Yasuhito Sakano

Clinical experience with the Bicarbon heart valve prosthesis.

BacgroundWe have previously reported mid-term results of a study, which ended in January 2000, on the Bicarbon valve. The study concluded that the valve showed excellent clinical results, associated with a low incidence of valve-related complications. In the present study, the same patients were prospectively followed for an additional 5 years.MethodsForty-four patients had aortic valve replacement (AVR), 48 had mitral valve replacement (MVR), and 13 had both aortic and mitral valve replacement (DVR). The mean age of the 105 patients was 61.2 ± 11.3 years. The mean follow-up was 6.1 ± 1.9 years with a cumulative follow-up of 616 patient-years.ResultsThere were 5 early deaths (4.7%: 4 in the AVR group and 1 in the MVR group) and 21 late deaths (3.4%/patient-year: 5 valve related deaths and 16 valve unrelated deaths). Survival at 8 years was 75.2 ± 7.0% in the AVR group, 76.6 ± 6.2% in the MVR group, and 55.4 ± 16.1% in the DVR group. The linearized incidence of thrombo-embolic complications, hemorrhagic complications, and paravalvular leaks in all patients was 0.65 ± 1.48%, 0.81 ± 1.69%, and 0.16 ± 0.54%/patient-year respectively. No other complications were observed.ConclusionThe Bicarbon prosthetic heart valve has shown excellent long-term clinical results, associated with a low incidence of valve-related complications.

Aorto-Right Atrium Fistula Caused by Detachment After Bentall's Operation: Report of a Case

A 70-year-old woman was admitted to our hospital for treatment of right heart failure 16 years after undergoing Bentalls operation with a Cabrol shunt procedure. Various investigations showed detachment of the coronary artery and graft. We surmised that the heart failure was caused by a massive left to right shunt between a pseudoaneurysm of the wrapping aortic wall and the right atrium. Intraoperatively, we found a small fistula between the wrapping aortic wall and the right atrium, with complete closure of Cabrol shunt. We performed regrafting of the ascending aorta and reconstruction of the coronary ostium under cardiopulmonary bypass. The patient had an uneventful postoperative course. Detachment of the coronary ostium is a common long-term complication of Bentalls operation, but a Cabrol shunt between the wrapping aortic wall and the right atrium rarely causes congestive heart failure. A fistula between a pseudoaneurysm and the right atrium is even more unusual.

Twenty-two year experience with the omniscience prosthetic heart valve.

This study was designed to evaluate the long-term clinical results of the Omniscience tilting disc valve. Omniscience valves were implanted in 51 patients (mean age, 50 ± 10 years); 18 had aortic valve, 24 had mitral valve, and 9 had both aortic and mitral valve replacements. Oral warfarin potassium and dipyridamole were prescribed as our anticoagulant therapy. Preoperatively, 42 patients were in New York Heart Association class III or IV, and 23 of 25 surviving patients were in class I or II after operation. There were 2 (3.9%) early deaths and 23 late deaths (3.5 ± 0.7% per patient-year). Cardiac related mortality including congestive heart failure, sudden death, and thromboembolism, and hemorrhagic complications were seen in 16 patients. Overall survival at 10, 15, and 20 years was 77 ± 6%, 62 ± 7%, and 46 ±7%, respectively. Thromboembolic complications were seen in 5 patients, for a rate of 0.8 ± 0.3% per patient-year; similarly, hemorrhagic complications were also seen in 5 patients. Nonstructural prosthetic valve dysfunction was seen in 4 patients, for a rate of 0.6 ± 0.3% per patient-year, and sudden death was seen in 2, a rate of 0.3 ± 0.2% per patient-year. The Omniscience prosthesis demonstrated excellent postoperative clinical status with low rates of valve related complications.

Clinical features of third open-heart valve surgery at the same valve position.

