Junichi Koizumi

Transaortic mitral valve repair combined with a modified Bentall procedure in a patient with Marfan's syndrome: report of a case.

We report a case of transaortic mitral valve repair combined with aortic root and arch replacement in a patient with Marfan’s syndrome. Preoperative computed tomography and echocardiography showed acute aortic dissection (DeBakey type 1), severe aortic regurgitation, annuloaortic ectasia, and mild mitral regurgitation (MR). We performed artificial chordae implantation to the anterior mitral leaflet (AML) through the aortic root, followed by insertion of an aortic composite graft and replacement of the aortic arch. The patient is well 55 months after the operation, with minimal MR. We think that the transaortic approach is a good alternative for exposure and correction of the AML and its apparatus in special circumstances.

Artery Fistula Causing Aortic Regurgitation in Pulmonary Atresia With Ventricular Septal Defect and Major Aortopulmonary Collateral Arteries

We report a case of aortic regurgitation (AR), coronary artery-to-pulmonary artery (CAPA) fistula, pulmonary atresia with ventricular septal defect (PA/VSD), and major aortopulmonary collateral arteries (MAPCAS). As a result of coronary steal and AR, myocardial ischemia and ventricular dysfunction occurred. When the patient was 2 months old with a body weight of 2.7 kg, we performed fistula ligation, aortic valvuloplasty, unifocalization of the MAPCAS, and right ventricle-to-pulmonary artery shunting. After the operation, the AR volume reduced, and the patient was scheduled for repair.

Aortic translocation using the hemi-mustard procedure for corrected transposition.

The management of congenitally corrected transposition of the great arteries and associated lesions is frequently challenging. Restrictive ventricular septal defect and mild pulmonary stenosis are contraindications to the double switch procedure, including the atrial-Rastelli switch procedure, due to the production of postoperative left ventricular outflow tract obstruction. We describe a case of aortic translocation using the hemi-Mustard procedure after left ventricular training in order to prevent postoperative left ventricular outflow obstruction.

Repair of a simple total anomalous pulmonary venous connection coexisting with a persistent left superior vena cava

A simple total anomalous pulmonary venous connection (TAPVC) coexisting with a persistent left superior vena cava (PLSVC) is extremely rare. Connection of the PLSVC with the coronary sinus behind the left atrium induces coronary sinus dilatation. This reduces the free posterior wall space to which the common pulmonary vein is anastomosed for repairing the anomalous connection. Postoperative recurrent pulmonary venous obstruction (PVO) is the most important complication. To prevent PVO, sufficient tension-free anastomosis is necessary. When dilated, the coronary sinus becomes an obstacle for obtaining sufficient incision length in the left atrial cavity. We encountered two cases of a simple TAPVC with a PLSVC in infants weighing 1.8 and 2.9 kg, respectively. To obtain sufficient incision length, we extended the incision line to the right atrium for an atypical supracardiac TAPVC and incised from the left atrium to the coronary sinus via the right atrium for an infracardiac TAPVC. Moreover, we recreated the atrial septum with a rightward shift using a tanned pericardium in both cases. The postoperative courses were uneventful, without recurrent PVO.

Feeding artery of giant left atrial myxoma visualized on computed tomography.

For reprint information contact: Hajime Kin, MD Tel: 81 19 651 5111 ext 7408 Fax: 81 19 624 8384 Email: h_kin@imu.ncvc.go.jp Department of Cardiovascular Surgery, Iwate Medical University Memorial HeartCenter, 1-2-1, Chuoudori Morioka, 020-8505, Iwate Japan. A 45-year-old woman presented with cerebral infarction due to right internal cranial artery emboli. Transesophageal echocardiography revealed giant left atrial tumor. Computed tomography revealed left atrial tumor and its feeding artery from the left circumfl ex artery. Resection of the tumor and mitral valve annuloplasty were performed.

Transcatheter Coil Embolization of Single Coronary Artery Fistula Using the Occlusion Test

The case of a patient in whom hemodynamic and electrocardiographic studies using the occlusion test for coronary artery fistulas (CAF) were safely performed prior to catheter embolization is reported. A 1-year-old girl had a separate right coronary artery arising from a left single coronary artery that formed a significant coronary artery fistula to the right ventricle. Coronary steal by the large coronary artery fistula narrowed the left coronary artery. The right coronary artery branches could not be clearly identified due to an overlap with the fistula. Due to the long porous CAF, embolic procedures could cause serious complications. We confirmed the safety by performing an occlusion test of the CAFs proximal blood vessels. Following total occlusion of the CAF for 10 minutes, pulmonary arterial pressure and aortic blood pressure were not significantly changed. No bradycardia, atrioventricular block, or ST changes were observed. Coil embolization treatment was performed safely. For patients with long distal CAF complicated with a single coronary artery, myocardial ischemia and conduction system disorders can be identified by performing the occlusion test before embolization.

Total arch replacement in a patient with a tracheostoma through a reverse L-shaped partial sternotomy

A conventional median sternotomy in a patient with a tracheostoma is susceptible to postoperative mediastinitis or graft infection after total arch replacement (TAR). An optimal surgical procedure has still not been established to circumvent these complications in such patients. We report a successful case of a 74-year-old man with a tracheostoma who received TAR through a reverse L-shaped partial sternotomy. This incision was simple and enabled us to secure an adequate operative field similar to that of a conventional median sternotomy. The patient was discharged without any evidence of infection or any other complications.

Pulmonary Artery Plasty with Internal Thoracic Arterial Patch in Fontan Candidate

Pulmonary Artery Plasty with Internal Thoracic Arterial Patch in Fontan Candidate Junichi Koizumi1), Akio Ikai1), Tomoyuki Iwase1), Tatsuya Furutake1), Katsuyoshi Kanno4), Satoshi Nakano2), Wataru Soda2), Shin Takahashi2), Kotaro Oyama2), Takashi Kobayashi3), and Hitoshi Okabayashi1) Department of 1)Cardiovascular Surgery, 2)Pediatric Cardiology, 3)Anesthegiology, Memorial Heart Center, Iwate Medical University, Iwate, Japan 4)Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children’s Hospital, Shizuoka, Japan