Japanese Journal of Cardiovascular Surgery Vol.39, No.4

Originals

A Refined Method for Aortic Occlusion under Brief Circulatory Arrest in Patients with a Severely Diseased Ascending Aorta S. Morizumi et al.……159

A Refined Method for Aortic Occlusion under Brief Circulatory Arrest in Patients with a Severely Diseased Ascending Aorta

（Department of Cardiovascular Surgery, Tsukuba Memorial Hospital, Tsukuba, Japan, and Department of Cardiovascular Surgery, Yokohama Rosai Hospital*, Yokohama, Japan）

Sei Morizumi Hiroshi Furukawa* Mutsumu Fukata*

Yoshihiro Suematsu Toshio Konishi*

Atherosclerotic morbidity of the ascending aorta is associated with an increased risk of perioperative cerebral damage during cardiac surgery. To minimize the risk, we developed a refined method for occluding the diseased ascending aorta. From April 2005 to December 2007, 18 patients underwent cardiac surgery. Just before aortic cross-clamping, the aorta was opened during brief circulatory arrest in order to flush out any possible remaining atheromatous debris. The specially designed intra-aortic occluder was applied to an extremely calcified aorta. There were no hospital mortalities or cerebrovascular accidents. In conclusion, our technique can greatly contribute to the prevention of embolic complications in patients with a severely diseased ascending aorta.
Jpn. J. Cardiovasc. Surg. 39:159-161（2010）

Keywords：ascending aorta, atherosclerosis, calcification, circulatory arrest, cerebrovascular accident

Suppression of Neointimal Hyperplasia by External Application of Cilostazol-Eluting Film at Anastomotic Sites in a Canine Model T. Kagatani et al.……162

Suppression of Neointimal Hyperplasia by External Application of Cilostazol-Eluting Film at Anastomotic Sites in a Canine Model

（Department of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan）

Tomoaki Kagatani Katsuhiko Oda Satoshi Kawatsu

Naotaka Motoyoshi Syunsuke Kawamoto Junetsu Akasaka

Yoshio Nitta Yoshikatsu Saiki Atsushi Iguchi

Koichi Tabayashi

Neointimal hyperplasia is the principal mechanism of graft failure in coronary artery bypass surgery. Systemic administration of cilostazol has been reported to suppress neointimal hyperplasia in some vascular injury models. We sought to deliver cilostazol locally in an attempt to augment its beneficial effect to inhibit neointimal hyperplasia at an anastomotic site. We examined whether the external application of a novel cilostazol-eluting film can inhibit neointimal hyperplasia in a vascular anastomosis model. Canine femoral artery graft interposition was performed in 20 beagle dogs, assigned to 4 groups of 5 dogs each:a graft interposition without copolymer of L-lactide and ε-caprolactone（P（LA/CL））film（control group）and groups with P（LA/CL）film containing cilostazol of either 10mg, 40mg, or 80mg doses. All the cilostazol-eluting film with 10mg, 40mg, and 80mg dose groups had a reduced intima/media ratio compared to the control group（0.15±0.03, 0.11±0.03, and 0.12±0.03, vs. 0.31±0.03, p＜0.05). Immunohistochemical analyses for proliferating cell nuclear antigens revealed reduced cellular proliferating activity associated with decreased α-actin positive cells in the cilostazol-eluting film groups compared to the control group. External application of cilostazol-eluting film can inhibit neointimal hyperplasia, at least in part, by inhibiting smooth muscle cell proliferation in the intima.
Jpn. J. Cardiovasc. Surg. 39:162-171（2010）

Keywords：neointimal hyperplasia, cilostazol, P（LA/CL), arterial graft model

Initial Results of Thoracic Endovascular Repair with the Gore TAG Device Evaluated by the Japan SCORE System H. Midorikawa et al.……172

Initial Results of Thoracic Endovascular Repair with the Gore TAG Device Evaluated by the Japan SCORE System

（Department of Cardiovascular Surgery, Southern Tohoku General Hospital, Koriyama, Japan）

