Japanese Journal of Cardiovascular Surgery Vol.47, No5

Preface

• Clinical Trials Act and the Research in Cardiovascular Surgery　M. Nishimura Case Reports
  Clinical Trials Act and the Research in Cardiovascular Surgery
  Motonobu Nishimura
  

Case Reports

• ［Congenital Heart Disease］ Staged Repair of Anomalous Origin of the Right Pulmonary Artery from the Ascending Aorta in a Low Birth Weight Infant:A Surgical Option for the Relief of the Postoperative Right Pulmonary Artery Stenosis　T. Kawamata et al.…207
  Staged Repair of Anomalous Origin of the Right Pulmonary Artery from the Ascending Aorta in a Low Birth Weight Infant:A Surgical Option for the Relief of the Postoperative Right Pulmonary Artery Stenosis
  

  Takeshi Kawamata＊	Mio Noma＊	Tomomi Nakajima＊
  Muneaki Matsubara＊	Hideyuki Kato＊	Chiho Tokunaga＊
  Hiroaki Sakamoto＊	Yuji Hiramatsu＊

  
  

  （Department of Cardiovascular Surgery, University of Tsukuba Hospital＊, Tsukuba, Japan）
  

  A premature boy was born after 35 weeks gestation（1,561g in weight）with a diagnosis of anomalous origin of the right pulmonary artery from the ascending aorta（AORPA）and perimembranous ventricular septal defect（VSD). The fourteenth day after birth, banding of the right pulmonary artery was performed as a palliative operation. At the age of 5 months（3.9kg in weight), the right pulmonary artery branched from the ascending aorta, and was anastomosed to a flap made by the lateral wall of the main pulmonary artery with pericardial patch augmentation. VSD patch closure was performed concomitantly. Severe stenosis of the right pulmonary artery compressed by the ascending aorta and left pulmonary hypertension were revealed 3 weeks after the repair. At the age of 11 months, a surgical relief of the right pulmonary artery stenosis was performed. Transection of the ascending aorta provided an excellent exposure of the right posterior pulmonary artery. After patch plasty of the stenotic pulmonary artery, the divided ascending aorta was restored using a strip form patch on 4/5 circle of its posterior wall to extend the aorta and widen the space for the right pulmonary artery. This technique preserves growth potential of the ascending aorta. There are few reports of surgical repair of AORPA with VSD in low birth weight infants. We presented here a case with surgical relief of post-operative right pulmonary artery stenosis. Long term observation of repaired right pulmonary artery, and requiring residual slight hypertension of the left pulmonary artery.

   

  Jpn. J. Cardiovasc. Surg. 47:207-210（2018）

  Keywords：anomalous origin of the right pulmonary artery from the ascending aorta;low birth weight infant;staged repair;pulmonary artery reconstruction

  
  
• ［Acquired Cardiovascular Surgery］ A Surgical Case of Ventricular Double Rupture after Acute Myocardial Infarction　S. Sakamoto and K. Onoda…211
  A Surgical Case of Ventricular Double Rupture after Acute Myocardial Infarction
  

  Shunsuke Sakamoto＊

  Koji Onoda＊

  
  

  （Department of Cardiovascular Surgery, Shingu Municipal Medical Center＊, Shingu, Japan）
  

  A 76-year-old woman with acute myocardial infarction（AMI）suddenly fell down with cardiogenic shock. Echocardiography showed free wall rupture（FWR), therefore emergency operation was performed under IABP and PCPS assistance. Seven days after initial operation, onset of ventricular septal perforation（VSP）was recognized. Eighteen days after initial operation, the infarct exclusion technique with a bovine pericardial patch was performed. She has been doing well 4 months after the operation with trivial residual shunt. Mechanical complications after AMI are classified as FWR, VSP, and papillary muscle rupture. A combination of any two types of these is called ventricular double rupture. Ventricular double rupture is a very rare condition, and its prognosis is poor. We report here a surgical case with ventricular double rupture after AMI. 　　

