Japanese Journal of Cardiovascular Surgery Vol.44, No6

Preface

Invited Review

Original

  • Plasma Levels of D-dimer and Fibrin Degradation Product Could Be Predictors of Endoleaks after Endovascular Abdominal Aortic Aneurysm Repair　M. Mizumoto et al.…301
    Plasma Levels of D-dimer and Fibrin Degradation Product Could Be Predictors of Endoleaks after Endovascular Abdominal Aortic Aneurysm Repair

    Masahiro Mizumoto Tetsuro Uchida Seigo Gomi
    Azumi Hamasaki Yoshinori Kuroda Atsushi Yamashita
    Jun Hayashi Shuto Hirooka Takumi Yasumoto
    Mitsuaki Sadahiro

    （Second Department of Surgery（Cardiovascular Surgery), Yamagata University Faculty of Medicine, Yamagata, Japan）

    Objective:Although an endoleak is the most common complication after endovascular abdominal aortic aneurysm repair（EVAR), the proper and noninvasive method for the detection of endoleaks is not established. The purpose of this study is to investigate whether plasma levels of D-dimer and fibrin degradation product（FDP）could be predictors of endoleaks after EVAR. Methods:Between June 2011 and January 2014, 65 consecutive patients underwent EVAR at our institution. We evaluated 55 patients excluding 10 patients pre-existing conditions such as aortic dissection, arterial or venous thrombosis, conversion to open surgery, and difficulties in making outpatient visits. Enhanced computed tomography（CT）examination was performed during 12 months after EVAR. Persistent endoleaks and maximum aneurysmal diameter were evaluated at each follow-up time. Patients were divided into groups according to CT findings at 12 months after EVAR. There were 26 patients with endoleaks vs. 29 non-endoleak patients, 34 with unchanged aneurysm findings vs. 21 with shrinkage. No patient showed aneurysmal enlargement. Plasma levels of D-dimer, FDP, counts of platelet, prothrombin time（PT), and activated partial thromboplastin time（APTT）were also measured at the time of CT examinations. Results:There was no operative death and no major complication. Endoleaks in all patients were identified as type II. None of them required re-intervention. In the endoleak group, plasma levels of D-dimer and FDP were significantly higher than in the non-endoleak group in each postoperative period. In addition, postoperative counts of platelet were significantly lower in the endoleak group. PT and APTT test results showed no significant difference in the two groups. In the unchanged aneurysm group, postoperative D-dimer and FDP tended to be higher compared with the shrinkage group. Postoperative counts of platelet also tended to be lower in the unchanged group. There were no differences in PT and APTT test results. Conclusion:Plasma levels of D-dimer and FDP are potentially useful predictors of endoleaks after EVAR.　
    　　

    Jpn. J. Cardiovasc. Surg. 44:301-306（2015）

    Keywords：endovascular abdominal aortic aneurysm repair（EVAR）;endoleak;D-dimer;fibrin degradation product（FDP）

  • Long-Term Outcome of Ultrasonic Scalpel Coronary Artery Bypass Grafting Using Bilateral Internal Thoracic Arteries　A. Yamashita et al.…307
    Long-Term Outcome of Ultrasonic Scalpel Coronary Artery Bypass Grafting Using Bilateral Internal Thoracic Arteries

    Akitatsu Yamashita Satomi Inoue Toshiyuki Maeda
    Masaki Tabuchi

    （Department of Thoracic and Cardiovascular Surgery, Hokkaido Prefectural Kitami Hospital, Kitami, Japan, Division of Acellular Tissue and Regenerative Medical Material, Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University＊, Tokyo, Japan, and Department of Thoracic and Cardiovascular Surgery, Muroran City General Hospital＊＊, Muroran, Japan）