Hirofumi Midorikawa Megumu Kanno Takashi Takano

Kouyu Watanabe Yuzo Shimazu

We report the initial results of thoracic endovascular repair using the Gore TAG device（TAG）used in treatment of thoracic aortic aneurysms（TAA), and evaluate initial outcome based on the Japan SCORE（JS）system. From August 2008 to July 2009, thoracic aortic endovascular repair（TEVAR）for TAA was applied in 27 cases（men/women, 22/5, 53-88 years old, mean age 70.5). Locations included the distal arch in 7 cases, proximal descending TAA（dTAA）in 12 cases and middle or distal dTAA in 8 cases. Deployment of a stent-graft（SG）was successful in 27 cases（100%）and complete thrombosis of the aneurysm or complete entry closure was achieved in 26 cases（96.3%). There was 1 type 2 endoleak（3.7%), 2 iliac arterial injuries（7.4%）and 2 cases of temporary hemodialysis（7.4%). There was no occurrence of paraplegia or hospital death. The 30-day mortality rate and major complication rate examined by the Japan SCORE（JS）system did not show any statistical differences between the TEVAR group and the open repair（OR）group, however the data were higher in the TEVAR group, although not statisfically in the OR group. The OR group had a high complication incidence in comparison with the TEVAR group. Based on evaluation by the JS system, the initial results suggest that TAG for the treatment of TAA is superior to conventional open surgery.
Jpn. J. Cardiovasc. Surg. 39:172-176（2010）

Keywords：thoracic aortic aneurysm, stent graft, open surgery, Gore TAG device, Japan SCORE

Case Reports

Vacuum-Assisted Closure Technique to Avoid Abdominal Compartment Syndrome and Infection: A Successful Treatment of an Infected Abdominal Aortic and Left Common Iliac Aneurysms Complicated by MSSA Psoas Abscess A. Uehara et al.……177

Vacuum-Assisted Closure Technique to Avoid Abdominal Compartment Syndrome and Infection: A Successful Treatment of an Infected Abdominal Aortic and Left Common Iliac Aneurysms Complicated by MSSA Psoas Abscess

（Department of Cardiovascular Surgery, Tachikawa Medical Center, Tachikawa General Hospital, Nagaoka, Japan）

Akifumi Uehara Masahiro Sato Hiroki Sato

Koki Takizawa Tsutomu Sugimoto Kazuo Yamamoto

Shinpei Yoshii Shigetaka Kasuya

The patient was a 68-year-old woman with chief complaints of severe lumbago, left lateral abdominal pain and high fever. Computer tomography（CT）at a local hospital showed a left psoas abscess and a low density area around the terminal aorta. Blood tests indicated a high inflammatory response and MSSA was detected in a blood culture. Control of the infection was first attempted with antibiotics, but CT showed a pseudoaneurysm at the terminal aorta, and therefore she was transferred to our hospital. We diagnosed infected abdominal aortic and left common iliac aneurysms complicated by an MSSA psoas abscess, and performed extra-anatomic reconstruction with axillo-bifemoral bypass, aneurysmectomy and omentopexy in the psoas abscess cavity. Because of massive intestinal edema and mesentery, we attempted temporary abdominal closure with the vacuum-assisted closure（VAC）technique, and finally succeeded in closing without abdominal infection in the 6th operation, 42 days after the first operation. Infected abdominal aortic aneurysm complicated by psoas abscess is extremely rare and life threatening. The VAC technique is very effective not only in avoiding abdominal compartment syndrome but also in avoiding abdominal infection.
Jpn. J. Cardiovasc. Surg. 39:177-181（2010）

Keywords：infected abdominal aortic aneurysm, psoas abscess, abdominal compartment syndrome, vacuum assisted closure

Survival after Blow-out Type of Left Ventricular Free Wall Rupture due to Acute Myocardial Infarction: Multi-Detector Row Helical Computed Tomographic（MDCT）Detection of Myocardial Rupture T. Nakao…182

Survival after Blow-out Type of Left Ventricular Free Wall Rupture due to Acute Myocardial Infarction: Multi-Detector Row Helical Computed Tomographic（MDCT）Detection of Myocardial Rupture

（Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hiroshima, Japan）

Tatsuya Nakao

A 67-year-old man was admitted to our emergency room with strong chest and stomach pain. Electrocardiography and echocardiography revealed myocardial infarction of the anterolateral wall and cardiac tamponade. To investigate the cause of cardiac tamponade, we recommended 16-slice-non-gated MDCT. However, this revealed no aortic dissection, but did show loss of contrast in the anterior apex myocardial wall, diffuse stenosis of the LAD（left anterior descending artery;Seg.7）and occlusion of D2（second diagonal branch). A definitive diagnosis of blow-out type free wall rupture of the left ventricle was obtained. In the operating room, pulseless electrical activity（PEA）developed, so median sternotomy was immediately performed and bleeding from the anterolateral wall was found. After establishing extracorporeal circulation, surgical repair with a direct mattress suturing technique using felt-strips and CABG（SVG to #8）were performed. Complete hemostasis was achieved. The postoperative course was eventful:respiratory dysfunction due to deteriorating interstitial pneumonia developed. However, MDCT is a useful and non-invasive tool for the immediate detection of ventricular rupture and acute dissection of the ascending aorta, both of which may be the cause of cardiac tamponade.
Jpn. J. Cardiovasc. Surg. 39:182-186（2010）

