Japanese Journal of Cardiovascular Surgery Vol.41, No.1

Preface

• T. Maehara

Original

• The Efficiency of Data Collection Using the Japan Adult Cardiovascular Surgery Database（JACVSD）as a Historical Control in Clinical Trials A. Tomotaki et al.…1
  The Efficiency of Data Collection Using the Japan Adult Cardiovascular Surgery Database（JACVSD）as a Historical Control in Clinical Trials

  （Department of Healthcare Quality Assessment, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan, and Department of Cardiothoracic Surgery, Faculty of Medicine, the University of Tokyo*, Tokyo, Japan）

  Ai Tomotaki	Hiroaki Miyata	Suguru Okubo
  Noboru Motomura*

  Recently, the use of databases for clinical trials is being promoted. we used the Japan Adult Cardiovascular Surgery Database（JACVSD）data was used as a historical control in a clinical trial, and we analyzed following:the processes of using data and the efficiency of data collection, available variables for statistical analysis, and query functions for missing and invalid data. We chose available variables of JACVSD data and created rules for merging JACVSD data with interventional group data, in addition to analyzing the data collection processes for clinical trials. Subjects were selected from cases registered in the JACVSD. On statistical analysis, 63% of 76 variables were used;variables related to the patients’ symptoms had to be collected separately. Missing and invalid data were effectively excluded. We could conduct data collection efficiently by using the JACVSD as a historical control for clinical trials. Selecting subjects from the JACVSD could reduce the burden of selecting subjects from hospitals and prevent selection bias.
    Jpn. J. Cardiovasc. Surg. 41:1-7（2012）
  
  Keywords：Japan Adult Cardiovascular Surgery Database（JACVSD), clinical database, historical control, clinical trial, efficiency of data collection

Case Reports

• A Case of Surgical Revascularization for Abdominal Angina A. Furutachi et al.…8
  A Case of Surgical Revascularization for Abdominal Angina

  （Department of Cardiovascular Surgery, Saga Prefectural Hospital Koseikan, Saga, Japan）

  Akira Furutachi	Hitoshi Ohteki	Kozo Naito
  Junichi Murayama	Masanori Takamatsu

  A 68-year-old woman with multiple gastric ulcers was admitted to our hospital due to post-prandial abdominal pain. Multirow detector computed tomography（MDCT）showed severe stenoses of both the celiac trunk and superior mesenteric artery（SMA）;therefore, we decided to operate based on the presumed diagnosis of abdominal angina. We bypassed the stenoses using a saphenous vein graft from the right external iliac artery to the SMA, distal to the stenosis. The patient was symptom-free postoperatively. In summary, this case of abdominal angina was accurately evaluated preoperatively with MDCT and the flow meter®. Thereafter, a focal stenosis in the superior mesenteric artery was successfully treated with an external iliac-SMA bypass using a saphenous vein graft.
    Jpn. J. Cardiovasc. Surg. 41:8-11（2012）
  
  Keywords：abdominal angina，MDCT，flow meter®
• Popliteal Artery Pseudoaneurysm Associated with Osteochondroma T. Uchida et al.…12
  Popliteal Artery Pseudoaneurysm Associated with Osteochondroma

  （Department of Cardiovascular Surgery, Nihonkai General Hospital, Sakata, Japan, and Present address:Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan）

  Tetsuro Uchida*	Hideaki Uchino	Yoshinori Kuroda
  Kazue Nakashima	Takao Shimanuki

  Osteochondromas, or exostoses, are the most frequent benign bone tumors. Although many osteochondromas are asymptomatic, they are sometimes responsible for vascular complications, most often associated with the popliteal artery. Here, we present a rare case of pseudo-aneurysm of the popliteal artery secondary to an osteochondroma of the femur in a 48-year-old woman. During surgery, a pseudo-aneurysm developed from a 1-mm hole in the anterior aspect of the popliteal artery, which was closely related to the protrusion of the femoral osteochondroma. The surface of the osteochondroma was quite sharp, rigid and firm. It was removed completely through the lumen of the aneurysm. A short segment of the popliteal artery, including the hole, was resected with an end-to-end anastomosis. The postoperative course was uneventful, and the patient recovered completely. The precise pathogenesis of pseudo-aneurysmal formation is still unknown. We speculate that local compression of the popliteal artery by a spiky osteochondroma can stretch the vessel and lead to rupture of the artery by continuous friction. Considering the potential risk of this vascular complication, shonld be closely monitered patients with osteochondroma of the femur.
    Jpn. J. Cardiovasc. Surg. 41:12-15（2012）
  
