Yoshikazu Goto

Long-Term Thrombosis after Transvenous Permanent Pacemaker Implantation

To assess the efficacy of prophylactic administration of anticoagulant and antiaggregant drugs to prevent venous thrombosis after long‐term transvenous permanent pacemaker implantation, venograms were performed in 100 consecutive patients at the elective replacement of the pacemaker. Mean follow‐up period after initial transvenous permanent pacemaker implantation was 6.0 years. The venograms demonstrated normal in 77 patients. The remaining 23 venograms showed venous stenosis in 11 patients and total obstruction in 12 patients. Twenty‐one of these 23 patients had venous collateral circulation. No difference was found in the incidence of venous abnormalities according to the route of entry, the lead insulation, the total number of the implanted leads, and anticoagulant and antiaggregant drugs. All these patients have remained asymptomatic. In conclusion, the incidence of venous thrombosis after long‐term transvenous pacing is 23% and the causes of venous thrombosis may be endothelial trauma and underlying venous stenosis. As this article describes a retrospective limited study, we cannot find the efficacy of prophylactic administration of anticoagulant and antiaggregant drugs to prevent venous thrombosis formation after transvenous permanent pacemaker implantation. Further prospective study will be needed to assess the efficacy of prophylactic administration of anticoagulant and antiaggregant drugs.

Surgical treatment of the coronary artery to pulmonary artery fistulas in adults.

Coronary artery to pulmonary artery fistula (CA-PAF) is a rare congenital anomaly. The purpose of this retrospective study was to analyze 11 adult patients with CA-PAFs treated surgically, and to evaluate the surgical management and long-term results. There were no surgical deaths and all patients survived the follow-up periods (mean 7.2 years). All symptomatic patients improved their New York Heart Association functional class. As surgical correction is safe and effective, with good long-term results, all the patients with CA-PAF in adults can be candidates for surgery to prevent life-threatening complications.

Venous aneurysm of the cephalic vein: Report of a case

We herein report the rare case of a 41-year-old Japanese woman in whom a venous aneurysm in the left cephalic vein was excised under local anesthesia. Histological examination revealed significant diminution in the number and size of muscle and elastic fibers in the aneurysm wall. Conceivably, a combination of endophlebohypertrophy and a congenital focal defect of the elastic and muscle fibers might have contributed to the development of this venous aneurysm.

Transiliac vein approach to a permanent pacemaker implantation after aortic valve reoperation

This article describes the case of a 71 ‐year‐old woman in whom a permanent pacemaker implantation was performed through an iliac vein because of superior vena cava obstruction after aortic valve reoperation. During a 6‐month follow‐up, the patient did well and the pacemaker performance was satisfactory.

A localized fibrous tumor (mesothelioma) in the mediastinum: Report of a case

We report herein the rare case of a 51-year-old Japanese woman who underwent thoracotomy for a mass in the mediastinum which was found to be a benign localized fibrous tumor, otherwise known as a mesothelioma. The clinical behavior of this tumor is thought to be unpredictable, and therefore we emphasize that long-term follow-up of patients with localized fibrous tumors in necessary, even if the histological features are benign.

Inhibitory effect of methylene blue-induced photooxidation on intimal thickening of vein graft.

BACKGROUNDnWe have previously speculated that methylene blue-induced photooxidation of adventitial surface for 5 minutes can completely inhibit the intimal and medial growth of surgically prepared saphenous vein in vitro. In this study, inhibitory effect of methylene blue-induced photooxidation on intimal thickening of vein graft in vivo was investigated.nnnMETHODSnJugular vein grafts were photooxidized in 0.01% methylene blue solution for 5 minutes, and interposed into arterial circulation for 4 weeks in rabbits. Vein grafts were studied by morphometry and immunohistochemistry.nnnRESULTSnThe intimal thickening of photooxidized vein grafts were suppressed significantly compared with those in the nonphotooxidized group. Proliferated cell nuclear antigen (PCNA) index (total PCNA-positive cells/total cell count x 100%) of vein graft was significantly higher in the nonphotooxidized group than those in the photooxidized group.nnnCONCLUSIONSnMethylene blue-induced photooxidation is effective in the inhibition of intimal thickening of vein graft interposed in the arterial circulation for 4 weeks in vivo.

Hypoproteinemia caused by tricuspid regurgitation: Report of a case

A case of tricuspid regurgitation (TR) complicated by severe hypoproteinemia is presented herein. A 68-year-old man who had undergone coronary artery bypass grafting (CABG) for postinfarction angina suffered repeated inferior myocardial infarction due to obstruction of the proximal right coronary artery, 3 years after which he developed systemic edema. Investigations revealed TR associated with hypoproteinemia; however, treament consisting of aggressive diuretic therapy and albumin administration proved ineffective. The hypoproteinemia manifested as protein-losing enteropathy clinically, and the tricuspid valve was replaced to eliminate high venous pressure. The serum protein levels became normalized after the operation. Although TR is generally well tolerated in the absence of pulmonary hypertension, surgical management is recommended for patients with severe protein deficiency resistant to medical treatment.

Intrapericardial organized hematoma. A rare complication after open heart surgery.

Intrapericardial organized hematoma, which compresses cardiac chambers late after open heart surgery, is extremely rare. We report a case of intrapericardial organized hematoma in a 63-year-old man who underwent aortic valve replacement 8 years prior, which may have aggravated rheumatic mitral valve regurgitation compressing the mitral valve anulus. Under extracardiopulmonary bypass and cardioplegic heart arrest, we removed the hematoma and replaced the mitral valve with a 27 mm St. Jude Medical valve. There were no bleeding points on the heart and pericardium at operation and no history of blunt chest trauma. The etiology of the hematoma is uncertain.

Behçet’ Disease (‘Silk Route Disease’) and Mitral Valve Prolapse

Dear Sir, I read with interest the article on cardiac involvement in Behçet’s disease by Morelli et al. [1]. The finding of a high incidence of mitral valve prolapse in 50% of their patients is not surprising. The association of mitral valve prolapse and Behçet’s disease was first reported from China [2]. Shen et al. [3] from Shanghai reported in 1985 also a 50% incidence of mitral valve prolapse in their patients with Behçet’s disease. Behçet’s disease occurs most frequently in Japan and the Mediterranean countries but also in the population linking these two areas to each other [4]. It occurs most frequently between latitudes 30° and 45° north, in Asian and Eurasian populations. This area coincides with the old Silk Route. Thus, Behçet’s disease is sometimes also called ‘Silk Route disease’ [2, 4]. OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO

Surgical Treatment of Acute Aortic Dissection: Efficacy of Retrograde Cardioplegia for Myocardial Protection

The operative morbidity and mortality of patients with Stanford type A acute aortic dissection undergoing urgent operation using retrograde cadioplegia for myocardial protection were evaluated to assess the efficacy of such surgery. A total of 18 patients (12 men and six women. 19–71 years of age) were operated on 9–137 h after onset of dissection using cardiopulmonary bypass with deep hypothermia and retrograde cardioplegia. Graft replacement was performed in ten patients, primary anastomosis in three, and Cabrol and Bentall operations in five. All patients were weaned from cardiopulmonary bypass, but four died in hospital (mortality rate 22%). Thirteen patients were in good health at follow-up ranging from 3 to 98 months, and the remaining patient died from rectal cancer 5 months after surgery. It is concluded that urgent operation of patients with Stanford type A acute aortic dissection can be performed with reasonable operative and excellent follow-up results. Retrograde cardioplegia is an easy and reliable method of myocardial protection to repair the fragile aortic wall.