Japanese Journal of Cardiovascular Surgery Vol.39, No.6

Originals

  • A Study on the Implantation of a Left Ventricular Epicardial Lead during CABG in Patients with Low Cardiac Function M. Taoka et al.……285
    A Study on the Implantation of a Left Ventricular Epicardial Lead during CABG in Patients with Low Cardiac Function

    （Cardiovascular Surgery, Ayase Heart Hospital, Tokyo, Japan）

    Makoto Taoka Eiichi Tei Imun Tei
    Atsushi Fukumoto Kazuki Satoh
    In 306 patients who underwent elective coronary artery bypass graft（CABG）between January 2005 and July 2008, low cardiac functions（EF＜35%）were seen in 24 patients. Of these, 7（EF, 22.7±5.4%, NYHA 3.4±0.4）had a left ventricular epicardial lead implanted during surgery. On completion of bypass anastomosis, a screw-in-type epicardial lead was implanted. The mean threshold at implantation was satisfactory（1.1±0.4V). There were no complications related to intraoperative lead placement. In the aforementioned 7 patients, combined Cardiac resynchronization therapy defibrillator（CRT-D）implantation was performed in 4 during the postoperative period while they were still in the hospital. In 1 other patient, the procedure was conducted when he was readmitted for heart failure 3 months after discharge. The threshold for the left ventricular myocardial lead was satisfactory（1.0±0.1V). No postoperative complications, such as infections, hemorrhage, or twitching, were noted. For those patients who are likely to have a CRT-D placed after CABG, a left ventricular lead showed be implanted if possible for the safe and fast postoperative placemens of a defibrillator. However, the indications of myocardial lead implantation must be considered carefully.
      Jpn. J. Cardiovasc. Surg. 39:285-288（2010）

    Keywords：low cardiac function, coronary artery bypass grafting, cardiac resynchronization therapy
  • Comparison of Sealed Woven Polyester Grafts with Non-sealed Woven Polyester Grafts in Abdominal Aortic Surgery M. Sato et al.……289
    Comparison of Sealed Woven Polyester Grafts with Non-sealed Woven Polyester Grafts in Abdominal Aortic Surgery

    （Department of Cardiovascular Surgery, Kouseikai Hospital, Nagasaki, Japan）

    Manabu Sato Etsuro Suenaga Shugo Koga
    Hiromitsu Kawasaki
    The objective of this study was to evaluate the inflammatory responses in patients who received 1 of 2 different types of woven Dacron grafts. Abdominal aortic surgery was performed in 154 patients between 2002 and 2006, and 102 patients were enrolled in this study. Sealed woven Dacron grafts（INTERGARDTM woven graft, Group I）were implanted in 77 patients and non-sealed woven Dacron grafts（UBE woven graft, Group N）were implanted in 25 patients. All patients received either a bifurcated graft or straight graft replacement. Body temperature（BT), white blood cell counts（WBC), and C-reactive protein（CRP）levels were measured preoperatively and on postoperative days 1, 3, 5, 7 and 14, and were compared between the 2 groups. There were no differences in the patient’s mean ages, 73±9 and 71±7 years, or operation time, 213±57 and 210±63 min, between Groups I and N, respectively. Postoperative changes in BT and WBC were similar in both groups. CRP levels were higher in Group N than Group I on postoperative days 5 and 7, but these differences were clinically insignificant. Prolonged inflammatory response which lasted longer than 2 weeks occurred in 2 patients in Group I and in 1 patient in Group N. All patients eventually returned to baseline conditions without special treatments. Thus the postoperative inflammatory responses to coated and non-coated woven Dacron grafts were similar in abdominal aortic surgery.
      Jpn. J. Cardiovasc. Surg. 39:289-293（2010）

    Keywords：abdominal aortic aneurysm, synthetic vasculargraft, post-operative inflammatory response, coated vascular prosthesis
  • Early Induction of Continuous Hemodiafiltration for the Prevention of Organ Failure after Cardiac Surgery S. Kugawa……294
    Early Induction of Continuous Hemodiafiltration for the Prevention of Organ Failure after Cardiac Surgery

