Background: SOLO SMART (SOLO) was introduced in Japan as a new stentless tissue valve in April 2016. Postoperative thrombocytopenia has been reported to occurs after aortic valve replacement (AVR) using SOLO. Methods: The aim of our study was to evaluate the difference in incidence and clinical impact of postoperative thrombocytopenia in patients receiving AVR between SOLO group and stented bioprosthetic valve (Stented) group. We evaluated 67 patients who underwent AVR with bioprosthetic valve for AS between April 2017 and March 2020. Severe thrombocytopenia was defined as the lowest postoperative platelet count of < 5.0×10⁴/μl. We divided patients with AVR into SOLO and Stented groups, and compared the surgical results, prevalence of thrombocytopenia, and changes in platelet count. Results: Postoperative aortic valve area (AVA) and peak pressure gradient (P-PG) were significantly improved in the SOLO group. The lowest postoperative platelet count was significantly lower in the SOLO group. Severe thrombocytopenia was observed in 75% of the patients in the SOLO group and 7% of those in the Stented group. As a factor that causes postoperative thrombocytopenia, use of SOLO, age at surgery, and body surface area (BSA), showed significant differences (p＜0.05). Although the platelet count had the lowest value on the 2nd to 4th day after the operation, then recovered spontaneously, and at 1 month after the operation, the platelet level improved to normal values. However, in the Stented group, the platelet level recovered to the preoperative platelet level 1 week after operation, but in the SOLO group, the preoperative platelet level didn't recover even after 3 months, and as a result, it suggest that platelet recovery was prolonged in the SOLO group. Conclusion: Use of SOLO was an independent risk factor of severe thrombocytopenia after AVR. Although no clinically serious hemorrhagic complication was observed, use of SOLO may prolong postoperative platelet recovery. In consideration of the risk of thrombocytopenia, it was considered to be advantageous to select the SOLO for SAVR in cases with a narrow annulus diameter.

Objective: We examined complications of the downstream aorta after the frozen elephant trunk (FET) procedure. Methods: Complications were diagnosed in eight patients: true aneurysm alone in five patients; type A aortic dissection in two patients; and both true aneurysm and type B aortic dissection in one patient. Results: Elective surgery was performed in seven patients. Five patients received a Matsui-Kitamura stent graft (MKS) and three patients received a J Graft Open Stent Graft (JGOSG). The FET procedure was successfully applied in all cases. Over the long term, dilatation of the descending thoracic aorta (dTA) alone was identified in two patients and dilatation of the dTA and migration was identified in three patients using the MKS. Complications of graft kinking and migration were seen in one patient and distal stent graft-induced new entry in two patients using the JGOSG. Thoracic aortic stent graft repair was successfully performed for complications in seven patients. Conclusion: For the improvement of clinical results, FET devices need to offer flexibility and appropriate radial force.

A 76-year-old man with ischemic cardiomyopathy and functional severe mitral regurgitation, suffered from profound dyspnea. He displayed a very low ejection fraction (12%) and was diagnosed with cardiogenic shock. Initially, we inserted the IMPELLA 5.0 heart pump into the patient's left ventricle and began an optimal medical therapy regimen. Once hemodynamic stability was acquired, we performed left ventricular reconstruction, mitral valve replacement, and tricuspid annuloplasty. The patient was supported postoperatively with IMPELLA 5.0 and venoarterial extracorporeal membrane oxygenation. The patient was discharged on POD100. Overall, IMPELLA 5.0 may be a useful tool for perioperative support against cardiogenic shock.

We herein report an extremely rare cardiac tumor of lymphatic malformation in 77-year-old man. The computed tomography (CT) demonstrated a mass from the lateral side of the left atrium to the lateral and posterior wall of the left ventricle among intrapericardial adipose tissue involving the left coronary artery. We performed partial resection of the tumor for definitive diagnosis under cardiopulmonary bypass. The histological finding was cardiac lymphatic malformation and was considered to be benign. There was no evidence of the growth of any cardiac tumor during the one-year follow up.