    It seems obvious that artery grafts improve the long-term prognosis of coronary artery bypass grafting（CABG). Besides, the superiority of using bilateral ITAs compared with a single ITA has been reported. An ultrasonic scalpel was introduced in our hospital in April 2001, and since then, we have harvested bilateral ITAs with it in a full skeletonized fashion, and as a result, we have been using bilateral ITAs for CABG routinely. In this study, we reviewed the surgical outcomes in 256 patients who underwent CABG alone, using bilateral ITAs harvested with ultrasonic scalpel between April, 2001 and December, 2012. Of these patients, 194 underwent off-pump CABG（8 were converted to on-pump CABG), and 38 required emergency surgery. One patient died from cerebral infarction within 30 days after the operation. Of all 256 patients, 234 underwent graftograms within 2 weeks after surgery, and 10 patients（4.3%）needed re-intervention including redo CABG or PCI in the early stage. None of these suffered mediastinitis. We also studied long-term outcomes. The follow-up rate was 100% and the mean follow-up period was 2.97±2.6 years. The survival rate was 81.8%, and 72.6% at 5 years, and 10 years, respectively. The freedom from redo CABG was 99.5%, and 99.3% at 5 years, and 10 years, respectively. The freedom from PCI was 96.3%, and 95.2% at 5 years, and 10 years, respectively. The freedom from MACE was 90.3%, and 81.2% at 5 years, and 10 years, respectively. Bilateral ITAs harvested with an ultrasonic scalpel can be used for CABG safely and with satisfactory long-term results.

    Jpn. J. Cardiovasc. Surg. 44:307-311（2015）

    Keywords：CABG;ITA;skeletonization


Editorial

  • Comments to “Lessons Learned from an Erroneous Surgery:Inversely Implanted Apicoaortic Valved Conduit by T. Souma and S. Takanashi” 　H. Adachi…312 　H. Yokoyama…312
    Lessons Learned from an Erroneous Surgery:Inversely Implanted Apicoaortic Valved Conduit

    Takahiro Souma Shuichiro Takanashi

    （Sakakibara Heart Institute, Japan Research Promotion Society for Cardiovascular Diseases＊, Tokyo, Japan, and Present address:Chiba University Hospital＊＊, Chiba, Japan）

    A 62-year-old woman with severe aortic stenosis underwent apicoaortic bypass grafting. The graft was implanted inversely at first;on the next day, it was re-implanted in the right direction. She recovered once from heart failure;however, on postoperative day（POD）74, she died from respiratory failure. On POD 16, an in-house multidisciplinary investigatory commission reviewed the human factors that had led to the surgical error. Throughout the investigation, we provided relevant information about the event and explanations. We presented our apologies the patient’s family and offered to compensate them for their losses.

     

    Jpn. J. Cardiovasc. Surg. 44:313-317（2015）

    Keywords：Apico-Aortic Bypass;human factor;wrong surgery



Case Reports
  • Lessons Learned from an Erroneous Surgery:Inversely Implanted Apicoaortic Valved Conduit　T. Souma and S. Takanashi…313
    Lessons Learned from an Erroneous Surgery:Inversely Implanted Apicoaortic Valved Conduit

    Takahiro Souma Shuichiro Takanashi

    （Sakakibara Heart Institute, Japan Research Promotion Society for Cardiovascular Diseases＊, Tokyo, Japan, and Present address:Chiba University Hospital＊＊, Chiba, Japan）

    A 62-year-old woman with severe aortic stenosis underwent apicoaortic bypass grafting. The graft was implanted inversely at first;on the next day, it was re-implanted in the right direction. She recovered once from heart failure;however, on postoperative day（POD）74, she died from respiratory failure. On POD 16, an in-house multidisciplinary investigatory commission reviewed the human factors that had led to the surgical error. Throughout the investigation, we provided relevant information about the event and explanations. We presented our apologies the patient’s family and offered to compensate them for their losses.

     

    Jpn. J. Cardiovasc. Surg. 44:313-317（2015）

    Keywords：Apico-Aortic Bypass;human factor;wrong surgery



  • Mitral Valve Plasty in Postinfarction Partial Rupture of a Posterior Papillary Muscle　D. Tasaki et al.…318
    Mitral Valve Plasty in Postinfarction Partial Rupture of a Posterior Papillary Muscle

    Dai Tasaki Tomoya Yoshizaki Kenji Yokoyama

    （Department of Cardiovascular Surgery, Musashino Red Cross Hospital, Tokyo, Japan）

    We report the successful treatment of an 81-year-old woman after a difficult diagnosis of mitral valve regurgitation resulting from partial rupture of the posterior papillary muscle. The patient, with a chief complaint of dyspnea, was admitted to our hospital in October, 2010. Echocardiography revealed severe MR and an oscillating abnormal mass attached to the mitral posterior leaflet was assessed as vegetation. Her general condition worsened and coronary angiography revealed 90% stenosis at #6 and 99% stenosis at #12. Partial papillary muscle rupture of post acute myocardial infarction was ruled out. Urgent surgery was performed. It is found that tissue we had assessed as vegetation was a part of the posterior papillary muscle with no signs of infection. MVP with quadrangular resection（P3), annuloplasty and CABG（LITA-LAD, SVG-OM）was performed. The patient was discharged on the 28th postoperative day. Echocardiography showed no MR for four years after the surgery.

