Search

We report the case of a 25-year-old female who developed severe aortic regurgitation because of pulmonary autograft root dilatation late after Ross-Konno procedure. The geometric heights of all three cusps were relatively small, allowing for the David operation with a 24-mm straight graft. We carefully dissected the aortic root and, the dissection process was relatively straightforward, and the basal ring could be sutured properly. The latest follow-up TTE showed normal autograft valve function and mild aortic regurgitation. Even in the Ross-Konno procedure, valve-sparing root replacement is possible, as in the Ross procedure.

This case presentation of a 73-year-old man introduces a unique tricuspid valve repair with "endocardium leafletization" for Ebstein anomaly. In this procedure, an atrialized portion of the right ventricular endocardium was delaminated, starting from the level of the true tricuspid annulus, to create a neoleaflet in continuity with the displaced true leaflet. The obtained neoleaflet was then anchored to the true tricuspid annulus. Preoperative severe tricuspid regurgitation was effectively controlled with preserving sufficient leaflet mobility. This procedure can be one of the useful options for a certain lesion of Ebstein anomaly that aims to avoid excessive leaflet rotation and restore functional valve apparatus.

Background Intestinal ischemia and enterocyte injury are significant causes of death after cardiac surgery. Hemodialysis is a well-known risk factor for intestinal ischemia. However, the relationship between enterocyte injury and mortality is unclear. This exploratory study assessed the association between intestinal fatty acid–binding protein (I-FABP), a specific marker of enterocyte injury, at intensive care unit (ICU) admission and in-hospital mortality in patients on hemodialysis who underwent cardiac surgery with cardiopulmonary bypass. Materials and methods Forty-seven consecutive patients on long-term hemodialysis who underwent elective cardiac surgery (median age, 70 y; men, 27 [57%]) were prospectively enrolled. The association between serum I-FABP levels at ICU admission and in-hospital mortality was compared with the associations between serum I-FABP levels and prognostic severity scores, vasoactive-inotropic scores, and lactate levels. Results Only I-FABP levels at ICU admission were significantly related to in-hospital mortality (odds ratio, 5.54; 95% confidence interval [CI], 1.08-28.43) in the simple logistic regression analysis. Univariate and multiple linear regression analyses indicated prolonged cardiopulmonary bypass (ρ, 0.49; 95% CI, 0.15-0.83), higher mean norepinephrine dose (ρ, 0.07; 95% CI, 0.02-0.12), lower mean dopamine dose (ρ, −0.51; 95% CI, −0.94 to −0.08), and intra-aortic balloon pump use (ρ, 3.63; 95% CI, 1.68-5.59) were significant risk factors for high I-FABP levels. Conclusions Enterocyte injury at ICU admission was associated with in-hospital mortality after cardiac surgery for patients on hemodialysis. Intraoperative hidden hypoperfusion of the intestine may impact prognoses. Enterocyte injury prevention, early diagnosis, and intervention for intestinal ischemia might be required to improve outcomes.

Mitral valve (MV) repair for infective endocarditis (IE) is sometimes challenging. We investigated the durability of repair associated with the location of the infected lesion.The study comprised 83 patients (55 ± 18 years; active, 66; healed, 17) who underwent MV repair at our institution. Patients were categorized into 5 types based on the location of the main lesion: type I, posterior leaflet (n = 36); type IIC, clear zone of anterior leaflet (n = 12); type IIR, rough zone of anterior leaflet (n = 28); and type III, annulus (n = 7). Type IIR was divided into 2 subgroups: IIR-large (1 segment involvement, n = 9) and IIR-small (1 segment, n = 19).Follow-up was 95.2% completed for 7.2 ± 5.2 years. The rate of recurrent moderate or severe mitral regurgitation (MR) was 2.8% in type I, 0% in type IIC, 28.6% in type IIR, and 14.3% in type III. The freedom from recurrent moderate or severe MR was significantly lower in type IIR compared with the other types (63.1% ± 10.6% vs 96.8 ± 3.2% at 5 years, P .001). Moreover, the recurrence rate was higher in type IIR-large (55.6%) than in type IIR-small (15.8%, P = .068). Type IIR was an independent predictor of recurrent MR (hazard ratio, 11.1, 95% confidence interval, 2.52-78.2; P = .001).The durability of MV repair for IE was satisfactory in posterior leaflet infection without annulus invasion and in clear zone infection of the anterior leaflet. However, rough zone infection of the anterior leaflet, especially with more than 1 segment involvement, was associated with a high risk of recurrent MR.