  Jpn. J. Cardiovasc. Surg. 47:211-214（2018）

  Keywords：acute myocardial infarction;ventricular double rupture;free wall rupture;ventricular septal perforation
  
  

• An Adult Surgical Case of Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery　N. Ando et al.…215
  An Adult Surgical Case of Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery
  

  Norihiro Ando＊	Yasushige Shingu＊	Tomonori Ooka＊
  Hiroki Kato＊＊	Tsuyoshi Tachibana＊	Suguru Kubota＊
  and Yoshiro Matsui＊

  
  

  （Department of Cardiovascular and Thoracic Surgery, Hokkaido University, Graduate School of Medicine＊, Sapporo, Japan, and Emergency and Critical Care Center, Hokkaido University Hospital＊＊, Sapporo, Japan）
  

  Anomalous origin of the coronary artery from the pulmonary artery（ACAPA）is a rare congenital heart disease. A woman in her 60s was diagnosed as ARCAPA during examination for angina. A magnetic resonance image showed myocardial ischemia in a small area of the right coronary artery（RCA）and left anterior descending artery. Reimplantation of the RCA to the ascending aorta and patch plasty of the pulmonary artery were performed. Repositioning of the RCA orientation was necessary for relief of the kinking. The postoperative course was uneventful. She is now free from angina 15 months after surgery.

   

  Jpn. J. Cardiovasc. Surg. 47:215-219（2018）

  Keywords：anomalous origin of the right coronary artery from the pulmonary artery;surgical repair

  
  
• A Case of Aortic and Mitral Stenoses Recovered from Thrombocytopenia after Double Valve Replacement　K. Mori et al.…220
  A Case of Aortic and Mitral Stenoses Recovered from Thrombocytopenia after Double Valve Replacement
  

  Kousuke Mori＊	Mitsuhiro Yano＊	Masakazu Matsuyama＊
  Masanori Nishimura＊	Katsuya Kawagoe＊	Ayaka Iwasaki＊

  
  

  （Department of Cardiovascular Surgery, Miyazaki Medical Association Hospital＊, Miyazaki, Japan）
  

  A 77-year-old-woman was hospitalized at our institution following the diagnosis of severe aortic and mitral stenoses. Although she had thrombocytopenia before surgery, bone marrow examination revealed no abnormality. Thrombocytopenia was thought to be caused by shear stress accompanying valvular diseases. She underwent surgery for the replacement of aortic and mitral valves and the resection of left ventricular outflow tract myocardium. Because the mitral valve involved the calcification of the annulus the valve replacement was performed after decalcification using CUSA. After surgery, she experienced a transient sick sinus syndrome;however, the overall course was good, and the platelet counts spontaneously recovered. More than 12 months have passed since surgery, but the platelet counts remains around 110,000.

   

  Jpn. J. Cardiovasc. Surg. 47:220-223（2018）

  Keywords：aortic stenosis;mitral stenosis;thrombocytopenia;shear stress

  
  
• A Case of Cardiac Leiomyosarcoma Diagnosed with Recurrence after Resection of the Left Atrial Intramural Hematoma　K. Terazono et al.…224
  A Case of Cardiac Leiomyosarcoma Diagnosed with Recurrence after Resection of the Left Atrial Intramural Hematoma
  

  Kazuya Terazono＊	Takayuki Ueno＊	Yoshihiro Fukumoto＊
  Kosuke Mukaihara＊	Yoshikazu Kawazu＊	Shinya Kuramoto＊
  Yuta Shiramomo＊	Yutaka Imoto＊＊

  
  

  （Division of Cardiovascular Surgery, Kagoshima Medical Center, National Hospital Organization＊, Kagoshima, Japan, and Cardiovascular and Gastroenterological Surgery, Kagoshima University Graduate School of Medical and Dental Sciences＊＊, Kagoshima, Japan）
  