    （Department of Cardiovascular Surgery, Teikyo University School of Medicine, and Present address:Clinical Pathology, Showa University Hospital, Tokyo, Japan）

    Satoshi Kugawa
    Systemic inflammation after cardiac surgery using cardiopulmonary bypass（CPB), is closely associated with postoperative organ dysfunction. We evaluated the efficacy of continuous hemodiafiltration（CHDF）in controlling postoperative organ dysfunction, focusing on serum inflammatory substances and organ protection. We enrolled 14 patients with postoperative circulatory collapse. The mean age of patients was 71 years. Heart valve surgery was performed in 9 patients, coronary artery bypass grafting in 5 and graft replacement of the thoracic aorta in 2. The mean CPB time was 297±28 min. CHDF was initiated on the first or second postoperative day in 12 patients. A polysulfone membrane dialyzer and nafamostat mesilate were used for CHDF. 1）On blood examinations, serum IL-6 and IL-8 concentrations decreased 12 h after the initiation of CHDF（216±50→92±27pg/dl, 71±23→30±7 pg/dl, respectively). Serum aldosterone decreased at 12 h（144±20→104±21pg/ml). Four hours after the initiation of CHDF, systemic blood pressure significantly increased from 94±6 to 123±6 mmHg. The systemic vascular resistance index significantly increased from 1,431±137 dyn･sec･cm－5･m2 to 1,893±167. Urine volume significantly increased from 42±38 to 100±29ml/h. Serum creatinine decreased from 2.1±0.3mg/dl to 1.7±0.2mg/dl on the second day. Respiratory function had significantly improved at 24 h. Early induction of CHDF reduced serum inflammatory substances, resulting in quick circulatory recovery without organ failure.
      Jpn. J. Cardiovasc. Surg. 39:294-299（2010）

    Keywords：extracorporeal circulation, continuous hemodiafiltration, circulatory collapse, organ failure
  • Early Application of Continuous Hemodiafiltration（CHDF）after Open Heart Surgery on Hemodialysis Patients M. Yamamura et al.……300
    Early Application of Continuous Hemodiafiltration（CHDF）after Open Heart Surgery on Hemodialysis Patients

    （Department of Cardiovascular Surgery, Hyogo College of Medicine, Nishinomiya, Japan）

    Mitsuhiro Yamamura Masataka Mitsuno Hiroe Tanaka
    Masaaki Ryomoto Shinya Fukui Yoshiteru Yoshioka
    Tetsuya Kajiyama Yuji Miyamoto
    This study aimed to clarify whether continuous hemodiafiltration（CHDF）or hemodialysis（HD）was more effective after open heart surgery in dialysis patients. We evaluated 48 consecutive hemodialysis patients（28 men and 20 women, mean age:68±10 years）who underwent coronary artery bypass grafting（CABG）and/or aortic valve replacement（AVR）between January 2003 and December 2008. The patients were divided into 2 groups according to their postoperative dialysis treatment either continuous hemodiafiltration（CHDF）（CHDF group, n＝36）or hemodialysis（HD）（HD group, n＝12). Surgery in the CHDF group included 13 concomitant operations, 16 CABGs and 7 AVRs. There was only 1 concomitant surgery in the HD group, and there were 6 CABGs and 5 AVRs. There was no difference between the 2 groups regarding operation time, aortic clamp time, cardiopulmonary bypass time or intraoperative volume balance. CHDF was started significantly earlier than HD（8.0±5.8 vs. 21.0±1.0h, p ＜0.01), which resulted in the removal of a greater volume of body fluid, during the first postoperative 24h in the CHDF group（1,200±110 vs. 550±50ml, p ＜0.01). However, there was no difference between the 2 groups regarding the amount of postoperative chest drainage. There were 6 hospital deaths in the CHDF group（17%;3 heart failures, and 1 each of pneumonia, arrhythmia and massive intestinal necrosis). There was also 1 hospital death in the HD group（8.3%;heart failure). Most of the hospital deaths occurred after concomitant operations（6/7，86%). It is beneficial to start CHDF soon after open heart surgery in hemodialysis patients.
      Jpn. J. Cardiovasc. Surg. 39:300-304（2010）

