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Volume 41, Issue 5
Displaying 1-17 of 17 articles from this issue
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Preface
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[in Japanese]2012 Volume 41 Issue 5 Pages m5-m5_2
Published: September 15, 2012
Released on J-STAGE: October 26, 2012
JOURNAL FREE ACCESSDownload PDF (179K)
Original
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Yuichiro Yokoyama, Harumitsu Satoh2012 Volume 41 Issue 5 Pages 219-223
Published: September 15, 2012
Released on J-STAGE: October 26, 2012
JOURNAL FREE ACCESSTransvenous pacemaker leads may impair tricuspid valve coaptation, and is a well-known cause of tricuspid regurgitation (TR). The mechanism underlying TR may be the perforation or laceration of the valve leaflets, direct lead interference with the valve closure, or adhesion of scar tissue between the leads of the pacemaker and the valve leaflet. Recently, three-dimensional echocardiography has clarified the pathway of the pacing lead and its interference with the tricuspid valve, but surgical treatment is not conventionally performed in the early stages of TR because of the necessity of the pacing lead. Occasionally, patients with TR develop severe right-sided heart failure, and the operative mortality in such conditions is very high. Thus, it is important to study the relationship between transvenous leads and TR. Tricuspid valve surgery is usually performed after replacing the transvenous lead with an epicardial lead. However removal of the transvenous lead may cause injury to the right ventricle, and ventricular chronic stimulation thresholds with epicardial stimulation have been shown to be significantly higher than those with endocardial stimulation. We performed TR surgery in 5 patients without removing the transvenous leads. To avoid interference with the valve closure, we shifted the pacemaker leads to the commissure and fixed them to the annulus. All the patients underwent successful tricuspid valve repair or replacement, and the symptoms of right-sided heart failure improved after the operation. We concluded that this technique is a very simple, and feasible method for treatment of most patients with TR caused by pacing leads.View full abstractDownload PDF (1267K) -
Shuhei Azuma, Shin-ichi Higashiue, Toshihiro Kawahira, Keiji Matsubaya ...2012 Volume 41 Issue 5 Pages 224-227
Published: September 15, 2012
Released on J-STAGE: October 26, 2012
JOURNAL FREE ACCESSThere were 3,129 consecutive patients who underwent CABG by only one operator at Kishiwada Tokushukai Hospital between January 1991 and December 2010. These patients included 236 patients requiring chronic renal hemodialysis at the time of operation. They consisted of 181 men and 55 women, with an average age of 64.1±9.7 years. The mean duration of hemodialysis was 10.1±20.4 years. Diabetic nephropathy (133 cases, 56.4%) was the most common disease leading to required for hemodialysis. The operative mortality and the hospital mortality were 3.4% and 6.4% respectively. The 1-year survival rate, the 3-year survival rate, the 5 year survival rate and the 10-year survival rate were 72.4%, 48.3%, 32.4% and 14.3%. Multivariate logistic analysis revealed that only peripheral artery disease (PAD) was a significant risk factor for mortality (p<0.05). The infectious diseases were the most common cause of long term death (24.1%). The mortality rates of CABG in patients with dialysis-dependent renal failure are still higher than those for non-hemodialysis patients. Our data suggest that PAD is a great risk factor for mortality following CABG in hemodialysis patients.View full abstractDownload PDF (339K)
Case Reports
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Masami Shingaki, Masaaki Koide, Yoshifumi Kunii, Kazumasa Watanabe, Ka ...2012 Volume 41 Issue 5 Pages 228-230
Published: September 15, 2012
Released on J-STAGE: October 26, 2012
JOURNAL FREE ACCESSA 39-year-old woman, who had undergone aortic valve replacement with a Carpentier-Edwards pericardial bioprosthesis 16 years previously, was admitted to our hospital with a diagnosis of acute heart failure due to acute aortic regurgitation. An emergency operation was undertaken with the patient in a state of shock due to sudden cardiac arrest. The ascending aorta was cross clamped, and cardiac arrest was induced, and aortotomy was done. One of the leaflets of the CEP was entirely collapsed and dislocated to the LV side, which caused acute aortic regurgitation. Although there was no evidence of endocarditis, slight calcification and small perforation of the leaflet of the valve was observed. Aortic valve replacement was performed with a mechanical heart valve but it was impossible to wean from ECC, and therefore we additionally performed mitral valve annuloplasty with a prosthetic ring for moderate mitral regurgitation. After 4 h cardiopulmonary assistance, ECC was successfully withdrawn. She was discharged in a good condition an post operative day 29th.View full abstractDownload PDF (449K) -
