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Volume 43, Issue 3
Displaying 1-16 of 16 articles from this issue
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Preface
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[in Japanese]2014 Volume 43 Issue 3 Pages m3-m3_2
Published: 2014
Released on J-STAGE: June 11, 2014
JOURNAL FREE ACCESSDownload PDF (208K)
Case Reports
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Seiji Matsukuma, Kiyoyuki Eishi, Koji Hashizume, Tsuneo Ariyoshi, Shin ...2014 Volume 43 Issue 3 Pages 97-100
Published: 2014
Released on J-STAGE: June 11, 2014
JOURNAL FREE ACCESSProsthetic valve dysfunction due to pannus formation is an infrequent but serious complication of tricuspid valve replacement. An 87-year-old woman underwent tricuspid valve re-replacement for severe prosthetic valve stenosis and regurgitation. On removal, thick fibrous pannus and chordal attachments were observed on the ventricular side of the cusp, which corresponded to the septal leaflet of the native valve. Microscopic examination revealed inflammatory cell infiltration accompanied with severe fibrosis and scarring had compromised and broken the prosthetic valve cusp under the pannus. The elastic fiber, which was detected in the base of the pannus, suggested it was a remnant of the native tricuspid valve leaflet. Prevention of native tissue attachment to the prosthetic valve cusp, which may cause severe pannus formation, appears to be extremely important for the long-term outcome and valve durability. The choice of prosthesis for the tricuspid position remains controversial. We should especially consider the height of stent posts and the continuity between the cusp and suture ring in the choice of the bioprosthetic valve for tricuspid position.View full abstractDownload PDF (694K) -
Kao Tanoue, Aya Saito, Osamu Kinoshita, Dai Kawashima, Miyuki Shibata, ...2014 Volume 43 Issue 3 Pages 101-104
Published: 2014
Released on J-STAGE: June 11, 2014
JOURNAL FREE ACCESSA 72-year-old woman was admitted to our department with a diagnosis of severe aortic stenosis was also diagnosed Inherited antithrombin deficiency was also diagnosed after she suffered from a pulmonary thromboembolic event 10 years previously and had been taking warfarin since then. On admission, her antithrombin activity was 53% of normal, and her PT-INR level was maintained around 2.5. Preoperative management of anticoagulation therapy included discontinuation of warfarin, and supplementation of antithrombin with heparin infusion. On the day of operation, antithrombin activity was maintained above 80% by administering antithrombin, and aortic valve replacement with a mechanical valve prosthesis was carried out under standard cardiopulmonary bypass support using heparin. Heparin infusion was continued with antithrombin supplementation until PT-INR recovered to round 2.5 with warfarin. Her intra- and postoperative courses did not show any thromboembolic events, and she was discharged 14 days after the surgery.View full abstractDownload PDF (505K) -
Hideaki Kanda, Hiroyuki Yamamoto, Yosuke Hisashi, Yoshiya Shigehisa, H ...2014 Volume 43 Issue 3 Pages 105-107
Published: 2014
Released on J-STAGE: June 11, 2014
JOURNAL FREE ACCESSType II endoleak after stent graft for abdominal aortic aneurysm generally permits a wait-and-see approach, however, additional second therapy is necessary if the aneurysm increases. A 78-year-old woman had undergone endovascular treatment with a stent-graft for abdominal aortic aneurysm. Computed tomography (CT) 3 months after the operation showed type II endoleak, and enlargement of the aneurysm was noted at 1 year. She underwent transarterial embolization for third and fourth lumbar arteries, but endoleak from the fourth lumbar artery remained, and the aneurysm was further enlarged. Surgical conversion was performed 2 years after the first operation. We applied a ligature to the forth lumbar artery by a laparotomy. Postoperative CT revealed disappearance of the endoleak. As endovascular treatment for abdominal aortic aneurysm is increasing and the number of cases necessitating additional therapy appears to be rising, we need to develop processes and strategies for coping with endoleaks.View full abstractDownload PDF (584K) -
Shigehiro Morishima, Takashi Ono, Megumu Kanno, Hirofumi Midorikawa, T ...2014 Volume 43 Issue 3 Pages 108-113
Published: 2014
Released on J-STAGE: June 11, 2014