    Keywords：open heart surgery, hemodialysis, continuous hemodiafiltration（CHDF）

Case Reports

  • A Case of Surgical Therapy for Coronary Aneurysm with Kawasaki Disease K. Tanaka et al.……305
    A Case of Surgical Therapy for Coronary Aneurysm with Kawasaki Disease

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

    Koyu Tanaka Yoshihito Irie Takao Imazeki
    Kyu Rokkaku Masahito Saito Yohei Okita
    Koichi Ryu
    A 51-year-old man admitted to our hospital because of an ECG abnormality pointed out by his local doctor. He had been hospitalized for scarlet fever at age 10. A coronary artery CT scan showed coronary artery aneurysm of the left main trunk（LMT), and coronary angiography showed 3-vessel disease including a chronic total occlusion of the right coronary artery（RCA). We performed conventional coronary artery bypass grafting（CABG）using an arterial graft and aneurysmectomy. The patency of the graft was confirmed by coronary angiography postoperatively. The pathological diagnosis of the coronary aneurysm was Kawasaki disease. CABG is a standard procedure for coronary artery aneurysms with Kawasaki disease. However, there are no established treatment guidelines on whether to perform aneurysmectomy. We chose CABG with aneurysmectomy because of the possibility of intra-aneurysmal thrombosis leading to peripheral occlusion, and the cause of the coronary artery aneurysm could not be determined. However, even if additional treatment by percutaneous coronary intervention（PCI）is not possible, it is important to avoid occlusion of the graft.
      Jpn. J. Cardiovasc. Surg. 39:305-308（2010）

    Keywords：Kawasaki disease, coronary aneurysm, coronary artery bypass grafting（CABG）
  • A Case of Constrictive Pericarditis with Mild Pericardial Thickening K. Kanno et al.……309
    A Case of Constrictive Pericarditis with Mild Pericardial Thickening

    （Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan, and Present addresses:Department of Cardiovascular Surgery, Iwate Medical University Hospital*, Morioka, Japan, and Department of Cardiovascular Surgery, JA Hiroshima General Hospital**, Hatsukaichi, Japan）

    Kazuyoshi Kanno* Taira Kobayashi** Tatsuhiko Komiya
    A 58-year-old man presented with hydrothorax, an irregular heart rate, and symptoms of heart failure approximately equivalent to the New York Heart Association（NYHA）class 2. Echocardiographic and cardiac catheterization findings suggested constrictive pericarditis, but CT scans revealed only slight thickening of the pericardium. He had liver cirrhosis, to the extent that surgery appeared to be high risk in this case. The patient was thus managed medically but showed no tendency fowards improvement despite 6 months of treatment. He was then given a diagnosis of having hepatic dysfunction due to a congestive liver associated with constrictive pericarditis. Pericardiectomy was then performed. Postoperatively, his hepatic function improved markedly and his symptoms disappeared. This case is described, with reference to the literature.
      Jpn. J. Cardiovasc. Surg. 39:309-313（2010）

    Keywords：constrictive pericarditis, hepatopathy, pericardiectomy, surgical treatment
  • Spontaneous Left Main Coronary Artery Dissection Treated by Emergency Coronary Artery Bypass Grafting H. Osawa et al.……314
    Spontaneous Left Main Coronary Artery Dissection Treated by Emergency Coronary Artery Bypass Grafting

