|Yuki Kuroda||Kenji Minakata||Kazuhiro Yamazaki|
|Hisashi Sakaguchi||Shingo Hirao||Shinya Takimoto|
|Kazuhisa Sakamoto||Tomohiro Nakata||Tadashi Ikeda|
（Department of Cardiovascular Surgery, Kyoto University Hospital＊, Kyoto, Japan）
Objective:The aim of this study is to describe a series of patients undergoing reoperation due to hemolytic anemia after mitral valve surgery and assess the mechanisms and surgical outcomes. Methods:Between 2009 and 2014, we performed redo mitral valve surgery in 11 patients who had refractory hemolytic anemia after mitral valve surgery at Kyoto University Hospital. The mean age of the patients was 72.2±6.8 years old, and there were 5 men. Results:Preoperative echocardiography demonstrated that only 3 patients had●grade 3 mitral regurgitation（MR), the rest of the patients had only mild to moderate MR. The mechanisms of severe hemolysis included paravalvular leakage（PVL）after mitral valve replacement（MVR）in 8 patients, structural valve deterioration（SVD）after MVR using a bioprosthesis in one, and residual/recurrent mitral regurgitation after mitral valve plasty（MVP）in two. All the patients except one（re-MVP）underwent MVR. The mean interval between previous operation and current operation was 14.1±9.4 years in post-MVR cases, and 2.0±1.9 years in post-MVP cases. There were three late deaths, one of which was due to cardiac death（exacerbation of heart failure due to pneumonia). There was one patient who required re-MVR for recurrent hemolysis due to PVL after MVR. Conclusion:Although hemolytic anemia after mitral valve surgery is rare, it often requires reoperation regardless of the degree of MR at late follow-up period. Thus, patients after mitral valve surgery should be carefully followed-up.
Jpn. J. Cardiovasc. Surg. 45:67-72（2016）
Keywords：hemolytic anemia;mitral valve replacement;mitral valve plasty;paravalvular leakage;structural valve deterioration
|Ken Yamanaka||Tatsuhiko Komiya||Hiroshi Tsuneyoshi|
（Department of Cardiovascular Surgery, Kurashiki Central Hospital＊, Kurashiki, Japan）
We encountered left main coronary artery hypoplasia in a 14-year-old boy. He had a history of syncope after exercise. Computed tomography revealed hypoplasia of the left main coronary artery and the syncope on exertion was diagnosed as due to myocardial ischemia. We performed off-pump coronary artery bypass（OPCAB）graft using the left internal thoracic artery. The postoperative course was uneventful and chest symptoms were not recognized in daily life. Left main coronary artery hypoplasia is rare, but is associated with adverse cardiac events, including sudden cardiac death. In cases like this, coronary artery bypass graft is indicated.
Jpn. J. Cardiovasc. Surg. 45:73-75（2016）
Keywords：hypoplasia of LMT;myocardial ischemia;OPCAB;LITA
|Kunihiko Yoshino||Kohei Abe||Yusuke Nakanishi|
|Joji Ito||Hiroyasu Misumi|
（Department of Cardiovascular Surgery, St. Luke’s International Hospital＊, Tokyo, Japan）
Balloon aortic valvuloplasty（BAV）is a treatment for high risk patients with severe aortic valve stenosis（AS). Rapid pacing is needed to reduce cardiac output when dilating the balloon, but it may cause cardiac ischemia or lethal arrhythmia. In this case report, percutaneous cardiopulmonary support（PCPS）was used to prevent these complications with BAV. We achieved adequate blood pressure and cardiac output during BAV without using rapid pacing by drawing a certain amount of blood into the reservoir equipped with the PCPS circuit. When performing BAV, PCPS may be a useful option for the patients who have high risks of circulatory failure.
Jpn. J. Cardiovasc. Surg. 45:76-79（2016）
|Hirohito Ishii||Kunihide Nakamura||Eisaku Nakamura|
|Jogi Endo||Masanori Nishimura||Yukie Shirasaki|
（Department of Surgery, Division of Cardiovascular Surgery, University of Miyazaki＊, Miyazaki, Japan）
We describe a case of ruptured coronary artery aneurysm with a coronary artery to a pulmonary artery fistula. An 89-year-old woman with general fatigue and dyspnea was admitted. At the visit she went into shock and was restored by rehydration therapy. Enhanced computed tomography shows a coronary aneurysm（maximum diameter of 50mm）at the left side of pulmonary artery and mild pericardial effusions. She was scheduled for an emergency operation due to the ruptured coronary artery aneurysm with a coronary artery to pulmonary artery fistula. We performed aneurysmectomy and ligation of the coronary artery to the pulmonary artery fistula under cardiopulmonary bypass. We also reviewed 23 cases of ruptured coronary artery aneurysm with coronary artery extending to a pulmonary artery fistula in Japan. The disease is a rare clinical state and regarded as an indication for emergency surgery.