During mitral annuloplasty, we twisted the harvested auto-pericardium to enable adequate ring sizing and implanted it to prevent ring-related complications. Indication for twisted auto-pericardial band (APB) was limited to patients with less than severe annular dilation to ensure high reproducibility and durability. The aim of this study was to investigate the long-term outcomes of twisted APB annuloplasty. From 1999 to 2009, 107 patients (62 ± 12 years, degenerative 92 and infective endocarditis 15) with isolated posterior mitral leaflet (PML) prolapse with inter-commissural distance of 32 mm or smaller underwent twisted APB annuloplasty. Of these, 104 patients without early leaflet repair failure were studied. Leaflet repairs were predominantly performed by quadrangular resection. Median APB size was 28 mm. Follow-up rate was 98.1% and duration was 10.9 ± 4.8 years. There were two early and 34 late deaths. Survival and freedom from cardiac-related death at 15 years were 61.7% ± 5.6% and 83.8% ± 4.7%, respectively. Age and male sex were independent predictors of mortality. There were four late reoperations for recurrent severe mitral regurgitation (MR), three of which were due to new chordal rupture. Freedom from reoperation and freedom from moderate or severe MR at 15 years were 93.1% ± 3.5% and 81.3% ± 6.2%, respectively. No patients developed hemolysis, ring dehiscence, or infective endocarditis. The long-term outcomes of twisted APB for isolated PML prolapse without severe annular dilation are satisfactory. Twisted APB annuloplasty may be a preferable option to reduce ring-related complications with sufficient durability.

A 73-year-old Japanese man was admitted with extreme intradialytic hypertension of four months’ duration that was refractory to antihypertensive agents. He had started hemodialysis five years previously because of diabetic nephropathy. Coronary angiography revealed coronary artery disease with significant stenosis of the left main trunk and the right coronary artery, and he underwent a coronary artery bypass graft. Thereafter, the intradialytic hypertension disappeared. Ischemic heart disease appears to be one cause of intradialytic hypertension.

Summary: Objectives: Asians are smaller than Europeans and North Americans, but aortic valve replacement (AVR) in small patients has not been examined. We aimed to compare short- and mid-term outcomes of AVR between small and non-small patients. Methods: We retrospectively divided 173 patients who underwent AVR into small (S, n = 95) and non-small (NS, n = 78) groups according to body surface area (≤1.6 in men, ≤1.5 in women) and analyzed differences in baseline characteristics, procedural and post-procedural variables, and survival. Results: Mean age differed significantly between the S and NS groups (71.9 ± 11.2 vs. 66.2 ± 9.8 years), as did the proportion of women (60.0% vs. 24.4%). Implanted valves (19.6 ± 1.6 mm vs. 20.7 ± 1.7 mm) were significantly smaller and more bioprosthetic valves (57.9% vs. 41.0%) were used in the S group. Effective orifice area index and the rate of moderate and severe patient-prosthesis mismatch were not significantly different. No significant intergroup differences were found in hospitalization duration, 30-day mortality, survival rates, or valve related complications. Conclusions: Small patients were older and the proportion of women was higher. The implanted aortic valves were smaller and more were biological prostheses. However, mortality rate did not differ and short- and mid-term outcomes were safe and favorable. Keywords: Aortic valve replacement, BSA, Prosthesis-patient mismatch, Left ventricular mass index

Intestinal fatty acid-binding protein (I-FABP), a biomarker of enterocyte injury, has been reported to be a diagnostic marker of intestinal ischemia and a prognostic marker in critically ill patients. However, the kinetics of I-FABP in renal failure patients is unknown. We sought to identify I-FABP levels in patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD) on hemodialysis (HD) and to identify the manner in which the I-FABP levels change.Adult patients who were admitted for elective cardiac surgery with either normal renal function (NRF), CKD, or ESKD on HD were enrolled. Serum I-FABP levels in NRF and CKD patients and in ESKD patients before and after HD were determined.A total of 124 patients were evaluated: 47 NRF, 53 CKD, and 24 ESKD. The I-FABP levels of the CKD patients and pre-HD ESKD patients were significantly higher than those of the NRF patients (P = 0.018 and P 0.001, respectively). I-FABP levels were significantly negatively correlated with the estimated glomerular filtration rate in NRF and CKD patients (Spearman's ρ = -0.313, P = 0.002). In addition, I-FABP levels in ESKD patients were significantly lower after HD than those before HD (P 0.001).I-FABP levels in CKD and pre-HD ESKD patients were significantly higher than those in NRF patients. In addition, I-FABP was significantly eliminated by HD in patients with ESKD. Clinicians and researchers should consider this aspect of I-FABP when using it as a diagnostic and prognostic marker in patients with renal insufficiency.