  Keywords：popliteal artery pseudoaneurysm, osteochondroma
• Type A Aortic Dissection during the Treatment of Tuberculous Pericarditis T. Matsuba et al.…16
  Type A Aortic Dissection during the Treatment of Tuberculous Pericarditis

  （Department of Cardiovascular Surgery, Kagoshima Medical Center, Kagoshima, Japan）

  Tomoyuki Matsuba	Goichi Yotsumoto	Kousuke Mukaihara
  Takayuki Ueno	Kazuhisa Matsumoto	Yoshihiro Fukumoto
  Hitoshi Toyohira	Masafumi Yamashita

  A 69-year-old woman, who had undergone a right nephrectomy for renal tuberculosis in her teens, was admitted with a low grade fever, anorexia and progressive dyspnea. Transthoracic echocardiography showed cardiac tamponade and chest CT revealed an enlarged ascending aorta. She was treated with pericardiocentesis. Specimens of pericardial effusion failed to demonstrate any acid-fast bacilli, but they did reveal a high level of adnosine deaminase（72IU/l). A diagnosis of tuberculous pericarditis was considered, and antituberculous chemotherapy was started. However, he presented with severe back pain 32 days later and CT revealed type A acute aortic dissection. We therefore replaced the ascending aorta and aortic root. A histopathological examination of the ascending aorta revealed evidence of a granulomatous inflammatory reaction with Langhans giant cells. She thereafter received antituberculous chemotherapy with 4 drugs for 2 months, with continued rifampicin and isoniazid treatment. There was no evidence of any graft infection after 70 days.
    Jpn. J. Cardiovasc. Surg. 41:16-20（2012）
  
  Keywords：tuberculous pericarditis, tuberculous aortitis, acute aortic dissection, in situ reconstruction
• Successful Medical Treatment of Prosthetic Valve Endocarditis with a Perivalvular Abscess C. Ueki et al.…21
  Successful Medical Treatment of Prosthetic Valve Endocarditis with a Perivalvular Abscess

  （Department of Cardiovascular Surgery, Kurashiki Central Hospital, Okayama, Japan）

  Chikara Ueki	Takeshi Shimamoto	Genichi Sakaguchi
  Tatsuhiko Komiya

  A 68-year-old man visited our hospital with a high fever with chills 4 years after aortic valve replacement. Streptococcal species were cultured with a venous blood culture. An echocardiogram and a cardiac computed tomography（CT）scan revealed a perivalvular abscess（11mm×15mm). Because his prosthetic valve functioned well, he was treated with intravenous ampicillin and gentamicin. Cardiac CT scan performed at 6 weeks showed the perivalvular abscess to have disappeared and he was discharged from the hospital. He is free from recurrence of the abscess 20 months after the initiation of therapy.
    Jpn. J. Cardiovasc. Surg. 41:21-24（2012）
  
  Keywords：prosthetic valve endocarditis, perivalvular abscess, Streptococcal species
• A Case of Stentless Aortic Valve Reoperation for Severe Aortic Regurgitation due to Dilation of the Sinotubular Junction K. Hisamoto et al.…25
  A Case of Stentless Aortic Valve Reoperation for Severe Aortic Regurgitation due to Dilation of the Sinotubular Junction

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

  Kazuhiro Hisamoto	Masaaki Toyama	Masanori Katoh
  Mitsuhisa Kotani	Yuji Kato	Yukiharu Sugimura

  A 72-year-old woman underwent a double aortic valve replacement with the Freestyle aortic bioprosthesis and subcoronary implantation with the Mosaic mitral bioprosthesis because of rheumatic multivalvular heart disease in 2000. During her annual follow-up, her Sinotubular junction was observed to have gradually increased in diameter on echocardiography and computed tomography. Therefore, 9 years after surgery we performed a reoperation for severe aortic regurgitation. Intraoperatively, the stentless bioprosthesis was found to be structurally intact. We believe that the dilation of the Sinotubular junction associated with a stentless bioprosthesis in the subcoronary position have caused her severe aortic regurgitation.
    Jpn. J. Cardiovasc. Surg. 41:25-28（2012）
  
  Keywords：stentless bioprosthesis, reoperation, STJ
• Redo Total Arch Replacement for a Patient with Pseudoaneurysm of the Thoracic Aortic Graft S. Kimura and Y. Ueno…29
  Redo Total Arch Replacement for a Patient with Pseudoaneurysm of the Thoracic Aortic Graft