Blunt traumatic rupture of the heart carries a high mortality rate. Anatomical injuries have included the atrium, appendage and ventricle but injury to the left appendage has been reported very rarely. We present the case of a 71-year-old female who was a driver in a motor collision with major front-end damage where air bags were deployed. After being intubated and receiving pericardiocentesis for cardiac tamponade at an advanced critical care and emergency medical center, the patient was taken to our hospital and emergently to the operating room for exploration. There was brisk bleeding coming from a 2 cm laceration on the left atrial appendage. The injury was repaired using 4-0 polypropylene felt pledget-supported horizontal mattress sutures on the beating heart with the assistance of cardiopulmonary bypass. The present report describes this patient and our findings from a literature review.

Herein, we present a case of aortic root replacement 42 years after aortic valve replacement (AVR) with the Björk-Shiley Spherical (BSS) valve in a patient with an aortic root aneurysm. The patient was a 67-year-old man who had undergone AVR with BSS and aortic root enlargement for the treatment of infective endocarditis and aortic insufficiency at 25 years of age. He underwent aortic root replacement for an enlarged aortic root (73 mm). Under general anesthesia, median re-sternotomy was performed, and the BSS valve was removed. The valve functioned well with no pannus or thrombus. We performed an aortic root replacement using a composite graft consisting of a 24-mm mechanical valve and 30-mm artificial graft. We experienced a rare case of long-term durability of the BSS valve, which functioned well for 42 years.

The patient is a 39-year-old-man who had rheumatic heart disease and had undergone mitral and aortic valve replacements with mechanical St. Jude prostheses as well as tricuspid valve repair and a MAZE procedure 17 years previously. He was admitted with ventricular tachycardia (VT) and an implantable cardioverter-defibrillator (ICD) was implanted. Four months later, he was admitted again with VT, and attempts to manage the VT with drugs were not successful. We performed electro-anatomical mapping and ablation for VT by re-median sternotomy. His postoperative course was uneventful. At 15 months after surgery, no recurrence of VT was recognized.

Mid-ventricular obstructive hypertrophic cardiomyopathy is rare and often complicated by apical ventricular aneurysm, which can cause life-threatening ventricular arrhythmias. A 76-year-old male patient came to our hospital because of an electrocardiogram abnormality (giant T-wave inversion). Transthoracic echocardiography showed myocardial hypertrophy at the level of the papillary muscles, apical thinning, and aneurysm formation. The patient was diagnosed with mid-ventricular obstructive hypertrophic cardiomyopathy with apical ventricular aneurysm. During follow-up, the patient developed exertional dyspnea, and nonsustained ventricular tachycardia was noted on Holter monitoring. Therefore, we opted for surgical treatment. The patient was placed on cardiopulmonary bypass and treated with apical aneurysmectomy, followed by myectomy with a trans-apical approach. Postoperative echocardiography showed an increased left ventricular end-diastolic volume. The patient no longer had difficulty breathing and did not develop postoperative ventricular arrythmia. He has been uneventful six months after surgery. We considered surgical treatment was effective in treating arrhythmias and heart failure.

The case was a 77-year-old woman with a history of coronary artery bypass surgery 9 years earlier. After the surgery, aortic stenosis appeared and gradually progressed. During follow-up, she presented with a high degree of mitral annular calcification (MAC). A mobile verrucous mass in the left ventricle attached to the calcified posterior mitral annulus. We replaced the aortic valve and resected the mass (size, 3×26 mm). The mass with a club-shape was hard but fragile. Pathological examination revealed that it was a calcified substance without cell components covered with a thin membrane. Immunostainings with CD31 and Factor VIII-related antigen, a vascular endothelial cell marker, were both positive. Thus, the resected mass was diagnosed as a detached calcified mitral annulus. In order to avoid embolic events, early resection would be appropriate for an MAC-related mobile mass.

Ascites is a rare sign of aortic valve disease. Here, we report two cases of refractory ascites that had resulted from aortic stenosis and insufficiency and consequently improved after aortic valve replacement. The first case was a 44-year-old female who had undergone aortic valve repair for aortic stenosis 15 years earlier. She complained of dyspnea and severe abdominal distension due to unimproved massive ascites despite medical therapy. She was diagnosed with aortic stenosis and insufficiency and functional tricuspid insufficiency as well as complete atrioventricular block. She underwent mechanical aortic valve replacement, tricuspid annuloplasty and DDD pacemaker implantation. The second case was a 61-year-old man with a history of alcoholic liver disease who had been hospitalized for massive ascites, progressing rapidly in spite of aggressive medical therapy. Echocardiography revealed severe aortic stenosis and insufficiency; thus, he underwent bioprosthetic aortic valve replacement. Both patients were completely free from ascites about 6 months after surgery.