Although ICU-AW is a common condition in critically ill, it is unclear which intervention is best to treat. We applied combined exercise training and nutritional supplementation, and these were effective to recover the skeletal muscle function and exercise capacity. We should recognize necessity of nutritional support in ICU-AW patients., Clinical Case Reports, 6(7), pp.1214-1218; 2018

Physical deconditioning often occurs during the acute phase after cardiovascular surgery, and unassisted walking is required to achieve independence, to manage cardiac diseases, and to prevent recurrences. This study aims to investigate the characteristics of independent walking after cardiovascular surgery. We conducted a retrospective cohort study in patients who underwent cardiovascular surgeries (total of 567 patients): 153 in the coronary artery bypass grafting (CABG) group, 312 in the heart valve surgery group, and 102 in the aortic surgery group. We evaluated the effect of each surgery group on the cardiac rehabilitation (CR) progression. The factors associated with independent walking were age, renal diseases, intensive care unit (ICU) length of stay, and post-operative respiratory complications in the CABG group. In the heart valve surgery group, the factors were New York Heart Association functional classification, renal and respiratory diseases, ICU length of stay, duration of mechanical ventilatory support, and post-operative cardiovascular and respiratory complications. In the aortic surgery group, these were ICU length of stay and acute kidney injury. The CR progression in patients who underwent aortic surgery was significantly longer than those who underwent CABG and heart valve surgery (p < 0.001). New intervention strategies are needed for patients with prolonged ICU stays., Healthcare, 9(11), art. no. 1475; 2021

To compare three-dimensional dynamics between implanted Cosgrove-Edwards and Sorin Memo-3D annuloplasty rings during the cardiac cycle. We examined 11 Cosgrove-Edwards rings and 20 Sorin Memo-3D rings after mitral plasty using real-time three-dimensional transesophageal echocardiography. We evaluated ring height, ellipticity, and geometry during one cardiac cycle. Four evenly spaced phases each selected during systole and diastole were assessed using REAL VIEW software. The height of the Cosgrove-Edwards and Sorin Memo-3D rings was similar (2.3 ± 0.8 vs. 1.9 ± 0.9 mm, p = 0.44). The maximum difference in ring height during one cardiac cycle (change in height) was larger for the Cosgrove-Edwards than the Sorin Memo-3D rings (2.3 ± 0.8 vs. 1.5 ± 0.6 mm, p = 0.014). Ellipticity and the maximum difference in ellipticity during one cardiac cycle (change in ellipticity) were larger for Cosgrove-Edwards than Sorin Memo-3D rings (80.0 ± 9.1 vs. 72.0 ± 4.8 %, p = 0.014, respectively, and 12.0 ± 3.1 vs. 6.0 ± 1.8 %, p

We report the case of a 15-year-old male patient who had developed aortic regurgitation primarily because of aortic annulus dilatation late after definitive repair of tetralogy of Fallot. Valsalva sinus dilatation was not remarkable enough for root replacement. For the purpose of total root remodelling, the Sleeve procedure was employed. This procedure not only reduced the root diameters but also augmented commissure heights. With concomitant non-coronary cusp plication, aortic regurgitation was effectively controlled. Thus, the Sleeve technique may be a preferable option for patients who develop aortic regurgitation, due to dilatation of the annulus or sinotubular junction without significant dilatation of the sinus of Valsalva, after congenital heart surgery., European journal of cardio-thoracic surgery, 56(6), pp.1196-1198; 2019

Purpose: We evaluated the outcomes of open heart surgery and long-term quality of life for patients 85 years and older. Methods: We enrolled 46 patients 85 years and older who underwent cardiac and thoracic aortic surgery between May 1999 and November 2012. Long-term assessment was performed for 43 patients; three patients who died in the hospital were excluded. Patient conditions were assessed before surgery, 6 months and 12 months after surgery, and during the late period regarding the need for nursing care, degree of independent living, and living willingness. Results: Three patients (6.5%) died during hospitalization and 22 (51%) died during the follow-up period. The 1-, 3-, 5-year survival rates were 74%, 49%, and 36%. During the late period, of 21 surviving patients, 18 patients (85%) were living at home. The need for nursing care was comparable before and after surgery. The degree of independent living decreased after surgery. Living willingness was similar before and after surgery. Conclusion: Among patients 85 years or older who underwent open heart surgery, 85% were living at home. All patients could perform activities of daily living without any assistance while maintaining living willingness.

The diagnosis of prosthetic valve endocarditis may be challenging in patients with an atypical clinical presentation. Virtually all infections associated with mechanical prosthetic valves are localized to the prosthesis-tissue junction at the sewing ring and are accompanied by tissue destruction around the prosthesis. Because the orifice of the mechanical prosthetic valve is made of metal and pyrolytic carbon, which do not enable the adherence of microorganisms, any vegetation originating from the interior of the valve orifice is usually rare. Here we present a rare case of pannus-induced mechanical prosthetic valve endocarditis that was difficult to diagnose.