  （Department of Cardiovascular Surgery, Shimonoseki City Central Hospital, Shimonoseki, Japan）

  Satoshi Kimura

  Yasutaka Ueno

  Aortic pseudoaneurysm is a rare but life-threatening complication after graft replacement. One of the main challenges of surgery is the appropriate and safe method of re-entering the chest cavity. Therefore, it is necessary to consider a strategy which includes cardiopulmonary bypass. The patient was a 64-year-old man who had undergone hemi-arch replacement for pseudoaneurysm of the native thoracic aorta 17 years previously. The exact surgical details of the previous operation were unknown. He experienced progressive chest pain for 1 month, and noticed a parasternal pulsatile mass. An enhanced computed tomographic scan revealed a pseudoaneurysm originating from the thoracic aortic artificial graft itself, which had eroded the left parasternum and which would possibly rupture out of the skin. Preoperative examinations suggested a high risk of bleeding if redo sternotomy was performed. Therefore, we decided to perform open surgical repair with a cardiopulmonary bypass with cannulation through the femoral artery and vein before resternotomy. In addition, we performed a transthoracic left ventricular venting and selective cerebral perfusion using bilateral axillary arteries, which enabled core cooling in case of uncontrollable hemorrhage. He successfully underwent redo graft replacement of the thoracic aorta, and his postoperative course was uneventful.
    Jpn. J. Cardiovasc. Surg. 41:29-32（2012）
  
  Keywords：graft replacement of thoracic aorta, pseudoaneurysm, reoperation
• Coronary Artery Bypass Grafting in a Patient with Situs Inversus Totalis K. Sato et al.…33
  Coronary Artery Bypass Grafting in a Patient with Situs Inversus Totalis:A Case Report and Review of the Literature

  （Department of Cardiovascular Surgery, Oji General Hospital, Tomakomai, Japan）

  Koji Sato	Tatsuya Murakami	Yutaka Makino
  Takashi Sugiki

  A 70-year-old man with dextrocardia with situs inversus, presented to our hospital complaining of chest pain. ECG showed ST elevations in leads II, III and aVf, and ST depressions in leads V3 through V6. Blood tests showed creatinine kinase elevation. He underwent coronary angiography, which revealed obstruction of the anatomical right coronary artery and we diagnosed acute inferior myocardial infarction. However, the anatomical left coronary artery was not clearly identifiable because of its anomalous origin. He was transferred to our intensive care unit and intra-aortic balloon pumping was initiated. Coronary 3D-CT was then performed to obtain an anatomical overview of the coronary artery system. This enabled a second coronary angiography which showed obstruction of the left anterior descending artery and stenosis of the left main trunk in the first diagonal branch and the ramus intermedius branch. Coronary artery bypass grafting surgery（CABG）was indicated. He underwent conventional quintuple CABG using the right internal thoracic artery and saphenous vein grafts. Preoperatively we made digital mirror images of the original coronary angiographic images to clarify his coronary artery anatomy. During surgery, the main surgeon continuously stood on the patient’s left side except when opening and closing the chest, which enabled us to perform CABG. The postoperative course was uneventful. CABG in a patient with situs inversus totalis is very rare. We present this case with a review of the relevant literature.
    Jpn. J. Cardiovasc. Surg. 41:33-37（2012）
  
  Keywords：situs inversus totalis, dextrocardia, coronary artery bypass grafting（CABG), coronary CT, anomalous coronary artery origin
• A Case Report of Left Ventricular Myxoma and a Review of Literatures H. Yamada et al.…38
  A Case Report of Left Ventricular Myxoma and a Review of Literatures

  （Cardiovascular Surgery, Osaka Police Hospital, Osaka, Japan, and Present address:Higashi-Takarazuka Satoh Hospital*, Takarazuka, Japan）

