Japanese Journal of Cardiovascular Surgery Vol.38, No.1

Originals

  • The Long-Term Survival and Predictors of Heart Failure after Endoventricular Circular Patch Plasty Y. Nishimura et al.……1
    The Long-Term Survival and Predictors of Heart Failure after Endoventricular Circular Patch Plasty

    （Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan）

    Yoshiyuki Nishimura Yasuhide Ookawa Hiroshi Baba
    Syunsuke Fukaya Masakazu Aoki
    Shinji Ogawa , Masashi Komeda
    Endoventricular circular patch plasty（the Dor procedure）has been demonstrated to improve outcome in patients with ischemic cardiomyopathy. However, in some of them congestive heart failure（CHF）occurred during follow-up. This study examined the effects of the Dor procedure on the long-term survival and predictors of CHF after this procedure. Hemodynamic and clinical results were analyzed and predictors of CHF were examined. Postoperative ESVI in the CHF group was larger than that in the non-CHF group. The delayed MR rate was greater following the CHF group (82.4%) compared to the non-CHF group（19.2%). Despite mitral valve repair（N＝8), 3 patients had delayed MR. All of them were greater than MR3. Hemodynamic and clinical results were improved by the Dor procedure. However, cardiac events were usually occurred during the follow-up. The predictor of CHF was delayed MR. Therefore, patients with preoperative MR should be treated. If preoperative MR is greater than 3, there will be MR recurrence cases after MVP only. Therefore, patients with preoperative MR（3 or 4）should be treated by alternative surgical procedures.
      Jpn. J. Cardiovasc. Surg. 38:1-6（2009）
  • Effectiveness of Wound Infection Control in Open Heart Surgery for Neonates and Infants less than Three Months Old H. Sakurai et al.……7
    Effectiveness of Wound Infection Control in Open Heart Surgery for Neonates and Infants less than Three Months Old

    （Department of Cardiovascular Surgery, Social Insurance Chukyo Hospital, Nagoya, Japan）

    Hajime Sakurai Shin-ichi Mizutani Noriyuki Kato
    Toshimichi Nonaka Junya Sugiura , Yuki Hatano
    The incidence of wound infection and delayed wound healing was greater in neonates and infants less than 3 months old who had undergone open heart surgery through a median sternotomy than in older patients. To reduce these problems, we stopped using continuous absorbable braided suture for skin and subcutaneous tissue closure in August 2005, and used interrupted non-absorbable monofilament suture instead. Around the same time, we adopted hydrocolloid dressing as a substitute for gauze dressing. We evaluated the effectiveness of wound management by comparing 28 patients who had undergone surgery before August 2005 with 22 patients who underwent surgery after that date. The age at surgery was 45±30 and 21±23 days, respectively. The patients in the earlier period were significantly older than in the later period. There were no significant differences in body weight at surgery, operating time, or cardiopulmonary bypass time between the groups. The time for wound closure was 30±11 and 22±4 min, respectively, and the patients were hospitalized after surgery for 61±41 and 44±31 days. Both were significantly shorter in the later group of patients. There was a single case of mediastinitis, in the earlier period. Wound infection or delayed wound healing occurred in 8 patients in the earlier period and in 3 patients in the later period. The only 4 patients who required wound resuturing were all in the earlier period. The incidence of wound infection and delayed wound healing tended to be low in the later period. We believe that interrupted non-absorbable monofilament sutures improved the wound microcirculation and that the hydrocolloid dressing accelerated wound healing via its moisturizing and heat-retention action, pH buffering ability, and bacteriostatic activity, and that all these contributed to the better outcomes in the later period.
      Jpn. J. Cardiovasc. Surg. 38:7-10（2009）
  • Evaluation of Domestic and International Journals in the Field of Thoracic and Cardiovascular Surgery Using h-Index Y. Tomizawa……11
    Evaluation of Domestic and International Journals in the Field of Thoracic and Cardiovascular Surgery Using h-index

    （Department of Cardiovascular Surgery, Tokyo Womens’s Medical University, Tokyo, Japan）

