Atsuhiko Sato

Infective Endocarditis Associated with Sjögren's Syndrome

Sjögrens syndrome is one of the major autoimmune diseases, however infective endocarditis associated with Sjögrens syndrome has not previously been reported. A patient with Sjögrens syndrome associated with aortic valve regurgitation due to infective endocarditis, underwent successful aortic valve replacement. Patients with Sjögrens syndrome tend to be at a higher risk of intraoral infections due to diminished secretion of saliva. Particular care must be taken of Sjögrens syndrome patients as they can also be at an increased risk of infective endocarditis.

Easy pulmonary vein isolation using epicardial cryoablation.

The maze procedure can be accomplished by several techniques with varying degrees of success. These techniques include cut-and-sew, endocardial cryoablation, and epicardial ablation using heat-producing devices. We describe our surgical modification of pulmonary vein isolation with cryoablation using an epicardial and endocardial approach. This simple and reliable technique, which does not need any special device, will assist in mitral valve surgery for patients with chronic atrial fibrillation.

Enhanced Recovery (Fast-Track) After Cardiac and Vascular Surgery

Enhanced recovery after surgery (ERAS®) is an enhanced postoperative recovery program based on evidence-based medicine introduced by the European Society for Clinical Nutrition and Metabolism in 2005. Many reports have been shown that this program is useful not only in general surgery but also in cardiac and vascular surgery. The goals of this management are reducing operative stress, early restarting of meal consumption, early starting of postoperative rehabilitation, shortening the length of postoperative hospital stay, reducing medical costs, reducing patient anxiety perioperatively and encouraging the patient’s volition to recover, and securing safety and satisfactory results. Although only minimally invasive surgery has been continuously developing in Japan, this management is not yet widely used and conventional management remains standard in many institutions. In this chapter, we introduce the many elements of ERAS® management for cardiac and vascular surgery divided into the preoperative, intraoperative, and postoperative periods, according to our experiences and past reports.

Long‐term outcome in a case of translocated mitral valve replacement for massive mitral annular calcification

Few reports have described long‐term outcomes after translocated mitral valve replacement. We describe tips, potential pitfalls, and long‐term outcome associated with the construction of a new mitral annulus and reinforcement of prosthesis attachment using a mitral prosthetic valve with an equine pericardial collar in a woman with extensive mitral valve calcification.

Aortic valve replacement in a patient with MPO-ANCA-positive Goodpasture disease

Goodpasture disease (GD) is a rare autoimmune disorder characterized by the development of pathologic autoantibodies against both glomerular and alveolar basal membranes. Approximately one third of the patients with GD are also positive for anti-neutrophil cytoplasmic antibody (ANCA). In this case report, a 74-year-old woman was diagnosed as having myeloperoxidase (MPO)-ANCA-positive GD with severe aortic valve stenosis (AS). She underwent immunosuppressive therapy and plasmapheresis that led to GD remission. Whether a cardiac surgery affects a MPO-ANCA-positive GD in remission is unknown. We reported the outcomes after aortic valve replacement for severe AS in a patient with MPO-ANCA-positive GD.

Use of a Stent Graft for Patent Ductus Arteriosus in an Octogenarian Eliminates Ductus Flow.

Closure of a patent ductus arteriosus (PDA) in the elderly is a high-risk procedure because of tissue fragility and many possible complications. The patient in our case was an 81-year-old woman with a window-type PDA caused by cardiac failure. Based on the anatomy of the PDA and aorta and to minimize invasion, we used a stent graft to close the PDA. This approach was successful; hemodynamics improved and ductus flow was eliminated during the follow-up period without intervention from the pulmonary artery side.

Midterm results of left coronary artery reimplantation through the transverse sinus of the pericardium in adult Bland-White-Garland syndrome

The anomalous origin of the left coronary artery from the pulmonary artery - known as Bland-White-Garland syndrome - is a rare congenital malformation that affects 1 in 300,000 live births. Most patients die in infancy without any surgical treatment. Some patients who survive past childhood often have varying symptoms such as myocardial ischemia, impaired left ventricular function, mitral regurgitation, and progressive heart failure, depending on the development collateral circulation. In the present report, we describe a procedure wherein the left coronary artery ostium was translocated through the transverse sinus of the pericardium in a 43-year-old mother with Bland-White-Garland syndrome and concomitant mitral regurgitation and report on the associated midterm results.

Purulent Pericardial Effusion and Mycotic Pseudoaneurysm Following Insertion of a Bare Metal Stent

A 65‐year‐old male was diagnosed with purulent pericarditis, caused by Staphylococcus aureus five weeks after bare metal stenting for a 90% stenosis of the right coronary artery ostium. Subsequently, he developed a pseudoaneurysm in the right coronary sinus of Valsalva (CSV) requiring surgical intervention during the treatment of the pericarditis. Bacteremia after percutaneous coronary intervention (PCI) occurs in < 1% of patients and usually has insignificant clinical sequelae. We present an infected coronary bare metal stent of the proximal right coronary artery after PCI that resulted in a purulent pericardial effusion and mycotic pseudoaneurysm of the right coronary sinus of Valsalva (CSV). The patient successfully underwent surgical treatment. doi: 10.1111/jocs.12530 (J Card Surg 2015;30:433–435)

Hancock valve deterioration in tricuspid position for Ebstein's anomaly.

A 65-year-old woman with a Hancock valve implanted 25 years earlier for Ebsteins anomaly underwent a successful second tricuspid valve replacement with a Mosaic valve because of significant tricuspid regurgitation. At surgery, it was found that the Hancock valve had a cylinder-shaped hole and had lost its entire structure. Tricuspid valve dysfunction may be tolerated for a long time before surgery is contemplated.