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This report presents a modified procedure of tricuspid valve ring annuloplasty (R-TAP) with posterior annular plication for functional tricuspid regurgitation (TR). Sutures on the native annulus were placed by a standard fashion in R-TAP, and those on the posterior annulus and its bilateral commissures were passed through in a narrow range between the 3 and 4 o'clock positions of the 26-mm ring. The other sutures were done with an usual manner and the ring was fixed to the annulus, resulting in the posterior annular plication( bicuspidization). Follow-up was performed for more than 5 years( mean: 7.9 years, range:5.5~11.5 years) by echocardiography in 13 cases. Postoperative TR reduced significantly to less than moderate, which was maintained during the entire follow-up period, even in the case with atrial fibrillation. There was no sign of tricuspid stenosis. R-TAP with posterior annular plication was feasible, reproducible, and effective, although further investigation is needed.

The patient was an 81-year-old man. Transcatheter aortic valve implantation( TAVI) was performed for severe aortic stenosis using Evolut R. The patient moved to intensive care unit without an adverse event after the operation. But repeated acute heart failure occurred several times during hospital stay. Mitral regurgitation (MR) was worsened from mild at baseline to moderate or more by transthoracic echocardiography. Various factors that worsened MR after TAVI have been reported, and treatment strategy for severe aortic stenosis patients with MR should be carefully developed.

This is a 3-case report of successful descending thoracic and thoracoabdominal aortic surgery by preserving the spinal perfusion artery (SPA) identified preoperatively. In Case 1, an 85-year-old woman, computed tomography (CT) showed Crawford type Ⅴ thoracoabdominal aortic aneurysm (TAAA:60 mm) and a SPA originated from L2. In Case 2, a 76-year-old man, CT revealed type Ⅳ TAAA( 58 mm) and a SPA originated from Th11. In Case 3, a 74-year-old man, CT detected an infectious pseudoaneurysm(44 mm) in the descending thoracic aorta with 2 SPAs originating from Th10 and L2. The ranges of graft replacement were Th7-Th12, Th12-L4, and Th8-Th10, respectively, while preserving all SPAs. All patients recovered well without postoperative neurological deficits. Although the protective effect of the SPA preservation against the spinal cord ischemia is still controversial, preoperative identification of the SPA was useful for planning a surgical strategy for descending thoracic and thoracoabdominal aortic repair surgery.

This is a 2-case report of successful aortic repair surgery for the retrosternal giant aortic aneurysm. Our surgical strategy is "deep hypothermia and left ventricular( LV) unloading under cardiopulmonary bypass before approaching to the aortic aneurysm" in case of possible catastrophic bleeding. Case 1, a 64-year-old woman, had a retrosternal pseudoaneurysm (80 mm) at the distal anastomosis of a Dacron graft used to replace the ascending aorta 7 years before. An LV vent tube was cannulated via the right upper pulmonary vein through an inferior T-shaped ministernotomy. Case 2, an 86-year-old woman, had a retrosternal chronic aortic dissecting aneurysm (66 mm). An LV vent cannula was inserted via the LV apex through a left minithoracotomy. Arch replacement and ascending aorta replacement were performed in Case 1 and 2, respectively, without cardiac, neurological, or any other complications. This strategy is safe and useful in a case with complex aortic disease.

This is a 3-case report of mitral valve replacement (MVR) with an On-X mechanical valve followed up to 10 years. Case 1(64-year-old man) and case 2 (66-year-old woman) experienced traffic accident and traumatic event, respectively, in their chronic phase after MVR. Case 1 had multiple bone fractures of the bilateral lower limbs, which was followed by systemic infection and pyogenic spondylitis. He needed long-term antibiotics therapy for more than 4 years. Case 2 fell down at home and severely hit her head, which resulted in a traumatic subarachnoid hemorrhage. She was in a deep coma, and needed discontinuation of anticoagulation therapy for 4 weeks. Case1, 2, and 3(54-year-old man) are doing well in New York Heart Association functional class I without any valve-related thromboembolic or hemorrhagic events at 10, 9 and 8 years after MVR, respectively. On-X valve performance has also been found well maintained in all cases by echocardiography, even after traumatic accident or discontinuation of anticoagulation in Case 1 and 2. In this report, the On-X mechanical valve demonstrated good midterm result of its valve performance in the mitral position and its potential advantages in antithrombogenicity.

