Arata Muraoka

Side-to-side anastomosis using 4 interrupted sutures in small coronary arteries

Side-to-side anastomosis in sequential bypass grafting of coronary arteries 1.0 mm in diameter or smaller, requires delicate surgical techniques with a high degree of technical difficulty. However, using only 4 interrupted sutures, we have performed side-to-side anastomosis in sequential grafting without difficulty in a short operative duration. We applied this technique in 58 distal anastomosis procedures, achieving an early angiographic graft patency rate of 100%.

Starr-Edwards valves at the aortic and mitral positions implanted for 39 years.

Cloth-covered Starr-Edwards caged ball valves implanted in the aortic and mitral valve positions for 39 years were extracted. Both showed valve dysfunction resulting from pannus overgrowth. The metal cages of the Starr-Edwards valves were covered with worn cloth. This case indicates the extended durability of Starr-Edwards valves and the importance of the design and materials of prosthetic heart valves to avoid pannus overgrowth and prosthetic valve abrasion.

Surgical removal of a fractured guidewire entrapped in the coronary artery

We experienced a case with a remnant of a fractured guidewire in the coronary artery. Surgical removal of the total wire by manual traction was unsuccessful. The wire was then cut near the right coronary orifice, and its proximal portion was removed. Cardiac interventionists should recognize that percutaneous coronary intervention is associated with the risk of various cardiovascular accidents. Patients should be informed of such risks.

Left ventricular blood cyst in an adult case

We present a 57‐year‐old man with a 1.5‐cm‐diameter blood cyst in the left ventricle, which was incidentally detected by conventional diagnostic echocardiography before colon surgery. The cyst originated from the papillary muscle, and the pathological findings were compatible with a cardiac blood cyst.

Unique nonstructural dysfunction of the omnicarbon valve: case report

BackgroundPannus formation may disturb the leaflet movement of the prosthetic valve.Case presentationA 61-year-old woman presented with exertional dyspnea. She had undergone mitral valve replacement with a bioprosthetic valve 31 years ago, which was replaced with a tilting disc valve 22 years ago. The present laboratory findings revealed hemolytic anemia. Echocardiography showed an increased mean pressure gradient through the mitral valve and moderate to severe regurgitation around the minor orifice of the tilting disc valve. She therefore underwent a third operation. Pannus formation was found on the prosthetic valve ring, but it did not obliterate the prosthetic valve orifice. After removing the valve, the posterior wall of the left ventricle was seen to be associated with thickened endocardium. A bileaflet valve was implanted. Postoperative echocardiography showed that the implanted valve functioned well.ConclusionsNonstructural dysfunction of the mechanical heart valve might occur long after operation. These changes are particularly observed with a tilting disc valve.

Intractable Hemolytic Anemia after Heart Valve Surgery

Heart valve surgery consists of valve replacement and repair. Both operations have been standard strategies for treating heart valve diseases worldwide, and are associated with excellent long-term clinical results. Hemolytic anemia after heart valve surgery, however, is a troublesome complication related to implanted prosthetic valves or rings.

Multiple papillary fibroelastomas in the right heart

Background: Cardiac multiple papillary fibroelastonas are rare. Methods and Results: A 70-year-old woman presented with an exertional dyspnea. A trans-thoracic echocardiogram showed a moving mass near the inferior vena cava in the right atrium. She underwent an operation for a cardiac tumor. A trans-esophageal echocardiogram during the operation showed a mass in the right ventricle, which had echo properties similar to the mass in the right atrium. The mass in the atrium was resected including the attached intima, and the mass in the ventricle was resected by the shave method. Her postoperative course was uneventful. A pathological examination showed that the two tumors were papillary fibroelastomas. Conclusion: A precise examination should be performed when a cardiac tumor is diagnosed to investigate the possibility of multiple lesions.