     

    Jpn. J. Cardiovasc. Surg. 44:318-321（2015）

    Keywords：postinfarction;papillary muscle rupture;MVP


  • A Pseudoaneurysm of the Left Internal Iliac Artery after Intravesical Bacillus Calmette-Guerin Therapy　M. Okamoto et al.…322
    A Pseudoaneurysm of the Left Internal Iliac Artery after Intravesical Bacillus Calmette-Guerin Therapy

    Masahiko Okamoto Kouji Tsutsumi Takahito Itoh
    Ichiro Kashima

    （Department of Cardiovascular Surgery, Ashikaga Red Cross Hospital, Ashikaga, Japan）

    We report a case of pseudoaneurysm of the left internal iliac artery after intravesical Bacillus Calmette-Guerin（BCG）therapy for bladder cancer. A 75-year-old man was referred to us with lumbar pain and recurring fever. One year previously he was treated for bladder cancer with transurethral resection，followed by adjuvant intravesical BCG therapy lasting 11 months. Computed tomography scanning demonstrated a pseudoaneurysm and perianeurysmal inflammatory changes in the region of the left internal iliac artery. An emergency operation was performed under a diagnosis of impending rupture of the tuberculous left internal iliac arterial aneurysm. Because of the urinary tract stenosis, which was caused by the aneurysm, we inserted a ureteral stent preoperatively. We performed aneurysmectomy and femorofemoral cross over bypass. After 10 months of antituberculous chemotherapy, CT showed no recurrence of infectious aneurysm. Although intravesical BCG therapy is generally considered safe, serious complications including vascular complication have been reported. A mycotic origin should be considered when an aneurysm is discovered after BCG therapy. The prophylactic use of a ureteral stent in mycotic iliac arterial surgery may lead to minor complications.

     

    Jpn. J. Cardiovasc. Surg. 44:322-325（2015）

    Keywords：intravesical Bacillus Calmette-Guerin therapy;pseudoaneurysm;bladder cancer


  • Surgical Strategy and Tactics for a Saphenous Vein Graft Aneurysm　T. Masuda et al.…326
    Surgical Strategy and Tactics for a Saphenous Vein Graft Aneurysm

    Tomoaki Masuda Shu Yamamoto Takanori Suezawa
    Takeshi Shichijo    

    （Department of Cardiovascular Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Japan）

    A 74-year-old woman underwent a triple CABG with saphenous vein grafts to the left anterior descending artery, left circumflex artery and right coronary artery（RCA）17 years previously. Periodic echocardiography by primary care doctor showed a mediastinal mass. She was referred to our hospital and we diagnosed saphenous vein graft aneurysm（SVGA）by enhanced computed tomography. The aneurysm was 60 mm in diameter and originated from the SVG, extending to the RCA. Only around the proximal anastomosis was enhanced, while the other part of the aneurysm was filled with thrombus. Coronary angiography showed collateral circulation to RCA and the other 2 grafts were patent. Resternotomy was done under cardiopulmonary bypass and closure of the proximal anastomosis with aneurysm excision was successfully performed. The postoperative course was uneventful and she was discharged on the 26th post-operative day. We report our surgical strategy in this case.

    Jpn. J. Cardiovasc. Surg. 44:326-329（2015）

    Keywords：coronary artery bypass grafting;saphenous vein graft;graft aneurysm


  • A Case of Frozen Elephant Trunk Technique for Aortic Dissection in Loeys-Dietz Syndrome　T. Furukawa et al.…330
    A Case of Frozen Elephant Trunk Technique for Aortic Dissection in Loeys-Dietz Syndrome

    Tomokuni Furukawa Naomichi Uchida Yoshitaka Yamane
    Shingo Mochizuki Kazunori Yamada Takaaki Mochizuki

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

    The patient was a 37 year-old man. We diagnosed Loeys-Dietz syndrome based on his physical characteristics that were widely spaced eyes and brachycephaly etc. Since he developed De Bakey III b aortic dissection 3 months later, he needed surgical repair for saccular-shaped distal arch aortic aneurysm. We performed total aortic arch replacement for the aneurysm and valve-sparing aortic root reconstruction for dilatation of the Valsalva sinus. Furthermore we performed the frozen elephant trunk technique for residual aortic dissection at the same time. After 18 months from the operation, we were able to recognize by computed tomography that the false lumen of the aorta next to the stent graft was thrombosed and absorbed and finally disappeared. The stent graft treatment for patients with connective tissue disease might be an effective method and deserves more attention.