    （Department of Cardiovascular Surgery, Aizawa Hospital, Matsumoto, Japan）

    Hajime Osawa Toshihiro Fujimatsu Fumie Takai
    Hiroyuki Suzuki
    Spontaneous coronary artery dissection is a rare but often fatal cause of acute myocardial ischemia that occurs in young or middle-aged and otherwise healthy patients. We report a case of spontaneous left main coronary artery dissection in a young woman who was treated with emergency coronary artery bypass grafting. She improved after surgery but required a long recuperative period because of her cardiac failure and multiple organ failure, developed expiring on the 78th postoperative day. Spontaneous coronary artery dissection is unpredictable, and sudden death is the usual mode of clinical presentation. Prompt diagnosis and coronary artery revascularization are essential in order to achieve a favorable outcome in such cases.
      Jpn. J. Cardiovasc. Surg. 39:314-317（2010）

    Keywords：spontaneous coronary artery dissection, coronary artery bypass grafting（CABG）, left main coronary artery, acute myocardiol infarction
  • Ascending Aorta and Total Arch Replacement in a Stanford Type A Aortic Dissection with Island Reconstruction for an Isolated Left Vertebral Artery N. Ishida et al.……318
    Ascending Aorta and Total Arch Replacement in a Stanford Type A Aortic Dissection with Island Reconstruction for an Isolated Left Vertebral Artery

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

    Narihiro Ishida Katsuya Shimabukuro Yukihiro Matsuno
    Hirofumi Takemura
    The ascending aorta and aortic arch were replaced in a 72-year-old woman with Stanford type A aortic dissection. Preoperative three-dimensional computed tomography（3D-CT） revealed that the anatomy of an isolated left vertebral artery was abnormal. After hypothermic circulatory arrest, a 12-mm sealed graft was connected to the island-shaped arch under retrograde cerebral perfusion, followed by antegrade cerebral perfusion via a branch of the graft. The main graft was distally anastomosed, and the graft of the cerebral arteries was subsequently anastomosed on the main graft under continuous cerebral and systemic perfusion. The patient tolerated all procedures well without cerebral or bleeding complications, and was discharged 18 days after surgery. This technique was useful for island reconstruction, even with abnormal cerebral arteries and bleeding control of this anastomosis was simple compared to the conventional island technique.
      Jpn. J. Cardiovasc. Surg. 39:318-320（2010）

    Keywords：arch vessel anomalies, isolated left vertebral artery, total arch replacement
  • Peripheral Pulmonary Artery Aneurysm Secondary to Tricuspid Valve Infective Endocarditis in an Intravenous Drug User M. Nishimura et al.……321
    Peripheral Pulmonary Artery Aneurysm Secondary to Tricuspid Valve Infective Endocarditis in an Intravenous Drug User

    （Second Department of Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan）

    Masanori Nishimura Mitsuhiro Yano Hiroyuki Nagahama
    Masakazu Matsuyama Kohji Furukawa Atsuko Yokota
    Hirohito Ishii Toshio Onitsuka
    We report a case of tricuspid infective endocarditis with peripheral pulmonary artery aneurysm. A 31-year-old man with a history of intravenous drug abuse was admitted to our institution. Echocardiography showed severe tricuspid valve insufficiency and large vegetation（10mm）attached to the tricuspid valve. Computed tomography（CT）revealed a right peripheral pulmonary artery aneurysm. We operated because of the large amount of vegetation. Before the operation, we performed coil embolization for peripheral pulmonary aneurysm. During the operation, we removed the posterior leaflet with vegetation, and performed tricuspid valve repair. The postoperative course was uneventful. Postoperative echocardiography did not show any tricuspid valve insufficiency or vegetation.
      Jpn. J. Cardiovasc. Surg. 39:321-324（2010）

    Keywords：infective endocarditis, tricuspid valve, drug abuse, pulmonary artery aneurysm, coil embolization
  • A Rare Case of Intramyocardial Lipoma K. Ishimaru et al.……325
    A Rare Case of Intramyocardial Lipoma

    （Department of Cardiovascular Surgery, and Department of Vascular Surgery*, Higashi Takarazuka Satoh Hospital, Takarazuka, Japan）