ObjectiveThe purpose was to investigate changes of the affected aorta after endovascular treatment for complicated ulcer-like projection (ULP), including aneurysmal change or rupture of ULP, or both, in patients with type B aortic intramural hematoma (IMH).MethodsThe study evaluated 18 patients (nine men) undergoing thoracic endovascular aortic repair for progressive aneurysmal formation of ULP (n = 17), rupture of ULP (n = 5), or both. Patients were a median age of 72 years (range, 45-83 years). Regular follow-up computed tomography studies were performed after treatment (mean follow-up, 61.2 months). A workstation was used to calculate changes on computed tomography images in the size or volume of ULP, affected aorta, and IMH. The growth rate of the volume of the affected aorta and IMH was also calculated before and after treatment. We evaluated the data using the paired t-test.ResultsA stent graft was successfully deployed and ULPs disappeared in all patients. IMH disappeared in 16 or decreased in two after treatment. There were significant differences in the mean maximum aortic diameter (37.8 ± 5.2 vs 34.5 ± 5.2 mm; P = .0006), mean IMH volume (39.4 ± 12.1 vs 2.0 ± 6.0 mL; P < .0001), and total volume of the aorta with IMH (158.1 ± 40.2 vs 128.9 ± 28.0 mL; P < .0001) before and after treatment.ConclusionsEndovascular treatment is a useful treatment for complicated ULP in patients with IMH. Endovascular treatment also contributes to ideal remodeling of the affected aorta.

We encountered a 63-year-old female in whom the left coronary ostium was located close to the commissure between the right and left coronary cusps, and performed aortic root replacement leaving the left coronary artery and surrounding the sinus of Valsalva. The sinus of Valsalva, prosthetic valve cuff, and prosthetic vessel were sutured together when the region other than the left coronary artery-containing sinus of Valsalva was sutured. The hemostatic effect of our procedure, which is for cases in which preparation of a coronary button is difficult, was favorable and antegrade coronary arterial blood flow could be maintained.

To investigate the degree of calcification of fresh autologous pericardium applied for posterior mitral annuloplasty and its influence on the repaired mitral valve. Thirty-nine patients (31 degenerative and 8 infective endocarditis; mean age at surgery: 62 ± 11 years) were enrolled in this study. Sixteen-slice multi-detector computed tomography was performed to identify calcification of autologous pericardium. The mean clinical follow-up was 4.6 ± 2.6 years (maximum 8.8 years) and the mean computed tomography follow-up period was 3.6 ± 2.5 years (maximum 7.6 years) after surgery. Pericardial calcification was detected in 15 patients. The earliest detection of calcification was 2.5 years after surgery. There was a weak correlation between pericardial calcification and postoperative years (Pearson’s product correlation coefficient: 0.476; p = 0.0019). However, severe calcification of autologous pericardium did not occur in any case. There was no association between pericardial calcification and recurrent mitral regurgitation (p = 0.1145). The mean mitral valve orifice area and the mean transmitral pressure gradient in the 15 patients with calcification were 3.0 ± 0.6 cm2 and 2.1 ± 1.0 mmHg, respectively. Calcification of the fresh autologous pericardium increased with postoperative years. It had no adverse effects on repaired mitral valve in the short-term follow-up period. We will report the findings once again when the follow-up reaches 10 years.

Purpose. Mechanical valve replacement is associated with complications, however, there is little information on the quality of life (QOL) of octogenarians who had undergone mechanical valve replacement at a relatively younger age. We examined survival, valve-related events, and the QOL of octogenarians who had undergone mechanical valve replacement. Methods. A total of 56 octogenarians who underwent mechanical valve replacement between 1969 and 1997 (age at the time of surgery, 65.6 ± 6.7 years), completed a questionnaire on survival, valve-related events, and QOL (basic activities of daily living, instrumental activities of daily living, mental health). Results. The mean follow-up was 12.4 ± 6.6 years, and the cumulative follow-up period was 642.4 patient-years. Six valve-related deaths (0.9%/patient-year) were registered during the follow-up. Furthermore, 11 valverelated events (1.8%/patient-year) were recorded. The mean age of the 21 survivors was 82.9 ± 1.8 years, and 19 of the survivors lived at home. Their QOL was excellent. Conclusion. The valve-related deaths and events in octogenarians who had previously undergone mechanical valve replacement at a younger age were within acceptable limits. The QOL was similar to that of octogenarians described in previous studies., General Thoracic and Cardiovascular Surgery, 60(4), pp.213-216; 2012