    Yasuko Tomizawa
    Domestic and international thoracic, cardiac and vascular surgery（TCVS）journals were evaluated using Impact Factor（IF）and h-index, since the information should be valuable when selecting a journal in this field to submit a manuscript. The h-index was introduced by Hirsch to show the quality and quantity of articles. Scientific databases such as PubMed, Scopus and Web of Science（WoS）were used in this study. For surgery, there were 452 journals in PubMed, 170 in WoS and 165 in the list of journal analytics of Scopus in July 2008. Two journals in surgery from Japan were listed in WoS. One of them was “Surgery Today（ST).” Four journals from Japan were listed in Scopus journal analytics, and ST had the highest h-index among the four. Citations of ST have increased in the last decade, although the numbers of published articles were similar for ST and Jpn. J. Thoracic. Surg. When “trend” is defined as the number of articles divided by number of citations, ST performed best among Japanese journals in the 2008 Scopus list. A strong correlation existed between IF and the h-index for TCVS journals. However, there are some limitations in the h-index, since it shows lifetime contribution. The order for IF and h-index was reversed occasionally because of the difference in the calculation methods. Eight TCVS-related journals were listed in WoS:J. Thorac. Cardiovasc. Surg.（JTCVS), Ann. Thorac. Surg.（ATS), J. Vasc. Surg.（JVS), Eur. J. Cardiothorac. Surg.（EJCTS), J. Cardiovasc. Surg.（JCVS), Thorac. Cardiovasc. Surg.（TCVS), J. Cardiac. Surg.（JCS), and Heart Surg. Forum（HSF). Three major journals in TCVS:JTCVS, ATS and JVS, had a high h-index greater than 117, compared to 59 for EJCTS. When the h-graphs were superimposed, the “h” values of JTCVS, ATS, and JVS were close to each other. When comparing the 4 minor journals in WoS:JCVS, TCVS, JCS and HSF, as well as ST, journal analytics showed that JCVS had the best trend among the five. It was concluded that the h-index is valuable for the evaluation and comparison of TCVS journals, since the index can be obtained easily using online databases, and the “trend” of a journal is helpful in making a choice when submitting a manuscript to minor TCVS journals.
      Jpn. J. Cardiovasc. Surg. 38:11-16（2009）

Short Communications

  • A Surgical Case of Severe Mitral Regurgitation with Idiopathic Hypereosinophilic Syndrome T. Hayashi et al.……17
    A Surgical Case of Severe Mitral Regurgitation with Idiopathic Hypereosinophilic Syndrome

    （Department of Cardiovascular surgery, Seirei Mikatahara General Hospital, Hamamatsu, Japan and Department of Cardiovascular Surgery, Kobe University Hospital*, Kobe, Japan）

    Taro Hayashi Teruo Yamashita , Yutaka Okita*
    Idiopathic hypereosinophilic syndrome（IHES）is a rare systemic disease, but frequently associated with the eosinophil-infiltrated end organ（cardiac, hematologic, cutaneous, neurologic, pulmonary, splenic and thromboembolic）failure. Mechanical valve replacement for valvular heart disease in cases of IHES has the potential of thromboembolic accidents in the early post-operative period, even though the strict anti-coagulant therapy was performed. We reported a younger IHES case with congestive heart failure due to severe mitral regurgitation who underwent mitral valve repair instead of replacement. In this case, only the lateral scallop of the posterior mitral leaflet was involved with endocarditis due to the eosinophyl infiltration, with no other symptoms, i.e., initial hyperplasia and thrombus in the left ventricle that were detected in the most cases with IHES endocarditis. Mitral annuloplasty with the complete ring was simply performed because of the presence of sufficient intact anterior leaflet. The eosinophil count had been strictly controlled with imatinib mesilate in addition to the anti-coagulant therapy, and any thromboembolic event had been detected post operatively. In case of valvular heart disease due to IHES endocarditis, valve repair should be firstly attempt and imatinib mesilate is very useful and effective for preventing from post-operative thromboembolic accidents in FIP1L1-PDGFRα gene positive cases.
      Jpn. J. Cardiovasc. Surg. 38:17-21（2009）
  • Successful Surgical Repair Case of Cardiac Rupture after Acute Myocardial Infarction K. Matsuki and H. Fujiwara……22
    Successful Surgical Repair Case of Cardiac Rupture after Acute Myocardial Infarction