Keywords：acute myocardial infarction, left ventricular free wall rupture, blow out type, MDCT

A Case of Adrenocorticotropic Hormone Deficiency after Surgery for Cardiac Valvular Disease A. Sato et al.……187

A Case of Adrenocorticotropic Hormone Deficiency after Surgery for Cardiac Valvular Disease

（Department of Cardiovascular Surgery, First Department of Internal Medicine, Faculty of Medicine, Oita University, Oita, Japan）

Aiko Sato Hirofumi Anai Tomoyuki Wada

Hirotsugu Hamamoto Toru Shimaoka Takashi Shuto

Takeshi Sakaguchi Koro Goto Hironobu Yoshimatsu

Shinji Miyamoto

A 59-year-old man was admitted to our hospital with severe mitral incompetence. Mitral valve repair, tricuspid annuloplasty and the Maze procedure were performed. After weaning from cardiopulmonary bypass, his systolic blood pressure（SBP）dropped to 40mmHg. Immediate administration of catecholamines markedly increased SBP but his continuing low blood pressure required additional treatment with vasopressin and hydrocortisone. On postoperative day 12 in the general ward, he suddenly lapsed into an intractable hypoglycemic coma. Endocrine function tests revealed adrenocorticotropic hormone deficiency. Since the time of writing has been doing well with 20 mg of hydrocortisone.
Jpn. J. Cardiovasc. Surg. 39:187-190（2010）

Keywords：cardiac valvular disease, adrenocorticotropic hormone deficiency, hypoglycemia, hypotension

Coronary Artery Bypass Grafting in a Man with Myocardial Ischemia and Left Ventricular Noncompaction K. Maeda et al.……191

Coronary Artery Bypass Grafting in a Man with Myocardial Ischemia and Left Ventricular Noncompaction

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

Koichi Maeda Nobuo Sakagoshi Ryohei Matsuura

Yasuhisa Shimazaki

Noncompaction of the left ventricular myocardium（NCLV）is a rare congenital cardiomyopathy resulting from an arrest in normal endomyocardial embryogenesis. The prognosis of NCLV is poor, including progress on to heart failure. However, some cases of NCLV in adults have been recently reported. To the best of our knowledge, there are only 3 cases of cardiac operations reported in patients with NCLV in adults. We describ a 54-year-old man with NCLV and severe coronary artery disease. Echocardiography demonstrated NCLV and low LVEF（25%). Coronary angiography（CAG）showed triple vessel disease with total occlusion of vessels #1 and #6. Tl-cintigraphy and magnetic resonance imaging（MRI）demonstrated viability from the base to the middle of the anterior wall. Coronary artery bypass grafting（CABG）was done after controll of the heart failure. The postoperative course was uneventful and the patient was discharged 7 days after operation. LVEF improved to 52% after surgery. Careful observation of cardiac function is vital because of the possibility of progression to heart failure.
Jpn. J. Cardiovasc. Surg. 39:191-194（2010）

Keywords：noncompaction of the left ventricular myocardium, old myocardial ischemia, coronary artery bypass grafting, scintigram, magnetic resonance imaging

Two Cases of Total Arch Replacement for Ruptured Type B Intramural Hematoma S. Goto et al.……195

Two Cases of Total Arch Replacement for Ruptured Type B Intramural Hematoma

（Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan, and Gifu Prefectural General Medical Center*, Gifu, Japan）

