The patient was a six-month-old girl with an anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). She had fever and visited a family physician at 5 months of age. Because of poor oxygenation, she was referred to our pediatric department and intubated soon after hospitalization. Echocardiography showed that the orifice of left coronary artery was just above pulmonary commissure, the left ventricular ejection fraction was 9%, and the level of mitral regurgitation was moderate. Right coronary angiography showed that the left coronary artery contrasted against the collateral arteries. The left coronary artery originated from the left side of the pulmonary trunk. After recovery of the general condition with medical therapy, the patient underwent coronary artery reconstruction by the modified spiral cuff technique on the 21st day of hospitalization. The temporary detachment of pulmonary valve and its commissure for making a margin around the left coronary artery enabled us to make the spiral cuff in almost the usual manner. She was moved to the intensive care unit with the support of extracorporeal membrane oxygenation (VA-ECMO) and was successfully weaned off the VA-ECMO 5 days after the surgery. The postoperative course was good, and she was discharged from our hospital 3 months after the surgery. The echocardiogram one year after the surgery showed a left ventricular ejection fraction of 30%, mild mitral regurgitation, and mild pulmonary regurgitation. Our experience indicates that the spiral cuff technique is a useful coronary reconstruction method for the treatment of ALCAPA, especially in cases presenting a considerable distance between the origin of the left coronary artery and the transplantation site. There are few reports regarding the surgical treatment of infantile ALCAPA showing reduced left ventricular function. Coronary artery reconstruction using the spiral cuff method and planned VA-ECMO are useful surgical procedures in such cases. Our experience also suggests that the establishment of a treatment strategy including mechanical support is essential to improve the results in severe ALCAPA cases.

The patient was a 34-year-old woman who had been routinely monitored after receiving a childhood diagnosis of partial anomalous pulmonary venous connection, but unilaterally discontinued follow-up examinations after the age of 18. At 33 years of age, she was admitted to our hospital after a physical examination revealed an abnormal shadow on a chest X-ray. Transthoracic echocardiography detected an atrial septal defect (ASD), and contrast-enhanced computed tomography showed that the right lower pulmonary vein drained to the inferior vena cava. The patient was diagnosed with scimitar syndrome with ASD. Cardiac catheterization showed a pulmonary/systemic flow ratio (Qp/Qs) of 2.48 and a left-to-right shunt rate of 59.7%. Surgical treatment was deemed to be indicated. The right lower pulmonary vein was anastomosed to the anterolateral wall of the right atrium, and an intra-atrial baffle repair was performed from the orifice within the right atrium to the left atrium through the existing ASD using untreated fresh autologous pericardium. Two years after the operation, good blood flow was maintained within the baffle with no stenosis at the anastomotic site. This report describes a rare case of scimitar syndrome with ASD in an adult woman, and provides a review of the existing literature.

Congenital mitral regurgitation (MR) occurs infrequently and the number of reported adult surgical cases is small. A 77-year-old man presented with an exacerbation of congestive heart failure. He had a 19-year history of receiving medical treatment for MR and atrial fibriration. Transthoracic and transesophageal echo cardiograms revealed severe MR due to the restriction of the posterior mitral leaflet with very short chorda tendanea attached beneath the posterior leaflet preoperatively. We diagnosed this case to have congenital MR (Carpentier type III) in an adult based on the specific findings of echocardiography and mitral valve plasty was thus performed. All the dysplastic chordae of the P2 and P3 in the immovable leaflet region were cut and the reconstructed by the fifth artificial chordae. These procedures successfully allowed the posterior mitral leaflet to recover its normal shape and movability. Postoperative echocardiography showed no further mitral regurgitation and normal leaflet motion.

Essential thrombocythemia is considered one of the chronic myeloproliferative disorders resulting in arterial thromboembolism, venous thrombosis, and bleeding tendency. We report a case of left ventricular aneurysm with successful treatment of the complications of this disease. A 66-year-old man who suddenly experienced right upper limb paralysis was carried to a nearby hospital. Computed tomography revealed multiple cerebral infarctions. An electrocardiogram confirmed findings of old myocardial infarctions in the anteroseptal wall. Echocardiography indicated a left ventricular aneurysm with mobile thrombus. The blood tests showed an abnormally high platelet count of 120×104/μl. His left ventricular thrombus showed an increasing tendency regardless of heparin administration ; thus, he was transferred to our hospital. The resection of the aneurysm and left ventricular restoration was performed emergently to avoid re-embolism. There was a soft thrombus inside the aneurysm at its apex. During cardiopulmonary bypass, the activated clotting time was not prolonged easily. We gave additional heparin and antithrombin III. The patient had no problem with hemostasis or postoperative bleeding. We started low-molecular-weight heparin from the second postoperative day and he was diagnosed with essential thrombocythemia by bone marrow biopsy. We started warfarin and aspirin on the fifth day after surgery. The number of platelets increased to 183×104/μl on the 8th day ; thus, oral administration of hydroxycarbamide was started. His platelet count fell to less than 100×104/μl around 3 weeks after surgery and he was discharged on the 34th day without new embolisms.

