1.A Case of Abdominal Aortic Aneurysm Associated with Postoperative Paraplegia
Motohiro Oshiumi ; Shinichi Ishii ; Hirokuni Naganuma ; Makoto Sumi ; Kazuhiro Hashimoto
Japanese Journal of Cardiovascular Surgery 2003;32(6):362-365
We present a very rare case of abdominal aortic aneurysm associated with paraplegia. A 68-year-old man developed paraplegia following resection of a infrarenal abdominal aortic aneurysm. The aorta was clamped just below the renal arteries. In this case interruption of the radicular artery magna (RAM; Adamkiewicz artery) might have caused serious ischemia of the spinal cord. Spinal cord ischemia is a very rare and unpredictable complication in surgery of infrarenal abdominal aortic aneurysms because the spinal cord is generally protected from irreversible ischemia during infrarenal aortic occlusion by the presence of the RAM which arises above the renal artery (Even if RAM interruption might arise, the lower renal artery, and other radicular arteries are usually present above the renal arteries). We feel that reducing aortic cross-clamping time as short as possible and avoiding intra- and postoperative hypotensive episodes to keep adequate blood flow of collaterals seem to be the most important factors to prevent spinal cord ischemia.
2.Successful Replacement of the Aortic Valve and Aortic Arch Using a Freestyle Valve for Postoperative Aortic Regurgitation after Reconstruction of Acute Aortic Dissection.
Asatoshi Mizuno ; Shigeki Horikoshi ; Fumie Saitoh ; Motohiro Oshiumi
Japanese Journal of Cardiovascular Surgery 2002;31(4):300-303
A 61-year-old man had undergone reconstruction of the ascending aorta for acute aortic dissection (DeBakey type I), He had aortic valve regurgitation at 10 months, and cardiac failure at 18 months respectively after his previous operation. Cardiac failure can progress relatively fast in cases of postoperative aortic regurgitation due to redissection, so early surgical intervention should be considered. In this case, redissection of the aortic root at the site of non-coronary sinus was noted intraoperatively, and intraoperative findings suggested necrosis of the aortic wall related to the use of GRF glue. The aortic root replacement using a Freestyle valve was performed, which was followed by arch replacement. The Freestyle valve provided good haemodynamic function and low thrombogenicity. The use of this valve in this case which had residual dissection of the descending aorta might be useful because of the excellent haemodynamic function without anticoagulant therapy and long-term durability.
3.A Case of Giant Coronary Artery Aneurysm in the Right Atrium Associated with a Right Coronary-Right Atrial Fistula
Motohiro Oshiumi ; Kazuhiro Hashimoto ; Hiroshi Okuyama ; Ryuichi Nagahori ; Gen Shinohara ; Masamichi Nakano
Japanese Journal of Cardiovascular Surgery 2004;33(5):352-355
Coronary artery fistula is an unusual congenital anomaly, particularly in association with coronary aneurysm. In the present case, a right coronary fistula leading to the right atrium was associated with a giant coronary aneurysm. There have only been 3 such cases reported in the literature. Since both the aneurysm and the fistula were completely thrombosed, no heart murmur was detected and the patient was initially diagnosed as having an intracardiac tumor by echocardiography.
4.A Case of Traumatic Tricuspid Regurgitation with Cyanosis Caused by Patent Formen Ovale
Yuhou Inoue ; Yoshihiko Mochizuki ; Yoshiei Shimamura ; Motohiro Oshiumi ; Yasuyuki Yamada ; Yasushi Matushita ; Kunihiro Eda ; Shinichirou Miyoshi
Japanese Journal of Cardiovascular Surgery 2006;35(2):98-101
A 47-year-old man was referred to our hospital for multiple rib fractures and pneumohemothorax due to a traffic accident. After admission, tricuspid valve regurgitation and hypoxemia were also diagnosed. Although fixation of the fractured ribs with plates and removal of hematoma in the pleural cavity were performed, hypoxemia did not improve. He was discharged on home oxygen therapy. Ten months and 3 years after the traffic accident, pulmonary perfusion scintigraphy suggested a right-to-left shunt. Transesophageal echocardiography demonstrated an opening of the foramen ovale and a right-to-left interatrial shunt. Direct closure of the patent foramen ovale and tricuspid valve replacement with the Carpentier-Edwards bioprosthesis were performed and hypoxemia disappeared after the second operation. Traumatic tricuspid valve regurgitation with cyanosis is extremely rare. However, it is important to take the possibility of patent foramen ovale into consideration in patients with traumatic tricuspid valve regurgitation and cyanosis.
