Yuji Katayama

Mitral Valve Stenosis Caused by Abnormal Pannus Extension over the Prosthetic Ring and Leaflets After Duran Ring Mitral Annuloplasty

Abstract  We treated a 61‐year‐old woman with mitral stenosis caused by pannus formation after Duran ring annuloplasty. Pannus overgrowth on the ring with extension onto both leaflets narrowed the mitral orifice and severely restricted the mobility of the valve leaflets. Mitral valve replacement with a St. Jude Medical mechanical heart valve prosthesis was successfully performed, and the postoperative course was uneventful. Patients undergoing Duran ring annuloplasty should be followed up with the consideration of possible mitral stenosis caused by pannus extension, as the cause for pannus formation remains unclear.

Surgical strategy for impending rupture of an infected anastomotic pseudoaneurysm of the aorta 9 years after a Bentall procedure: radical surgery involving en bloc resection of the infected sternum, pseudoaneurysm, and artificial vascular graft.

Infection of the sternum and anterior mediastinitis after open heart surgery are serious complications that are intractable with high case fatality rates. Frequently, infection spreads to an artificial foreign body in the mediastinum, causing difficulties with treatment. We report a case of infected pseudoaneurysm of the aorta at the anastomotic site of the artificial vascular graft. The infection spread from sternal osteomyelitis 9 years 5 months after aortic root replacement (Bentall procedure) for acute aortic dissection. We performed radical surgery that included en bloc resection of the infected sternum, pseudoaneurysm, and artificial vascular graft, with successful results. We report here the surgical strategy including the approach.

Surgical Repair for Entire Inferior Vena Cava Occlusion in Budd-Chiari Syndrome

Successful repair of thrombotic occlusion of the entire inferior vena cava, including the iliac and hepatic veins, was performed on a 51-year-old man with Budd-Chiari syndrome associated with severe liver dysfunction.

Extensive resection and double-patch reconstruction for left atrial myxoma.

The efficacy and safety of surgical intervention for atrial myxoma are established, but the operative approach to tumor resection and atrial reconstruction are controversial. A biatrial approach is generally used for excision of atrial myxoma and has many advantages. In contrast, there are a few reports about the method of double-patch reconstruction, and the right and left atrium are individually reconstructed with the two patches. We found it to be effective in the case reported here. We suggest that this method can be applied to atrial myxoma in which extensive resection is necessary.

Huge Unruptured Aneurysm of the Sinus of Valsalva with Bicuspid Aortic Valve: A Case Treated Successfully by Surgery.

大動脈弁二尖弁に巨大非破裂バルサルバ洞動脈瘤を合併した稀な症例を経験した. 症例は47歳, 男性. 小児期より弁膜症を指摘されていたが精査は受けておらず, 最近生じてきた嚥下時の違和感により受診した. 検査の結果, 心右側に突出した70×70mm大の巨大非破裂バルサルバ洞動脈瘤と高度の大動脈弁閉鎖不全および狭窄を認めた. 術中所見で弁尖の硬化を伴った大動脈弁二尖弁を認め, 上行大動脈最大径は42mmと拡張しており, modified Bentall 手術 (Carrel patch 法) を行った. 病理所見は硬化性病変が主体で一部に中膜の変性を認めた.