    （Department of Cardiovascular Surgery, Hachinohe City Hospital, Hachinohe, Japan）

    Taro Hayashi Katsuo Matsuki , Hidenori Fujiwara
    Blow-out type cardiac rupture after acute myocardial infarction（AMI）is usually a fatal complication. We report the case of a 64-year-old man, admitted to our hospital for AMI with cardiac shock. ECG and echocardiography showed a cardiac rupture after anterior AMI. We performed an emergency operation with a percutaneous cardiopulmonary support system（PCPS）and intra-aortic balloon pumping（IABP). The actively bleeding site, located at the anterior wall, was approximated using a large mattress suture with felt strips to close the rupture site, and the site was covered with fibrin glue. The patient was discharged on POD 48. We report a successful surgery for a case of blow-out type cardiac rupture after AMI.
      Jpn. J. Cardiovasc. Surg. 38:22-25（2009）
  • Successful Treatment of Prosthetic Graft Infection after Descending Thoracic Aortic Reconstruction K. Yamana et al.……26
    Successful Treatment of Prosthetic Graft Infection after Descending Thoracic Aortic Reconstruction

    （Department of Cardiovascular Surgery, Komaki City Hospital, Komaki, Japan）

    Koji Yamana Masaru Sawazaki , Siro Tomari
    Thoracic graft infection is a serious complication with high mortality. We report a case of successful treatment of graft infection after descending thoracic aortic reconstruction. A 69-year-old woman underwent surgery for impending rupture of descending thoracic aneurysm. The aneurysm was replaced with prosthetic graft（Hemashield®). She had a high fever on the 8th postoperative day（POD). We started antibiotic treatment, but her skin broke out in a rash shortly after the therapy because of drug allergy. We stopped treatment with all drugs on the 25th POD. She left our hospital on the 98 POD, but was readmitted 5 months after the operation because of fever. A CT scan and Gallium scintigraphy demonstrated fluid and air collection around the graft and Staphylococcus epidermidis was detected from the culture fluid of her blood. Because of the difficulty in replacing infected grafts, sensitive antibiotics to the pathogen was administered. Inflammatory reactions improved and her general condition was stabilized. On 39 days after re-admission, she was discharged. The patient is now asymptomatic, 14 months after the operation.
      Jpn. J. Cardiovasc. Surg. 38:26-30（2009）
  • A Case of Infective Endocarditis with Incarcerated Vegetation in Mitral Orifice T. Furukawa et al.……31
    A Case of Infective Endocarditis with Incarcerated Vegetation in Mitral Orific

    （Department of Cardiovascular Surgery, Kurashiki-Central Hospital, Okayama, Japan and Present address:Department of Cardiovascular Surgery, Onomichi General Hospital*, Onomichi, Japan）

    Tomokuni Furukawa* Tatsuhiko Komiya Nobunari Tamura
    Genichi Sakaguchi Taira Kobayashi Akihito Matsushita
    Gengo Sunagawa , Takashi Murashita
    A 69-year-old woman was admitted with fever and dyspnea. We diagnosed the congestive heart failure due to infective endocarditis（IE）with mitral valve regurgitation and stenosis. We immediately started medical therapy in order to control both the heart failure and the infection. However, we had to semi-emergency mitral valve replacement additionally perform a days after the initial hospitalized due to a progression of the heart failure. The operative findings showed an area of vegetation to be incarcerated in the mitral orifice. In cases of IE which are associated with mitral stenosis, we therefore should consider the possibility that vegetation may be present in the mitral orifice and closely follow such patients by echocardiography.
      Jpn. J. Cardiovasc. Surg. 38:31-34（2009）
  • A Case of Aortic Valve Plasty for Non-coronary Cusp Fracture after Infective Endocarditis T. Furukawa et al.……35
    A Case of Aortic Valve Plasty for Non-coronary Cusp Fracture after Infective Endocarditis

