Hirohisa Murakami

Surgical management of multiple ventricular septal defects: the role of the felt sandwich technique.

OBJECTIVE Recently, the felt sandwich technique has been widely used to close muscular ventricular septal defects. We evaluated the early and midterm results of our strategy (a combination of the sandwich technique and direct closures) and assessed the role of the sandwich technique in the treatment of multiple ventricular septal defects. METHODS Twenty-nine consecutive patients underwent an operation for multiple ventricular septal defects and associated cardiac malformations. They included 17 boys and 12 girls with a median age of 6.0 months. Thirteen patients had 4 or more ventricular septal defects (Swiss cheese septum). RESULTS There was no surgical or follow-up mortality, and no reoperations were required. There were no cases of heart block and no significant residual shunts in the latest follow-up study. Two patients with Swiss cheese septum had postoperative congestive heart failure. Three muscular ventricular septal defects were closed with the sandwich technique in these 2 patients, whereas 1 or fewer ventricular septal defects were closed with the sandwich technique in the other 27 patients. Seven (77.8%) of 9 patients who underwent the sandwich procedure had septal dysfunction, whereas 5 (25.0%) of the other 20 patients showed septal dysfunction (P < .05). CONCLUSIONS The outcome of the surgical repair of multiple ventricular septal defects was satisfactory. Although the sandwich technique is simple and effective, the use of numerous felt patches disturbed the movement of the interventricular septum. An effort should be made to close the muscular ventricular septal defect directly to avoid postoperative cardiac dysfunction. Large apical ventricular septal defects, especially those located just underneath the moderator band, are considered suitable for the sandwich technique.

Aortic Root Reimplantation for Isolated Sinus of Valsalva Aneurysm in the Patient With Marfan's Syndrome

We describe an isolated extracardiac unruptured acquired aneurysm in the right coronary sinus of Valsalva, which was seen in a 55-year-old woman with Marfans syndrome. The patient underwent aortic root replacement using a reimplantation technique. Pathologic examination revealed absence of the medial elastic fiber of the aortic wall of the normal sinus of Valsalva. This result supports the preference of entire root replacement instead of patch repair of the affected sinus for the isolated aneurysm in 1 sinus of Valsalva in a patient with Marfans syndrome.

Left ventricular restoration for cardiac sarcoidosis: report of two cases

Although sarcoidosis may involve the myocardium, there is little available information on its treatment, especially in cases requiring surgery, such as left ventricular restoration or mitral valve repair. This report presents two surgical cases with cardiac sarcoidosis treated by left ventricular restoration and mitral valve repair for a ventricular aneurysm and dilated cardiomyopathy with mitral regurgitation.

A True Aneurysm of Posterior Tibial Artery

True aneurysms of tibial artery are uncommon. We report a case of a 47-year-old woman who suffered from a distal embolism in the left toes. The surgical intervention involved an aneurysmectomy and the interposition of the posterior tibial artery using the saphenous vein graft. She has been doing well 22 months after the operation.

Stanford Type A Acute Aortic Dissection With Intimal Intussusception

A70-year-old woman with a sudden onset of dizziness, disturbance of speech, and nausea was brought to our hospital. A contrast-enhanced computed tomography (CT) scan of the patient’s chest and abdomen showed no flaps in the ascending aorta (Fig 1A), but an intussuscepted flap appeared in the aortic arch, obstructing all arch vessels (Fig 1B). A three-dimensional CT scan providing an intravascular view from the proximal aortic arch revealed that the intimal flap was inverted and invaginated into the distal aortic arch (Fig 2). On the basis of these findings, we made a diagnosis of Stanford type A acute dissection of the aorta with intimal intussusception caused by a circumferential intimal tear. Emergency surgery was done, and revealed the circumferential intimal tear at the level of the sinotubular junction and the absence of an intimal layer in the ascending aorta. The dissected tubular intimal flap was inverted and invaginated into the aortic arch. The ascending aorta was replaced with a Dacron graft. The patient’s postoperative course was uneventful, without any neurologic complications, and she was discharged in good condition at 18 days after her operation. Complete circular dissection of the aorta was reported for the first time by Bostroem1) in 1887. Aortic dissection

Double‐Patch Repair by a Bilateral Ventriculotomy for Postinfarction Ventricular Septal Defect

Repair of a postinfarction ventricular septal defect (VSD) is a challenging procedure with a high risk of postoperative residual shunt and subsequent mortality. This retrospective study aimed to assess a modified infarct exclusion technique with a biventricular approach.