     

    pn. J. Cardiovasc. Surg. 44:330-333（2015）

    Keywords：open stent graft;frozen elephant trunk technique;Loeys-Dietz syndrome;aortic dissection;aortic aneurysm


  • A Case of Pseudoaneurysm of Mitral-Aortic Intervalvular Fibrosa after Aortic Valve Replacement　S. Ikenaga et al.…334
    A Case of Pseudoaneurysm of Mitral-Aortic Intervalvular Fibrosa after Aortic Valve Replacement

    Shigeru Ikenaga Hiroshi Ito Kensuke Sakata

    （Division of Cardiovascular Surgery, Saiseikai Shimonoseki General Hospital, Shimonoseki, Japan）

    The mitral-aortic intervalvular fibrosa（MAIF）is a fibrous skeleton between the mitral and aortic valves. We describe a case of a pseudoaneurysm of MAIF（MAIFPsA）3 months after an aortic valve replacement. A 75-year-old man had undergone aortic valve replacement using a bioprosthesis（SJM Trifecta 23mm). He developed congestive heart failure 3 months after surgery. Trans-esophageal echocardiography and multi-detector computed tomography detected a MAIFPsA and severe paravalvular leakage. The patient underwent a new operation. After the aortic prosthesis was removed, an orifice of the pseudoaneurysm, which was composed of the anterior mitral leaflet and the aortic annulus, were revealed. The defect was repaired with a bovine pericardial patch, sutured to the anterior mitral leaflet and aortic annulus. A new bioprosthesis（Carpentier-Edwards PERIMOUNT 21mm）was implanted in the supra-annular position. His postoperative course was uneventful.

     

    Jpn. J. Cardiovasc. Surg. 44:334-337（2015）

    Keywords：mitral-aortic intervalvular fibrosa（MAIF）;aortic valve replacement


  • A Surgical Case of Papillary Fibroelastoma Located in the Tricuspid Valve Chordae　K. Nakahara et al.…338
    A Surgical Case of Papillary Fibroelastoma Located in the Tricuspid Valve Chordae

    Ko Nakahara Hirohisa Goto Megumi Fuke
    Masayuki Sakaguchi Kazunori Nishimura  

    （Department of Cardiovascular Surgey, Nagano Red Cross Hospital, Nagano, Japan）

    Papillary fibroelastoma（PFE）is the second most common type of benign cardiac tumor after myxoma, and is most commonly found in the left side of the heart. In this study, we report a case of PFE located in the tricuspid valve chordae. The patient was a 65-year-old woman in whom a heart murmur was detected during a routine medical examination. A follow-up examination identified a cardiac tumor, and she was subsequently referred to our medical department. Echocardiography and contrast-enhanced computed tomography indicated a mobile mass of approximately 1 cm in the right ventricle, and she was determined to be a candidate for surgery. After cardiopulmonary bypass, we instigated cardioplegic arrest, made an incision in the right atrium, and observed the right ventricle through the tricuspid valve. We observed a yellowish sea-anemone-like mass approximately 9 mm from the chordae of the anterior leaflet of the tricuspid valve. Thus, the mass was resected with the chordae and tricuspid annuloplasty. Postoperative progress was satisfactory, and the subject was discharged on the 19th day of hospitalization. Histopathological examination indicated a mixture of thick fibrous and adipose tissues, which led to the diagnosis of PFE. PFE is a relatively rare disease that comprises 8% of primary cardiac tumors. IA often occurs in the left heart and can cause cerebral infarction, myocardial infarction, and other symptoms of embolism. However, because small masses and those that occur in the right heart are not accompanied by clinical symptoms, such cases are often discovered during routine echocardiography. The present study reports a case of PFE that occurred in the tricuspid valve chordae that was diagnosed via echocardiography.