    （Department of Cardiovascular Surgery, Kurashiki-Central Hospital, Okayama, Japan and Present address:Department of Cardiovascular Surgery, Onomichi General Hospital*, Onomichi, Japan）

    Tomokuni Furukawa* Tatsuhiko Komiya Nobunari Tamura
    Genichi Sakaguchi Taira Kobayashi Akihito Matsushita
    Gengo Sunagawa , Takashi Murashita
    A 20-year-old male was referred to our hospital to undergo operative treatment due to aortic valve insufficiency which had gradually worsened. The patient’s chief complaint was a loss of breath upon effort which had progressively worsened after undergoing aortic valve plasty（AVP）for aortic valve insufficiency with infective endocarditis at another institution. AVP by the cusp extension method had been performed because of the patient’s youth and there had been no change in the morbid state, except for the presence of a non-coronary cusp. In addition, the aortic valve insufficiency was controlable and postoperative course was also excellent. The cusp extension method was therefore considered to be an appropriate procedure for this case since it would allow the patient to return it to a state with a more normal heart, since the valve organization after this procedure would be able to reach a maximum level.
      Jpn. J. Cardiovasc. Surg. 38:35-39（2009）
  • Total Aortic Replacement for Type B Aortic Dissection after Aortic Root Replacement and Repair of a True Aneurysm of the Right Subclavian Artery in a Patient with Marfan Syndrome M. Inaoka and A. Fujii……40
    Total Aortic Replacement for Type B Aortic Dissection after Aortic Root Replacement and Repair of a True Aneurysm of the Right Subclavian Artery in a Patient with Marfan Syndrome

    （Department of Thoracic and Cardiovascular Surgery, Hakodate Goryoukaku Hospital, Hakodate, Japan）

    Masami Inaoka , Akira Fujii
    A 34-year-old woman with Marfan syndrome was admitted to our department in June, 2006 for surgical treatment of the dilated aortic arch and aneurysm of the right subclavian artery. The aortic root and ascending aorta had been replaced because of AAE, severe AR and ascending aortic aneurysm in 1999. The infrarenal abdominal aorta had been replaced for lower limb ischemia due to acute type B aortic dissection in 2001. The descending aorta and thoracoabdominal aorta had been replaced in 2002 and in 2005 respectively for diffuse and extensive dilatation of the false lumen. The remaining dilated entire aortic arch was replaced and right subclavian artery aneurysm was managed by arterial reconstruction in 2006. The whole aorta was replaced in 5 consecutive operations over 7 years. The patient recovered uneventfully and returned her job after discharge. Total aortic replacement for aortic dissection after aortic root replacement is rare and true aneurysm of the subclavian artery is also rare in patients with Marfan syndrome. Staged aortic replacement for treatment of extensive aortic disease is safe with satisfactory result. Regular follow up is important even if total aortic replacement has been completed.
      Jpn. J. Cardiovasc. Surg. 38:40-43（2009）
  • Successful Surgical Repair for Rupture of Penetrating Atherosclerotic Ulcer with MRSA Infection of a Porcelain Descending Aorta K. Yoshimoto et al.……44
    Successful Surgical Repair for Rupture of Penetrating Atherosclerotic Ulcer with MRSA Infection of a Porcelain Descending Aorta

