Takao Ida

Simple method for determining proper length of artificial chordae in mitral valve repair

A simple method for determining the length of artificial chordae in mitral reconstructive operations is described. A small tourniquet is used for fine adjustment of the length of polytetrafluoroethylene stitches before tying them during leaking test. We have used this technique in 10 consecutive patients with anterior mitral leaflet prolapse since August 1992. Intraoperative transesophageal echocardiography revealed no or only trace mitral regurgitation after valve repair in all cases. This method minimized the time of determining the proper length of artificial chordae and achieved good results.

Right-Sided Partial Sternotomy for Minimally Invasive Valve Operation: “Open Door Method”

A simple technique for minimally invasive valve operations is described. With a 10-cm midline skin incision, excellent exposure of both the mitral and aortic valves is achieved through a right-sided partial sternotomy, which enables us to perform easy repair or replacement of these valves.

The successful surgical repair of a left ventricular-right atrial communication and aneurysm of the mitral valve caused by infective endocarditis : report of a case

We report herein the case of a 42-year-old man who developed a left ventricular-right atrial communication and aneurysm of the mitral valve caused by infective endocarditis, which was associated with aortic regurgitation. Based on the findings of congestive heart failure, prolongation of the PR interval, and the added threat of rupture of the mitral aneurysm, surgical treatment was decided upon as the best course of action. The aortic and mitral valves were replaced with prosthetic mechanical valves, and the septal communication was simultaneously closed with a patch. The patients postoperative course was uneventful and he has been in good health since. Thus, we believe that aggressive surgical intervention for complicated lesions such as those seen in our patient may be life-saving, even in the presence of inflammatory signs.

Etiology of aortic valve disease and recent changes in Japan:a study of 600 valve replacement cases

BACKGROUND Recent studies on the etiology of aortic valve disease in the US showed a decrease in rheumatic valve disease and an increase in age-related degenerative disease. The purpose of this study was to describe the etiology of aortic valve disease and its temporal changes in Japan, based on a large number of cases. METHODS The medical charts of all patients who underwent aortic valve replacement at our institute between 1977 and 1999 were reviewed. Among the 600 patients analyzed, 213 (36%) had pure aortic stenosis, 265 (44%) had pure aortic regurgitation, and 122 (20%) had combined stenosis and regurgitation. RESULTS The causes were rheumatic change (49%), degenerative change (19%), bicuspid valves (18%), infective endocarditis (5%) and others (9%). Rheumatic disease continued to be the most common cause of aortic stenosis, but its frequency decreased from 100% in 1977-1979 to 37% in 1995-1999. In contrast, the frequency of degenerative change among stenotic valves increased recently from 11% in 1990-1994 to 30% in 1995-1999. Similarly, rheumatic disease remained to be the leading cause of aortic regurgitation, with a decline in frequency from 46% in 1985-1989 to 27% in 1995-1999. The percentage of degenerative change among regurgitant valves did not change appreciably. CONCLUSIONS There was a shift in the causes of aortic valve disease, with a decrease in rheumatic disease and an increase in degenerative disease. This trend was similar to that observed in the US. These findings suggest the increasing importance of aortic valve disease due to degenerative change.

Cardiac pseudoaneurysm coupled with a rupture of the papillary muscle complicating myocardial infarction.

As a complication of myocardial infarction, dual rupture of the left ventricular myocardium and the papillary muscle is a rare condition. In such a case, the heart is predisposed to reduced output because of unloading of the ventricle during systole, resulting in the patient being in danger of deteriorating into a severe state or dying suddenly from cardiogenic shock.We report a rescued case of a 65-yearold woman, who had cardiogenic shock due to left ventricular pseudoaneurysm, coupled with partial rupture of the posteromedial papillary muscle three weeks after posterior myocardial infarction. Emergent left ventriculography revealed a large aneurysmal cavity and regurgitation towards the left atrium.The patient underwent emergent aneurysmectomy with mitral valve replacement.

Right Atrial Isolation for Atrial Fibrillation Associated With Atrial Septal Defect

Two patients with atrial fibrillation associated with an atrial septal defect underwent simultaneous surgical correction of the atrial septal defect and right atrial isolation. The right atrium was surgically isolated while the continuity with the sinoatrial node was preserved in the remainder of the heart. After the operation, the patients maintained normal sinus rhythm for 99 and 65 months. Thus, right atrial isolation offers an alternative to the current surgical treatment for atrial fibrillation associated with an atrial septal defect.

Pseudoaneurysm of the Saphenous Vein Graft Related to Artificial Rubber Pericardium: A Case Report

Pseudoaneurysm is an unusual complication of coronary artery bypass grafting. Such aneurysms are caused by technical surgical failures, or inflammation of the sternum and medi astinum following sternotomy observed as an early or mid-term complication of cardiac surgery. This case was an 80-year-old man with a piece of artificial rubber pericardium used for complete closure of the pericardium. A large pseudoaneurysm developed in the body of the saphenous vein graft 15 years after surgery. The old rubber synthetic pericardium was severely degenerative, which induced inflammation and disrupted the saphenous vein graft.

Reoperative minimally invasive axillocoronary artery bypass to the obtuse marginal branch

A 73-year-old man was admitted with unstable angina, having severe coronary artery disease involving 3 vessels. He had undergone coronary artery bypass grafting to the left anterior descending artery and the obtuse marginal branch using saphenous vein grafts in 1979. Computed tomography showed severe calcium deposition and atherosclerosis in the ascending and descending aorta. We conducted axillocoronary artery bypass to the obtuse marginal branch and left internal thoracic artery as an in situ graft to the left anterior descending artery without cardiopulmonary bypass. Grafts were satisfactory and clinical results good.

Mid-Term Results of the Use of Radial Artery Graft for Coronary Artery Bypass (Radial Artery Graft Versus Saphenous Vein Graft).

術後1年以上経過した左回旋枝もしくは対角枝に橈骨動脈を用いたCABG134例を対象に術後中期遠隔成績を大伏在静脈と比較し検討した.平均観察期間は2年4ヵ月.RAは108本,SVGは42本をこの領域にバイパスした.吻合部位はRA群がPLに69本,OMに29本,DBに10本のバイパスを施行した.SVG群はそれぞれ26本,14本,2本であった.早期グラフト開存率はRA群では97.9%,SVG群では91.7%であった.術後1年ごとのTMTによる評価ではRA群では99.0%が,SVGでは90.9%が陰性であった.冠動脈造影での開存率はRA群では92.9%で,SVG群では50.0%であった.左回旋枝,対角枝に対するCABGのグラフトとしてRAは有用と考えられた.

Treatment of Dissecting Aortic Root Aneurysm Complicated by Abscess after Valve Replacement

A 41-year-old man with a prosthetic aortic valve developed endocarditis with perivalvular leakage, formation of an abscess, and left ventricular-aortic discontinuity, 16 months after aortic valve replacement. Moreover, he developed a complicated huge dissecting ascending aortic aneurysm with thrombotic occlusion of the right coronary artery. Successful repair of this complicated aortic root lesion was achieved using a composite valved graft and employing coronary bypass grafting.