     

    Jpn. J. Cardiovasc. Surg. 44:338-341（2015）

    Keywords：papillary fibroelastoma;cardiac tumor;tricuspid valve


  • Mitral Valve Repair via a Right Mini Thoracotomy in a Patient with Aplastic Anemia　S. Miyasaka et al.…342
    Mitral Valve Repair via a Right Mini Thoracotomy in a Patient with Aplastic Anemia

    Shigeto Miyasaka Keisuke Morimoto Yoshikazu Fujiwara
    Futoshi Kobayashi    

    （Department of Cardiovascular Surgery, Tottori Prefectural Central Hospital, Tottori, Japan）

    Aplastic anemia is a syndrome characterized by pancytopenia, and performing an open heart operation for patients with this syndrome may be associated with an increased surgical risk for both bleeding and post-surgical infection. We report a case of mitral regurgitation complicated with aplastic anemia that underwent a mitral valve repair via a right lateral minithoracotomy. The patient was a 70-year-old woman who presented with shortness of breath on exertion. She was found to have aplastic anemia based on pancytopenia（WBC 2,150/μl, Hgb 8.8g/dl, PLT 5.0×104/μl）and the results of a bone marrow biopsy. Echocardiography showed severe mitral valve insufficiency at the same time, and the patient was referred for surgery. To deal with the decrease in white blood cells and platelets, prior to surgery, a granulocyte colony-stimulating factor was administered, 30 units of platelet concentrate were transfused during the operation, and mitral valve repair via a right lateral minithoracotomy was performed. After surgery, there were no complications due to infection or bleeding, and the subsequent course was favorable. Several studies have reported the advantages in right minithoracotomy of less intraoperative bleeding and a lower infection rate compared with full sternotomy. In cases of this kind, in which there is a tendency toward bleeding and ease of infection, we believe that right lateral minithoracotomy may be a useful option to consider.

     

    Jpn. J. Cardiovasc. Surg. 44:342-345（2015）

    Keywords：aplastic anemia;mitral valve insufficiency;right lateral minithoracotomy


  • A Suspected Case of Heyde Syndrome with Bleeding of the Small Intestine before Aortic Valve Replacement for Severe Aortic Valve Stenosis　T. Kono et al.…346
    A Suspected Case of Heyde Syndrome with Bleeding of the Small Intestine before Aortic Valve Replacement for Severe Aortic Valve Stenosis

    Takanori Kono Toru Takaseya Yuichiro Hirata
    Kumiko Wada Takahiro Shojima Kazuyoshi Takagi
    Koji Akasu Koichi Arinaga Hidetoshi Akashi
    Hiroyuki Tanaka    

    （Department of Cardiovascular Surgery, Kurume University School of Medicine, Kurume, Japan）

    The patient was a 74-year-old woman who had undergone mitral valve replacement with a mechanical valve for rheumatic mitral valve stenosis at age 60. She was scheduled for aortic valve replacement for severe aortic stenosis. However, she had significantly worsening anemia before the operation. Capsule endoscopy showed angiodysplasia with bleeding in her small intestine, which was considered the cause of the anemia. Because of progressive anemia, we tried embolization under angiography. However, there was no evidence of extravasation. Neither melena nor exacerbation of anemia was observed, and she underwent aortic valve replacement. She was discharged on postoperative day 22 without gastrointestinal bleeding. Heyde syndrome is aortic valve stenosis associated with gastrointestinal bleeding induced by von Willebrand disease and angiodysplasia in small intestine. Molecular multimeric analysis of von Willebrand factor and the existence of angiodysplasia with hemorrhage of the digestive tract are important for definitive diagnosis. Capsule endoscopy, which is a general examination, is more useful for diagnosis than molecular multimeric analysis of von Willebrand factor. Aortic valve replacement is the only therapeutic option for Heyde syndrome. It is important to decide the appropriate timing of AVR with cardiopulmonary bypass.

     

    Jpn. J. Cardiovasc. Surg. 44:346-349（2015）

    Keywords：Heyde syndrome;aortic stenosis;angiodysplasia;von Willebrand factor



  • Migration of a Temporary Epicardial Pacing Wire into the Ascending Aorta　S. Makita and T. Maruyama…350
    Migration of a Temporary Epicardial Pacing Wire into the Ascending Aorta

    Satoru Makita Toshiyuki Maruyama  

    （Department of Cardiovascular Surgery, Yokosuka Kyosai Hospital, Yokosuka, Japan）

    A 77-year-old woman was referred to our hospital for the treatment of aortic insufficiency and paroxysmal atrial fibrillation. She underwent aortic valve replacement, pulmonary vein isolation and left atrial appendectomy. Temporary epicardial pacing wires（TEPWs）were placed on the right ventricle at the operation, and were cut flush with her skin surface prior to discharge because of difficulty in traction removal. She was discharged in good condition. Sixteen days after her discharge, she was re-admitted for fever. A computed tomography revealed cellulitis of the chest, and migration of one retained TEPW extending from the ascending aorta to the right subclavian artery. Removal of the migrated TEPW and sternal resection with omentopexy for sternal osteomyelitis were performed. Her postoperative course was uneventaful. TEPWs should be completely removed when possible. If TEPWs are retained, this should be kept in mind when the patient presents with complications postoperatively.

