Intracardiac repair for cardiac anomalies associated with a transposed aorta from the right ventricle is a technically demanding operation. We present two cases of left ventricular outflow tract (LVOT) obstruction after the use of an ePTFE flat patch to reconstruct the LVOT. Case 1 : A 10-year-old boy had undergone the Rastelli operation, VSD enlargement, and intraventricular re-routing using an ePTFE flat patch for repair of the DORV with noncommitted VSD and pulmonary stenosis at the age of 5. Five years later, catheter examination revealed severe LVOT obstruction. Intraventricular re-routing using a part of the ePTFE graft concomitant with re-replacement of an extracardiac conduit was successfully performed. Case 2 : A 13-year-old girl had undergone a double-switch operation (Senning operation, the Rastelli operation, and intraventricular re-routing by the use of an ePTFE flat patch) for the repair of corrected TGA, PA and VSD at the age of 7. Six years later, catheter examination revealed severe LVOT obstruction. Intraventricular re-routing using part of the ePTFE graft concomitant with re-replacement of an extracardiac conduit was successfully performed. We consider that the use of a flat patch for reconstruction of a left ventricular out flow tract in cases with transposition of the aorta from the right ventricle involves a risk of future development of LVOT obstruction.

A 55-year-old woman with fever and consciousness disorder diagnosed as infective endocarditis was transported to our hospital. She had atopic dermatitis. A mobile vegetation at the mitral valve was revealed by the transesophageal echocardiography, and a computed tomography (CT) scan showed cerebral infarction, left renal infarction and suspected embolization of the vegetation. Streptococcus aureus was detected in the blood culture test. We conducted emergent surgery, mitral valve plasty was performed. On the second day after the operation, the hemoglobin began to decrease, and the hemodynamics became unstable. The contrast CT examination revealed arterial bleeding from the left kidney, which had an infarction before the operation. We performed emergent catheter liquid embolization for the superior polar branch of the left renal artery, and the hemodynamics improved thereafter. There has been no report of renal hemorrhage after cardiac surgery for infective endocarditis. This case reminded us that cardiac surgery for infective endocarditis may cause various complications of organs.