    Kazuhiko Ishimaru Hiroto Iwasaki Toru Ishizaka
    Hisashi Satoh Takashi Shintani* Takashi Shibuya*
    A 72-year-old woman was admitted with a sensation of compression and shortness of breath. A mass was detected in the right atrium（RA）by transthoracic echocardiography. Preoperative chest computed tomography showed an RA tumor measuring 30×24mm in the lateral wall. We performed resection under the cardiopulmonary bypass. Histopathological examination confirmed that this tumor was a lipoma.
      Jpn. J. Cardiovasc. Surg. 39:325-327（2010）

    Keywords：intramyocardial tumor, lipoma
  • Tricuspid Valve Repair for Active Infective Endocarditis Complicated by Vertebral Osteomyelitis and a Pancreatic Abscess K. Watanabe et al.……328
    Tricuspid Valve Repair for Active Infective Endocarditis Complicated by Vertebral Osteomyelitis and a Pancreatic Abscess

    （Department of Cardiovascular Surgery, Takeda General Hospital Foundation, Aizuwakamatsu, Japan）

    Keitaro Watanabe Satoru Maeba Takahiro Taguchi
    A 65-year-old man was admitted with a high fever and back pain. Because magnetic resonance imaging revealed osteomyelitis in the lumbar spine, we started antibiotic therapy. Echocardiography revealed large vegetation on the tricuspid valve, and abdominal contrast computed tomography revealed a pancreatic abscess. As the vegetation increased in size and mobility it became non-responsive to medical treatment, and surgical removal of the vegetation with tricuspid valve repair were therefore performed. After additional antibiotic therapy, he was discharged 42 days after surgery. No further recurrence of endocarditis has been observed as of the time of writing.
      Jpn. J. Cardiovasc. Surg. 39:328-331（2010）

    Keywords：infective endocarditis, vertebral osteomyelitis, tricuspid valve repair, pancreatic abscess
  • Rupture of Left Ventricular Outflow Tract Pseudoaneurysm Concomitant with Infectious Endocarditis A. Katayama et al.……332
    Rupture of Left Ventricular Outflow Tract Pseudoaneurysm Concomitant with Infectious Endocarditis

    （Department of Cardiovascular Surgery, Hiroshima City Asa Hospital, Hiroshima, Japan）

    Akira Katayama Naomichi Uchida Kentaro Tamura
    Miwa Sutoh Naoki Murao Masatsugu Kuraoka
    An 82-year-old woman fell into a state of shock during the treatment for a urinary tract infection. Computed tomography and transthoracic echocardiography revealed massive pericardial effusion. Pericardiectomy was performed in the operating room and hemorrhagic effusion was observed. Emergent sternotomy was performed, and the bleeding site was located at the posterior portion of the left ventricular outflow. We diagnosed a rupture of a left ventricular outflow tract pseudoaneurysm after infectious endocarditis. A pericardium patch closure of the pseudoaneurysm and an aortic valve replacement were performed. The patient was discharged 35 days after the operation without recurrence of infection. Left ventricular outflow tract pseudoaneurysms is an uncommon complication following infective endocarditis, aortic valve surgery or chest trauma. Transesophageal echocardiography and multidetector-row computed tomography（MDCT）is useful for identifying such lesions.
      Jpn. J. Cardiovasc. Surg. 39:332-334（2010）

    Keywords：infective endocarditis, left ventricular outflow tract pseudoaneurysm, cardiac tamponade
  • Successful Repair of Critical Anastomotic Bleeding after Surgery for Ruptured Infected Thoracic Aortic Aneurysm kT. Inoue et al.……335
    Successful Repair of Critical Anastomotic Bleeding after Surgery for Ruptured Infected Thoracic Aortic Aneurysm

    （Depertment of Cardiac Surgery, The Jikei University School of Medicine, Tokyo, Japan）