5.A Case of Distal Aortic Arch Aneurysm 45 Years after Left Thoracoplasty.
Katsuhisa Onoguchi ; Takashi Hachiya ; Tatsuumi Sasaki ; Kazuhiro Hashimoto ; Hiromitsu Takakura ; Motohiro Oshiumi ; Shigeyuki Takeuchi
Japanese Journal of Cardiovascular Surgery 2000;29(4):282-285
A 76-year-old man developed dysphagia and esophageal stenosis was diagnosed. A computed tomographic scan of the chest demonstrated a large aneurysm of the distal aortic arch. The patient had undergone left thoracoplasty 45 years previously for the treatment of lung tuberculosis, then the aortic arch with the aneurysm was displaced backward because of the narrowed upper thoracic cavity and the esophagus was sandwiched between the aortic arch and the spine. The patient was thought to be in danger of developing an aortoesophageal fistula, so an emergency operation was performed in spite of his age and general condition. He was successfully treated with graft replacement including reconstruction of three arch vessels and his severe dysphagia improved.
6.Mechanical Valve Stuck in the Mitral Position in a Patient with Antiphospholipid Syndrome.
Hiromitsu Takakura ; Tatsuumi Sasaki ; Kazuhiro Hashimoto ; Takashi Hachiya ; Katsuhisa Onoguchi ; Motohiro Oshiumi ; Shigeyuki Takeuchi
Japanese Journal of Cardiovascular Surgery 2000;29(6):414-417
A 69-year-old woman, who had undergone mitral valve replacement, developed acute congestive heart failure and was transferred to our institution. Cineradiography demonstrated that two leaflets of the St. Jude Medical valve were stuck in a closed position. Emergency redo mitral valve replacement was performed with a CarboMedics valve. Postoperative hematological studies yielded a diagnosis of antiphospholipid syndrome. Although postoperative anticoagulant therapy was performed more carefully than usual, the prosthesis became stuck again. Therefore, a third operation was performed using a tissue prosthesis. We concluded that mitral valve plasty should be a first option for patients with antiphospholipid syndrome undergoing mitral valve surgery. Should prosthetic valve replacement be required, a tissue prosthesis would be best.
7.A Case of Quadricuspid Aortic Valve Associated with Single Coronary Ostium.
Hiromitsu Takakura ; Tatsuumi Sasaki ; Kazuhiro Hashimoto ; Takashi Hachiya ; Katsuhisa Onoguchi ; Motohiro Oshiumi ; Shigeyuki Takeuchi
Japanese Journal of Cardiovascular Surgery 2001;30(1):26-28
A 63-year-old man developed acute congestive heart failure with orthopnea and was transferred to our institution. Aortography and transesophageal echocardiography demonstrated that the aortic valve was congenitally quadricuspid. In preoperative coronary angiography, the left anterior descending artery and the circumflex artery arose from the same orifice of the right coronary artery. So far as we know, quadricuspid aortic valve associated with a single coronary ostium is an extremely rare congenital cardiac anomaly combination. During aortic valve replacement for this particular case, antegrade cardioplegia including a selective coronary perfusion was considered unreliable, thus continuous retrograde blood cardioplegia was employed for intraoperative myocardial protection.
8.A Case of Endoventricular Circular Patch Plasty for Postinfarction Akinetic Aneurysm of Left Ventricle, Associated with Severe Pulmonary Hypertension and Sustained Ventricular Tachycardia.