Hypertrophic cardiomyopathy with apical aneurysm is known to have high risk of a sudden death due to ventricular arrhythmias or thromboembolisms. We report a surgical case of surgical case of this disease. A 67-year-old man was found to have abnormality in an electrocardiogram during his checkup, and subsequent careful examinations revealed his disease. He had no symptoms and the pressure gradient at the obstruction was about 30 mmHg, but there was thrombus in the apical aneurysm. After anticoagulant therapy, the thrombus dissolved. We scheduled an operation on him because he was judged to have high risk of a sudden death. In the operation, excision of the apical aneurysm, and hypertrophic midventricular myocardium were performed, concomitant with cryoablation to the border between the aneurysm and normal myocardium. Although complete atrioventricular block occurred postoperatively and he needed permanent pacemaker implantation, he was discharged from the hospital 21 days postoperatively without any other complications. He is doing well at two years and six months, postoperatively.

We present a successful case of a patient with multiple metal allergy—cobalt, nickel, chromium, and zinc—who had a past history of systemic metal dermatitis. He was a 58-year-old man who complained of exertional chest discomfort. After admission, he had a fever and his blood culture was positive with methicillin-sensitive Staphylococcus aureus. Three days later, multiple micro cerebral infraction was detected in magnetic resonance imaging. After an improvement of inflammatory reaction, he was transferred to our facility for cardiac examination. Moderate mitral regurgitation due to valve perforation and multiple coronary vessel stenosis were detected. Mitral valve replacement and coronary artery bypass grafting were planned to perform. We chose surgical materials based on a preoperative epicutaneous (patch) test and his clinical course was uneventful without any allergic reaction. Metal contact allergy is an important issue in cardiovascular surgery. A collaboration with dermatologists is essential for the preparation of surgical materials.

A 71-year-old female, who had diabetes mellitus and chronic renal failure on dialysis, had undergone mitral valve repair and tricuspid valve annuloplasty. Five months after the operation, she suffered from infectious endocarditis and underwent mitral valve replacement. Postoperatively, a total fluid volume of 300 to 600 ml/day was drained from the pericardial tube, and its appearance became milky after the start of oral intake of food. She was diagnosed with chylomediastinum. Despite fasting and total parenteral nutrition for 2 weeks and subcutaneous octreotide administration, the volume of fluid drainage was not reduced. Therefore, we planned lymphangiography treatment with Lipiodol on postoperative day 37. On operation, under local anesthesia, the left inguinal lymph node was punctured under ultrasound guidance, and Lipiodol was injected at a rate of 12 ml/h for 1h. On the next day, the volume of fluid drainage was reduced, and the pericardial tube could be removed 9 days after lymphangiography.

Here, we present a case of successful aortic valve repair of traumatic aortic regurgitation (AR). A man in his early twenties had a chest blunt trauma due to a bicycle accident 6 years earlier and suffered sternum fracture. He recovered without cardiovascular complications. Three months previously, a new diastolic murmur was detected on medical checkup. Transthoracic echocardiography (TTE) showed severe AR, and the left ventricular end-diastolic-/end-systolic dimension was 69/51 mm. Transesophageal echocardiography showed severe AR with perforation of the non-coronary cusp and dilatation of the aortic annulus (29.6 mm). Aortic valve repair was performed with an autologous pericardial patch and external suture annuloplasty. Postoperative TTE showed normal aortic valve function with trivial AR. He was discharged on postoperative day 11. Three months later, TTE showed trivial AR along with a reduced left ventricular dimension and improved left ventricular ejection fraction.

Entrapment of an intravascular ultrasonography (IVUS) catheter is an infrequent but serious complication associated with percutaneous coronary intervention (PCI). We report a case of successful surgical treatment of an IVUS catheter entrapped in a coronary stent after PCI. An-80-year-old man was admitted to a hospital with sudden anterior chest pain. He underwent PCI to left circumflex branch (Cx) and left anterior descending artery (LAD), followed by IVUS to ascertain stent expansion of the LAD stent. The IVUS catheter became entangled in the stent and could not be withdrawn from the outside. The patient was transferred to our hospital for its surgical removal. For the emergent surgery, we opened the stent region in the LAD and directly removed the IVUS catheter with the twisted stent. The opened place in the LAD was directly closed. Additional coronary bypass grafting involving two vessels was performed. The postoperative course was uneventful with no graft occlusion.

We present a 62-year-old woman who was diagnosed with primary pulmonary arterial sarcoma with pulmonary hypertension. CT showed a large defect inside both main pulmonary arteries in accordance with the accumulation of FDG-PET. To relieve the symptom and to prevent sudden death, removal of a massive pulmonary tumor and postoperative chemotherapy were planned. Utilizing the intermittent systemic circulatory arrest under deep hypothermia (18°C), the pulmonary artery trunk and both main pulmonary arteries were opened. The tumor stacking inside the pulmonary artery was removed and its origin at the commissure of the pulmonary artery valve was resected. The defect was repaired with a pulmonary valve replacement. Histopathological examination revealed high grade sarcoma. Her postoperative course was uneventful ; however, she died of cerebral hemorrhage during chemotherapy six months after surgery.