Soki Kurumisawa

Chylous Ascites after Abdominal Aortic Aneurysm Repair

A 73-year-old man was transferred for treatment of abdominal aortic aneurysm. He had no history of abdominal surgeries. Grafting between the infra-renal abdominal aorta and the bilateral common iliac arteries was performed. Proximal and distal cross clamps were applied for grafting. He developed chylous ascites on the 5th post-operative day, 2 days after initiation of oral intake. Fortunately, he responded to treatment with total parenteral hyper-alimentation for 10 days, followed by a low-fat diet. There was no recurrence of ascites.

Life- and limb-saving endovascular therapy in a patient with acute abdominal aortic occlusion.

A 79-year-old man developed severe bilateral ischemic symptoms in the lower limbs. Chest-abdominal-pelvic contrast computed tomography (CT) showed acute occlusion involving the abdominal aorta, and endovascular therapy (EVT) was used as emergency treatment. Two self-expandable stents placed in the thrombus area resulted in restoration of blood flow to the lower limbs, despite limited stent expansion, and movement of these limbs. Follow-up CT showed good stent expansion. The patient had a favorable recovery without additional surgery. This case suggests that EVT might be an additional option for acute abdominal aortic occlusion if surgery or thrombolytic therapies are not possible.

Unique nonstructural dysfunction of the omnicarbon valve: case report

BackgroundPannus formation may disturb the leaflet movement of the prosthetic valve.Case presentationA 61-year-old woman presented with exertional dyspnea. She had undergone mitral valve replacement with a bioprosthetic valve 31 years ago, which was replaced with a tilting disc valve 22 years ago. The present laboratory findings revealed hemolytic anemia. Echocardiography showed an increased mean pressure gradient through the mitral valve and moderate to severe regurgitation around the minor orifice of the tilting disc valve. She therefore underwent a third operation. Pannus formation was found on the prosthetic valve ring, but it did not obliterate the prosthetic valve orifice. After removing the valve, the posterior wall of the left ventricle was seen to be associated with thickened endocardium. A bileaflet valve was implanted. Postoperative echocardiography showed that the implanted valve functioned well.ConclusionsNonstructural dysfunction of the mechanical heart valve might occur long after operation. These changes are particularly observed with a tilting disc valve.

Successful surgical treatment of ruptured thoracic aortic aneurysm in pregnancy.

A 31-year-old woman who was 38-weeks pregnant was referred for surgery of a ruptured thoracic aortic aneurysm associated with aortic coarctation. Computed tomography showed a large thoracic aneurysm with pleural effusion as well as a fetus (Figure 1). Her family history was negative for cardiovascular diseases or sudden death. Under general anesthesia, she successfully underwent an emergency cesarean section by an obstetric team, and then aortic surgery was performed by our cardiovascular team. Cardiopulmonary bypass was established via a median sternotomy and an additional left anterior thoracotomy. The ascending aorta and right femoral artery were cannulated for cardiopulmonary bypass. A 1000-mL hemothorax was drained from the left pleural cavity. Coarctation of the aorta was observed proximal to the aneurysm. After deep hypothermic circulatory arrest, the aneurysm was replaced with a 22-mm Dacron graft. We chose a proximal anastomosis site on the ascending aorta, and the aortic coarctation was closed (Figure 2). The cardiopulmonary bypass time was 301min, cardiac ischemic time was 30min, and hypothermic arrest time was 30min. The postoperative course was uneventful for both the mother and the neonate.

Bioprosthetic aortic valve replacement 12 years after percutaneous aortic valvuloplasty in a young female adult with hope of pregnancy

A 26‐year‐old woman who had congenital aortic valve stenosis presented with exertional dyspnea. She had undergone percutaneous balloon aortic valvuloplasty 12 years previously at the age of 14. When she was 20 years old, she delivered a neonate by elective cesarean section at the 31st week of gestation because the mean pressure between the left ventricle and the ascending aorta was 52 mmHg.

Multiple papillary fibroelastomas in the right heart

Background: Cardiac multiple papillary fibroelastonas are rare. Methods and Results: A 70-year-old woman presented with an exertional dyspnea. A trans-thoracic echocardiogram showed a moving mass near the inferior vena cava in the right atrium. She underwent an operation for a cardiac tumor. A trans-esophageal echocardiogram during the operation showed a mass in the right ventricle, which had echo properties similar to the mass in the right atrium. The mass in the atrium was resected including the attached intima, and the mass in the ventricle was resected by the shave method. Her postoperative course was uneventful. A pathological examination showed that the two tumors were papillary fibroelastomas. Conclusion: A precise examination should be performed when a cardiac tumor is diagnosed to investigate the possibility of multiple lesions.

A case of asbestos-related constrictive pericarditis

A 78-year-old man presented with exertional dyspnea and lower leg edema for 3 months. He had a 25-year history of the exposure to asbestos, and pulmonary asbestosis was diagnosed 3 years ago. An echocardiogram and cardiac catheterization were compatible with constrictive pericarditis. He underwent pericardiectomy. On the right ventricle, the pericardium was firmly attached to the epicardium. Pathological examination confirmed the thickness of the pericardium and epicardium without specific findings indicating pathogeneses.

Delayed visceral ischemia induced by type B aortic dissection

A 56‐year‐old man presented with a sudden severe abdominal pain 13 days after the onset of type B acute aortic dissection. Chest computed tomography revealed type B aortic dissection, and the true lumen was narrowed by the expanding false lumen. Blood flow through the celiac trunk, superior mesenteric artery, and left renal artery was reduced. Blood flow through the distal abdominal aorta and bilateral femoral arteries was clearly recognized. Laboratory findings such as transaminases were rapidly worsening.