JOURNAL FREE ACCESSRecoarctation, systemic hypertension, aortic aneurysm and intracranial aneurysm are generally observed within a certain period after the surgical procedure for aortic coarctation, which is known as a systemic diseases caused by not only morphological abnormalities but also arterial functional abnormalities of artery. Here, we report a case who showed complications of recoarctation, hypertension and subarachnoid hemorrhage after surgery for aortic coarctation. A 17-year-old boy originally presented to our hospital with upper extremity systemic hypertension. Recoarctation after surgery for aortic coarctation was diagnosed in his childhood, following which hypertension was followed while he received continuous treatment with anti-hypertensive drugs. He was hospitalized with sudden headache and loss of consciousness. Since subarachnoid hemorrhage was diagnosed by computed tomography, clipping of intracranial aneurysms was performed. After the clipping procedure, he underwent percutaneous intravascular stenting angioplasty. However, the pressure gradient remained and sufficient dilatation was not obtained because of the hypoplastic anatomical distal aortic arch (from the left internal carotid artery to the site of recoarctation) due to the development of collateral circulation with rib notch. At age 21, extra-anatomical bypass (from the ascending aorta to the descending aorta) was performed because of persistent upper extremity systemic hypertension. However, systemic hypertension continued to require antihypertensive medication.View full abstractDownload PDF (565K) -
Masahiro Osumi, Tadashi Tashiro, Hideichi Wada, Masaru Nishimi, Hitosh ...2014 Volume 43 Issue 3 Pages 114-117
Published: 2014
Released on J-STAGE: June 11, 2014
JOURNAL FREE ACCESSCongenital quadricuspid aortic valve is a very rare malformation. We report two cases with severe aortic regurgitation due to isolated quadricuspid aortic valve. It consisted of three equal cusps and one smaller cusp, which was identified at the time of valve replacement surgery for severe aortic regurgitation.View full abstractDownload PDF (592K) -
Hiroyuki Seo, Hiromichi Fujii, Takanobu Aoyama, Yoshikado Sasako2014 Volume 43 Issue 3 Pages 118-123
Published: 2014
Released on J-STAGE: June 11, 2014
JOURNAL FREE ACCESSA 62-year-old man with a history of insulin-dependent diabetes mellitus was admitted to our hospital because of a high-grade fever and general fatigue. Laboratory data showed evidence of inflammation and Streptococcus pneumoniae was identified in the blood cultures. Transthoracic echocardiography revealed vegetations on the right coronary cusp of the aortic valve and septal leaflet of the tricuspid valve, and an aorto-right ventricular fistula secondary to abscess formation in the aortic annulus. We diagnosed active infective endocarditis with an aorto-cavity fistula and performed an emergency operation. The infected tissue was curetted as much as possible and the fistulous openings in the right ventricle and aortic root were closed using bovine pericardial patches. We subsequently performed aortic annular reconstruction and aortic full-root replacement using a Freestyle® stentless valve. Although a permanent pacemaker was implanted to treat a complete atrioventricular block, the postoperative course was uneventful and the C-reactive protein level normalized. He was discharged on the 46th postoperative day. Postoperative echocardiography revealed no signs of valve dysfunction, recurrent endocarditis, or residual abscess cavity and shunt. Infective endocarditis with abscess formation complicated by a fistula formation between the cardiac chambers is rare, and surgical treatment for this is challenging. In such cases, both radical debridement of the infected tissue and precise closure of the fistulous tract are essential.View full abstractDownload PDF (1044K) -
Takanori Kono, Eiki Tayama, Hidetsugu Hori, Tomohiro Ueda, Kenichi Ima ...2014 Volume 43 Issue 3 Pages 124-128
Published: 2014
Released on J-STAGE: June 11, 2014
JOURNAL FREE ACCESSWe report a patient with candidemia, and remote organ infection, who underwent surgical treatment of aortic valvular stenosis. The patient was a 77-year-old man. Candida glabrata was detected in a blood culture during pharmacological treatment for pyelonephritis associated with vesicoureteral transition stenosis. A ureteral stent had been placed to preserve urine outflow, and vesicoureteral surgery had been scheduled. However, the urological surgery had to be performed first because of severe aortic valvular stenosis. After long-term (5 months) of antifungal treatment, Candida was no longer detected in the urine or blood cultures, but the serum β-D-glucan level did not fall below the reference value (21.6 pg/ml at the last measurement). It was difficult to control the infection further, and we decided to perform aortic valve replacement. There was no evidence of endocarditis at surgery, but pathological examination revealed traces of the fungus in the tissue of the aortic valve. The post-operative course was uneventful, and urological surgery was carried out 45 days later. Infection recurred when the antifungal medication was temporarily discontinued. The infection was then controlled by resumption of the antifungal medication. The patient has been free of recurrence for the past year since the aortic valve replacement. In the present case, in which a mycosis from a remote source was not readily eradicated prior to valve replacement, we were able to obtain good results by first administering long-term antifungal medication to quell the inflammation as much as possible.View full abstractDownload PDF (734K) -