Kouji Furukawa, Takahiro Hayase, Mitsuhiro Yano2012 Volume 41 Issue 5 Pages 231-234
Published: September 15, 2012
Released on J-STAGE: October 26, 2012
JOURNAL FREE ACCESSA 78-year-old woman who had undergone triple coronary bypass grafting with the right internal thoracic artery (RITA) to the left anterior descending artery 8 years previously was referred to our hospital because of heart failure due to progressive aortic valve stenosis. Coronary angiography showed that all of the coronary grafts were patent, and multidetector-row computed tomography demonstrated the functional RITA graft located close to the posterior of the sternum at the level of the second costal cartilage. To prevent injury of the RITA graft, we initially performed an inverted-L-shaped partial sternotomy extended to the right second intercostal space. After institution of peripheral cardiopulmonary bypass, we performed careful removal of adhesions along the posterior of the sternum under decompressed conditions and accomplished resternotomy safely. The patent internal thoracic artery grafts were never dissected and the patient was cooled to a rectal temperature of 22°C. After aortic crossclamping, myocardial arrest was obtained with systemic hyperkalemia by instilling 40 mEq of potassium chloride into the cardiopulmonary bypass circuit and we successfully performed aortic valve replacement. This method is an alternative approach for re-do cardiac surgery after previous bypass grafting in patients with a functional RITA graft located close to the posterior of the sternum.View full abstractDownload PDF (352K) -
Hiroyuki Watanabe, Shigeyasu Takeuchi, Mitsunori Okimoto, Hisanori Fuj ...2012 Volume 41 Issue 5 Pages 235-237
Published: September 15, 2012
Released on J-STAGE: October 26, 2012
JOURNAL FREE ACCESSRuptured abdominal aortic aneurysm (AAA) associated with horseshoe kidney is an extremely rare condition. A 76-year-old man with lung cancer treated by radiotherapy was transfered to our hospital for emergency surgery of a ruptured AAA. Preoperative abdominal CT revealed an AAA 70 mm in diameter, massive hematoma in the retroperitoneal space and horseshoe kidney with a huge renal cyst. Because the patient was in serious condition, we performed emergency operation immediately after arrival at our hospital. The AAA was replaced by a straight prosthtic graft without division of the renal isthmus, however one aberrant renal artery was sacrificed. The postoperative course was uneventful with no evidence of renal dysfunction. In cases of ruptured AAA in a state of shock, emergency operation is first priority. Even though we could do only minimal preoperative examinations, the surgery of the ruptured AAA with horseshoe kidney can be performed safely, if an accurate perioperative judgement for the treatment of abberant artery and renal isthmus is made.View full abstractDownload PDF (513K) -
Kosuke Mukaihara, Goichi Yotsumoto, Tomoyuki Matsuba, Kazuhisa Matsumo ...2012 Volume 41 Issue 5 Pages 238-242
Published: September 15, 2012
Released on J-STAGE: October 26, 2012
JOURNAL FREE ACCESSWe report the case of a 55-year-old woman with aortitis syndrome. She was admitted to our hospital because of repeated chest pain and syncope. An electrocardiogram and the laboratory data suggested acute myocardial infarction, and coronary angiography showed severe bilateral coronary ostial stenosis. No valvular disease was observed. Aortitis syndrome was suspected because of the stenosis of the brachiocephalic artery in addition to the bilateral coronary ostial stenosis, while the patient did not have elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Coronary artery bypass grafting was performed, and the patient's postoperative course was uneventful. However, she again experienced chest pain 9 months after surgery due to aortic regurgitation (AR) and diffuse narrowing change of the left internal thoracic artery graft. Aortic valve replacement and Re-CABG was performed, and the patient was treated with steroid therapy postoperatively. The postoperative course was uneventful, but the patient thereafter died due to bleeding of a malignant adrenal tumor at 21 months after the second surgery.View full abstractDownload PDF (1108K) -
Noriyuki Hatanaka, Takashi Ueda2012 Volume 41 Issue 5 Pages 243-246
Published: September 15, 2012
Released on J-STAGE: October 26, 2012
JOURNAL FREE ACCESSA 76-year-old woman was admitted to our hospital because of sudden onset of chest pain and dyspnea. Echocardiography, chest CT, and cardiac catheterization revealed an isolated extracardiac unruptured left sinus of Valsalva aneurysm, with stenosis of the main trunk of the left coronary artery. Neither aortic regurgitation nor aortic annular dilatation was recognized. As an infection associated sinus of Valsalva aneurysm could not be ruled out, we performed patch closure using autologous pericardium and coronary artery bypass grafting to the left coronary system. The postoperative course was uneventful. One year after the operation, CT revealed that aneurysm of the left sinus of Valsalva had disappeared and that the grafts were patent.View full abstractDownload PDF (562K) -
