Ichiro Matsumaru

Clinical and pathological features of degenerative mitral valve disease : billowing mitral leaflet versus fibroelastic deficiency

PURPOSE Degenerative mitral valve disease is distinguished with billowing mitral leaflet (BML) or fibroelastic deficiency (FED). The purpose of this study is to evaluate the clinical characteristics and the pathohistological differences between BML and FED. METHODS A total of 73 patients who diagnosed as degenerative mitral valve disease pathologically after mitral valve surgery for severe mitral regurgitation were enrolled. On the basis of echocardiographic features and gross appearances, they were classified as BML (9 cases) and FED (64 cases). RESULTS In the BML group, multiple segments of the leaflet showed billowing with elongated chordae. Therefore excessive valve tissue needed to be removed by multiple resection and suture. The FED patients had focal myxomatous changes with ruptured chordae, a single resection and suture was frequently employed. In pathological examination, the valve thickness of the BML was nearly twice as thick as the FED, and the mucopolysaccharide accumulation of the Spongiosa in the BML was over 50%, while 30% in the FED. CONCLUSION BML presents the characteristic valve thickening due to its abnormal production of mucopolysaccharide. Since excessive tissue was voluminous in the BML, high-grade plasty techniques, such as combination of multiple resection and chordal reconstruction were required.

Successful surgical repair for Emery–Dreifuss muscular dystrophy valvular disease with long-term follow-up

Emery-Dreifuss muscular dystrophy (EDMD) is an X-linked muscular dystrophy in which cardiac involvement can be serious. The disease progresses rapidly and the prognosis is strongly associated with cardiac involvement. We present the case of a 49-year-old man who was admitted with shortness of breath. Echocardiography revealed a huge right atrium and severe tricuspid regurgitation caused by annular dilatation and destruction of leaflets and chordae by pacemaker leads. Tricuspid valve replacement, right atrial plication and implantation of epicardial pacemaker leads were performed. The patient is in a good condition seven years after surgery. Cardiac transplantation is the desired therapy for valvular disease in EDMD cardiomyopathy, but this case indicates that valve replacement is also acceptable if performed with the appropriate timing.

Echocardiographic visualization and quantification of mitral complex during mitral repair for severe functional mitral regurgitation

From the Department of Cardiovascular Surgery, Nagasaki University Hospital, Nagasaki, Japan. Disclosures: Authors have nothing to disclose with regard to commercial support. Received for publication Feb 7, 2017; accepted for publication March 6, 2017; available ahead of print April 27, 2017. Address for reprints: Kikuko Obase, MD, Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan (E-mail: kobase@nagasaki-u.ac.jp). J Thorac Cardiovasc Surg 2017;154:1252-5 0022-5223/

Swinging Calcified Amorphous Tumors With Related Mitral Annular Calcification

36.00 Copyright 2017 by The American Association for Thoracic Surgery http://dx.doi.org/10.1016/j.jtcvs.2017.03.045

Characteristics and treatment strategies of mitral regurgitation associated with undifferentiated papillary muscle

Among cardiac calcified amorphous tumors, the mitral annular calcification-related calcified amorphous tumor is extremely rare. We herein describe 3 surgical cases of swinging calcified amorphous tumor with related mitral annular calcification. The clinical, echocardiographic, and pathophysiologic features are reported here together with a brief review of the literature.

Spiral suspension, a novel repair technique for severe functional tricuspid regurgitation

PurposeIn this report we review our experience of operations on mitral regurgitation associated with abnormal papillary muscles/chordae tendineae of the mitral valves and discussed the clinical characteristics, operative findings, and treatment strategies.MethodsUndifferentiated papillary muscle was defined as a hypoplastic chordae tendineae with anomalous formation of papillary muscles attached to the mitral valves directly. Consecutive 87 patients undergoing surgery for mitral regurgitation at our institution were reviewed and 6 of them had undifferentiated papillary muscle.ResultsThe underlying mechanism of regurgitation was prolapse at the center of the anterior leaflet in 3 cases and tethering, a wide area of myxomatous degeneration, and annular dilatation in one case, respectively. Five patients underwent mitral valve plasty and 1 patient received replacement. Anomalous formation of chordae tendineae was corrected by resection and suture with transplantation at the tip of the leaflet to which abnormal chordae were attached in 2 cases, while resection and suture with chordal shortening was performed in 1 case, and chordal reconstruction using artificial chordae was employed in 2 cases. There was no operative death, and postoperative echocardiography showed no residual regurgitation in any of the cases.ConclusionsMitral regurgitation associated with undifferentiated papillary muscle resulted from prolapse or tethering and impaired flexibility of leaflets. It was possible to successfully treat the patients by mitral valve plasty unless complex congenital cardiac malformation coexisted. Detailed examinations of attached papillary muscle by echocardiography and intraoperative inspection are necessary and surgical techniques should be selected appropriately in each case.

Successful repair of mesenteric ischemia in acute type A aortic dissection

From the Department of Cardiovascular Surgery, Nagasaki University Hospital, Nagasaki, Japan. Disclosures: Authors have nothing to disclose with regard to commercial support. Received for publication Sept 6, 2017; revisions received Dec 31, 2017; accepted for publication Jan 16, 2018; available ahead of print March 9, 2018. Address for reprints: Kikuko Obase, MD, Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan (E-mail: kobase@nagasaki-u.ac.jp). J Thorac Cardiovasc Surg 2018;156:649-52 0022-5223/

Valve-sparing aortic root re-implantation for commissural detachment with fibrous strand

36.00 Copyright 2018 by The American Association for Thoracic Surgery https://doi.org/10.1016/j.jtcvs.2018.01.082

Afebrile Pannus-Induced Blood Culture–Negative Mechanical Valve Endocarditis

A 64-year-old man with acute type A aortic dissection had superior mesenteric artery occlusion and marked metabolic acidosis. By an emergency laparotomy, bypass grafting from the left external iliac artery to the superior mesenteric artery was performed with great saphenous vein. After deep sedation and antihypertensive management in the intensive care unit, the acidosis resolved, and central repair was carried out. At 10 months postoperatively, his course has been uneventful without mesenteric complications.

The efficacy of low prime volume completely closed cardiopulmonary bypass in coronary artery revascularization.

Both aortic valve commissural detachment and commissural fenestration are rare causes of aortic regurgitation. In general, aortic valve replacement is the mainstay treatment for aortic regurgitation caused by commissural detachment or commissural fenestration. We herein describe valve-sparing aortic root re-implantation and aortic valve repair for aortic regurgitation and aortic root dilatation in an extremely rare case accompanied by both commissural detachment and commissural fibrous strand of fenestrated cusp.