Takeshi Sakaguchi, Toshiaki Watanabe, Ryo Hirayama, Koji Hagio, Mai Ma ...2014 Volume 43 Issue 3 Pages 129-133
Published: 2014
Released on J-STAGE: June 11, 2014
JOURNAL FREE ACCESSAn 88-year-old woman presented at a local hospital with a left femoral pulsatile mass. CT revealed saccular aneurysms with irregular intima in the descending thoracic aorta, the right common femoral artery and the left superficial femoral artery. They were 60 mm, 30 mm, and 25 mm in diameter, respectively. After referral to our hospital, multiple inflammatory aneurysms were strongly suspected by detailed examinations. Endovascular treatment including thoracic endovascular aortic repair and surgical replacement were performed by two-stage operations. After steroid therapy was started postoperatively, her c-reactive protein (CRP) value decreased. Nevertheless, the thoracic aortic aneurysm enlarged and she died due to hemorrhage. Multiple inflammatory aneurysms are extremely rare. We consider that appropriate steroid therapy and close follow-up are most important.View full abstractDownload PDF (772K) -
Kenta Uekihara, Takeshi Sakaguchi, Mai Matsukawa, Ryo Hirayama, Koji H ...2014 Volume 43 Issue 3 Pages 134-137
Published: 2014
Released on J-STAGE: June 11, 2014
JOURNAL FREE ACCESSAn 80-year-old man presented with a history of retrosternal gastric tube reconstruction for esophageal cancer. He experienced sudden chest pain, and temporarily lost consciousness, before being transferred to our hospital. Contrast-enhanced computed tomography revealed acute Stanford type A aortic dissection and a retrosternal gastric tube. We performed emergency operation using a median sternotomy approach. Before median sternotomy, we detected the gastric tube in the subxiphoid and suprasternal spaces. The anterior and right sides of the gastric tube were dissected bluntly from the posterior surface of the sternum and median sternotomy was performed. The gastric tube was mobilized to the left side and we were able to obtain the usual operative view for ascending aorta graft replacement. Intraoperatively, the gastric tube remained intact and uninjured. The patient was transferred to another hospital for rehabilitation on postoperative day 34.View full abstractDownload PDF (579K) -
Tomomitsu Kanaya, Hiroki Hata, Nobuo Sakagoshi2014 Volume 43 Issue 3 Pages 138-141
Published: 2014
Released on J-STAGE: June 11, 2014
JOURNAL FREE ACCESSA 54-year-old man with ischemic mitral regurgitation underwent surgical ventricular restoration, mitral valve plasty and a coronary artery bypass. A chest X-ray 7 days later revealed pleural effusion on the right side. A chest tube was inserted and about 1,000 ml of fluid was drained. However, re-expansion pulmonary edema (RPE) occurred 2 h later. Positive pressure ventilation and intravenous infusion with a diuretic improved the RPE. He was resuscitated on the following day to receive percutaneous cardiopulmonary support (PCPS) for unstable hypoxemia and hypotension. Oxygenation improved, PCPS was withdrawn 2 days later, and the endotracheal tube was removed. Re-expansion pulmonard. He was resuscitated on the following day to receive percutaneous cardiopulmonary support (PCPS) for unstable hypoxemia and hypotension. Oxygenation improved, PCPS was withdrawn 2 days later, and the endotracheal tube was removed. Re-expansion pulmonary edema might cause fatal short-term cardio-respiratory failure. We considered that RPE requires appropriate early diagnosis, early treatment and aggressive therapy, including PCPS.View full abstractDownload PDF (541K) -
Hiroyuki Johno, Hirotaka Murata, Shouji Fujiwara2014 Volume 43 Issue 3 Pages 142-145
Published: 2014
Released on J-STAGE: June 11, 2014