  Cardiac leiomyosarcoma and atrial intramural hematoma are extremely rare. Here, we present the case of a 52-year-old woman with dyspnea. Echocardiography showed a large mass in the left atrium. Tumor resection was performed. A pathological diagnosis of intramural hematoma was made. Ten months later, she presented to our hospital again with dyspnea. Echocardiography and computed tomography showed recurrence of the left atrial tumor. Another tumor resection operation was performed. The tumor originated from the inferior wall of the left atrium, and it was surrounded by atrial wall thickening. Complete resection was not possible. Although postoperative chemotherapy was prescribed, the patient died of heart failure nine months after the second operation.

   

  Jpn. J. Cardiovasc. Surg. 47:224-227（2018）

  Keywords：malignant cardiac tumor;leiomyosarcoma;left atrial intramural hematoma;recurrence

  
  
• Left Ventricular Overlapping Surgery for Broad Ventricular Aneurysm Associated with Cardiac Sarcoidosis:The First Case Report　J. Oba et al.…228
  Left Ventricular Overlapping Surgery for Broad Ventricular Aneurysm Associated with Cardiac Sarcoidosis:The First Case Report
  

  Jun’ichi Oba＊	Tsukasa Miyatake＊	Kimihiro Yoshimoto＊
  Atsushi Okuyama＊	Satoshi Sugimoto＊

  
  

  （Department of Thoracic and Cardiovascular Surgery, Asahikawa City Hospital＊, Asahikawa, Japan）
  

  Left ventricular overlapping operation was applied to a woman with cardiac sarcoidosis who presented with cardiopulmonary arrest. She did not have any particular history, with minimal risk factors for atherosclerosis. By-stander cardiopulmonary resuscitation delivered by her husband saved her life. Acute coronary syndrome was denied by emergency coronary arteriography. However, left vetriculography revealed broad dyskinetic area inconsistent with coronary distribution. Those findings raised a high suspicion of cardiac sarcoidosis, although this was unconfirmed. Broad ventricular aneurysm and a history of cardiac arrest and congestive heart failure prompted us to operate on her. Left ventricular overlapping operation was applied followed by ICD implantation and steroid induction. The pathologic examination of the ventricular wall showed noncaseous epithelioid granulomas and polynuclear giant cells, which are consistent with cardiac sarcoidosis. She has been leading a healthy daily life without signs of heart failure for one and a half years after discharge. Lesions of cardiac sarcoidosis have a broad spectrum from narrow localized to wide generalized aneurysm. Appropriate surgical strategy should be performed according to the location and the extent of the lesion. Left ventricular overlapping operation is among the alternatives.

   

  Jpn. J. Cardiovasc. Surg. 47:228-234（2018）

  Keywords：cardiac sarcoidosis;cardiopulmonary arrest;left ventricular overlapping surgery;left ventricular restoration;implantable cardioverter-defibrillator（ICD）
  

  
  
• Beating Heart Mitral Valve Replacement via Right Thoracotomy for Ischemic Mitral Valve Regurgitation after Coronary Artery Bypass Surgery　K. Zaikokuji et al.…235
  Beating Heart Mitral Valve Replacement via Right Thoracotomy for Ischemic Mitral Valve Regurgitation after Coronary Artery Bypass Surgery
  

  Kenta Zaikokuji＊	Akihiro Mizuno＊	Tatsuhito Ogawa＊
  Jien Saito＊	Hisao Suda＊＊

  
  

  （Department of Cardiovascular Surgery, Nagoya City East Medical Center＊, Nagoya, Japan, and Department of Cardiovascular Surgery, Nagoya City University Graduate School of Medical Science＊＊, Nagoya, Japan）
  

  Reoperative valve surgery is known to be more complex and associated with increased morbidity and mortality, especially for patients with patent coronary artery bypass grafts. A 69-year old man with a history of coronary artery bypass grafting was referred to our hospital with breathing difficulties and a heart murmur. Bypass grafts were all patent, but due to severe ischemic mitral valve regurgitation, we performed beating heart mitral valve replacement via right thoracotomy. The procedure was performed with video assistance, and both the anterior and the posterior chordae tendineae were preserved. The postoperative course was uneventful. He was discharged 7 days after surgery without any complications. This technique is a safe and feasible option for a mitral valve reoperation that avoids graft injuries, minimizes the risks of bleeding, and shortens the operative time.