Shinnosuke Goto Masafumi Matsui Norikazu Kawai*

Hideaki Manabe Hisato Takagi Takuya Umemoto

Type B intramural hematoma（IMH）is not considered to be a life-threatening condition, and medical treatment is the first treatment choice. We report 2 cases of ruptured type B intramural hematoma. Total arch replacement was performed via median sternotomy, which is not a common surgical strategy for type B dissection. Case 1:a 77-year-old woman was transferred to our hospital with chest and back pain. CT revealed type B IMH with a large hematoma in the anterior mediastinum. She underwent total arch replacement, but she died of respiratory failure on the 167th postoperative day. Case 2:a 60-year-old man was transferred to our hospital with chest and back pain. CT revealed a type B IMH with a large hematoma on the anterior side of the arch. He underwent total arch replacement, but died of sepsis on the 13th postoperative day. We had 2 rare cases of ruptured type B IMH. In both cases, postoperative courses were problematic. However, median sternotomy could be an approach for ruptured type B dissection in some cases.
Jpn. J. Cardiovasc. Surg. 39:195-198（2010）

Keywords：type B thrombosed type acute aortic dissection, rupture, median sternotomy, intramural hematoma

A Case of Cholesterol Crystal Embolism after Endovascular Aortic Repair for AAA M. Okamoto et al.……199

A Case of Cholesterol Crystal Embolism after Endovascular Aortic Repair for AAA

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

Masahiko Okamoto Masashi Nagumo Testuya Goto

Akihiro Yoshitake Takahisa Miki Koji Osumi*

We report a case of cholesterol crystal embolism（CCE）after endovascular aortic repair for abdominal aortic aneurysm（AAA). A 68-year-old man with AAA underwent endovascular aortic repair. He complained of left lower abdominal pain after the operation. Abdominal CT showed renal infarction on postoperative day 10. Renal dysfunction developed after postoperative day 17. A biopsy of the renal infarct lesion demonstrated characteristic cholesterol clefts in the small arteries. We diagnosed CCE. Steroid therapy was administered and the patient’s condition improved remarkably. Diagnosis of CCE is difficult and its prognosis still remains poor. Therefore, we should keep this unusual complication in mind.
Jpn. J. Cardiovasc. Surg. 39:199-202（2010）

Keywords：endovascular aortic repair, cholesterol crystal embolism, abdominal aortic aneurysm

Coronary Aneurysms in an Elderly Man Presumed to Be due to Childhood Kawasaki Disease H. Osada et al.……203

Coronary Aneurysms in an Elderly Man Presumed to Be due to Childhood Kawasaki Disease

（Department of Cardiovascular Surgery, Kyoto University Hospital, Kyoto, Japan）

Hiroaki Osada Yoshiaki Saji Akira Marui

Kazuhiro Yamazaki Takeshi Nishina Kenji Minakata

Tadashi Ikeda Ryuzo Sakata

A 60-year-old man was admitted to our institution with abnormal ECG findings. Coronary CT and angiography showed coronary aneurysms from the left main trunk to the bifurcation of the left anterior descending artery, and the left circumflex artery, with severe stenosis and complete obstruction of the proximal right coronary artery. Morphological evaluation findings strongly suggested that the coronary aneurysms were highly related to childhood Kawasaki disease. We successfully performed triple vessel coronary artery bypass grafting. Here, we report a very rare case of coronary aneurysms presumed to be due to childhood Kawasaki disease in an elderly man.
Jpn. J. Cardiovasc. Surg. 39:203-205（2010）

Keywords：Kawasaki disease, coronary aneurysm, CABG

An Operative Case of Idiopathic Nonspecific Inflammatory Aneurysms of the Abdominal Aorta H. Suzuki et al.……206

An Operative Case of Idiopathic Nonspecific Inflammatory Aneurysms of the Abdominal Aorta

（Cardiovascular Surgery, Heart and Aortic Center, Aizawa Hospital, Matsumoto, Japan）

Hiroyuki Suzuki Toshihiro Fujimatsu Hajime Oosawa

We report a case of surgical treatment for idiopathic nonspecific inflammatory aneurysms of the abdominal aorta（AAA）with high-dose steroid therapy. The patient was a 35-year-old man who underwent steroid therapy（30mg/day prednisolone）for idiopathic nonspecific inflammatory AAA and right common iliac artery aneurysm（CIAA）for 5 months. However, the sizes of the aneurysms were slowly increasing, and they were sacculated types, so surgical replacement was performed. Before the operation we continued to give 30mg/day prednisolone, because decreasing the medicine made the c-reactive protein（CRP）value rise. Perioperatively the therapy continued, and the postoperative course was uneventful. With appropriate steroid therapy, replacement of idiopathic nonspecific inflammatory aneurysms of the abdominal aorta can be performed. It is also important to follow up the patient from long-term, to monitor for pseudoaneurysms from anastomosis or new aneurysms.
Jpn. J. Cardiovasc. Surg. 39:206-210（2010）

