Hiroya Minami

Primary osteosarcoma of heart with severe congestive heart failure

We present a case report on a 54-year-old woman with extraskeletal osteosarcoma of the left atrium featuring severe congestive heart failure. We resected the tumor, which occupied the left atrium and had widely infiltrated the atrial wall, but the patients died of the tumor 9 months after surgery. This is to our knowledge the 32nd case of cardiac osteosarcoma ever reported.

Aortic aneurysm and aortic regurgitation following aortic valve replacement due to Takayasu's arteritis

A 26-year-old man who underwent aortic valve replacement for aortic regurgitation due to Takayasus arteritis 2 years earlier experienced left amaurosis persisting for some minutes. Computed tomography showed aneurysmal dilation of the ascending aorta to a diameter of 60 mm and occlusion of the left carotid artery. Cardiac echography showed perivalvular leakage. Following administration of a calcium antagonist, the patients amaurosis subsided and brain bloodstream scintigraphy showed no abnormalities. We resected the aneurysm instead of using Bentalls operation. Following an uncomplicated postoperative course, the patient was discharged 21 days after surgery and echocardiography has shown no perivalvular leakage to date.

Aortic regurgitation caused by rupture of the abnormal fibrous band between the aortic valve and aortic wall

This report documents the sudden onset of aortic regurgitation (AR) by an exceptional cause. A 68-year-old woman suddenly experienced general fatigue, and AR was diagnosed. One year later, we performed aortic valve replacement. At surgery, three aortic cusps with a larger noncoronary cusp had prolapsed along with a free-floating fibrous band that had previously anchored the cusp to the aortic wall. Its rupture had induced the sudden onset of AR. There was no sign of infectious endocarditis. We performed successful aortic valve replacement.

Surgical removal of an intravascular ultrasonography catheter captured in a stent after percutaneous coronary intervention

A-79-year-old woman underwent percutaneous coronary intervention (PCI) to the right coronary artery (RCA) for effort angina, followed by intravascular ultrasonography (IVUS) to ascertain stent expansion. The IVUS catheter became entangled in the stent and could not be withdrawn from the outside. The patient was transferred to our hospital for its surgical removal. For the emergent surgery, we opened the stent region in the RCA and directly removed the IVUS catheter with the twisted stent. Additional coronary artery bypass grafting (CABG) involving three vessels was performed. She was discharged 42 days after surgery.

Perivalvular leakage 25 years after initial mitral valve replacement with a Björk-Shiley prosthesis

An 80-year-old woman had undergone initial mitral valve replacement using a Björk-Shiley mechanical valve owing to mitral stenosis 25 years earlier. Suddenly, she had anemia and an increased lactic dehydrogenase (LDH) level. Transesophageal echography (TEE) showed perivalvular leakage. In a redo operation, two side-by-side stitches of the valve on the posterior annulus were loosened without cutting and the sewing cuff at that site was floated over the annulus, leading to the perivalvular leakage. The valve was easily removed; and round, hard, degenerative calcified tissue composed of remnant mitral valve in the suture site during the initial operation was found just under the sewing cuff. After resection of this calcified round tissue, a 25-mm bioprosthesis was put in place. Her postoperative recovery was uneventful, and 47 days after surgery she was discharged without perivalvular leakage or anemia.

Modified Ross procedure with stentless bioprosthesis and pericardial xenograft for the right ventricular outflow tract: Usefulness of autologous pericardial patch for hemostasis

A 31-year-old man with severe aortic regurgitation due to a defective bicuspid valve underwent surgery using modified Ross procedure. The right ventricular outflow tract (RVOT) was reconstructed with a 25 mm stentless xenograft valve sutured with a rolled equine pericardium. Oozy bleeding from the RVOT was controlled with an autologous pericardial patch and fibrin glue. Postoperative echocardiography showed no aortic regurgitation. No blood transfusion was required.

Impending rupture in an aortic arch aneurysm by Candida infection

A 68-year-old man was hospitalized with the complaints of left back pain and fever. He had a history of using steroids to treat uveitis for about thirty years. Computed tomography on the chest demonstrated an impending rupture in an aortic arch aneurysm, which was consequently surgically excised. Candida albicans was identified in the wall of the aneurysm, so fluconazole and itraconazole were administered. The patient was discharged at 120 days after surgery without recrudescence of the candida. To our knowledge, this is the fifteenth case of a successfully treated aneurysm caused by candida infection.

Successful operation for mitral regurgitation in a patient with Gilbert’s syndrome

A 72-year-old woman complaining of dyspnea on effort was diagnosed as having mitral regurgitation (MR). Asymptomatic jaundice had initially been noticed during primary school, and an examination had shown hyperbilirubinemia. After the diagnosis of constitutional jaundice, she had remained well without further examination or medical treatment. Laboratory data showed a total serum bilirubin (TB) level of 12.2 mg/dl and a direct bilirubin level of 0.6 mg/dl. Transesophageal echocardiography showed severe MR, and we replaced the mitral valve. Postoperatively, genetic analyses identified constitutional jaundice as Gilbert’s syndrome with Y486D mutation. The TB level gradually decreased. Four years after operation she is doing well with moderate hyperbilirubinemia and a TB level of 5 mg/dl. She is free from heart failure.

A Case of Two-Stage Operation for Distal Arch Aortic Aneurysm with Occluded Right Middle Cerebral Artery

症例は68歳,女性.嗄声を主訴に近医耳鼻咽喉科を受診し,精査により最大短径60mmの遠位弓部大動脈瘤を指摘された.術前検査で右中大脳動脈閉塞による安静時の脳血流低下および脳血流予備能の低下が認められたため,胸部大動脈瘤手術に先立って右浅側頭動脈-中大脳動脈吻合術を行った.脳外科手術後18日目の脳血流シンチにて脳血流の改善を確認したのち,22日目に全弓部大動脈人工血管置換術を施行した.術直後から24ヵ月後の現在まで神経学的合併症はなく良好に経過している.本症例では浅側頭動脈-中大脳動脈吻合術を先行させ,二期的に胸部大動脈瘤手術を行うことで胸部大動脈瘤の周術期の虚血性脳合併症を回避することができた.

Staged Operation for a Patient with Ischemic Heart Disease and Abdominal Aortic Aneurysm Complicating Idiopathic Thrombocytopenic Purpura

症例は62歳,男性.60歳時に特発性血小板減少症(ITP)と診断され,副腎皮質ステロイドを投与されていた.経過中に最大短径53mmの腹部大動脈瘤を指摘され手術目的で入院した.術前心筋シンチで虚血所見を認めたため冠動脈造影を行ったところ,冠動脈バイパス術の適応となる3枝病変を認めた.入院時血小板数が2.1万/μlであったので,術前5日間γ-グロブリン投与と術中血小板輸血を併用し心拍動下4枝冠動脈バイパス術を行った.出血合併症なく,術後14日目に退院した.2回目入院時の血小板数は4.6万/μlと減少を認めたため,同様にγ-グロブリン療法を施行した.腹部大動脈瘤人工血管置換術を行い,合併症なく術後11日目に退院した.本症例はITPを合併する患者に対し,心大血管手術の二期的手術を行った初の報告である.