     

    Jpn. J. Cardiovasc. Surg. 44:350-353（2015）

    Keywords：temporary epicardial pacing wire;migration;aorta;complications


  • Three Cases of Coronary Artery Disease Associated with Hereditary Protein S Deficiency　M. Ito et al.…354
    Three Cases of Coronary Artery Disease Associated with Hereditary Protein S Deficiency

    Masamichi Ito Yasuhiro Kamikubo Makoto Takahira

    （Cardiovascular Surgery, Kushiro City General Hospital, Kushiro, Japan）

    We encountered 3 cases of protein S deficiency accompanied by coronary artery disease（CAD). None of the patients had been given diagnoses of congenital protein S deficiency prior to referral to our department. Our examination revealed three-vessel CAD with distal lesions. CAD was of early onset in two patients in their 40s. In 2 of the 3 patients, off-pump coronary artery bypass was performed, and continuous heparin infusion was postoperatively changed to oral warfarin. These patients had a favorable postoperative course and graft patency was maintained. In the third patient, who underwent repeated percutaneous coronary revascularization, in whom coronary artery bypass was contrain-dicated, oral warfarin alleviated the symptoms of CAD. No disease progression was observed in coronary angiography performed at the one-year follow-up examination.

     

    Jpn. J. Cardiovasc. Surg. 44:354-357（2015）

    Keywords：hereditary protein S deficiency:coronary artery disease:coronary artery bypass grafting

  • A Case of Primary Cardiac Angiosarcoma Associated with Cardiac Tamponade　Y. Sukehiro et al.…358
    A Case of Primary Cardiac Angiosarcoma Associated with Cardiac Tamponade

    Yuta Sukehiro Hideichi Wada Yuichi Morita
    Masayuki Shimizu Hiromitsu Teratani Masahiro Ohsumi
    Shinji Kamiya Noritoshi Minematsu Hitoshi Matsumura
    Tadashi Tashiro    

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

    We report a rare case of primary cardiac angiosarcoma in the right atrium. A 47-year-old man was admitted to our hospital with cardiac tamponade. Echocardiography and computed tomography revealed a tumor in the right atrial cavity. We performed tumor resection to confirm the histological diagnosis, to prevent tumor embolism, and to increase the possibility of improving the prognosis. The tumor was resected with the right atrial wall and right pericardium. The right atrium was then reconstructed with a bovine pericardial patch. The pathological diagnosis was angiosarcoma. The patient survived only about 6 months after surgical resection, but there was no local recurrence. This report presents a very rare case of cardiac angiosarcoma associated with cardiac tamponade.

     

    Jpn. J. Cardiovasc. Surg. 44:358-361（2015）

    Keywords：primary cardiac tumor;angiosarcoma;right atrium tumor;cardiac tamponade


  • A Case of Caseous Calcification of a Mitral Annulus with Mitral Regurgitation and Ischemic Heart Disease　E. Ikushima et al.…362
    A Case of Caseous Calcification of a Mitral Annulus with Mitral Regurgitation and Ischemic Heart Disease

    Eigo Ikushima Toru Yasutsune Masato Sakamoto

    （Department of Cardiovascular Surgery, Kitakyushu Municipal Medical Center, Kitakyushu, Japan）

    Caseous calcification of mitral annulus is a rare disease characterized by tumors of the mitral cusps. Operative case reports, however, are rare because this lesion seldom negatively affects hemodynamics. We encountered a 67-year-old female case of mitral regurgitation with caseous calcification of mitral posterior annulus due to ischemic heart disease and performed mitral valve replacement and CABG. The excision of the mitral thickened lesion resulted in a defect of the mitral annulus, which needed to be repaired with an autologous pericardial patch. We mainly report the intraoperative findings of this case.

     

    Jpn. J. Cardiovasc. Surg. 44:362-365（2015）

    Keywords：caseous calcification;mitral annular calcification;ischemic mitral regurgitation


Editor’s Post Script
  • N. Shiiya