Motohiro Oshiumi ; Kazuhiro Hashimoto ; Tatsuumi Sasaki ; Takashi Hachiya ; Katsuhisa Onoguchi ; Hiromitsu Takakura ; Shigeyuki Takeuchi ; Kiyokazu Kokaji
Japanese Journal of Cardiovascular Surgery 2001;30(1):44-47
Endoventricular circular patch plasty was performed in a 42-year-old man, with a postinfarction akinetic aneurysm. The case was complicated with severe congestive heart failure, marked pulmonary hypertension (70% of systemic pressure) and sustained ventricular tachycardia. Cardiac catheterization data revealed low ejection fraction (20%), high pulmonary capillary wedge pressure (33mmHg) and high pulmonary arterial pressure (70/33mmHg), associated with enlarged end diastolic volume index (142ml/m2). After the operation, contractile and volumetric improvements were observed, however the severe pulmonary hypertension remained without any improvement. Disappearance of life-threatening arrhythmia allowed his discharge from the hospital, but unsatisfactory hemodynamic data, except for improved ejection fraction to 49%, turned our attention to patient selection and alternative treatment (cardiac transplantation) for such a severe case.
9.Emergency Double Valve Replacement for Acute Mitral Regurgitation due to Ruptured Chordae Tendineae Associated with Congenital Bicuspid Aortic Valve Insufficiency.
Motohiro Oshiumi ; Kiyozou Morita ; Kazuhiro Hashimoto ; Asatoshi Mizuno ; Hiromitsu Takakura ; Hirokuni Naganuma
Japanese Journal of Cardiovascular Surgery 2002;31(6):425-427
We present a rare case of mitral valve prolapse associated with congenital bicuspid aortic valve, followed by abrupt left chordae tendineae rupture resulting in severe left heart failure and cardiac arrested. The patient, a 43-year-old man who had been admitted because of sudden orthopnea suffered cardiac arrest on arrival in the emergency unit. After successful cardiopulmonary resuscitation, emergency double-valve replacement (SJM 25mm for the aortic valve and Carbomedics 31mm for the mitral valve) was performed; his postoperative course was uneventful. Concerning the pathogenesis of the acute rupture of the chordae tendineae in this patient with no evidence of infective endocarditis, it was likely that chronic and progressive left ventricular volume overload due to aortic regurgitation caused by congenital bicuspid aortic valve was the causative factor of abrupt rupture of the chordae tendineae during the course of mild mitral valve prolapse.
10.A Case of Mitral Valve Replacement with Rupture of the Left Ventricle
Yoshimasa Sakamoto ; Kazuhiro Hashimoto ; Hiroshi Okuyama ; Kazuaki Shiratori ; Motohiro Oshiumi ; Makoto Hanai ; Takanori Inoue ; Gen Shinohara ; Shouhei Kimura ; Takayuki Abe
Japanese Journal of Cardiovascular Surgery 2004;33(6):391-394
A 56-year-old woman suffering from mitral stenosis had underwent PTMC (percutaneous transvenous mitral commissurotomy) at age 46. After she developed congestive heart failure, mitral valve replacement (MVR) with Carbomedics 29M and tricuspid annuloplasty (TAP) was carried out. Four hours after admission to the ICU, massive bleeding was noticed. Cardiopulmonary bypass was restarted in the operating room. Laceration and hematoma were found at the posterolateral wall of the left ventricle. Under cardiac arrest with removal of the prosthetic valve, an internal tear was detected about 2cm below the anterolateral commissure (Miller Type III). The tear was covered with a horse pericardial patch (2×3cm) using 6-0 running sutures with reinforcement with gelatin-resorcine-formaline (GRF) glue between the laceration and the patch. MVR sutures in the annulus above the ventricular tear were first passed through the annulus, the pericardial patch and then the prosthetic cuff. Additionally, an epicardial tear was covered and reinforced with the fibrin sheet, GRF glue and pericardial patch in turn. Cardiopulmonary bypass was weaned easily without bleeding. The patient was intentionally on respiratory support with sedation for 3 days. The subsequent postoperative course was uneventful.