The aim of this study was to evaluate the efficacy of carperitide in maintaining renal function during intraoperative and postoperative management of patients with renal dysfunction undergoing elective cardiovascular surgery.The subjects were 88 patients with a preoperative serum creatinine level ≥1.2 mg/dl who underwent elective cardiovascular surgery using cardiopulmonary bypass. They were prospectively divided into a group that received carperitide from the start of surgery (carperitide group, n = 44) and a group that was not given carperitide (control group, n = 44). Carperitide infusion was initiated at the beginning of surgery and was continued for ≥5 days, with the central dose being 0.02 g/kg/min. The primary endpoint was the serum creatinine level on postoperative day (POD) 3.The serum creatinine levels on PODs 3, 4, and 7 were significantly lower, and creatinine clearance on PODs 2 and 3 was significantly higher in the carperitide group than in the controls. One patient in the control group and no patient in the carperitide group required continuous hemodiafiltration, but the difference was not statistically significant.Continuous low-dose infusion of carperitide from the start of cardiovascular surgery maintained renal function in patients with preoperative renal dysfunction.

The aim of this study was to determine the mechanism of systolic anterior motion (SAM) after mitral valve (MV) repair by analyzing the clinical data of patients with MV repair.A total of 104 MV repairs were performed for patients with isolated degenerative posterior leaflet prolapse. Eight patients (7.7%) developed SAM with severe mitral regurgitation. We compared the preoperative and intraoperative findings of the two groups (8 patients in the SAM group, 96 in the non-SAM group) and reported the clinical courses of the SAM patients.Preoperative left ventricular end-diastolic and end-systolic diameters were significantly smaller and the preoperative left ventricular ejection fraction was significantly greater in the SAM group than in the non-SAM group. The number of patients with a sigmoid septum and the number with anterior leaflet-septal contact (LSC) during diastole were significantly larger in the SAM group. Incidence of billowing posterior leaflet, prolapsed segments, and operative techniques were comparable for the two groups. SAM improved with correction of hemodynamic status in four patients. In four other patients secondary cardiopulmonary bypass was required to resolve SAM. SAM resolved with additional repairs in two patients, whereas the other two required MV replacement. Of the six patients in whom conservative treatment or re-repair was successful, one had recurrent SAM 3 months after surgery.The sigmoid septum and LSC may predict SAM after MV repair. A strict follow-up is imperative for patients with persistent or recurrent SAM.

We successfully performed aortic root replacement and partial aortic arch replacement by a T-shaped sternotomy at the second intercostal space in a patient who had undergone tracheotomy for respiratory insufficiency and cardiac failure caused by methicillin-resistant Staphylococcus aureus pneumonia during preservation treatment of chronic type A aortic dissection and aortic regurgitation.

Ventricular septal perforation (VSP) is a rare but life-threatening complication of acute myocardial infarction (AMI). Even with assisted circulation heart failure often progresses quickly, and urgent surgical intervention is required to close the VSP. For several years, we have been performing a double patch closure technique using an equine pericardial patch. In this report, we present details of our patch closure technique and the VSP surgical results; we also examine the problems we encountered.The present study was a review of nine patients who underwent our patch closure of VSP secondary to AMI. We used a large double-layered equine pericardial patch to close the VSP and did not exclude the infarction area from the left ventricular cavity. No necrotic myocardium was excised to avoid simultaneous excision of stunned myocardium.No patients died within 30 days of the surgery, and there were no in-hospital deaths. Over a mean clinical follow-up period of 4.5 years, no residual shunts were detected, and all patients were alive and had New York Heart Association functional class II.Our patch closure technique was effective for closing VSPs securely. The operating times and cardiopulmonary bypass times were short, and blood loss was minimal. Our patch closure technique may improve the prognosis of VSP.

Medical management of the acute radiation injury might be an important area to which the procedures of regeneration medicine and stem cell therapy could contribute, since organ stem cells might be targets of radiation injury. Furthermore, since the recovery of blood flow is an important factor in the restoration of many tissues, therapeutic angiogenesis is assumed to become essential treatment in this field. In 2003 we started a project of therapeutic angiogenesis by implantation of autologous bone marrow mononuclear cells in conformity to the protocol of Therapeutic Angiogenesis Using Cell Transplantation trial, which treated patients with severe lower limb ischemia. Two cases of Buerger disease were treated and their symptoms were improved within 2–4 weeks after the transplantation. Angiography indicated that there emerged new blood vessels in patient's treated limb. Augmentation of blood flow was suggested by thermography in one case. In both cases, no serious adverse symptoms due to this treatment were observed. In the present trial, we could recognize effectiveness and safety of therapeutic angiogenesis. We need to improve the present procedure with introduction of evolving knowledge regarding mechanisms of physiological, pathological and utilizable therapeutic angiogenesis and should develop the best strategy of tissue regeneration medicine for victims of radiation exposure.

