1.A Case of Ascending-To-Descending Aorta Bypass Grafting for Coarctation of the Aorta Associated with Turner Syndrome
Ryo Hirayama ; Masamichi Nakajima ; Toshiya Koyanagi ; Ryusuke Suzuki ; Toshiaki Watanabe
Japanese Journal of Cardiovascular Surgery 2009;38(3):226-228
A 22-year-old woman without any serious distincted symptoms was found to have hypertension on a health examination. On further examinations, involving echocardiography and chest enhanced CT, showed dilatation of the ascending aorta, aortic coarctation, well-developed intercostal arteries and other collateral arteries. She was only 137 cm tall and weighed 52 kg. Besides, she had not had menstruation for the past two years. Chromosomal studies revealed Turner syndrome. Left lateral thoracotomy was thought to have the risk of heavy bleeding from collateral arteries, therefore we chose ascending-to-descending aorta bypass grafting through median sternotomy. She had an uncomplicated postoperative course. Here we report about operation in a adult case of coarctation of the aorta and discuss the usefulness of extraanatomical bypass grafting.
2.A Case Report of Surgical Treatment for Infectious Endocarditis with Ventricular Septal Defect and Double-Chambered Right Ventricle
Ryusuke Suzuki ; Masamichi Nakajima ; Toshiaki Watanabe ; Ken Okamoto ; Akiyuki Takahashi
Japanese Journal of Cardiovascular Surgery 2003;32(5):300-303
We report a successfully treated case of infectious endocarditis with ventricular septal defect (VSD) and double-chambered right ventricle. A 41-year-old man complained of dyspnea. Echocardiography showed his tricuspid valve, aortic valve, and pulmonary valve had vegetation and severe regurgitation. He received treatment with antibiotics but it was not effective. He underwent TVR, AVR, pulmonary valve resection, VSD patch closure and RV abnormal muscle resection. Pathological findings of resected valves showed infectious endocarditis. He recovered uneventfully and resumed his original social activities.
3.A Surgery Case of Heparin-Induced Thrombocytopenia as a Complication of Ventricular Septal Perforation after Acute Myocardial Infarction
Yuki Yoshioka ; Ryusuke Suzuki ; Tomoya Miyamoto ; Kenta Uekihara ; Takeshi Sakaguchi ; Mai Matsukawa ; Ryo Hirayama ; Masamichi Nakajima
Japanese Journal of Cardiovascular Surgery 2017;46(6):305-310
A 66-year-old man with an unknown medical history developed chest pain and a diagnosis of acute myocardial infarction (AMI) was given by his physician. Percutaneous coronary intervention was performed in the left anterior descending artery. Echocardiography revealed ventricular septal perforation (VSP) ; therefore, the patient was transferred to our hospital. After admission, his platelet count dropped rapidly during heparin administration, and left ventricular thrombosis and deep vein thrombosis were noted, raising a suspicion of heparin-induced thrombocytopenia (HIT). To establish cardiopulmonary bypass, argatroban alone was insufficient to prolong the Powered by Editorial Manager® and ProduXion Manager® from the Aries Systems Corporation activated clotting time (ACT) ; thus, nafamostat mesilate was also used for coronary artery bypass grafting and surgical repair of VSP. It took many hours to normalize the ACT, requiring re-exploration for excessive bleeding. On the 37th postoperative day, the patient was transferred to another hospital. We performed cardiac surgical procedures using argatroban in a patient who developed HIT during the course of VSP following AMI ; however, we had difficulty in controlling the ACT. Since, to the best of our knowledge, there are no previous studies reporting surgical case of VSP complicated by HIT, we present this case with a review of the relevant literature.