    Takahiro Inoue Kazuhiro Hashimoto Yoshimasa Sakamoto
    Michio Yoshitake Hirokuni Naganuma Noriyasu Kawada
    Gen Shinohara Toshiyuki Hoshina Koichi Muramatsu
    Infected aortic aneurysm is very difficult to treat and is associated with a high mortality rate. A 78-year-old man had been scheduled to undergo selective endovascular repair for distal aortic arch aneurysm. While standby, however, he was admitted to our emergency room because of hemoptysis. Rapid dilatation of the aneurysm shown on serial CT and elevated of inflammatory reactions yielded a diagnosis of infected aortic aneurysm. Because the aneurysm had ruptured into the left lung, emergency surgery was performed. Six days after the first operation, critical bleeding due to anastomotic disruption of the distal aorta caused by infection and subsequent cardiac arrest occurred. We immediately started open chest massage and controlled the bleeding manually in the ICU, while an operating room was prepared. In the redo operation, anastomotic disruption was repaired using the visceral pleura under deep hypothermic circulatory arrest. Anastomotic bleeding is a potentially life-threatening condition, therefore extremely prompt measures are vital. Appropriate management based on the assumption of anastomotic bleeding was very important in the postoperative course of this case of infectious aortic aneurysm.
      Jpn. J. Cardiovasc. Surg. 39:335-338（2010）

    Keywords：ruptured thoracic aortic aneurysm, infected aortic aneurysm, anastomotic bleeding
  • Early Structural Valve Deterioration of Third-Generation Porcine Bioprosthesis in Patients M. Kotani et al.……339
    Early Structural Valve Deterioration of Third-Generation Porcine Bioprosthesis in Patients

    （Department of Cardiovascular Surgery, Kameda Medical Center, Kamogawa, Japan）

    Mitsuhisa Kotani Masaaki Toyama Masanori Katoh
    Yuji Kato Kazuhiro Hisamoto Yukiharu Sugimura
    A 78-year-old woman underwent mitral valve replacement（MVR）with bioprosthesis in 1984. By 1997 the valve had become dysfunctional and was replaced with a Mosaic valve. Dyspnea on exertion occurred in 2005 and a systolic murmur was detected at that time. Echocardiography revealed severe mitral regurgitation（MR). The mitral valve was replaced for the third time. The explanted valve showed commissural dehiscence at the stent position and calcified leaflets. The mitral valve of a 70-year-old man was replaced with a bioprosthesis in 1986, and again with a Mosaic valve in 1997 because the original bioprosthesis had become dysfunctional. Seven years later, a systolic murmur appeared and echocardiography revealed severe MR. The valve was replaced for the third time. A leaflet tear was found in the removed valve. The Mosaic valve is a third generation porcine bioprosthesis that reportedly has excellent long-term durability. However, in these cases, the Mosaic valves deteriorated prematurely, and no obvious causes of this early structural deterioration could be identified. Continued long-term follow up is necessary, and the possibility of premature deterioration should be considered when selecting bioprostheses.
      Jpn. J. Cardiovasc. Surg. 39:339-342（2010）

    Keywords：bioprosthesis, structural valve deterioration, reoperation, Mosaic valve
  • Pleuro-peritoneal Shunting for Refractory Pericardial Effusion after Coronary Artery Bypass Grafting T. Matsumoto et al.……343
    Pleuro-peritoneal Shunting for Refractory Pericardial Effusion after Coronary Artery Bypass Grafting

    （Cardiovascular Surgery, Matsuyama Red Cross Hospital, Ehime, Japan）

    Takashi Matsumoto Masayoshi Umesue Hironori Baba
    Kanzi Matsui
    A-75-year-old man had refractory late cardiac tamponade after an off-pump coronary artery bypass grafting. He was initially treated by pericardiocentesis with oral nonsteroidal anti-inflammatory drugs, but the treatment failed. Pericardial fenestration was conducted twice for refractory pericardial effusion during his hospitalization. He presented again with recurrence of cardiac tamponade 2 months after the last pericardial fenestration. Therefore, a pleuroperitoneal shunt system was implanted. He recovered well and was discharged without reaccumulation of pericardial effusion.
      Jpn. J. Cardiovasc. Surg. 39:343-346（2010）