Yasuhiro Sawada, Shunsuke Sakamoto, Kazuya Fujinaga, Nin Tanaka, Toru ...2012 Volume 41 Issue 5 Pages 247-249
Published: September 15, 2012
Released on J-STAGE: October 26, 2012
JOURNAL FREE ACCESSWe report the Lampshade Technique : a new technique using Carbo-Seal Valsalva (Sorin Biomedica, Saluggia, Italy) to facilitate preparation of a composite graft. A Bentall operation and an ascending aorta replacement were performed with a composite graft using a Carbo-Seal Valsalva. This new technique can be considered useful as it can reduce the time required for preparing a composite graft, and create a skirt portion for continuous suturing to prevent bleeding.View full abstractDownload PDF (280K) -
Tetsuro Uchida, Cholsu Kim, Yoshiyuki Maekawa, Eiichi Oba, Jun Hayashi ...2012 Volume 41 Issue 5 Pages 250-252
Published: September 15, 2012
Released on J-STAGE: October 26, 2012
JOURNAL FREE ACCESSThe patient was a 63-year-old man, who had developed cerebral infarction during treatment for sleep apnea syndrome. He also presented typical features of deep venous thrombosis of the right lower extremity. Transesophageal echocardiography clearly showed the blood flow passing through the patent foramen ovale (PFO) followed by Valsalva maneuver. Paradoxical cerebral embolism caused by a PFO was diagnosed. Several procedures were considered to prevent recurrence of cerebral infarction, he underwent PFO closure by minimally invasive procedure, so-called port-access cardiac surgery. He started walking on the day of surgery, and postoperative echocardiography showed no residual shunt flow. Currently, no catheter-based PFO closure device is allowed in Japan, the PFO closure by the port-access technique should be considered as a feasible alternative.View full abstractDownload PDF (407K) -
Yoshihiro Ko, Koji Nomura, Takayuki Abe, Toshiyuki Hoshina, Yuzuru Nak ...2012 Volume 41 Issue 5 Pages 253-256
Published: September 15, 2012
Released on J-STAGE: October 26, 2012
JOURNAL FREE ACCESSWe surgically treated a case of anomalous origin of the left coronary artery from the pulmonary artery with the specific route of the left coronary artery in a 17-month-old boy. He had suffered persistent cough and poor weight gain since the age of 4 months. An ultrasound cardiography, at the age of 16 months, revealed retrograde blood flow of the left coronary artery into the main pulmonary artery. Moreover, a chest computed tomography showed an anomalous left coronary artery arising from the bifurcation of the right pulmonary artery and winding in contact on the posterior aortic wall. Though the anomalous left coronary artery shared adventitia with the aortic wall we were able to separate the coronary artery from the aorta, and the patient underwent direct transplantation of the left coronary artery. The postoperative course was uneventful and recovery was rapid.View full abstractDownload PDF (412K) -
Takashi Matsueda, Masahiro Osumi, Motoki Tatsuo, Atsushi Kurushima, Ta ...2012 Volume 41 Issue 5 Pages 257-261
Published: September 15, 2012
Released on J-STAGE: October 26, 2012
JOURNAL FREE ACCESSAnomalous aortic origin of a coronary artery (AAOCA) can cause sudden death, especially in young athletes. AAOCA does not have any clinical cardiovascular manifestations and sudden death is often the first manifestation ; hence, it is difficult to diagnose AAOCA before a major episode occurs. We report the case of a 58-year old woman with a right coronary artery arising from the left sinus and passing between the aorta and the pulmonary artery. Although the results of the exercise treadmill test and various other tests were normal, this patient underwent coronary artery bypass, surgery using the right internal thoracic artery to preventing sudden death. Two years after the operation, she is asymptomatic and has normal results on the exercise treadmill test.View full abstractDownload PDF (514K) -
Taishi Fujii, Tamaki Takano, Megumi Fuke, Kazunoki Komatsu, Kazuyoshi ...2012 Volume 41 Issue 5 Pages 262-265
Published: September 15, 2012
Released on J-STAGE: October 26, 2012
