Munehiro Saiki

Quadricuspid aortic valve associated with aortic stenosis and regurgitation.

A 75-year-old man with moderate aortic stenosis and regurgitation admitted due to heart failure underwent uneventful aortic valve replacement with a Carpentier-Edwards pericardial bioprosthesis valve. A quadricuspid aortic valve discovered incidentally during surgery consisted of 4 of different sizes and a supernumerary cusp between the right and noncoronary cusps. No coronary abnormality was involved. Resected cusps showed fibrotic thickening with calcification and no sign of previous inflammatory disease. Although quadricuspid aortic valve is a very rare anomaly, its potential for severe valve failure in adulthood should not be neglected.

Mycotic abdominal aortic pseudoaneurysm caused by a penetrating atherosclerotic ulcer: report of a case.

We report a case of mycotic abdominal aortic pseudoaneurysm caused by a penetrating atherosclerotic ulcer (PAU). An 81-year-old woman was admitted to a local hospital with fever and abdominal pain, and when her symptoms were not improved by antibiotics, she was referred to our department. Computed tomography (CT) and angiography showed a saccular aneurysm below the renal arteries, and an emergency laparotomy was performed because we suspected a mycotic abdominal aortic pseudoaneurysm. An abscess was found on the proximal side of the jejunum, caused by an aneurysm penetrating the serosa. We diagnosed a mycotic pseudoaneurysm after finding the anterior wall of the aorta penetrated by intense calcification. The pseudoaneurysm was resected with the abscess and the area was covered with a pedicled omental flap to prevent infection. An axillofemoral bypass was also done. The patient recovered well.

Single-Stage Endovascular Treatment Performed on Multiple Aortic Aneurysms in a Patient with Behçet’s Disease—Report of a Case

A 50-year-old male diagnosed with Behçets disease was referred to our department for stent graft treatment because of thoracic, abdominal, and right common iliac artery (CIA) aneurysms. He had a superior mesenteric artery aneurysm in 2005 that was treated with resection and bypass surgery through the radial artery. He later underwent four abdominal surgical procedures for conditions such as intestinal perforation and ileus. Stent graft treatment was performed. The postoperative course was uneventful; postoperative computed tomography (CT) showed no apparent endoleak, while that performed at 3 years post-discharge showed that the aneurysms had decreased in size.

Acute aortic dissection at 33 weeks of gestation with fetal distress syndrome

The present report describes a female patient, 33 weeks pregnant, who demonstrated complicated abnormal placenta formation and fetal distress, and who presented with an acute type A aortic dissection. The patient underwent an immediate cesarean section and hysterectomy followed by a successful emergency surgical aortic repair, thereby obtaining a favorable outcome for both mother and baby.

Outlet strut fracture and leaflet escape of Bjork–Shiley convexo–concave valve

Prosthetic valve fracture is a serious complication and may arise in patient post-valve replacement. We experienced an outlet strut fracture and leaflet escape of a Bjork–Shiley convexo–concave valve. We performed an emergency redo mitral valve replacement and successfully retrieved the fractured strut and escaped leaflet from superficial femoral artery and the abdominal aorta. The patient showed an uneventful postoperative recovery.

Two Cases of Thoracic Aortic Aneurysm with Right Aortic Arch: Comparison of Two Operative Strategies for Hybrid Thoracic Endovascular Repair

Hybrid TEVAR was performed in 2 patients with right aortic arch accompanied by Kommerells diverticulum and aortic aneurysm. In patient 1, total debranch + TEVAR was performed with 1-stage median sternotomy. In patient 2, total arch replacement and insertion of a peripheral elephant trunk were performed first, followed by TEVAR. No endoleaks or aortic events were observed in either case during the observation period, and both patients had good postoperative clinical courses. We report our experience with two such cases that were treated with two different methods of hybrid TEVAR, and discuss the merits and demerits of each treatment method.

Transparasternal transpericardial operation in the treatment of chronic empyema with bronchopleural fistula

A 78-year-old man with a lung destroyed by chronic empyema underwent pleuropneumonectomy, 4 months after open-window thoracostomy, via a transparasternal transpericardial approach. This approach is safe and effective in great vessel and bronchus dissection and applicable to cases of persistent chronic empyema such as our.

Outcomes of Anterolateral Thoracotomy With or Without Partial Sternotomy for Kommerell Diverticulum

BACKGROUND Kommerell diverticulum is a rare aortic arch anomaly. The indications for operative intervention and surgical strategy are still controversial. The standard surgical procedure at our institution is total aortic arch plus descending aortic replacement using anterolateral thoracotomy with partial sternotomy. The aberrant subclavian artery is reconstructed anatomically or extraanatomically. METHODS From 2002 to 2014, 6 patients (1 woman), aged 55 to 78 years, underwent graft replacement through an anterolateral thoracotomy or anterolateral thoracotomy with a partial sternotomy approach for Kommerell diverticulum. All patients underwent graft replacement of the descending aorta or total aortic arch plus descending aorta in addition to aberrant subclavian artery reconstruction. RESULTS No hospital deaths or major complications occurred. Recurrent nerve injury developed at discharge in 1 patient. All patients were well during the follow-up period (range, 11 to 116 months). CONCLUSIONS Kommerell diverticulum and its associated symptoms were surgically treated with acceptable outcomes.

A Case of Ischemic Cardiomyopathy with Refractory Lethal Arrhythmia Which Successfully Underwent the Implantation of Left Ventricular Assist Device

Association of Takotsubo cardiomyopathy (TC) and complete atrioventricular block(CAVB) is rare. We present interesting two cases of TC with CAVB having different clinical courses. A 75-year-old women presented with dyspnea. On admission, she developed CAVB with junctional escape rhythm on electrocardiogram (ECG) and acute heart failure. After the treatment with temporary pacing, she underwent coronary angiography and left ventriculography which showed apical akinesis with normal coronary arteries. Her ECG improved to normal sinus rhythm without AV conduction disturbance for a week. Echocardiography showed complete recovery of apical wall motion within one month. The 123 I-metaiodobenzylguanidine imaging (MIBG) presented reduction of uptake in the apical area after the improvement of apical wall motion. She had fairly good clinical course with standard therapy for heart failure and discharged without pacemaker implantation on the 14th day. The second case was a 56-year-old women admitted for syncope. On admission, she also presented CAVB with junctional escape rhythm on ECG and akinesis of the apical area in echocardiography. Her coronary artery was normal and apical wall motion improved gradually. The 123Ismethyliodophenylpentadecanoic (BMIPP) acid imaging also showed the reduction of fatty acid metabolism in apical myocardium. She had been managed under temporary pacing for a week and was implanted permanent pacemaker without the recovery of AV conduction.

Resection of a cardiac tumor extending into the inferior vena cava presenting as Budd-Chiari syndrome

This report describes the successful treatment of a case of cardiac adenocarcinoma with the clinical presentation as Budd-Chiari syndrome. Complete surgical excision of the atriocaval mass was successfully achieved under deep hypothermic circulatory arrest. Histopathological diagnosis of this tumor was tubular adenocarcinoma with positive immunostaining by carcinoembrionic antigen. Subsequent systemic search could not detect any evidence of extra-cardiac primary site and distant metastatic lesion. A 2-year follow-up without any adjuvant therapy revealed no sign of recurrence.