JOURNAL FREE ACCESSTransvenous pacemaker lead extraction (TLE) techniques for pacemaker lead infection have developed in recent years. Several minimally invasive methods for TLE have been devised, but fatal complications are not rare in these procedures. We present the case of a 26-year-old woman with Brugada syndrome referred to our hospital with wound infection, 3 years after implantation. She had the 2 infected leads completely removed with laser sheaths and underwent antibiotic therapy. On post operative day 8, pulsatile mass with thrilling was noted at the suprasternal notch. Enhanced CT examination revealed the fistula between the brachiocephalic artery and vein (AVF). Operation was scheduled to close the fistula. Early in the morning of the scheduled operation day, extensive bleeding from the ruptured mass on the suprasternal notch occurred and emergency operation was done to suture the bleeding point and ligate both side of the fistula of the brachiocephalic vein, using an occlusion balloon inserted into the brachiocephalic artery. The postoperative course was uneventful. AVF after TLE is a rare complication. Although the cardiac implantable electronic device can provide life-saving benefits, device-associated complications should be managed carefully.View full abstractDownload PDF (846K) -
Takao Tsuchida, Kentaro Yano, Hitoshi Fukumoto2014 Volume 43 Issue 3 Pages 146-149
Published: 2014
Released on J-STAGE: June 11, 2014
JOURNAL FREE ACCESSPrimary cardiac lymphomas are rare cardiac neoplasms with poor prognoses. We report a 61-year-old man who presented with superior vena cava (SVC) syndrome. Trans-thoracic echocardiography showed a 77×91-mm mass occupying the right atrium. The tumor obstructed the SVC. The deteriorating hemodynamics of our patient prompted a surgical intervention. We resected as much of the tumor as possible under cardiopulmonary bypass. The postoperative course was uneventful, and the SVC syndrome disappeared. Pathological examination was consistent with malignant lymphoma, diffuse large B-cell type. After cardiac operation, the patient was treated with rituximab, cyclophosphamaide, adriamycin, vincristin, and prednisone (CHOP-R). The patient has been in good health for 30 months without signs of recurrence.View full abstractDownload PDF (924K) -
Koji Sato, Kazuyoshi Sato, Masatoshi Motohashi, Kazuaki Ishihara, Kouh ...2014 Volume 43 Issue 3 Pages 150-153
Published: 2014
Released on J-STAGE: June 11, 2014
JOURNAL FREE ACCESSAn 85 year-old woman underwent mitral valve replacement with Carpentier-Edwards PERIMOUNT (CEP) at the age of 72 because of rheumatic mitral stenosis. Thirteen years after its implantation, prosthetic valve dysfunction developed increasingly severe aortic valve stenosis and she underwent double valve replacement. Prolapse was found in one leaflet of the explanted CEP valve, while neither visible calcification nor tear was detected.View full abstractDownload PDF (485K) -
Naoki Kanemitsu, Kazuo Yamanaka, Takeshi Nishina, Keiichi Hirose, Akih ...2014 Volume 43 Issue 3 Pages 154-157
Published: 2014
Released on J-STAGE: June 11, 2014
JOURNAL FREE ACCESSWe report a case of septal branch aneurysm. A 61-year-old woman was referred to our hospital because of heart murmur. Septal branch aneurysm (25×15 mm) was diagnosed by echocardiography and coronary angiography, and followed up annually with multi-detector row computed tomography (MDCT). Nine years later, another aneurysm proximal to the known aneurysm, which protruded above the epicardium, has rapidly dilated from 5 to 11 mm. We therefore performed closure of the orifice of the septal branch concomitant with bypass grafting ; left internal mammary artery to distal LAD. After the procedure, the aneurysm in the septum had completely collapsed. Her postoperative course was uneventful.View full abstractDownload PDF (873K) -
Tetsuya Kajiyama, Shinya Fukui, Masataka Mitsuno, Hiroe Tanaka, Masaak ...2014 Volume 43 Issue 3 Pages 158-161
Published: 2014
Released on J-STAGE: June 11, 2014
JOURNAL FREE ACCESSWe report a patient with Leriche syndrome who had ileal conduit and a right lower quadrant stoma. A 47-year-old man with a history of bladder cancer had undergone radical total cystectomy with formation of an ileal conduit and right lower quadrant stoma 2 years previously. CT scanning revealed total occlusion of the distal aorta. He experienced right lower leg pain after 30 m of walking. Through a repeat midline laparotomy incision, the abdominal aorta was dissected with a transperitoneal approach. To avoid dissection around the ileal conduit, the retroperitoneum was incised (open) at the right of the ascending colon and at the left of the sigmoid colon. A prosthetic graft (Interguard 14×7 mm) was pulled bilaterally through these incisions, to the external iliac arteries. Abdominal aorto-bilateral external iliac artery bypass grafting was performed and the patient was discharged without complications on the 15th postoperative day.View full abstractDownload PDF (466K)
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