   

  Jpn. J. Cardiovasc. Surg. 47:235-238（2018）

  Keywords：mitral valve regurgitation;mitral valve replacement;reoperation;minimally invasive surgical procedures;beating heart surgery
  

• A Case of Constrictive Pericarditis after Minimally Invasive Mitral Valve Surgery Requiring Pericardiectomy　T. Ozeki et al.…239
  A Case of Constrictive Pericarditis after Minimally Invasive Mitral Valve Surgery Requiring Pericardiectomy
  

  Takahiro Ozeki＊	Toshiaki Ito＊	Atsuo Maekawa＊
  Sadanari Sawaki＊	Masayoshi Tokoro＊	Junji Yanagisawa＊
  Mamoru Orii＊	Toshiyuki Saiga＊

  
  

  （Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital＊, Nagoya, Japan）
  

  A 68-year-old man was referred to our hospital for mitral valve stenosis, tricuspid valve insufficiency and atrial fibrillation. We performed mitral valve replacement, tricuspid valve plasty, and the MAZE operation through a right small thoracotomy under endoscopic assistance. He was discharged uneventfully 7 days after the operation. However, about 2 months later, he developed pericardial effusion, right pleural effusion, and leg edema implying as having right heart failure. Although he was treated with diuretics and steroids, improvement was temporary and he was hospitalized repeatedly. Cardiac catheterization demonstrated dip and plateau pattern of the right ventricular pressure curve. We diagnosed that he has constrictive pericarditis, although the finding of the chest CT was non-specific without remarkable thickening or calcification of the pericardium. We performed pericardiectomy through median sternotomy without pump assist. Leather-like thickening of the pericardium was recognized in the right, anterior, and inferior portion. Resection of the thickened pericardium led to instantaneous improvement of right ventricular motion and drop of central venous pressure. The patient is in NYHA Class I, one year after pericardiectomy. Constrictive pericarditis could occur even after minimally invasive surgery, and that possibility should be kept in mind if intractable right heart failure persists.

   

  Jpn. J. Cardiovasc. Surg. 47:239-242（2018）

  Keywords：constrictive pericarditis;minimally invasive cardiac surgery;pericardiectomy

  
  
• ［Aortic Disease］ A Case of Spontaneous Ascending Aortic Rupture Which Was Difficult to Distinguish from Stanford Type A Acute Aortic Dissection　K. Kumagai et al.…243
  A Case of Spontaneous Ascending Aortic Rupture Which Was Difficult to Distinguish from Stanford Type A Acute Aortic Dissection
  

  Kunitaka Kumagai＊	Keisuke Morimoto＊	Kimiyo Ono＊
  Hiroaki Kuroda＊

  
  

  （Department of Cardiovascular Surgery, Sanin Rosai Hospital＊, Yonago, Japan）
  

  A 77-year-old man was admitted to our hospital with sudden anterior chest pain followed by shock. An echocardiography showed enlargement of the sinus of Valsalva, severe aortic regurgitation and pericardial effusion. A chest CT scan showed a crescent sign in the ascending aorta. The preoperative diagnosis was a ruptured Stanford type A acute aortic dissection and an emergency operation was performed. In the operative findings, a bloody pericardial effusion, a hematoma around the ascending aorta and a tear（less than 2cm）of the ascending aorta just distal area of the sinotubular junction were observed. In this case, since the enlargement of the sinus of Valsalva and the severe aortic regurgitation were observed, we performed a replacement of the ascending aorta including the aortic root with an artificial vascular graft（J graft 28mm）and a biological valve（Magna EASE 25mm). The pathologic examinations revealed a rupture of ascending aorta in all layers and a hematoma outside the adventitia. The pathologic diagnosis showed a spontaneous aortic rupture. The postoperative course was good and he was discharged 1 month after the surgery. A spontaneous aortic rupture is defined as an aortic rupture without a trauma, an aneurysm or a dissection. It is rare but fatal and it is said that surgical treatment is necessary. We report a successful surgical case of the spontaneous aortic rupture which was difficult to distinguish from a Stanford A type acute aortic dissection.

