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We report a case of transaortic mitral valve repair combined with aortic root and arch replacement in a patient with Marfan's syndrome. Preoperative computed tomography and echocardiography showed acute aortic dissection (DeBakey type 1), severe aortic regurgitation, annuloaortic ectasia, and mild mitral regurgitation (MR). We performed artificial chordae implantation to the anterior mitral leaflet (AML) through the aortic root, followed by insertion of an aortic composite graft and replacement of the aortic arch. The patient is well 55 months after the operation, with minimal MR. We think that the transaortic approach is a good alternative for exposure and correction of the AML and its apparatus in special circumstances.

Osteogenesis imperfecta is a disease in which fragile bones readily cause fracture. Valvular disease concurrently develops. However, the surgery-related mortality rate is approximately 30%. In this study, we report 2 patients with osteogenesis imperfecta who underwent valvular heart surgery. Patient 1 was a 31-year-old male. He had previously been diagnosed as having osteogenesis imperfecta. Echocardiography suggested aortic valve insufficiency, and aortic valve replacement was performed. Patient 2 was a 59-year-old male. During admission, osteogenesis imperfecta was diagnosed. Echocardiography suggested mitral valve insufficiency, and mitral valve plasty was performed. In the 2 patients, intraoperative hemorrhage was marked. However, there were no fatal complications. We also reviewed the literature.

Papillary fibroelastoma is a rare cardiac tumour. We describe a patient with mitral valve regurgitation and aortic valve papillary fibroelastoma. The patient was 62-year-old woman. She was referred to us for surgical treatment of mitral valve. Preoperative echocardiography showed rheumatic mitral valve regurgitation (Sellers grade III) and it also demonstrated mobile masses of the aortic valve. At operation, mitral valve was repaired by a posterior annuloplasty. Through the aortotomy, small tumors were found to be attached to each cusps of the aortic valve and they were successfully removed. The histopathologic diagnosis was papillary fibroelastoma of the aortic valve. The postoperative course was uneventful.

We have developed a new technique of mitral annuloplasty applicable in patients with rheumatic mitral regurgitation. This technique is designed to advance anteriorly the posterior annulus and leaflet and to gain more coaptation area. Technical details of this procedure are presented.

A 61-year-old male with degenerative aortic valve regurgitation, mitral valve regurgitation and chronic atrial fibrillation underwent a combined reparative procedure consisting of aortic valve repair, mitral valve repair and maze procedure. Surgery was successful and postoperatively the patient is in NYHA class I, without anticoagulation. To the best of our knowledge, this is the first clinical report of this combined reparative surgery. As advances are made in valve repair surgery, it is expected that similar combined procedures will be performed more frequently in future. The benefits of avoiding valve replacement and anticoagulation after such combination treatment is discussed.

We report a case of constrictive pericarditis with atrial fibrillation after mitral valve repair and the Maze III procedure. A 66-year-old male underwent mitral valve repair and the Maze procedure for mitral valve regurgitation and chronic atrial fibrillation. About 4 months after discharge, he suffered from shortness of breath. Physical examination revealed a heart rate of 80 beats/min with irregular rhythm, external jugular venous dilatation and abdominal ascites. Electrocardiography revealed atrial fibrillation, and chest X-ray revealed moderate left pleural effusion. Computed tomographic images of the chest showed a that thickened pericardium. A distinct diastolic dip and plateau pattern were recognized on cardiac catheterization. The right atrial, right ventricular end-diastolic, and pulmonary wedge pressures were elevated. Idiopathic pericarditis and recurrent atrial fibrillation were diagnosed and pericardiectomy was performed through a median sternotomy incision. Intraoperatively, the atrial fibrillation converted spontaneously to sinus rhythm. The postoperative hemodynamics improved after pericardiectomy. Total pericardiectomy alone may not convert the rhythm to sinus rhythm in patients with constrictive pericarditis and chronic atrial fibrillation. In this case, atrial fibrillation converted to sinus rhythm during the procedure. This case report suggests that adequate unloading of atrial pressures is necessary for the maintenance of sinus rhythm in patients who have undergone the Maze procedure.

Mitral regurgitation secondary to ischemic heart disease carries a significant mortality even after emergency open heart surgery. From 1993 to 1997, four patients were operated on for ischemic mitral regurgitation secondary to papillary muscle rupture. These patients were between 58 and 69 years of age and all were in class III or IV of the New York Heart Association Classification. The responsible infarction area was located in the lateral wall in 2 patients, and inferior in others. The interval between the onset of acute myocardial infarction and the appearance of mitral regurgitation was from 1 to 10 days. Three patients had partial rupture (defined as only one or several heads of papillary muscle ruptured), and one had total papillary muscle rupture. Primary mitral plasty was performed in 3 patients, including 1 patient who had undergone patch closure of ventricular septal perforation at the onset of acute myocardial infarction. Mitral plasty combined with coronary artery bypass grafting was performed in 1 patient. Only one case, who had total papillary muscle rupture, required reoperation for recurrence of mitral regurgitation. We suggest that even in the case of ischemic mitral regurgitation, when a papillary muscle rupture is partial, mitral repair is performed because of its potential for improving therapeutic results.

Background and Aims of the Study: The safety of combining mitral valve repair with the maze procedure for chronic atrial fibrillation in the surgical management of patients with mitral valve disease is not well elucidated. We present our operative results regarding mortality and morbidity after such combined surgery. As a comparison, our operative results after mitral valve repair in patients without chronic atrial fibrillation are presented., Methods: Between April 1993 and December 1994, 39 patients with chronic atrial fibrillation underwent mitral valve repair and concomitant maze procedure (group 1) at the Iwate Medical University. During the same period, 36 patients with sinus rhythm and one patient with DDD pacemaker underwent mitral valve repair (group 2). In order to evaluate the operative risk, morbidity, and mortality of adding the maze procedure to mitral valve repair, total cardiopulmonary bypass time, aortic cross-clamp time, intraoperative blood loss, intubation period, and duration of ICU stay were compared between the groups., Results: Total cardiopulmonary bypass time and aortic cross-clamp time in group 1 were longer than in group 2 (174.0 +/- 38.8 min versus 150.1 +/- 54.4 min; p = 0.032, 122.5 +/- 30.7 min versus 95.8 +/- 38.2 min; p = 0.0012). However, the duration of ICU stay, intubation period, and intraoperative blood loss were not different between the groups. There were no hospital deaths in either group. Four patients in group 1, and two patients in group 2 required re-exploration for bleeding (p = NS). Two patients in group 1, and none in group 2 required pacemaker implantation postoperatively (p = NS). Two patients in group 2, and none in group 2 had minor cerebral infarction (p = NS). At hospital discharge, 28 patients in group 1 (72%) and 35 patients (97%) in group 2 were in sinus rhythm., Conclusions: The maze procedure can be combined with mitral valve repair without adding undue operative risk to patients. Those patients with chronic atrial fibrillation undergoing mitral valve repair may be advised for the possibility of concomitant maze procedure.