4.An Operated Case of Cardiac Compression by Chronic Expanding Hematoma in the Pericardial Cavity after Cardiac Surgery
Masahiro Dohi ; Tomoya Inoue ; Taiji Watanabe ; Osamu Sakai ; Akiyuki Takahashi ; Yuichirou Murayama ; Masamichi Nakajima
Japanese Journal of Cardiovascular Surgery 2009;38(2):130-134
A rare surgical case of chronic expanding hematoma in the pericardial cavity is reported. A 78-year-old man had undergone coronary artery bypass grafting 2 years previously. He had suffered from general malaise, increasing shortness of breath and systemic edema from 18 months after the operation. Echocardiography revealed an intrapericardial mass compressing the cardiac chambers resulting in insufficiency of the ventricular expansion. Under extracardiopulmonary bypass and cardiac beating, resection of the mass and additional coronary artery surgery were implemented. The mass was encapsulated with thick fibrous membrane containing old degenerated coagula the bacterial culture of which was negative and was histopathologically diagnosed as chronic expanding hematoma. The patient's postoperative course was uneventful and symptoms with cardiac failure were relieved. There has been no recurrence for more than 18 months.
5.Surgical Repair of Coronary Artery Fistulas with a Giant Coronary Artery Aneurysm Dilated from Valsalva Sinus
Nanae Nishiki ; Akiyuki Takahashi ; Masahiro Dohi ; Taiji Watanabe ; Osamu Sakai ; Masamichi Nakajima
Japanese Journal of Cardiovascular Surgery 2011;40(2):58-61
We report a case of a 64-year-old man who had a fistula from the right coronary artery to the right ventricle, with an asymptomatic giant coronary aneurysm. Multi-detector computer tomography showed an aneurysm from the sinus of Valsalva to the mid-right coronary artery (RCA). Its diameter was over 50 mm. We performed aneurysmectomy direct closure of the fistula, and coronary artery bypass graft with saphenous vein graft cardiopulmonary bypass. The enlarged RCA orifice was closed with a vascular prosthesis, and the postoperative course was uneventful.
6.Surgery for Type A Aortic Dissection Six Years after Adult Aortic Coarctation Correction in a Patient with Turner Syndrome
Yuki Yoshioka ; Ryusuke Suzuki ; Ryo Hirayama ; Tomoya Miyamoto ; Masaharu Mouri ; Kenta Uekihara ; Mai Matsukawa ; Toshiaki Watanabe ; Masamichi Nakajima
Japanese Journal of Cardiovascular Surgery 2016;45(5):242-246
The case was a 27-year-old woman with a history of Turner syndrome. The patient underwent ascending-descending aorta bypass for aortic coarctation 6 years previously and underwent subsequent follow-up on an outpatient basis. She consulted our department because of fever, chest pain and headache as the main complaints. Age-indeterminate type A aortic dissection was found on computed tomography, and she was admitted to the hospital on the same day. Echocardiography also revealed an enlarged aortic root and bicuspid aortic valve. Aortic root replacement and total arch replacement were performed, and her postoperative course was favorable. It is reported that in cases of Turner syndrome with aortic coarctation, aortic aneurysm and aortic dissection are likely to occur due to the vulnerability of the aortic wall. We encountered a patient with Turner syndrome who underwent ascending-descending aorta bypass for adult aortic coarctation and subsequently developed type A aortic dissection, underwent aortic root and total arch replacement, and rehabilitated after surgery, as well as provide bibliographic considerations.
7.Successful Staged Repair of an Anomalous Origin of the Right Pulmonary Artery from the Ascending Aorta.
Toshihiro Funatsu ; Hidefumi Kishimoto ; Hiroaki Kawata ; Takuya Miura ; Takayoshi Ueno ; Shigemitsu Iwai ; Masamichi Ono ; Tomoko Kita ; Toru Nakajima ; Takeshi Nakada
Japanese Journal of Cardiovascular Surgery 2000;29(1):25-28
We report a successful staged repair of anomalous origin of right pulmonary artery from the ascending aorta in a neonate. A two-day-old girl, who suffered from severe circulatory failure, was admitted. In spite of all medical treatment, acidosis and systemic hypotension developed. Right pulmonary artery banding was performed in an emergency procedure, resulting in immediate elevation of systemic blood pressure. Definitive operation was subsequently performed on the 48th day after birth. The right pulmonary artery, which was de-banded and divided from aorta, was anastomosed directly to the pulmonary trunk in a side-to-end manner. The postoperative course was uneventful and the pulmonary artery pressure was within the normal range.