrast enhanced CT showed good morphology and she was discharged without complication. Surgical treatment of symptomatic popliteal venous aneurysm is considered useful strategy.

     

    Jpn. J. Cardiovasc. Surg. 51 : 53-56 (2022)

    Keywords：popliteal venous aneurysm；pulmonary thromboembolism；tangential aneurysmectomy


  • Axillary-Axillary Bypass Grafting for Subclavian Steal Syndrome with Progressive Aphasia　H. Nomura et al.…57
    Axillary-Axillary Bypass Grafting for Subclavian Steal Syndrome with Progressive Aphasia
    Hayate Nomura＊ Yukihiro Hayatsu＊ Fumiya Haba＊
    Kazuhiro Yamaya＊ Masaki Hata＊

    (Department of Cardiovascular Surgery, Sendai Kosei Hospital＊, Sendai, Japan)

    A 79-years-old female underwent total arch replacement for an aortic arch aneurysm. A postoperative CT scan showed no abnormalities on the anastomotic sites, including the supra-aortic neck vessels. However, 10 months after the operation, she visited our outpatient clinic to complain of left shoulder pain. A CT scan demonstrated complete occlusion of the left subclavian artery, and doppler echography detected a subclavian steal phenomenon. Eleven months after the operation, the patient was transferred to our hospital because of the transient loss of consciousness and progressive aphasia. MRI revealed hyperintensive lesions in the boundary area between the left temporal and occipital lobes, enlarged in a DWI (diffusion-weighted image) with time. Axillary-axillary bypass grafting was performed to suppress the progression of cerebral ischemia caused by a subclavian steal phenomenon. Aphasia seemed to be improved soon after the bypass and diminished on postoperative day 2. The hyperintensive area on DWI regressed, and no other lesion was found on a postoperative MRI. She was discharged without apparent sequelae, including aphasia. We report a successful case of revascularization for subclavian steal syndrome with aphasia.

     

    Jpn. J. Cardiovasc. Surg. 51 : 57-60 (2022)

    Keywords：subclavian steel syndrome ; axillary-axillary bypass ; aphasia


Invited Commentary

  • Tetsuro Uchida…61

NP Report

  • K. Shigetomi and M. Tabata…63
U-40
  • U-40 Column Career Development for Young Cardiovascular Surgeons　H. Yamamoto et al.…U1
    Career Development for Young Cardiovascular Surgeons
    Hiroaki Yamamoto* Kumiko Wada Eigo Ikushima
    Syotaro Higa Hiromitsu Teratani Syuji Nagatomi
    Katsuya Kawagoe Takafumi Abe Takeaki Harada

    (Department of Cardiovascular Surgery, Ureshino Medical Center*, Saga, Japan).

    The U-40 generation of surgeons are practicing through trial and error, and form various careers. At the 51st Annual Meeting of the Japanese Society of Cardiovascular Surgery, U-40 Special Project, we looked back on the U-40 generation and more senior doctors to see what kind of future visions, problems and careers they have had. We conducted a questionnaire for the purpose of visualizing the future prospects of the U-40 generation. In this article, we report the results.

     

    Jpn. J. Cardiovasc. Surg. 51(1) : U1-U10 (2022)


Editor’s Post Script
  • G. Matsumiya