    （Division of Cardiothoracic Surgery, Asahikawa City Hospital, Asahikawa, Japan）

    Kimihiro Yoshimoto Junichi Oba Taro Minamida
    Akira Adachi Tsukasa Miyatake , Hidetoshi Aoki
    A 41-year-old man with focal glomerulosclerosis had been treated by hemodialysis for 22 years. Kidney transplantation from a living donor was performed once, but the transplanted kidney was removed out because it had been infected by methicillin-resistant Staphylococcus aureus about 3 months previously. He was admitted to our hospital with over 38℃ fever 2 months after the removal. He had hemoptysis and marked back pain. Computed tomography scan revealed ruptured descending aorta. The descending aorta was circumferentially calcified but not enlarged. We thought that a penetrating atherosclerotic ulcer had formed in a crack of the porcelain aorta and ruptured with infection. First we tried endovascular treatment with stent-graft implantation. It was useful to control hemoptysis, but a small amount of type I leakage remained. Finally, after controlling the infection, we performed prosthesis replacement with extra-corporeal circulation and surrounded the artificial aorta with the omentum. The postoperative course was uneventful and he recovered completely.
      Jpn. J. Cardiovasc. Surg. 38:44-48（2009）
  • A Case of Successful Surgical Treatment for Acute Type A Aortic Dissection in Late Pregnancy with Marfan Syndrome M. Kabasawa et al.……49
    A Case of Successful Surgical Treatment for Acute Type A Aortic Dissection in Late Pregnancy with Marfan Syndrome

    （Division of Cardiovascular Surgery, Funabashi Municipal Medical Center, Chiba, Japan）

    Masashi Kabasawa Yoshiharu Takahara
    Kenji Mogi , Masaharu Hatakeyama
    We report a case of successful surgical treatment for acute aortic dissection in a patient with late pregnancy with Marfan syndrome. The patient was a 32-year-old primipara. She experienced sudden precordial pain and visited on other hospital at 29 weeks’ gestation. She was given a diagnosis of acute type A aortic dissection on computed tomography（CT), and was referred to our hospital for surgery. The earliest possible operation was required, but, in view of the risk of massive bleeding following placental separation due to heparin administration for cardiopulmonary bypass, Caesarian section and abdominal total hysterectomy were initially performed, followed 2 days later by the Bentall procedure plus prosthetic graft replacement of the ascending aorta and aortic arch in a two-stage operation. The postoperative course of the mother and infant was uneventful. The treatment strategy for Marfan syndrome complicated by aortic dissection in late pregnancy is very important. We were able to safely perform surgery and perioperative management using a two-stage operation, that is, by performing Caesarian section first, then strictly controlling circulatory dynamics under sedation and artificial ventilation in the ICU, and subsequently performing repair of the heart and aorta after the subsidence of obstetric hemorrhage.
      Jpn. J. Cardiovasc. Surg. 38:49-52（2009）
  • Quadricuspid Aortic Valve S. Katahira et al.……53
    Quadricuspid Aortic Valve

    （Department of Cardiovascular Surgery, Sendai City Medical Center, Sendai Open Hospital, Sendai, Japan）

    Shintaro Katahira Seijiro Yoshida , Yoshimasa Moizumi
    A 43-year-old woman was admitted with heart murmur. Transthoracic echocardiography（TTE）and aortgraphy revealed severe aortic regurgitation and also transesophageal echocardiography（TEE）and multi-row detector computed tomography（MDCT）demonstrated quadricuspid aortic valve. Combined cardiac surgery such as aortic valve replacement and replacement of the ascending aorta was successfully performed. Quadricuspid aortic valve is a rare anomaly. MDCT is a useful device for the morphological and functional evaluation of the aortic valve disease non-invasively.
      Jpn. J. Cardiovasc. Surg. 38:53-55（2009）
  • A Successful Surgical Repair for Mesenteric Ischemia Associated with Acute Type A Dissection K. Iwata et al.……56
    A Successful Surgical Repair for Mesenteric Ischemia Associated with Acute Type A Dissection