The patient was a 67-year-old woman in whom patent ductus arteriosus was diagnosed in childhood but not treated. In April 2000, she was hospitalized for exacerbation of heart failure. Marked restrictive impairment was seen: % VC was 36.1%, and FEV1% was 77.0% (respiratory function tests). As calcification was present, and since the aortic opening measured 20 mm, coil occlusion or thoracoscopic surgical interruption were considered difficult to perform. Because of concerns about postoperative respiratory complications associated with thoracotomy, the ductus was occluded under local anesthesia using an original occluder consisting of a vascular graft and modified Z-stent. Postoperatively, during more than three years of follow-up, the patient has remained well with no residual shunt or occluder migration. Consequently, patent ductus arteriosus occlusion using an original occluder appears to be a superior, minimally invasive technique that can successfully treat large ductus arteriosus complicated by calcification.

We developed a new technique of aortic root repair which may be able to eliminate the potential problem of leaflet damage, resulting from the direct contact of the aortic leaflets with synthetic vascular grafts during systole. This report describes our technique of annuloaortic repair and the operative results. Between February 1995 and October 1998, 13 patients underwent annuloaortic repair. The patients included 8 males and 5 females (mean age 50 years). Four patients had grade IV/IV aortic regurgitation (AR), 5 had III/IV AR, 2 had II/IV AR, and 1 had no AR preoperatively. Regarding the preoperative functional status, 1 patient was classified as New York Heart Association class IV, 5 were class III, 6 class II, and 1 class I. Concomitant cardiovascular procedures were performed in 12 cases. Aortic valvuloplasty or annuloplasty was performed in 7 patients. Both operative and short-term postoperative results with pre- and postoperative echocardiographic findings were studied retrospectively. The mean total cardiopulmonary bypass time was 212 min. The mean aortic cross-clamp time was 130 min. Circulatory arrest was induced in 5 patients. Postoperatively, 7 patients had no AR. Three patients had grade I/IV AR and 3 had grade II/IV AR. Perioperative changes in aortic annulus, mid-sinus portion, and sinotubular junction diameters were determined echocardiographically in 5 patients. The preoperative diameters were 2.7 +/- 0.4, 5.4 +/- 0.5, and 4.7 +/- 1.0 cm, respectively. The postoperative diameters were 2.3 +/- 0.5, 4.2 +/- 0.5, and 3.5 +/- 0.5cm, respectively. Ten patients were class I and 2 were class II. This technique of annuloaortic repair with or without aortic valvuloplasty is applicable to a certain subset of patients with aortic root disease and AR. Both the indications for this procedure and the long-term results should be confirmed.

A 46-year-old woman was admitted to our hospital because of progressive exertional dyspnea and occasional premature ventricular contraction. An enhanced computed tomographic scan revealed partial defect of the left ventricular myocardium and prominent trabecular meshwork at the same thin-wall segment. She underwent resection and endoventricular patch plasty using cardiopulmonary bypass. Histopathologic examination showed transmural fibro-fatty replacement of the myocardium, with an extremely thickened endocardium. Here we report an extremely rare case of surgery in a patient with arrhythmogenic left ventricular cardiomyopathy associated with left ventricular noncompaction.

Recently aortic root replacement and free-hand aortic valve replacement with cryopreserved allograft are accepted and established as useful procedures in USA and Europe. Otherwise allograft aortic valve failure due to structural valve degeneration, progressive loss of leaflet extensibility or progressive aortic root dilatation are reported. Aortic root replacement and free-hand aortic valve replacement with cryopreserved allograft were performed on three patients in the Department of Cardiovascular Surgery, NCVC between March of 1992 and March of 1994. We evaluated the mid-term function of implanted allograft. Case 1, 2, 58-year-old male and 42-year-old male with aortic regurgitation due to Aortitis had modified Bentall procedures with composite graft and had redo surgery for aortic regurgitation due to graft detachment with cryopreserved allograft using "aortic root replacement". Case 3: 54-year-old male received a cryopreserved allograft for aortic stenosis/regurgitation using "free-hand technique". Postoperative echocardiogram showed excellent valve function without regurgitation any calcification in all cases. However chest computed tomography suggested the new calcification of allograft wall at 15 months after operation in Case 1 who was administered steroid agents, despite no calcification in Case 2 during 17 months follow-up.