This report discusses intraoperative endoscopic evaluation of the aortic valve performed in 2 cases of aortic valve repair. The "direct" or real image by the endoscopy helped to confirm the preoperatively-known lesion and even to detect a new legion which was not detected preoperatively. The endoscopy also enabled the evaluation of the aortic valve under the pressure-loaded condition without releasing the aortic clamp. Postoperative aortic regurgitation was grade I or less in both cases, although it progressed to grade II at 1 year in case 2. Echocardiographic parameters demonstrated no change in the size of the aortic root configuration for 8 and 5 years in case 1 and case 2, respectively. Intraoperative aortic endoscopy was useful to define the pathogenesis of aortic regurgitation and to evaluate the cusp repair procedures, which may contribute to a good mid-term result of aortic valve repair.

Primary malignant cardiac tumors occur extremely rarely. Among these, leiomyosarcomas are exceptionally rare. We described a case of left atrial leiomyosarcoma in which surgical intervention was followed by adjuvant radiation therapy. A 74-year-old male was admitted for dyspnea. Chest X-ray showed severe pulmonary congestion. Echocardiography revealed large tumor in the left atrium. Emergency operation was performed. The tumor invaded the left atrial wall and the mitral valve, and the lesion was resected as extensively as possible. Postoperative pathologic examination confirmed leiomyosarcoma. He underwent adjuvant radiotherapy postoperatively. However, early local recurrence was recognized. He died due to sudden circulatory collapse in 8th postoperative month. As cardiac leiomyosarcomas have extremely poor prognosis, complete resection and effective postoperative adjuvant therapy are necessary.

Total arch replacement for extended distal arch aneurysm has been known to have a poor outcome because of a limited view on the distal side. An open stent-grafting technique has been employed in many institutions, but several complications have been reported. Specifically, embolism of the distal artery from aneurysm debris and injury to the aortic wall are serious complications. Therefore, we have developed and tested a new sheathless stent-grafting system. We use a small-sized sheath (12 Fr) as an inner cylinder and a stainless-steel Z-shaped stent (Gianturco:William Cook Europe A/S) in the distal part of the graft. This system is deployed by releasing 3-0 polypropylene suture after inserting the full-length graft. The major advantages of this system, compared with other devices, include flexibility, less invasiveness to the aortic wall and low potential for graft migration. This new system may be feasible and clinically effective in the surgical treatment of extended distal arch aneurysm.

We have performed a simple and uniform technique for reconstruction of artificial chordae in patients with anterior mitral prolapse since 1994. In this study, we investigated the long-term clinical and echocardiographic results of chordae replacement with Gore-Tex sutures for anterior mitral leaflet prolapse.A pair of Gore-Tex sutures is passed through a small autologous pericardium and tied on one side of the pericardium. Double-armed mattress stitches on the side without a knot are passed through the head of the papillary muscle and another small pericardium and then tied down. Using this simple technique, 2 pairs of artificial chordae are made. The length of the artificial chordae is determined during the leak test. Chordal replacement with this technique was performed in 30 patients (mean age, 59.3 years) with anterior mitral leaflet prolapse. Echocardiography was performed annually in these patients. Follow-up ranged from 0.2~16.2( 8.0±5.1) years.There were no hospital deaths. Twenty-one patients had no mitral regurgitation( MR) and the others had trivial or mild MR. There were 2 reoperations and 4 cases with recurrent moderate MR in this series. Kaplan-Meier survival and freedom from reoperation at 15 years were 84% and 93%,respectively. Overall, freedom from recurrent moderate or severe MR at 15 years was 81%.Our simple chordae replacement technique with Gore-Tex sutures for anterior mitral prolapse, results in good long-term durability. To avoid recurrence of regurgitation, intraoperative complete repair is essential.