Jpn. J. Cardiovasc. Surg. 45:80-83（2016）
Keywords：ruptured coronary artery aneurysm;coronary artery to pulmonary artery fistula
|Shinichi Imai||Kentaro Sawada||Eiji Nakamura|
|Shohei Yoshida||Hayato Fukuda||Satoru Tobinaga|
|Seiji Onitsuka||Shinichi Hiromatsu||Hidetoshi Akashi|
（Department of Surgery, Kurume University School of Medicine＊, Kurume, Japan）
We report a case of successful anatomical reconstruction with omentopexy of an infected abdominal aortic aneurysm（AAA）in a patient with a previous history of coronary artery bypass grafting with the right gastroepiploic artery. A 60-year-old man was referred to our institute because of fever and abdominal pain during hemodialysis for chronic renal failure. Antibiotic therapy was started after computed tomography revealed an infected abdominal aortic aneurysm. After infection control, surgical treatment was scheduled. At surgery, left axillo-bifemoral bypass was performed first, because it was unclear whether the omentum was large enough for omentopexy. At laparotomy, adequate omentum and infective AAA were confirmed. AAA repair using a rifampicin-soaked graft, and omentopexy were performed. Enterobacter aerogenes was detected from the resected aortic wall. After the operation, intravenous antibiotic was used for 25 days until CRP was normalized. One year follow-up showed no sign of re-infection.
Jpn. J. Cardiovasc. Surg. 45:84-88（2016）
Keywords：infected aneurysm;anatomic revascularization;extra-anatomic bypass;omentopexy;CABG
|Takuma Yamasaki||Eisei Koh||Yuji Kaku|
|Shuhei Fujita||Junko Katagiri|
（Department of Cardiovascular Surgery, Kyoto Daini Red Cross Hospital＊, Kyoto, Japan）
A 64-year-old woman was admitted to our hospital with sudden chest and back pain. Computed tomography showed acute type A aortic dissection complicated with malperfusion of the left main coronary artery（LMT). Immediately after the CT, the patient went into sudden shock. Electrocardiogram showed ventricular tachycardia and ventricular fibrillation. Percutaneous cardio-pulmonary support was administered and coronary arteriogram（CAG）was performed. CAG revealed LMT stenosis and intravascular ultrasound showed mobile intimal flap at the LMT. Percutaneous coronary intervention of the LMT was performed. The patient recovered from shock and was treated with ascending aorta replacement with CABG. The patient was discharged from the hospital without any major complication.
Jpn. J. Cardiovasc. Surg. 45:89-93（2016）
Keywords：acute aortic dissection;left main coronary trunk;malperfusion;percutaneous coronary intervention;percutaneous cardiopulmonary support
|Yosuke Motoharu||Haruo Aramoto||Togo Norimatsu|
|Minoru Tabata||Toshihiro Fukui||Shuichiro Takanashi|
（Cardiovascular Surgery, Sakakibara Heart Institute＊, Tokyo, Japan, and Cardiovascular Surgery, Fukuoka Wajiro Hospital＊＊, Fukuoka, Japan）
An 80-year-old man was admitted to our hospital with a diagnosis of distal aortic arch aneurysm. A preoperative chest CT demonstrated a 54mm in diameter distal aortic arch and coronary angiography revealed stenosis of LAD and the diagonal branch. We planned a thoracic endovascular repair after total arch replacement with a coronary artery bypass graft. A ZTEG-2P-30-200-JP was deployed at the proximal side of the elephant trunk, and a ZTEG-2P-34-152-JP was deployed. About 10 months later, a chest CT demonstrated a 90mm in diameter distal native aortic arch, and anemia had increased to Hb 7.7g/dl. A CT and angiography revealed a type II endoleak and so we tried to close the endoleak through a left thoracotomy approach. Twenty-eight months after the TEVAR, the patient had esophageal perforation and stent graft infection. At first, we resected the esophagus and reconstructed it with a gastric tube. Secondly, a descending thoracic aorta replacement was performed. The patient suffered from a cerebral infarction. However, infection was controlled successfully and he was transferred to another hospital for rehabilitation 69 days after the descending aorta replacement.
Jpn. J. Cardiovasc. Surg. 45:94-99（2016）
Keywords：aortic aneurysm;TEVAR;endoleak;AEF;graft infection