    （Department of Cardiovascular Surgery, Kinan Hospital, Wakayama, Japan）

    Keiji Iwata Yasuhisa Shimazaki , Tomohiko Sakamoto
    A 65-year-old woman presented to a local hospital with chest, back and right leg pain. She was transferred to our hospital because her abdominal pain gradually increased. CT scan demonstrated an acute type A aortic dissection from the proximal ascending aorta to the right common iliac artery, with a 48mm diameter in the ascending aorta. The proximal superior mesenteric artery（SMA）was completely occluded by the thrombosed false lumen. Echocardiography showed minor aortic regurgitation, and no pericardial effusion. Her hemodynamics were stable, but abdominal pain persisted. Emergency laparotomy, performed because of mesenteric infarction with intestinal necrosis, provided no evidence of any intestinal necrosis. She underwent left external iliac artery to distal SMA bypass with a saphenous vein graft, because the intestine looked pale. Then the total arch replacement was performed two days later. The patient’s postoperative course was uneventful, and her abdominal symptom completely disappeared.
      Jpn. J. Cardiovasc. Surg. 38:56-59（2009）
  • Unsuccessful LITA Harvest due to Sternocostoclavicular Hyperostosis T. Miyauchi et al.……60
    Unsuccessful LITA Harvest due to Sternocostoclavicular Hyperostosis

    （General and Cardiothoracic Surgery Graduate School of Medicine, Gifu University, Gifu, Japan）

    Tadamasa Miyauchi Katsuya Shimabukuro Eiji Murakami
    Yukio Umeda Yukiomi Fukumoto
    Narihiro Ishida , Hirofumi Takemura
    A 78-year-old man presented at the emergency department with anterior chest pain. Coronary angiography（CAG）revealed three-vessel disease and percutaneous transluminal coronary angioplasty（PTCA）was performed on the right coronary artery. A preoperative plain chest computed tomography（CT）scan revealed hyperostosis of the sternum and clavicle. The patient underwent elective coronary artery bypass surgery 49 days later. During surgery, the thickness of the sternum caused difficulties with implementing median sternotomy. The pleura was also thicker than usual and even pulsation of the left internal thoracic artery（LITA）could not be determined due to severe adhesion. We harvested the right internal thoracic artery（RITA）instead of the LITA. The RITA was in a similar condition, but a 5cm proximal portion could be prepared. The saphenous vein graft was anastomosed to the left anterior descending coronary artery after proximal anastomosis to the ascending aorta with the heartstring device because of the calcified aorta. The RITA-saphenous vein composite graft was anastomosed sequentially to the distal right coronary and circumflex artery. The patient’s postoperative course was uneventful but he complained of numbness and lassitude of both upper extremities for one month. A postoperative contrast-enhanced CT scan revealed a patent LITA surrounded by thick tissue, indicating inflammatory disorders. The CT findings indicated a diagnosis of sternocostoclavicular hyperostosis. The postoperative CAG findings indicated that all bypass grafts were patent and the patient was discharged 32 days after surgery. Sternocostoclavicular hyperostosis is an inflammatory disease that might require surgeons to carefully reconsider graft selection.
      Jpn. J. Cardiovasc. Surg. 38:60-63（2009）
  • A Case of Partial Arch and Descending Aortic Replacement for a Ruptured Type B Acute Aortic Dissection K. Shibata et al.……64
    A Case of Partial Arch and Descending Aortic Replacement for a Ruptured Type B Acute Aortic Dissection

    （Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Japan and Present address:Department of Cardiovascular Surgery, Kitasato University School of Medicine*, Sagamihara, Japan）

    Ko Shibata* Haruo Makuuchi Toshiya Kobayashi
    Masahide Chikada Hirosi Murakami Takamaro Suzuki
    Hirokuni Ono Kiyoshi Chiba , Tokuichiro Nagata
    Ruptured type B acute aortic dissection（AAD）is a life-threatening condition, in which surgical treatment most often yields unsatisfactory results. We report a case of a ruptured type B AAD in a 67-year-old man detected on computed tomography that required a partial aortic arch replacement with reconstruction of the left subclavian artery with adjunct deep hypothermic circulatory arrest（DHCA). Although the patient had a postoperative stroke, he recovered markedly with rehabilitation. DHCA and open proximal anastomosis are useful for the surgical treatment of type B AAD, however, an elaborate strategy to prevent an intraoperative cerebral embolism is especially important.
      Jpn. J. Cardiovasc. Surg. 38:64-66（2009）
  • Mitral Valve Replacement for Libman-Sacks Endocarditis in Antiphospholipid Syndrome Secondary to Systemic Lupus Erythematosus Complicated with Thrombocytopenic Purpura M. Yoshikawa et al.……67
    Mitral Valve Replacement for Libman-Sacks Endocarditis in Antiphospholipid Syndrome Secondary to Systemic Lupus Erythematosus Complicated with Thrombocytopenic Purpura