    Keywords：cardiac tamponade, pleuroperitoneal shunt, coronary artery bypass grafting
  • Two Cases of Postinfarction Ventricular Septal Perforation due to Obstruction of the Right Coronary Artery S. Obata et al.……347
    Two Cases of Postinfarction Ventricular Septal Perforation due to Obstruction of the Right Coronary Artery

    （Department of Cardiovascular Surgery, Fukuyama Cardiovascular Hospital, Fukuyama, Japan）

    Shogo Obata Shogo Mukai Hironobu Morimoto
    Daisuke Futagami
    We report 2 cases of postinfarction ventricular septal perforation（VSP）attributable to obstruction of the right coronary artery. Case 1 was a 63-year-old man in whom VSP developed after percutaneous coronary angioplasty for complete obstruction of the right coronary artery. He developed papillary muscle rupture intraoperatively, requiring mitral valve replacement and subsequent treatment for right-side heart failure. He was discharged l7 weeks after surgery. Case 2 was a 77-year-old man. During catheterization following the detection of 99% obstruction of the #2 segment of the right coronary artery, VSP was found and the patient underwent emergency surgery. Postoperative echocardiography and ventriculography did not reveal a residual shunt or mitral regurgitation（MR). However, he suddenly developed acute MR in the 4th postoperative week and died of acute heart failure. VSP attributable to obstruction of the right coronary artery is difficult to repair surgically because of its anatomical location, among other reasons, and mitral valve replacement is sometimes needed if VSP is accompanied by necrosis of the mitral valve papillary muscle. Appropriate care is therefore needed in this case.
      Jpn. J. Cardiovasc. Surg. 39:347-350（2010）

    Keywords：postinfarction ventricular septal perforation（VSP）, RCA, MR
  • Recurrent Pulmonary Venous Stenosis after Repair of Mixed-Type Total Anomalous Pulmonary Venous Connection N. Atsumi et al.……351
    Recurrent Pulmonary Venous Stenosis after Repair of Mixed-Type Total Anomalous Pulmonary Venous Connection

    （Department of Cardiovascular Surgery, Tokyo Metropolitan Hachioji Children’s Hospital, and Department of Cardiothoracic Surgery, the University of Tokyo*, Tokyo, Japan）

    Naotaka Atsumi Haruo Yamauchi* Mitsuhiro Kawata*
    Takeshi Yoshii*
    A 10-day-old male neonate underwent repair of mixed-type total anomalous pulmonary venous connection. The left upper pulmonary vein connected to the left innominate vein by way of a vertical vein. The other veins converged to form a common pulmonary vein and drained to the coronary sinus. As the common pulmonary vein was not stenotic, normal coronary sinus unroofing was undertaken and the postoperative course was uneventful. Five months later pulmonary vein stenosis（PVS）occurred at the junction of the common pulmonary vein and coronary sinus. At reoperation the common pulmonary vein was deeply incised to the point near the pulmonary venous orifice, and the stenotic tissue was resected. Although he was discharged from the hospital on the 10th postoperative day, PVS recurred at age 9 months and a second reoperation was undertaken. This time, the common pulmonary vein was excised and the anterior wall of each pulmonary vein was incised to drain independently and directly to the left atrium without causing turbulence. The left upper pulmonary vein was anastomosed to the left atrial appendage. Pulmonary angiography 18 months after the second reoperation revealed the pulmonary venous pathway to be nonstenotic.
      Jpn. J. Cardiovasc. Surg. 39:351-354（2010）

    Keywords：total anomalous pulmonary venous connection, pulmonary vein stenosis, reoperation
  • Two Successful Proximal Reoperation Cases after Acute Type A Dissection Repair T. Sakamoto et al.……355
    Two Successful Proximal Reoperation Cases after Acute Type A Dissection Repair

