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Cerebral complications of infective endocarditis (IE) [particularly, mycotic aneurysm, visualized as a hypointense spot on T2*-weighted brain magnetic resonance imaging (MRI)] are associated with a high incidence of postoperative cerebral or subarachnoid hemorrhage. We have adopted a policy of performing elective open heart surgery after performing a MRI enhanced by gadolinium in such patients whenever possible after improvement in inflammatory findings around a cerebral aneurysm.Fifty-six patients (35 men and 21 women, mean age 56 years) diagnosed with active-phase IE between January 2000 and December 2010 were analysed retrospectively.Six patients who had not undergone MRI were excluded. The remaining patients were classified into four groups according to preoperative brain MRI findings-Group A (n = 13): cerebral haemorrhage, cerebral infarction, abscess and encephalitis; Group B (n = 7): simple or multiple black dots ( = hypointensive spots) with cerebral haemorrhage or cerebral infarction; Group C (n = 15): simple or multiple black dots alone; Group D (n = 15): no abnormal MRI findings. None of the 12 patients who successfully underwent elective surgery in Groups B and C developed postoperative cerebral complications.Brain MRI is an important tool for the detection of asymptomatic intracranial abnormalities associated with IE and evaluation of the preoperative bleeding risk of patients. Patients with contrast enhancement around black dots are at high risk for bleeding, and performing open heart surgery in such patients whenever possible after the improvement of inflammatory findings reduces the potential risk of cerebral haemorrhage.

An 86-year-old woman was scheduled to undergo aortic valve replacement and coronary artery bypass graft. On postoperative day 3, she developed sudden-onset neck pain followed by weakness in the right arm. Her symptoms worsened with time, and she developed paraplegia. At 60 h after the first complaint, spontaneous spinal epidural hematoma (SSEH) from C2 to C6 with spinal cord compression was diagnosed from a magnetic resonance image of the cervical region. We decided on conservative therapy because operative recovery was impossible. Delayed diagnosis led to grievous results in the present case. When neurological abnormalities follow neck or back pain after open heart surgery, SSEH must be considered in the differential diagnosis. Further, if it is suspected, early cervical computed tomography/magnetic resonance imaging and surgery should be considered.

Recently pericardial drainage after cardiac surgery has been done using silicon tubes of small diameter. For more effective drainage, we set one of the drainage tubes circularly, coursing behind the left ventricle, through the transverse sinus, and ending at the right side of the atrium (circular pericardial drainage). As compared to conventional drainage using 28 Fr chloroethilene tubes, drainage time was shorter and no late tamponade had occurred. Circular pericardial drainage may be useful.

A 79-year-old woman who had a previous history of sudden onset of pain and coldness of her right leg was referred to our hospital. There were no palpable right popliteal and pedal pulses with the ankle-brachial pressure index being 0.63. Computed tomography showed a 2.6-cm diameter right buttock mass which had a continuation from the right internal iliac artery that entered the posterior thigh and continued to the popliteal artery. It was diagnosed as thrombosed right persistent sciatic artery (PSA) aneurysm. She was treated medically with intravenous and oral antiplatelets, and was left with no right leg symptoms. Follow-up CT obtained after 3 years from onset demonstrated that the diameter of the PSA aneurysm diminished from 2.6 to 1.2 cm. It is suggested that a patient who had the occluded complete type PSA aneurysm with no critical leg ischemia, local compression, or rupture can be observed without surgery. However, careful follow-up of the patient is essential.

We report a reoperative case in which a Valsalva graft was utilized on a 64-year-old woman who had previously undergone emergency repair of a DeBakey type I acute aortic dissection. On follow-up computed tomography (CT), she was found to have pseudoaneurysms of both proximal and distal anastomoses. We performed valve-sparing aortic root replacement (VSRR) with the reimplantation technique and total arch replacement, since we felt that a graft with pseudosinuses helps to prevent torsion of the coronary arteries. The postoperative course was uneventful, and postoperative echocardiography revealed no significant aortic valve regurgitation. The pathology results raised the hypothesis that pseudoaneurysm formation might have been related to the use of gelatin-resorcinol-formaldehyde (GRF) glue at the time of the initial intervention.