    （Division of Cardiovascular Surgery, Toyota Kosei Hospital, Toyota, Japan and Division of Thoracic and Cardiovascular Surgery, Nagoya Ekisaikai Hospital*, Nagoya, Japan）

    Masaharu Yoshikawa Osamu Kawaguchi Akira Takanohashi*
    Kei Yagami* Fumiaki Kuwabara* Yuichi Hirate*
    Yuichi Hirate* , Yoshiya Miyata*
    A 42-year-old woman with antiphospholipid syndrome（APLS）secondary to systemic lupus erythematosus（SLE）complicated with thrombocytopenic purpura was successfully treated by mitral valve replacement with a mechanical prosthesis and tricuspid valve annuloplasty for mitral valve stenosis and regurgitation due to Libman-Sacks endocarditis. Intraoperative hemorrhagic oozing due to thrombocytopenia was effectively managed with platelet transfusion. Negative microbial culture and pathological examination of the resected mitral valve demonstrated an atypical sterile verrucose lesion, the findings of which were typically characteristic of Libman-Sacks endocarditis in SLE. She was successfully discharged 31 days after the operation without any hemorrhagic or thromboembolic events. However, 100 days after surgery, she suffered from fatal cerebral infarction caused by poor Coumadin compliance. Regarding the prosthetic valve selection, it is reasonable to select the mechanical valve because 1）anticoagulation therapy is necessary for APLS, 2）the risk of the dialysis induction due to the lupus-induced renal failure leading to a high calcium turnover, which results in accelerated bioprosthetic valve calcification. In case of SLE with APLS, in which anticoagulation and antiplatelet therapy is required to prevent the thromboembolic event and thrombocytopenic purpura, after valve replacement, strict management of anticoagulation plays an essential role to prevent thromboembolic complication.
      Jpn. J. Cardiovasc. Surg. 38:67-70（2009）
  • Ross Operation for Prosthetic Valve Endocarditis in a Patient with Aortitis Syndrome S. Kadowaki et al.……71
    Ross Operation for Prosthetic Valve Endocarditis in a Patient with Aortitis Syndrome

    （Department of Surgery and Department of Cardiova-scular Surgery*, Teikyo University, Tokyo, Japan）

    Susumu Kadowaki Susumu Ishikawa* Akio Kawasaki*
    Kazuo Neya* Haruo Suzuki* Keiko Abe*
    Makoto Shibuya Hiroshi Takami , Keisuke Ueda*
    A 60-year-old man was admitted to our hospital due to cerebellum infarction. He had undergone replacement of the aortic valve and ascending aorta because of aortitis syndrome 2 years ago. Electrocardiogram showed complete atrioventricular block. Echocardiography showed aortic annular abscess and vegetation on the prosthetic aortic valve. A pulmonary autograft was transplanted of the aortic root（Ross operation）after complete resection of the infected sites. The postoperative course was uneventful. The ross operation was considered to be a treatment of choice for prosthetic aortic valve endocarditis.
      Jpn. J. Cardiovasc. Surg. 38:71-74（2009）
  • Postoperative Bleeding from the Right Lung after Aortic Root Replacement Treated Successfully with ECMO in a Patient Who Underwent Radical Operation for Tetralogy of Fallot 38 Years Ago Y. Kobayashi et al.…75
    Postoperative Bleeding from the Right Lung after Aortic Root Replacement Treated Successfully with ECMO in a Patient Who Underwent Radical Operation for Tetralogy of Fallot 38 Years Ago

