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.

A 46-year-old woman who originally presented acute abdomen was refferect to us. Her CT scan and echogram showed no abnormal findings in her abdomen. However, A 25-mm tumor-like mass was observed in her right atrium and right lower lobe. Based on the concern that the cardiac tumor might be a risk for embolic events, the tumor in her right atrium was resected under cardiopulmonary bypass in a semi-emergency manner. It was diagnosed as malignant lymphoma of B-cell type by histological examination. Two days after operation, she started to have abdominal pain and CT scan showed free air and a significant amount of effusion in her abdomen. Emergency laparotomy was performed and a single perforation with a tumor mass was observed in her small intestine. Segmentectomy was performed and her postoperative course since then was uneventful. Fifteen days after her initial operation, she was referred to the regional hematology center for chemotherapy. Primary cardiac lymphoma was classically defined as an extranodal lymphoma involving only the heart and/or pericardium; however the currently accepted definition is lymphoma with the vast bulk of the tumor intrapericardial even with small secondary lesions elsewhere. According to this recent definition, several cases with extensive extracardial involvements have been reported as primary cardiac lymphoma and our case marginally could be considered primary. Certain cutoffs must be proposed to quantify extracardiac disease in defining primary cardiac lymphoma.

A 67-year-old man had been followed up in our cardiology clinic for ischemic foot, and routine echocardiography revealed an 8×9mm highly echogenic mass on the mitral posterior leaflet. Because of the high thromboembolic risk, open-heart surgery was scheduled for surgical treatment of the tumor. His preoperative coronary angiogram showed 3 vessel disease. Coronary artery bypass grafting and tumor removal were performed consequently. His postoperative course was uneventful and the lesion was pathologically diagnosed a papillary fibroelastoma. No recurrence has occurred one year after the operation. Surgical treatment of cardiac tumors is mandatory for preventing embolism regardless of the size and location. Most of the tumors on cardiac valves are papillary fibroelastomas and recurrence of this tumor has not been reported so far. When the tumor is attached to a mitral leafet, simple tumor resection, with or without mitral valve repair, is justified instead of performing mitral replacement with en bloc resection of tumors and the entire leaflets.

BACKGROUND/AIMS: The pharmacokinetics of tacrolimus (TAC) is known to be largely influenced by single-nucleotide polymorphisms (SNPs) in CYP3A5. Patients starting TAC require careful dose adjustment, owing to the wide range of optimal dosages, depending on their CYP3A5 expression status. Here, we evaluated whether individualization of TAC dosages based on CYP3A5 SNPs would improve its therapeutic efficacy in ulcerative colitis. METHODS: Twenty-one patients were prospectively treated, with their initial dosage adjusted according to their CYP3A5 status (0.1, 0.15, and 0.2 mg/kg/day for CYP3A5*3/*3, CYP3A5*1/*3, and CYP3A5*1/*1, respectively). Their clinical outcomes were compared with those of patients treated with a fixed dose (0.1 mg/kg/day). RESULTS: The first blood trough level of CYP3A5 expressors, CYP3A5*1/*3 or CYP3A5*1/*1, and the overall rate in achieving the target blood trough level within a week in the individualized-dose group were significantly higher than those in the fixed-dose group (5.15±2.33 ng/mL vs. 9.63±0.79 ng/mL, P=0.035 and 12.5% vs. 66.7%, P=0.01). The remission rate at 2 weeks in the expressors was as high as that in the nonexpressors, CYP3A5*3/*3, in the individualized-dose group. CONCLUSIONS: Individualized TAC treatment is effective against ulcerative colitis regardless of the CYP3A5 genotype.
Colitis, Ulcerative ; Cytochrome P-450 CYP3A ; Genotype ; Humans ; Pharmacokinetics ; Polymorphism, Single Nucleotide ; Prospective Studies ; Tacrolimus ; Ulcer