Left ventricular rupture is one of the major lethal complications of mitral valve replacement. A case of successful repair of postoperative left ventricular rupture following mitral valve and aortic valve replacements, tricuspid valve annuloplasty in chronic renal failure is described. The patient was a 58-year-old male and suffered from mitral stenosis and regurgitation with left atrial thrombi, aortic stenosis and regurgitation, and tricuspid regurgitation. It has been 13 years since the patient was operated on for mitral stenosis with open mitral commissurotomy. Mitral valve and aortic valve replacements, tricuspid valve annuloplasty was performed under cardiopulmonary bypass and cardioplegic arrest using the extracorporeal ultrafiltration method (ECUM) and continuous venovenous hemodialysis (CVVH). The patient has been in good condition during weaning from cardiopulmonary bypass. After the operation, left ventricular rupture occurred due to transient high blood pressure in the operating room. The patient was quickly put back on cardiopulmonary bypass. In this case, the rupture occurred although no technical errors were thought to be made. The site of the rupture was type II in the Treasure classification. The left ventricular rupture was repaired with the patch closure method under cardiopulmonary bypass and cardioplegic arrest. The postoperative cardiac function was relatively well preserved. More attention should be paid to cases in this type of condition; mitral stenosis, long history, multiple valve replacements, and chronic renal failure. This patient died from sepsis caused by the infectious route of continuous ambulatory peritoneal dialysis (CAPD) on the 61st postoperative day.

Splenic artery aneurysm is considered to be a relatively uncommon disease. It is difficult to diagnose asymptomatic cases of splenic artery aneurysm when the physician does not recognize the presence of this disease. The recent development of diagnostic imaging technology has resulted in an increasing number of reported asymptomatic cases of splenic artery aneurysm using ultrasonography and computed X-ray tomography. An asymptomatic case of a 44-year-old woman who had an abdominal mass around the splenic hilus detected with ultrasonography is reported. Color-coded Doppler ultrasonography led to a preoperatively confirmed diagnosis of splenic artery aneurysm with the detection of intraluminal arterial flow in the mass. The aneurysm was a semispherical mass, 20×16×13mm in size. At operation, only aneurysmectomy was carried out and splenectomy was not performed. The patient was discharged with a complete cure on the 18th postoperative day. Color-coded Doppler ultrasonography is extremely effective in the diagnosis of abdominal splanchnic artery aneurysms.

We performed cardiac resynchronization therapy (CRT) in addition to aortic valve replacement (AVR) in a 74-year-old patient with poor cardiac function (New York Heart Association functional class III, ejection fraction 15%), complete right bundle branch block (CRBBB), left posterior hemiblock (LPH), and aortic valve insufficiency. Tissue Doppler echocardiography showed synchronicity of the septum and posterior segments in the left ventricle, and that contraction of the septum was in the systolic phase of the cardiac cycle after CRT. The New York Heart Association functional class improved from III to I after the operation. CRT of the dyssynchronized myocardium in a patient with CRBBB and LPH can improve regional cardiac function and synchronicity.

We performed cardiac resynchronization therapy (CRT) in addition to mitral valve replacement (MVR) in a 66-year-old patient with dilated cardiomyopathy (DCM) associated with complete left bundle branch block (CLBBB) and mitral valve insufficiency. Tissue Doppler echocardiography showed synchronicity of the septum and lateral wall in the left ventricle after CRT. New York Heart Association functional class improved from III to I after CRT and MVR. CRT of the dyssynchronic myocardium in a patient with DCM associated with CLBBB improves regional cardiac function and synchronicity.

BACKGROUND: In daily clinical practice, it is essential to properly evaluate the postoperative sliding distance of various femoral head fixation devices (HFD) for trochanteric fractures. Although it is necessary to develop an accurate and reproducible method that is unaffected by inconsistent postoperative limb position on radiography, few studies have examined which method is optimal. Therefore, the purpose of this study is to prospectively compare the accuracy and reproducibility of our four original methods in the measurement of sliding distance of the HFD. METHODS: Radiographs of plastic simulated bone implanted with Japanese proximal femoral nail antirotation were taken in five limb postures: neutral, flexion, minute internal rotation, greater external rotation, and flexion with external rotation. Orthopedic surgeons performed five measurements of the sliding distance of the HFD in each of the flowing four methods: nail axis reference (NAR), modified NAR, inner edge reference, and nail tip reference. We also assessed two clinical cases by using these methods and evaluated the intraclass correlation coefficients. RESULTS: The measured values were consistent in the NAR method regardless of limb posture, with an even smaller error when using the modified NAR method. The standard deviation (SD) was high in the nail tip reference method and extremely low in the modified NAR method. In the two clinical cases, the SD was the lowest in the modified NAR method, similar to the results using plastic simulated bone. The intraclass correlation coefficients showed the highest value in the modified NAR method. CONCLUSIONS: We conclude that the modified NAR method should be the most recommended based on its accuracy, reproducibility, and usefulness.
*Bone Nails ; *Dimensional Measurement Accuracy ; Fracture Fixation, Intramedullary/instrumentation/*methods ; Hip Fractures/*surgery ; Prospective Studies ; Reproducibility of Results