    （Department of Surgery and Department of Cardiova-scular Surgery*, Teikyo University, Tokyo, Japan）

    Yasuhiko Kobayashi Masataka Mitsuno Mitsuhiro Yamamura
    Hiroe Tanaka Masaaki Ryomoto Hiroyuki Nishi
    Shinya Fukui Noriko Tsujiya
    Tetsuya Kajiyama , Yuji Miyamoto
    We successfully performed aortic root replacement in an asymptomatic 52 year-old man with dilatation of the Valsalva sinuses（75mm). The patient had previously undergone a radical operation for the tetralogy of Fallot at 13 years of age and AVR at 46 years of age. Massive bleeding occurred in the lungs after weaning from CPB. Emergency bronchoscopy revealed that the bleeding came from the right middle and lower lobes. The bleeding was stopped conservatively on POD 3;however, V-V ECMO was started on POD 5 because of severe hypoxia. ECMO was successfully weaned on POD 11 and he discharged on POD 59. The presence of developed bronchial collaterals and barotrauma during the operation were speculated the causes of the bleeding from the right lung.
      Jpn. J. Cardiovasc. Surg. 38:75-78（2009）
  • Cardiac Papillary Fibroelastoma Which Occurred from the Tricuspid Valve K. Tanaka et al.…79
    Cardiac Papillary Fibroelastoma Which Occurred from the Tricuspid Valve

    （Department of Cardiovascular Surgery, Dokkyo Medical University, Koshigaya Hospital, Koshigaya, Japan）

    Koyu Tanaka Yohei Okita Masahito Saito
    Shigeyoshi Gon Yoshihito Irie , Takao Imazeki
    Cardiac papillary fibroelastoma（CPF）is a rare benign cardiac tumor. It commonly arises from the left side heart valve. We present two rare cases of CPF that originating from the right side of the heart confirmed by surgical resection. Case 1:A 67-year-old man was admitted for surgical resection of a cardiac tumor located in the right atrium. Transesophageal echocardiography revealed a mobile mass attached on the anterior leaflet of the tricuspid valve. The tumor was resected by open heart surgery. Histopathologic examination confirmed the tumor to be a CPF. Case 2:A 68-year-old man was admitted for surgical resection of a tumor occurred from the tricuspid valve. Transthoracic echocardiography revealed a tumor attached to the medial leaflet. The tumor was resected. Histopathologic examination confirmed it to be a calcified mass. However, the surface of tumor had many papillary projections macroscopically. We redo the histopathologic examination, and confirmed the tumor as a CPF finally. In both cases, postoperative courses were uneventful.
      Jpn. J. Cardiovasc. Surg. 38:79-82（2009）
  • Primary Papillary Fibroelastoma in the Left Ventricle Y. Tsunoda et al.……83
    Primary Papillary Fibroelastoma in the Left Ventricle

    Department of Cardiovascular Surgery, Sakakibara Heart Institute, Fuchu, Tokyo, Japan）

    Yu Tsunoda Toshihiro Fukui Hiroshi Seki
    Shigeyoshi Gon Susumu Manabe
    Tomoki Shimokawa , Shuichiro Takanashi
    A 76-years-old woman was admitted with a left ventricular tumor that was accidentally found by a transthoracic echocardiogram. The tumor was located in the papillary muscle near the apex, had an irregular surface, and was well mobile. The urgent operation was planned because the tumor might have caused of embolism. A cardiopulmonary bypass was established with distal ascending aortic cannulation and bicaval venous cannulations. The resection of the tumor was performed by a transaortic approach. Pathological examination confirmed the tumor as primary papillary fibroelastoma. During the operation, a thoracoscope was used to assist the resection of the tumor. It was useful for a good visualization in the left ventricle. In this case report we describe a rare case of primary papillary fibroelastoma in the left ventricle and a technique of resection using a transaortic approach with an assistance of a thoracoscope.
      Jpn. J. Cardiovasc. Surg. 38:83-85（2009）

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