JOURNAL FREE ACCESSA 77-year-old man underwent aortic valve replacement with a Carpentier-Edwards Pericardial Magna (19 mm) for aortic stenosis. He presented with a low grade fever and congestive heart failure 6 months after the initial valve replacement. Staphylococcus aureus was detected in blood culture, and peri-valvular leakage was revealed by echocardiography. Prosthetic valve endocarditis was diagnosed and underwent re-aortic valve replacement with Medtronic Mosaic 21 mm bioprothesis. Six months after the re-do operation, perivalvular leakage was newly observed between the right and non-coronary cusps, which was opposite to endocarditis affected cusps. The peri-valvular leakage was considered to have resulted from the fragile valve annulus because he did not have fever, and repeated blood culture showed no bacterial growth. We performed a third surgery and repaired the leakage by adding sutures through the right atrium and the interventricular septum to avoid directly suturing the fragile annulus. The post-operative course was uncomplicated, and no sign of endocarditis nor perivalvular leakage was observed during 9-months of observation. It is considered that the aortic valve fixation sutures through the right atrium and inter-ventricular septum are useful alternatives for fragile aortic annulus after prosthetic valve endocarditis.View full abstractDownload PDF (431K) -
Hideyuki Akashi, Toru Ishizaka, Hideo Tanaka, Masahisa Masuda, Goro Ma ...2012 Volume 41 Issue 5 Pages 266-269
Published: September 15, 2012
Released on J-STAGE: October 26, 2012
JOURNAL FREE ACCESSWe present the case of a 68-year-old woman with abdominal aortic aneurysm (AAA) complicated by right ectopic kidney, in another term, congenital pelvic kidney. The patient underwent AAA repair and right renal artery reconstruction using renal perfusion with cold Ringer's acetate, and no deterioration of renal function was observed. 3D-CT was essential diagnostic procedure in order to identify the blood supply to the ectopic kidney for planning a careful surgical technique.View full abstractDownload PDF (573K) -
Koki Eto, Hidenori Yoshitaka, Toshinori Totsugawa, Masahiko Kuinose, Y ...2012 Volume 41 Issue 5 Pages 270-275
Published: September 15, 2012
Released on J-STAGE: October 26, 2012
JOURNAL FREE ACCESSWe report a case of secondary aortoenteric fistula (SAEF). A 76-year-old man who had undergone bifurcated graft replacement for an abdominal aortic aneurysm 18 years previously was admitted to our hospital on 2008. Since the patient was in hemorrhagic shock and had several comorbidities, he first underwent emergency endovascular aneurysmal repair (EVAR). The patient recovered from shock, and then the duodenal fistula was closed and a temporary tube enterostomy was made on the next day. The patient's recovery was uneventful and he was discharged 34 days after EVAR without any sign of infection. However, the patient was admitted for a recurrent SAEF 16 months after the procedure. Although emergency surgery was performed, he died due to sepsis 11 days after surgery. EVAR could be useful to control bleeding associated with SAEF ; however, it would be necessary for a long-term results to perform additional radical surgery subsequently to ensure the patients' hemodynamic recovery.View full abstractDownload PDF (645K) -
Shingo Mochizuki, Shinichi Tsumaru, Kazunori Yamada, Takaaki Mochizuki ...2012 Volume 41 Issue 5 Pages 276-279
Published: September 15, 2012
Released on J-STAGE: October 26, 2012
JOURNAL FREE ACCESSA 22-year-old man shot himself with a nail gun. He was admitted to a local hospital with chest pain. Chest x-ray film and chest computed tomography showed 5 nails penetrating the left thorax and some of these nails were considered to reach the pericardium. He was transferred to our hospital for intervention. Left thoracotomy was performed. Three nails reached the left ventricle and one nail was embedded the left lung. The last nail was found by transesophageal echocardiography to be completely buried in the left ventricle wall. All nails were removed and the left ventricular wounds were repaired with felt 4-0 surgipro mattress sutures. He made an uneventful postoperative recovery with a normal postoperative echocardiography and he was discharged on postoperative day 12 in good condition.View full abstractDownload PDF (619K) -
Kazumasa Tsuda, Masaaki Koide, Yoshifumi Kunii, Kazumasa Watanabe, Sat ...2012 Volume 41 Issue 5 Pages 280-283
Published: September 15, 2012
Released on J-STAGE: October 26, 2012
JOURNAL FREE ACCESSPapillary muscle rupture is one of the common complications of acute myocardial infarction. We report a case of 77-years-old man with an acute posterior papillary muscle rupture without obvious coronary artery disease. The patient presented with cardiogenic shock and pulmonary edema. Emergency coronary angiogram showed no obstruction in coronary arteries. An echocardiogram and right heart catheterization data suggested acute mitral regurgitation caused by ruptured posterior papillary muscle. Percutaneous cardiopulmonary support was induced because of his unstable hemodynamics, and then emergency mitral valve replacement was performed. Intraoperative findings suggested some ischemic changes in the posterior papillary muscle. Pathologically, both old and new ischemic lesion presented in the same papillary muscle. Moreover, severe thickening of a small vessel wall was noted. This case presented one of the possible mechanisms of so-called idiopathic papillary muscle rupture.View full abstractDownload PDF (849K)
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