In general strategy for postcardiotomy heart failure includes inotropic support followed by the use of an intra-aortic balloon pump and percutaneous cardiopulmonary bypass support (POPS). The insertion of a ventricular assist system (VAS) may become necessary when these procedures fail to restore hemodynamic stability. The ABIOMED BVS 5000 left ventricular assist support system (LVAS) has been approved for clinical use in Japan since 1998. Here we describe our experience with the recovery of a 52-year-old man from postcardiotomy heart failure after using an ABIOMED BVS 5000 LVAS. The patient was admitted to our institution with dyspnea. Heart failure with severe left ventricular dysfunction was diagnosed, and recent myocardial infarction was suspected from his history and electrocardiogram. Two days after admission, ventricular fibrillation occured and the arrythmia was hard to control. PCPS was connected and emergency coronary angiography showed triple vessel disease. We performed emergency coronary artery bypass grafting with the heart beating under PCPS and immediately implanted an ABIOMED BVS 5000 device to achieve myocardial recovery after stopping PCPS. He was weaned from the LVAS at 6 days after surgery. His postoperative course was relatively uneventful and he was discharged after recovery.

Papillary muscle rupture after acute myocardial infarction (AMI) is an infrequent but fatal complication. We report a case of mitral valve repair performed in a patient with partial papillary muscle rupture after AMI. An 85-year-old man was admitted to our hospital for AMI with cardiac shock. Emergency coronary angiography revealed triple-vessel disease, and percutaneous coronary intervention for the culprit lesion of the left circumflex artery was successfully performed. Eleven days after the onset of the AMI, the pulmonary artery pressure abruptly increased to 60 mmHg and a pansystolic murmur was detected. Transesophageal echocardiography showed severe mitral regurgitation (MR) with flail in the A1—A2 region of the anterior mitral leaflet. We demonstrated erratic motion of the ruptured anterior head in the left ventricle, and this was diagnosed as partial rupture of the posterior papillary muscle. Intra-aortic balloon pumping (IABP) was performed to maintain the systemic circulation. Four days after the onset of acute MR (15 days following AMI), we performed mitral valve repair with coronary artery bypass grafting. We reattached the ruptured head to the viable posterior head with pledget sutures and performed annuloplasty using Carpentier-Edwards classical ring M28. Postoperative echocardiography showed no MR, and the patient was uneventfully discharged on the 45th postoperative day.

A 79-year-old man developed congestive heart failure. He was given a diagnosis of severe mitral regurgitation with calcification of the posterior mitral annulus and secondary tricuspid regurgitation. He had a history of esophageal resection with retrosternal gastric tube reconstruction about 20 years previously. We replaced the mitral valve with a mechanical prosthesis and performed tricuspid ring annuloplasty through a right parasternal approach. We did not risk resecting the calcified annulus, but fixed the prosthesis and annulus with the equine pericardium in between as a cushion and collar, to prevent perivalvular leakage. The postoperative course was uneventful.

An isolated quadricuspid aortic valve is an extremely rare congenital anomaly and there have been few surgical case reports published. A 47-year-old man with untreated diabetes mellitus was admitted to our institution because of fever and dyspnea. Transesophageal echocardiography showed severe aortic valve regurgitation and a quadricuspid valve with vegetations. Blood culture revealed Streptococcus agalactiae. Despite administration of antibiotics and treatment of his heart failure, the infection and heart failure were not controlled. Therefore, we performed aortic valve replacement in the presence of active infective endocarditis. The aortic valve had 2 equal-sized larger cusps and 2 equal-sized smaller cusps. There were vegetations on each cusp and an annular abscess was detected. The resection site of the abscess was reinforced with an autologous pericardial patch, and the aortic valve was replaced using a 21-mm SJM valve. His postoperative course was uneventful and he was discharged after recovery.

A 58-year-old man who complained of dyspnea on effort was given a diagnosis of decompensated congestive heart failure. Echocardiography revealed severe aortic regurgitation and cardiomegaly. We decided to perform aortic valve replacement with a mechanical valve, however his past history made us suspicious of allergy to metal. From his previous patient records, we determined he was allergic to many metals : gold, iron, platinum, cobalt, chrome, bronze, and zinc. Newly performed skin patch tests showed positive reactions to aluminum, tin, palladium, indium, iridium and stainless steel. We selected a CarboMedics mechanical valve made of nickel-titanium alloy. Aortic valve replacement with a 27-mm CarboMedics mechanical valve was performed by median sternotomy. At sternum closure, we used polyester non-absorbable suture thread, instead of surgical steel wire, because it contains stainless steel. His postoperative progress was good and he was discharged on the 10th postoperative day. One year after surgery he is doing well without any allergic symptoms.

We describe a case of Takotsubo cardiomyopathy in an 88-year-old woman who underwent endovascular aneurysm repair (EVAR) for an abdominal aortic aneurysm. The patient developed cardiac arrest shortly after the surgery. Following immediate resuscitation, her electrocardiogram showed extensive ST segment elevation in leads V2-V6, and echocardiography revealed apical akinesis with basal hyperkinesis. Emergency coronary angiography confirmed the absence of coronary lesions, and she was diagnosed with Takotsubo cardiomyopathy. Her cardiac function improved within a few days following the administration of catecholamines. Although EVAR is a less invasive surgical procedure, it may trigger Takotsubo cardiomyopathy. Prompt diagnosis and appropriate management of Takotsubo cardiomyopathy are essential to treat critical conditions in the acute phase.