A 70-year-old man received a mitral valve replacement (MVR) using a Mosaic valve for mitral regurgitation with valve tethering due to ischemic cardiomyopathy a year previously. Echocardiogram demonstrated mitral prosthetic valve regurgitation due to fixed leaflet 6 months ago. Despite medical treatment, he complained of dyspnea and renal function worsened. Therefore, he underwent re-MVR in the first year of MVR. We replaced the mitral valve with mechanical valve via right thoracotomy. Severe pannus growth was found in a non-coronary cusp corresponding to the posterior leaflet of the mitral valve. The bioprosthetic valve leaflet was folded and compacted by the pannus that covered the outflow surface of the leaflet.

A case of multiple coronary artery aneurysms associated with bilateral coronary-pulmonary artery fistulae is described. A 60-year-old man was found to have a continuous heart murmur. Plain chest X-ray showed mild cardiomegaly and an abnormal shadow at the left periphery of the heart. Enhanced chest CT revealed multiple round masses around the main pulmonary artery. Cardiac catheterization studies confirmed the presence of a left-to-right shunt of 26% at the site of the main pulmonary artery, with a pulmonary-to-systemic flow ratio of 1.35:1. Coronary angiography revealed multiple coronary artery aneurysms associated with bilateral coronary-pulmonary artery fistulae and an abnormal coronary artery adjacent to the right coronary artery. Mild aortic regurgitation was also noted on ascending aortography. On February 10, 2006, surgical intervention was undergone. The maximum diameter of the coronary artery aneurysms was 4cm and the aneurysmal wall was very thin. Dilated abnormal vessels connected with the aneurysms were also noted. Under complete cardiopulmonary bypass, extirpation of the aneurysms and ligation of the abnormal vessels were performed. Although the main pulmonary artery was opened to inspect the draining portion from the fistula, the orifice could not be confirmed. The aortic valve was replaced with a mechanical prosthesis. Histopathological findings of the excised specimen included fibrosis, myxoid change, and calcification. The postoperative clinical course was uneventful, and no residual mass was noted on chest CT. The patient was discharged on the 14th postoperative day.

Many patients with palpitation consult outpatient cardiology departments. They may present with cardiac tuning abnormality (arrhythmia), which manifests as morbid palpitations. Appropriate diagnosis and treatment of palpitation are crucial to prevent adverse cardiac events. However, palpitations, in addition to anxiety and dyspnea, are often not considered as significant factor for morbidity in Western medicine. Conversely, Kampo (traditional Japanese medicine) can be used to treat the constitution of the patients, including those with or without disease diagnosed by Western medicine. However, there are no reports on the efficacy of Kampo in many examples. In this study, we diagnosed and provided appropriate Western medicine treatment for 101 outpatients with palpitation who consulted our department. We give priority to it if we evaluate the treatment of the disease of Western medicine was required (group W : n = 19). When an appropriate diagnosis could not be made by Western medicine, or when no therapeutic effect was noted with Western medicine, we administered Kampo medicine alone (group K : n = 62) or combination therapy (Kampo and Western medicine ; group KW : n = 20). The treatment efficacy was evaluated in each of the three groups. We observed high efficacy in all 3 groups (group W = 100%, group K = 96%, and group KW = 100%). Therefore, for patient with palpitation, combined treatment with both Kampo and Western medicine could improve their symptoms.