    （Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui, Japan）

    Tomohiko Sakamoto Yasushi Tsutsumi Osamu Monta
    Keitaro Koshi Yousuke Takahashi Kimitoshi Kitani
    Hirokazu Ohashi
    We report 2 cases of successful proximal reoperations after acute type A dissection. Case 1:A 53-year-old man underwent ascending aorta and aortic arch replacement and aortic valve re-suspension for acute type A dissection with aortic valve regurgitation in 1992. Thirteen years after the first operation, computed tomography demonstrated a Valsalva aneurysm（74mm）and Doppler echocardiography showed moderate aortic valve regurgitation. Therefore, we performed an operation. We could not locate the dissection in the Valsalva sinus, and the aortic valve cusps had organic change. A David procedure was performed. The postoperative course was uneventful and he was discharged on the 19th postoperative day. Case 2:A 65-year-old woman underwent ascending aorta replacement and aortic valve resuspension for acute type A dissection with aortic valve regurgitation in 1997, but 11 years after the first operation, computed tomography demonstrated a Valsalva aneurysm（55mm）and arch aneurysm（65mm）with stenosis of the innominate vein and she had facial and left arm edema. Doppler echocardiography showed moderate aortic valve regurgitation. We could not find the location of dissection in the Valsalva sinus or aortic arch, and aortic valve cusps had no organic change. A Bentall procedure and total arch replacement were performed and her postoperative course was uneventful.
      Jpn. J. Cardiovasc. Surg. 39:355-358（2010）

    Keywords：acute aortic dissection, aortic root aneurysm, proximal re-operations
  • A Case of Quadricuspid Aortic Valve Complicated by Infectious Endocarditis T. Igarashi and S. Takahashi……359
    A Case of Quadricuspid Aortic Valve Complicated by Infectious Endocarditis

    （Division of Cardiovascular Surgery, Hoshi General Hospital, Fukushima, Japan）

    Takashi Igarashi Shoichi Takahashi
    We report a case of quadricuspid aortic valve concomitant with infective endocarditis. A 73-year-old woman was admitted to our hospital because of general fatigue, loss of body weight and high fever. Transthoracic echocardiography showed moderate aortic regurgitation and left ventricle-right atrium fistulae with vegetation. Infectious endocarditis was diagnosed. Since her fever and hemolytic anemia were not controlled by antibiotics, we operated and the aortic valve had four cusps and there were vegetations on the aortic valve and left ventricle outflow tract. Perforation of the membranous septum was observed. Complete debridement and aortic valve replacement with patch repair of a left ventricle-right atrium（LV-RA）fistula was performed. Although she needed a permanent pacemaker due to complete AV block, her postoperative course was uneventful.
      Jpn. J. Cardiovasc. Surg. 39:359-362（2010）

    Keywords：quadricuspid aortic valve, infectious endocarditis, hemolytic anemia, left ventricle-right atrium fistula, complete AV block
  • Surgical Repair of Various Pseudoaneurysms in 2 Patients with Vasculo-Behçet Disease Y. Sugimura et al.……363
    Surgical Repair of Various Pseudoaneurysms in 2 Patients with Vasculo-Behçet Disease

    （Department of Cardiovascular Surgery, Kameda Medical Center, Kamogawa, Japan）

    Yukiharu Sugimura Mitsuhisa Kotani Masanori Katoh
    Yuji Kato Kazuhiro Hisamoto Masaaki Toyama
    Vasculo-Behçet disease（VBD）is a special type of Behçet disease（BD）involving some vascular disorders like aneurysmal formation, arterial occlusion, and venous thrombosis in various vessels. VBD has a poor prognosis due to aneurysmal rupture or recurrence of vascular disorders despite optimal treatment. However, definite diagnosis in BD is made on the basis of clinical features, and early diagnosis is difficult. We report 2 patients whose first clinical symptoms were femoral-pseudoaneurysms. They received a diagnosis of VBD after surgery. The first patient was a 69-year-old man, who underwent autologous-vein patch closure of a perforated region in the left femoral artery. One year later, he had a pseudoaneurysm of the right profunda femoris artery, which was ligated. The second patient was a 51-year-old man, who underwent the interposition of the saphenous vein for defective artery due to left superficial femoral-pseudoaneurysm.
      Jpn. J. Cardiovasc. Surg. 39:363-366（2010）

    Keywords：Behçet disease, pseudoaneurysm