  Hiroshi Yamada	Takuya Miura	Takuji Kawamura
  Satoru Kuki	Shigeaki Ohtake

  A 61-year-old woman underwent a regular echocardiography in October 2008 in which a mass of 1cm in diameter was pointed out in the left ventricle apex. It did not dcrease, in spite of anticoagulation therapy, and therefore we performed surgery. The tumor was confirmed on the septal side of the cardiac apex by intraoperative cholangioscopy, and it was excised through the mitral valve. It was diagnosed as myxoma on immediate intraoperative pathological examination, and we confirmed that there was no tumor remnants on the resected stump histologically. The patient was discharged on the 13th day after the operation and 2 years later she was alive without recurrence of the tumor. This is the 25th case of left ventricular myxoma in Japan. In these reports, an initial resection of the tumor in the left ventricle was performed in 23 cases and the approach methods were described in 20 cases. The evaluation of the resected stump, regardless of remaining tumor, was described in only 3 cases. There were no reports of relapse after the operation. There are many reports which emphasize the usefulness of echocardiography, which is very helpful not only in the diagnosis, but also in periodic evaluations after the operation.
    Jpn. J. Cardiovasc. Surg. 41:38-42（2012）
  
  Keywords：left ventricular tumor, myxoma
• A Case of Metastasis to the Right Ventricle from Uterine Stromal Sarcoma T. Fujimiya et al.…43
  A Case of Metastasis to the Right Ventricle from Uterine Stromal Sarcoma

  （Department of Cardiovascular Surgery, Ohta Nishinouchi Hospital, Koriyama, Japan）

  Tsuyoshi Fujimiya

  Kouki Takahashi

  Masahiro Tanji

  We report a case of metastasis to the right ventricle from uterine stromal sarcoma. A 61-year-old woman was admitted to our hospital because of abdominal pain due to gallbladder stones. Preoperative transthoracic echocardiography showed a tumor in the right ventricle and tricuspid regurgitation. The tumor was multilocular and had grown in the right atrium over the tricuspid valve. We performed tumor resection and tricuspid valve plasty. Postoperative transthoracic echocardiography showed the tricuspid regurgitation had resolved.
    Jpn. J. Cardiovasc. Surg. 41:43-45（2012）
  
  Keywords：cardiac tumor, uterine sarcoma, tricuspid regurgitation
• Culture-negative Endocarditis Caused by Bartonella henselae T. Tengan et al.…46
  Culture-negative Endocarditis Caused by Bartonella henselae

  （Department of Cardiovascular Surgery, Okinawa Chubu Hospital, Uruma, Japan）

  Toshiho Tengan	Junya Yokoyama	Akio Nakasu
  Hiroshi Yasumoto	Hidemitsu Mototake

  There is Bartonella henselae（B. henselae） leads to cat-scratch disease and causes infective endocarditis, but shows as negative in blood cultures. We performed aortic valve replacement in a patient with aortic valve infective endocarditis which was regative on blood cultures. The patient had a contact history with a cat prior to admission. Thus, we suspected B. henselae and made a definitive diagnosis by PCR method and Warthin-Starry（WS）stain. A correct diagnosis was possible by detailed history taking and the use of appropriate antibiotics.
    Jpn. J. Cardiovasc. Surg. 41:46-48（2012）
  
  Keywords：negative blood cultures, Bartonella henselae, cat-scratch disease, bacterial endocarditis, aortic regurgitation, aortic valve replacement
• A Case of Left Main Trunk（LMT）Obstruction after Aortic Valve Replacement（AVR）Using Carpentier-Edwards PERIMOUNT MAGNA N. Nishioka et al.…49
  A Case of Left Main Trunk (LMT) Obstruction after Aortic Valve Replacement (AVR) Using Carpentier-Edwards PERIMOUNT MAGNA

  (Department of Cardiovascular Surgery, Hyogo Brain and Heart Center at Himeji, Himeji, Japan)

  Naritomo Nishioka	Naoto Morimoto	Keitaro Nakagiri
  Shunsuke Matsushima	Yuya Tauchi	Masaomi Fukuzumi
  Hirohisa Murakami	Masato Yoshida	Nobuhiko Mukohara

  We reported a 74-year-old female complicated by ostial obstruction of the left main trunk after aortic valve replacement for severe aortic stenosis. At surgery, the length from the orifice of the left main trunk to the aortic annulus was 3mm. After a 19mm Carpentier-Edwards PERIMOUNT MAGNA was implanted in supra-annular position, the orifice of left main trunk was concealed by a sewing cuff of the bioprosthesis. Before aortic declamping, saphenous vein graft was bypassed to the left anterior descending artery. The postoperative course was uneventful. Computed tomography demonstrated the ostial obstruction of the left main trunk by the bioprosthesis.
    Jpn. J. Cardiovasc. Surg. 41:49-52（2012）
  
  Keywords：small aortic annulus, Carpentier-Edwards PERIMOUNT MAGNA, LMT obstruction, bailout CABG