In profound heart failure, ventricular assist systems (VAS) have been used to maintain the systemic circulation and promote recovery of the failing heart. The authors' data suggest that the heart may not recover sufficiently if the patient needs left ventricular assist beyond 10 days. Recently, the authors treated six patients who were supported by VAS more than 3 weeks and were weaned from VAS. Four of six patients were weaned from VAS and continue well, despite marginal cardiac function. In the other two patients, the natural heart did not sustain stable recovery, but their general conditions made them fit to be candidates for heart transplantation. Based on these data, long-term support should be considered to promote recovery of heart function with the use of VAS for profound heart failure.

A 10-year-old girl having bilateral subclavian steal associated with severe coarctation of the thoracic aorta and an aberrant right subclavian artery was found, on admission, to have no difference between upper and lower extremity blood pressure, but echocardiography revealed severe thoracic aorta coarctation and systolic blood pressure in the carotid arteries exceeding 200 mmHg estimated by Doppler ultrasonography. Magnetic resonance imaging and angiography demonstrated bilateral subclavian steal without esophageal compression. We reconstructed the aortic arch using the left subclavian artery and a reversed Blalock-Park procedure, then repaired the coarctation with a 14 mm woven double velor vascular graft. The girl was symptom-free following uncomplicated recovery from surgery. Doppler ultrasonography 2 weeks after surgery showed the pressure gradient across the aortic arch had decreased from 180 mmHg to 60 mmHg. This residual gradient at the anastomosis between the ascending aorta and left subclavian artery may improve as native vessels grow.

A key to the success of mitral valve repair in patients with infective endocarditis is the technique used for reconstruction of the missing leaflet. We report the case of a 47-year-old man with active mitral infective endocarditis. After dissection of the infected segments of P3 and the posteromedial commissure, the defect was reconstructed using tissue from a billowing A2 medial and A3 segment. Chordal transfer with an anterior chord was performed to correct the A3 mild prolapse. Follow-up echocardiography showed recovery of mitral valve morphology and function without regurgitation.

A new intraventricular axial flow blood pump has been designed and developed as an implantable left ventricular assist device (LVAD). The pump consists of a tube housing (10 cm in length and 14 mm in diameter), a three-vane impeller combined with a guide vane, and a DC motor. This pump is introduced into the LV cavity through the LV apex, and the outlet cannula is passed antegrade across the aortic valve. Blood is withdrawn from the LV through the inlet ports at the pump base, and discharged into the ascending aorta. A pump flow of > 8 L/min was obtained against 90 mmHg differential pressure in the mock circulatory system. In an acute dog model, this pump could produce a sufficient output of 200 ml/kg/min. In addition, the pump flow profile demonstrated a pulsatile pattern, although the rotation speed was fixed. This is mainly due to the changes in flow rate during a cardiac cycle--that is, during systole, the flow rate increases to the maximum, while the differential pressure between the LV and the aorta decreases to the minimum. Thus, this simple and compact axial flow blood pump can be a potential LVAD, with prompt accessibility and need for less invasive surgical procedures.

Bisphosphonate drugs, including etidronic acid, are effective agents for the treatment of osteoporosis and may reduce arterial calcification. The aim of this randomised control trial was to characterise the effect of etidronic acid on arterial calcification in patients undergoing chronic haemodialysis.Patients undergoing chronic haemodialysis were assigned to one of two groups by a simple randomisation method: an etidronic acid group (n = 8; 400 mg/day for 24 weeks) and a control group (n = 6; no etidronic acid therapy). Serum calcium, phosphate, calcium-phosphate product, alkaline phosphatase, lactate dehydrogenase, activated colecalciferol and parathyroid hormone levels were measured at baseline and then at 4-weekly intervals thereafter.Calcification scores of the coronary arteries and the thoracic and abdominal aorta were determined by volume-correcting data collected by a multi- detector-row computerised tomographic scanner at baseline, at 6 months and at 1 year. Two patients in the etidronic acid group were excluded from the final analysis because of medical complications. The remainder of the patients (n = 6) showed no significant temporal changes in serum levels of assessed parameters. While no significant temporal changes in coronary calcification score were observed in either group, the mean aortic calcification score significantly decreased over time from 1000 +/- 460mm(3 )at baseline to 970 +/- 580mm(3) at the completion of treatment and 350 +/- 180mm(3) at 1 year (p = 0.009), corresponding to a mean percentage decrease of -64.1% (range -86.5% to -50.1%). By contrast, in the control group, the mean aortic calcification score significantly increased with time from 1460 +/- 1280mm(3) to 1510 +/- 1150mm(3) at the completion of treatment and 2070 +/- 1200mm(3) at 1 year (p = 0.006), corresponding to a mean percentage change in the calcification score of +130.0% (range 2.1-414%).Etidronic acid markedly reduced aortic calcification in patients with end-stage renal disease undergoing chronic haemodialysis. The effect of this agent on aortic calcification may attenuate the increase in aortic stiffness and result in improved long-term outcomes in patients undergoing chronic haemodialysis.