OBJECTIVE Recently, there has been an increase in case of repeated open-heart valve surgery and the clinical results of the second surgery are only slightly worse than those of the first surgery. However, clinical results of the third open-heart valve surgery at the same position are rarely reported. Clinical features of third open-heart valve surgery at the same position are discussed in this study. METHODS Between 1995 and 2004, 16 patients underwent third open-heart valve surgery at the same valve position under cardiopulmonary bypass. The average age of the 16 patients, 12 females and 4 males, was 56 +/- 15 years. Clinical features of the 16 cases were retrospectively analyzed. RESULTS Mechanical valve nonstructural dysfunction was the most common valve malady, followed by bioprosthetic valve dysfunction. The duration of surgery from skin incision to establishment of the cardiopulmonary bypass was 94 +/- 42 minutes. Myocardial ischemia time was 137 +/- 38 minutes and extracorporeal circulation time was 212 +/- 82 minutes. Early mortality was seen in 1 patient (6.25%) and late mortality was seen in 1 patient. CONCLUSION Mechanical valve nonstructural valve dysfunction leads to repeated valve surgery. The clinical results of the third open-heart valve surgery at the same valve position are acceptable, and the mid-term survival is excellent.

Left ventricular apical and atrial appendage thrombus with hypertrophic cardiomyopathy in sinus rhythm : a case report

A 47-year-old female with a history of untreated hypertension and diabetes mellitus was referred because of a left ventricular echocardiographic mass with congestive heart failure. At the time of admission, she had already had a cardio-embolic stroke with loss of recent memory and slight paralysis of the right upper arm. It was difficult to distinguish between thrombus and tumor. However, her clinical condition required surgical resection as soon as possible. We performed cardiac CT to evaluate the coronary arteries and to scan the mass at the left ventricular apex. This CT evaluation revealed another mass at the left atrial appendage. Thus, these two masses were highly suggestive of thrombi. Subemergency surgical resection of the two masses and a part of the myocardium at the left ventricular apex was successfully performed. The pathological results showed that both the mass in the left ventricular apex and the mass in the left atrial appendage were thrombi, and the myocardial disarray confirmed the echocardiographic diagnosis as hypertrophic cardiomyopathy.

Secondary pneumothorax induced by metastatic angiosarcoma

A 56-year-old man presented with loss of consciousness. He was referred to the nearest hospital where pericardial drainage was performed for hemodynamic deterioration caused by pericardial effusion. He remained in an unstable hemodynamic condition and was transferred to our hospital to stop bleeding from the pericardial cavity. A hemorrhagic mass was observed on the right atrium. The tumor was resected and the right atrium was repaired with autologous pericardium (Figure 1a). Angiosarcoma of the right atrium was confirmed by pathological examination (Figure 1b). Radiation therapy to the heart was initiated 2 weeks after the surgery, without chemotherapy. The patient developed a left pneumothorax 3 months after the surgery. Multiple bullous changes Asian Cardiovascular & Thoracic Annals 2017, Vol. 25(7–8) 559–560 The Author(s) 2017 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0218492317721587 journals.sagepub.com/home/aan

Operation for infected thrombus in the false lumen after ascending aortic repair for acute aortic dissection

Background:Aortic dissection requires operation for some reasons.Methods:We experienced a case for infected thrombus caused by Escherichia coli in the false lumen of the descending aorta 3 years af...

Predictive Factors for Mortality and Morbidity of Ruptured Abdominal Aortic Aneurysm Repair

Purpose: This study aimed to determine the morbidity and mortality of infrarenal ruptured abdominal aortic aneurysm (rAAA) repair, and to investigate the changes in perioperative laboratory values, as well as clarify the specific independent predictive factors for mortality and morbidity. We retrospectively evaluated patients who were treated in Jichi Medical University Hospital. Methods: A consecutive fifty-six patients with rAAA between April 2007 and August 2010 were studied. The possible predictive values of various patient-related variables on outcomes (mortality, major morbidity and renal insufficiency) were assessed by univariate and multivariate analysis. Results: The overall in-hospital mortality was 16.1%. In univariate logistic analyses, lactate dehydrogenase, alanine aminotransferase, as well as pre-operative and post-operative serum creatinine levels were significantly related to mortality. Blood transfusion volume, white blood cells and C-reactive protein levels were significantly related to major morbidity. Intraoperative blood loss, white blood cells, C-reactive protein levels, lactate dehydrogenase and pre-operative serum creatinine levels were significantly related to renal insufficiency. Conclusions: Emergency open repair can be safely performed in patients for infrarenal rAAA. In particular, we identified specific independent predictive factors of clinical examination and laboratory studies for mortality, major morbidity and renal insufficiency.