   

  Jpn. J. Cardiovasc. Surg. 47:243-247（2018）

  Keywords：spontaneous aortic rupture;acute aortic dissection
  

  
  
• A Case of Perigraft Seroma after Ascending Aorta Replacement That Was Cured by an Omental Pedicle Graft　S. Go et al.…248
  A Case of Perigraft Seroma after Ascending Aorta Replacement That Was Cured by an Omental Pedicle Graft
  

  Seimei Go＊	Shinya Takahashi＊	Shohei Morita＊
  Kazuki Maeda＊	Keijiro Katayama＊	Tatsuya Kurosaki＊
  Taijiro Sueda＊

  
  

  （Department of Cardiovascular Surgery, Hiroshima University＊, Hiroshima, Japan）
  

  A 40-year-old man with a family history of Marfan syndrome was admitted to our hospital because of acute Stanford type A aortic dissection. He underwent a Bentall operation with an artificial vascular graft. Postoperative computed tomography revealed a low-density area around the graft in the ascending aorta and at the left subclavian artery cannulation site. He showed no symptoms and was discharged uneventfully. Five months after the operation, a pulsatile subdermal tumor appeared in the center of the median sternotomy. Computed tomography showed low- and high density fluid accumulation surrounding the ascending aortic graft, and this was connected with a subdermal tumor. We suspected collapse of the anastomotic site and performed an emergency operation. The fluid around the aortic graft was clear and diagnosed as perigraft seroma. To prevent recurrence, we filled the space around the aortic graft with an omental pedicle graft. After the operation, perigraft seroma did not recurr. In addition, with the disappearance of the seroma in the mediastinum, fluid accumulation at the left subclavian artery cannulation site also disappeared.

   

  Jpn. J. Cardiovasc. Surg. 47:248-251（2018）

  Keywords：seroma;graft;omental pedicle graft
  

• A Case of Saved Transplanted Kidney by Axillo-Common Iliac Perfusion for Replacement of Ruptured Abdominal Aortic Aneurysm　K. Kawagoe et al.…252
  A Case of Saved Transplanted Kidney by Axillo-Common Iliac Perfusion for Replacement of Ruptured Abdominal Aortic Aneurysm
  

  Katsuya Kawagoe＊	Eisaku Nakamura＊	Koji Furukawa＊
  Mitsuhiro Yano＊	Kunihide Nakamura＊＊

  
  

  （Department of Cardiovascular Surgery, Miyazaki Medical Association Hospital＊, Miyazaki, Japan, and Department of Cardiovascular Surgery, Miyazaki University Hospital＊＊, Miyazaki, Japan）
  

  A 58-year-old man underwent renal transplantation 26 years previously and had been treated with immunosuppressive drugs. He presented at the local hospital with backache symptoms during the waiting period prior to repair of an abdominal aortic aneurysm. Computed tomography revealed a retroperitoneal hematoma around the abdominal aortic aneurysm. He was admitted to our hospital and emergency straight graft replacement was performed. After clamping of the aorta, we performed axillo-common iliac perfusion to protect the transplanted kidney. The patient recovered without transplanted kidney dysfunction.

   

  Jpn. J. Cardiovasc. Surg. 47:252-255（2018）

  Keywords：ruptured abdominal aortic aneurysm;renal transplantation;axillo-common iliac perfusion

  
  

Editor’s Post Script

• K. Minatoya