It is well known that Marfan syndrome is a genetic disorder characterized by congenital abnormality of connective tissue, in which the associated prognosis is affected by aortic lesions, and in particular the onset of aortic dissection, with some reports of familial aortic dissection. Meanwhile, it has been reported that in the absence of genetic disorder, aortic dissection occurring in two or more individuals within a family is rare. We experienced a mother-son case of non-Marfan syndrome that developed aortic dissection on the same day, and thus report our findings. Case 1 (son) was a 32-year-old man with no particular medical history observed. He had experienced epigastric pain in the early morning and come to the emergency room in our hospital, where contrast-enhanced computed tomography (CT) led to diagnosis of acute aortic dissection (Stanford type B). He was admitted to the intensive care unit, and received treatment by anti-hypertensive therapy. Case 2 (mother) was a 61-year-old woman who was prescribed internal medicines for hypertension. She had been informed that her son was hospitalized for aortic dissection, and had visited the hospital to see him. While visiting her son in the hospital room, she developed sudden chest pain and remarkable cold sweats, and upon undergoing contrast-enhanced CT, she was diagnosed with acute aortic dissection (Stanford type A). Then emergency hemiarch replacement was performed. In the family tree, there were some cases of cerebrovascular disease found on the mother's side. Pathology findings of the aorta for the mother revealed cystic medial necrosis and genetic screening subsequently performed revealed TGFBR2 mutation. Both subjects exhibited good progress, with the son discharged from hospital after three weeks, and the mother discharged 14 days after surgery.

A man in his fifties was diagnosed with retrograde type A acute aortic dissection. He underwent total arch replacement using the Gelweave Lupiae graft and staged thoracic endovascular aortic repair. Five days after discharge from the hospital, he was referred to our institution because of severe hemolytic anemia. Electrocardiography-gated computed tomography angiography demonstrated significant kinking of the graft adjacent to the proximal anastomotic site. Cine cardiac magnetic resonance imaging showed that graft kinking deteriorated during systole. We concluded that his hemolytic anemia was caused by graft kinking and surgical repair was required. The graft was transected at the kinking site and then reconstructed. After surgical repair, the hemolytic anemia improved immediately.

A 52-year old woman was referred to our hospital because of abdominal pain and restlessness. A chest contrast-enhanced CT showed huge pericardial effusion and intraluminal defects in the main pulmonary artery. We could not make a diagnosis based on the cytology of the pericardial effusion and histopathology of the mass with a sample taken by a catheter. Therefore, we undertook biopsies of the mass by median sternotomy, which led to the diagnosis of pulmonary intimal sarcoma. The tumor resection was performed to release the right ventricular outflow stenosis. We tried to resect the tumor as much as possible, and reconstructed the pulmonary artery and aortic root. She was discharged to home and survived 5 months after surgery.

A 68-year-old man suffered a pain in his right groin and was diagnosed with deep vein thrombosis at a previous medical clinic, two months earlier. He was referred to our hospital to treat deep vein thrombosis. However, adventitial cystic disease of the femoral vein was suspected from findings of preoperative contrast CT and ultrasonography. Under general anesthesia, the operation was performed. The venous wall was resected including an adventitial cyst, which was followed by the venous reconstruction using an autologous vein patch. Anticoagulant therapy was continued after the operation for one year. He was followed for 18 months after the surgery without a recurrence of the adventitial cystic disease. Venous adventitial cystic disease is extremely rare and may be misdiagnosed as deep vein thrombosis. Careful follow-up is mandatory, because the postoperative recurrence rate is reported to be substantially high.

A 76-year-old man presented with right leg numbness and general fatigue. The patient had no respiratory symptoms and negative PCR of COVID-19, but the lungs on CT scan revealed highly suspected COVID-19. The CT scan also showed occlusion from the right external iliac artery through below-knee arteries. Our surgical staff had personal protective equipment with powered air-purifying respirators and performed emergent surgical thrombectomy with the Fogarty balloon catheter. A few days after the operation, we found that the patient's antibody for COVID-19 was positive. The patient received anticoagulation and the postoperative course was uneventful. It is desirable to have more novel and precise knowledge of thrombosis in patients with COVID-19.