Takahiro Shojima

Dysfunction of an ATS valve in the aortic position: the first reported case caused by pannus formation.

A 64-year-old woman underwent aortic valve replacement with a 21-mm Advancing The Standard (ATS) open-pivot mechanical heart valve for bicuspid aortic valve stenosis. In addition to the appearance of a new cardiac murmur, echocardiography performed 3 years after surgery showed a high pressure gradient across the ATS valve and a reduction in the valve orifice area. Cineradiography of the valve revealed restricted leaflet opening. Subsequent multidetector-row computed tomography clearly demonstrated pannus overgrowth on the inflow aspect of the ATS valve. During a repeat operation, subvalvular overgrown pannus was confirmed and the ATS valve was replaced with a bioprosthetic valve. This is the first reported case of prosthetic valve dysfunction resulting from pannus formation in a patient with an ATS valve in the aortic position.

Infection management in a patient with a left ventricular assist device : a case report of long-term cefazolin sodium hydrate administration

A 55-year-old woman suffered from a bloodstream infection (Staphylococcus aureus), which originated from pump inflow and outflow skin exits, from 4 months after a parocorporeal left ventricular assist device (LVAD) had been implanted. In addition to local irrigation, repeated administration of a weekly unit of cefazolin hydrate was temporarily effective, but fever frequently recurred. Because short-term antibiotic administration had limited effectiveness, a much longer-term course of cefazolin was begun at 14 months post-LVAD implantation and was planned to continue until future transplantation. Unfortunately, the patient died from a cerebral embolism at 19 months after LVAD implantation; long-term consecutive cefazolin administration had suppressed the infection for over 5 months without side effects. To treat intractable LVAD-associated bloodstream infection, long-term administration of a narrow-spectrum beta-lactam drug is an effective option.

Inflammatory reaction of a pericardial foreign body after cardiac surgery

A 74-year-old man, who had undergone an aortic valve replacement for aortic regurgitation at the age of 57 and atrioventricular node ablation for refractory paroxysmal atrial flutter and concurrent pacemaker implantation at the age of 65, was admitted to our hospital due to fatigue and exertional dyspnea. He was diagnosed as constrictive pericarditis by cardiac catheterization, which has shown a dip-and-plateau sign of ventricular diastolic pressure. Subsequently, pericardiectomy was performed. At postoperative period, however, elevated levels of C-reactive protein (CRP) were sustained (4.5 to 12.0 mg/dL) and his symptoms were not improved. Whereas there was an unclear lesion evident on the chest X-ray as it overlapped the cardiac silhouette (Figure 1A), the computed tomography (CT) scan and three-dimensional (3D) reconstruction revealed a characteristic whirl-like radio-opaque foreign body, suggesting the retained surgical gauze pad (Figure 1B, C, and F: yellow arrows; Supplementary Data). At the same location, 18F-fluorodeoxyglucose (FDG)-positron emission tomography combined with CT or 3D-CT demonstrated intense FDG uptake in the foreign body, indicating an inflammatory reaction (Figure 1D, E, and G: red arrows; Supplementary Data), which we decided to surgically remove. The foreign body was identified as gauze without abscess (Figure 1H). After removal of the foreign body, his symptoms were diminished and CRP levels decreased from 12.0 to 2.6 mg/dL. The patient was discharged without other events. Cotton gauze may lead to exudative inflammatory reaction and have catastrophic implications for patient.

Characterization of SMAD2 Activation in Human Thoracic Aortic Aneurysm

Objective: Thoracic aortic aneurysm (TAA) reflects the local expansion of the thoracic aorta; the underlying causal molecular mechanism of TAA is not well understood. Recent studies have shown the importance of transforming growth factor beta (TGFβ) signaling in Marfan and Loeys–Dietz syndromes; however, its role in non-familial, non-syndromic TAA remains unclear. Materials and Methods: We performed histochemical and immunohistochemical analyses for activated (phosphorylated) SMAD2 (P-SMAD2) as an indicator of TGFβ signaling activities in the ascending TAA tissue as well as in the ascending aortic tissue with a normal diameter obtained from 7 patients without any clinical findings suggesting familial or syndromic TAA. Results: TAA samples showed a higher P-SMAD2-positive area than samples with a normal diameter. P-SMAD2 signal was higher in the outer zone of the aortic and TAA walls. Within the TAA tissue, P-SMAD2 staining showed the following two distinct patterns: layer-like staining at the border of the medial layer and the thickened intima and a spot-like staining within the medial layer surrounding the microvessels. Conclusion: These findings suggested that TGFβ signaling is activated in several distinct histopathological contexts in TAA, suggesting a complex role of TGFβ.

Double Right Atrial Blood Cysts

Blood cysts are exceedingly rare benign cardiac tumors, generally involving the cardiac valves. They are found mainly in the first month of life and in children and are very uncommon in adults. We present a rare case of double right atrium blood cysts, incidentally detected by transthoracic echocardiography in an 85-year old patient.