Keywords：inflammatory aneurysm, multiple aneurysms, sacculated aneurysm, steroid therapy

A Case of Widespread Stanford Type A Chronic Aortic Dissection Treated with Arch Replacement Using Transapical Aortic Cannulation, the Arch-First Technique, and Anastomosis of Both Lumens S. Takebayashi et al.……211

A Case of Widespread Stanford Type A Chronic Aortic Dissection Treated with Arch Replacement Using Transapical Aortic Cannulation, the Arch-First Technique, and Anastomosis of Both Lumens

（Department of Cardiovascular Surgery, and Department of Cardiology*, Cardiovascular Center, Oita Oka Hospital, Oita, Japan）

Satoshi Takebayashi Hidenori Sako Tetsushi Takayama

Keiji Oka Tetsuo Hadama Yoichi Tatsukawa*

The patient was a 61-year-old woman. In April 2005, she suffered a cerebral infarction and became paralyzed on the right side. In June 2005, a stent graft was placed to treat significant stenosis of the right coronary artery. Computed tomography（CT）in October 2006 revealed widespread patent aortic dissection in both the true and false lumens, extending from the origin of the ascending aorta to the three arch branches and both femoral arteries. Preoperative coronary angiography also showed occlusion of the left anterior descending branch. As a result of these findings, widespread Stanford type A chronic aortic dissection with coronary artery disease was diagnosed, and surgery was performed in February 2007. Brachiocephalic artery dissection and severe stenosis of the right subclavian artery were present, and the left common carotid artery and left subclavian artery were also dissected distally. In addition, both the true and false lumens were patent distal to the aortic arch, with the major abdominal branch bifurcating from both lumens and the dissection extending to the femoral artery, requiring cannulation of both lumens. During surgery, extracorporeal circulation was established by means of blood removal from the right atrium, transapical aortic cannulation, and cannulation of both luminens of the left femoral artery, in an effort to prevent malperfusion due to hypothermia. For revascularization, a Y-shaped artificial blood vessel was used to reconstruct the three arch branches first（the arch-first technique), after which an I-shaped artificial blood vessel was used to form anastomoses distally with both lumens, ensuring perfusion to the false lumen. The proximal anastomosis was then formed, and finally, a single coronary artery bypass graft（CABG）branch was performed using a great saphenous vein graft. No postoperative complications were encountered, and CT showed good blood flow through both luminens below the graft and aortic arch. The patient was discharged from hospital and returned home in an anbulatory condition independently 18 days postoperatively. In this case of widespread type A chronic aortic dissection, the cannulation site was selected and the order of reconstruction and methods of anastomosis were carefully chosen to avoid cardiac malperfusion during arch replacement, resulting in a good outcome.
Jpn. J. Cardiovasc. Surg. 39:211-215（2010）

Keywords：chronic aortic dissection, transapical aortic cannulation, arch-first technique, anastomosis of both luminens

Mitral Valve Replacement for Mitral Regurgitation with Annular Calcification after Esophageal Resection and Retrosternal Gastric Tube Reconstruction N. Kanemitsu et al.……216

Mitral Valve Replacement for Mitral Regurgitation with Annular Calcification after Esophageal Resection and Retrosternal Gastric Tube Reconstruction

（Department of Cardiovascular Surgery, Japan Red Cross Wakayama Medical Center, Wakayama, Japan, and Present address:Department of Cardiovascular Surgery, Kyoto University Hospital*, Kyoto, Japan）

Naoki Kanemitsu Masaki Aota Takeichiro Nakane

Takahide Takeda* Yutaka Konishi

A 79-year-old man developed congestive heart failure. He was given a diagnosis of severe mitral regurgitation with calcification of the posterior mitral annulus and secondary tricuspid regurgitation. He had a history of esophageal resection with retrosternal gastric tube reconstruction about 20 years previously. We replaced the mitral valve with a mechanical prosthesis and performed tricuspid ring annuloplasty through a right parasternal approach. We did not risk resecting the calcified annulus, but fixed the prosthesis and annulus with the equine pericardium in between as a cushion and collar, to prevent perivalvular leakage. The postoperative course was uneventful.
Jpn. J. Cardiovasc. Surg. 39:216-219（2010）

Keywords：retrosternal gastric tube reconstruction, esophageal cancer, right parasternal approach, mitral valve replacement, mitral annular calcification