Objective: Mitral valve repair is frequently performed now because it produces a favorable postoperative quality of life, as well as improved cardiac function. For the treatment of posterior leaflet prolapse, we perform a posterior mitral annuloplasty using an autologous pericardium. The present study assessed the efficacy of this operation. Methods: From April 1999 to October 2003, 42 patients underwent a posterior mitral annuloplasty using autologous pericardium for the treatment of posterior leaflet prolapse. There were 15 men and 27 women with an average age of 63.9 ±11.8 years. The length of the autologous pericardium matched the length of the posterior leaflet annulus as measured with Carpentier-Edwards ring sizer that was chosen based on the area of the anterior leaflet. Results: The average size of the Carpentier-Edwards ring sizer that was used to determine the length of the autologous pericardium was 27.7±1.3 mm, and the absolute length of the pericardium was 50.9±1.8 mm, and the average intra-operative jet area, as assessed by transesophageal echocardiography, was 0.36±0.47 cm2. The five-year freedom from reoperation was 97.1%, while the freedom from significant residual mitral regurgitation (≥3+/4+) was 92.0%. Two patients (4.8%) developed systolic anterior motion, and one patient (2.4%) had a cerebral infarction. None of the patients died after surgery, and no patients developed complications such as hemolysis or ring detachment. Conclusions: Posterior mitral annuloplasty using an autologous pericardium was shown to be a superior technique because it allows a sufficient annular repair with no complications such as hemolysis or ring detachment.

Prosthetic valve endocarditis (PVE) caused by Candida species is associated with high morbidity and mortality. A combination of surgical resection and antifungal drug therapy is the golden standard for treatment, yet surgical intervention is not possible in all cases of Candida PVE. We report a case of PVE due to Candida albicans cured by medical treatment alone. This case suggests that, in some instances, Candida PVE can be managed medically with antifungal therapy. Such a conservative approach should be applied with caution and necessitates very close follow-up on a long-term basis.

A 73-year-old woman underwent both mitral and aortic valve replacements with porcine heart valve prostheses because of severe mitral regurgitation and severe aortic regurgitation. Ten months after surgery, maximal flow velocity of the aortic valve reached 4.6 m/sec and moderate mitral regurgitation was detected. Repeated mitral and aortic valve replacements with mechanical heart valves were performed. The excised mitral valve showed thinning of the 3 cusps, and 2 of them were perforated. There was pannus overgrowth on the flow surface of the porcine aortic valve. Histologic examination of the excised mitral valve revealed marked inflammatory changes with macrophages.

A 54-year-old male who experienced a syncopal episode underwent aortic valve replacement for aortic stenosis and regurgitation. The aortic valve was incompetent as a result of thickening of the left coronary cusp and noncoronary cusp. In addition a saccular aneurysm was indicated on the left coronary cusp. A shelf of tissue protruding at right angles from the ventricular septum was particularly prominent below the right coronary cusp, resulting in subvalvular stenosis. The cause of the saccular aneurysm was most likely caused by the long-term effects of the jet stream instigated by discrete subaortic stenosis.

Purpose: In this report we review our experience of operations on mitral regurgitation associated with abnormal papillary muscles/chordae tendineae of the mitral valves and discussed the clinical characteristics, operative findings, and treatment strategies. Methods: Undifferentiated papillary muscle was defined as a hypoplastic chordae tendineae with anomalous formation of papillary muscles attached to the mitral valves directly. Consecutive 87 patients undergoing surgery for mitral regurgitation at our institution were reviewed and 6 of them had undifferentiated papillary muscle. Results: The underlying mechanism of regurgitation was prolapse at the center of the anterior leaflet in 3 cases and tethering, a wide area of myxomatous degeneration, and annular dilatation in one case, respectively. Five patients underwent mitral valve plasty and 1 patient received replacement. Anomalous formation of chordae tendineae was corrected by resection and suture with transplantation at the tip of the leaflet to which abnormal chordae were attached in 2 cases, while resection and suture with chordal shortening was performed in 1 case, and chordal reconstruction using artificial chordae was employed in 2 cases. There was no operative death, and postoperative echocardiography showed no residual regurgitation in any of the cases. Conclusions: Mitral regurgitation associated with undifferentiated papillary muscle resulted from prolapse or tethering and impaired flexibility of leaflets. It was possible to successfully treat the patients by mitral valve plasty unless complex congenital cardiac malformation coexisted. Detailed examinations of attached papillary muscle by echocardiography and intraoperative inspection are necessary and surgical techniques should be selected appropriately in each case., General Thoracic and Cardiovascular Surgery, 60(7), pp.406-410; 2012