A Case of Cystic Adventitial Disease of the Popliteal Artery and Study of 116 Cases Reported in Japan H. Takahashi et al.……220

A Case of Cystic Adventitial Disease of the Popliteal Artery and Study of 116 Cases Reported in Japan

（Department of Cardiovascular Surgery, Yodogawa Christian Hospital, Osaka, Japan）

Hideki Takahashi Naritomo Nishioka Takashi Azami

We report a rare case of cystic adventitial disease of the popliteal artery causing intermittent claudication. About 2 months previously, a 21-year-old man had sudden intermittent claudication in the left leg. The left-sided ankle brachial pressure index（ABI）at rest was 0.66. Computed tomography revealed that the arterial occlusion was segmentally caused by cystic lesions. A cystic adventitial lesion of the popliteal artery, measuring 9cm in diameter, was surgically removed and reconstruction was performed with a saphenous vein graft. Postoperatively the left ABI improved to 1.01, and his symptoms disappeared. The histopathological diagnosis was cystic adventitial disease and the cysts were in the adventitia. The postoperative course was uneventful and he has been without recurrence for 14 months.
Jpn. J. Cardiovasc. Surg. 39:220-225（2010）

Keywords：intermittent claudication, cystic adventitial disease of the popliteal artery, popliteal artery resection, autologous vein grafting, avoidance of recurrence

A Case of Cardiac Papillary Fibroelastoma in a Tricuspid Valve T. Kubota et al.……226

A Case of Cardiac Papillary Fibroelastoma in a Tricuspid Valve

（Department of Cardiovascular Surgery, Hakodate Central General Hospital, Hakodate, Japan, and Department of Cardiovascular Surgery, Hokkaido University Hospital*, Sapporo, Japan）

Takehiro Kubota Kimitaka Tasai Masatoshi Motohashi

Yoshiro Matsui*

Cardiac papillary fibroelastoma（CPFE）is a rare tumor, and is usually located in the atrioventricular or ventriculoarterial valves. It is occasionally identified by echocardiography or surgery. It can also be an unexpected finding at autopsy. As this tumor often occurs in left-sided cardiac chambers, early aggressive surgical resection is required in order to prevent severe systemic embolic complications. However, the operative indications of tumors on the right cardiac chamber are controversial. The patient was a 73 year-old man. He had had cerebral infarction at age 58. Before the currently reported operation, we found CPFE on the tricuspid valve but we could not find a patent foramen ovale（PFO）by the usual examinations. During surgery, we found a CPFE on the tricuspid valve that had a short stalk and PFO. We cut the short stalk of the CPFE easily, and closed the PFO directly. This patient did not need complicated valve repair. We speculated that this cerebral infarction was caused by a CPFE on the tricuspid valve and patent foramen ovale. Echocardiography is very useful in diagnosing CPFE. However, we should not neglect the possibility of PFO before surgery. The postoperative course was uneventful. We concluded that early surgical resection of CPFE, even in right-sided cardiac chambers, should be performed in order to prevent severe embolic complications, even without PFO diagnosis.
Jpn. J. Cardiovasc. Surg. 39:226-229（2010）

Keywords：cardiac tumor, cardiac papillary fibroelastoma, paradoxical embolization

A Case of Immunoglobulin G4-Related Cardiac Tumor around the Coronary Artery M. Okamoto et al.……230

A Case of Immunoglobulin G4-Related Cardiac Tumor around the Coronary Artery

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

Masahiko Okamoto Masashi Nagumo Tetsuya Goto

Akihiro Yoshitake Takahisa Miki Koji Osumi*

Immunoglobulin G4（IgG4)-related disease can occur in various organs, most of which comprise glandular or ductal tissue. We report a case of IgG4-related disease which occurred in a cardiovascular lesion. A 69-year-old man was found to have a tumorous lesion around the coronary artery. Open chest biopsy showed the diffuse lymphoplasmacytic infiltration, occasional eosinophils and numerous IgG4-positive plasma cells within the lesions. The serum concentration of IgG4 in the postoperative period was 1,080mg/dl（reference range, ＜135). We diagnosed IgG4-related periarteritis manifesting as a tumor around the coronary artery. This case suggests that IgG4-related disease can occur around the coronary artery and manifest as a periarterial mass lesion.
Jpn. J. Cardiovasc. Surg. 39:230-233（2010）

Keywords：IgG4-related disease, cardiac tumor, periarterial mass lesion, coronary artery