Tamponade occurring several years after open-heart surgery is rare ; the decision to surgically intervention for tamponade is a difficult one. We present our experience with a case of tamponade that occurred 4 years after open heart surgery. The patient was a 70-year-old man who underwent aortic valve replacement (Carbomedics^TM 27 mm), pulmonary vein isolation, right atrium maze operation, and ligation of the left atrial appendage. Four years after the surgery, he was admitted to our hospital because of dyspnea on exertion and leg edema. Echocardiography and computed tomographic (CT) scan revealed a hematoma in the intrapericardial cavity, which was pressing on the posterior wall of the left ventricle, for which surgery was indicated. After the hematoma was removed, there was bleeding from the left atrial appendage. Hemostasis was performed with one mattress suture. A postoperative CT scan demonstrated that the left ventricle deformity had disappeared and the cardiac hemodynamics were normalized. During the follow-up period, no recurrent hematoma was observed. This evidence suggests that tamponade occurred because of re-bleeding from the left atrial appendage where the bleeding was stopped by the pressure of the hematoma.

A 50-year-old man who had coronary artery bypass grafting (LITA-LAD, RA-RCA, SVG-OM-PL) 6 years previously was admitted with acute dissection of the aorta (DeBakey type I). Preoperative computed tomography showed that all coronary bypass grafts were patent. We replaced the graft of the ascending aorta and reconstructed the coronary artery bypass by re-sternotomy, circulatory arrest (rectal temperature: 23.6°C), retrograde cerebral perfusion, and intermittent retrograde cardioplegia. Because a radial artery (RA) graft and a saphenous vein graft (SVG) each had intact orifices, we detached them together and attached the grafts back to the aortic graft wall. He was weaned successfully from cardiopulmonary bypass without difficulty and postoperative transthoracic echocardiography (TTE) showed good left ventricle (LV) function. Postoperative multidetector-row computed tomography (MDCT) showed that the RA graft and SVG were patent. By performing circulatory arrest and intermittent retrograde cardioplegia, we successfully protected the myocardial function of a patient with acute aorta dissection after a CABG and we reconstructed the graft without needing further coronary anastomosis.

In this study, we report early and mid-term outcomes of endoscopic saphenous vein (SV) harvesting (EVH) for coronary artery bypass grafting. EVH is expected to have superior cosmetic results and fewer wound complications than conventional open techniques. EVH was performed in 262 patients from April 2008 to December 2010. From September 2010, we have administered heparin before EVH to prevent intraluminal SV clot formation. The mean age of the patients was 70±7.3 years, and 178 (67.9%) patients were men. The success rate of EVH was 97.3%. Hospital mortality was 1.2%. Postoperative wound complications occurred in only 7 (2.8%) patients. The early and mid-term patency was 95.8% (276/288) and 74.2% (187/252), respectively, as evaluated by postoperative angiography or computed tomography. Comparing the mid-term patency rate between the groups with or without systemic heparinization before EVH, statistical significance was not observed, but the mid-term patency was good in the group with systemic heparinization (82.5% vs. 73.6%, p=0.16). Actuarial 1-year and 3-year survival were 93.9% and 79%. Actuarial 1-year and 3-year major adverse cardiac event-free rates were 92.2% and 77.5%. In 10 patients who had SV graft occlusion during the observation period, percutaneous coronary intervention was required for the native coronary artery. EVH has great cosmetic advantages and has a good early patency. However, the mid-term patency is not satisfactory. Thus, systemic heparinization before EVH, improvement of the device and further clinical experience and techniques are required to improve the mid-term and late patency.

A 47-year-old man underwent a double-valve replacement involving aortic valve replacement (AVR) and mitral valve replacement (MVR) and Re-Re-DVR 6 and 8 months, respectively, after an initial DVR because of suspected prosthetic valve endocarditis. Detachment of the prosthetic mitral valve occurred during the early postoperative period, for which the patient again underwent treatment 15 and 21 months after the initial surgery. The operative findings showed that the detachment was caused by a wide cleavage of the aortic-mitral continuity. There were bacteria detected on a blood culture, and his C-reactive protein (CRP) level did not reduce at any time. On the basis of these findings, we suspected nonrheumatic inflammatory disease and started steroid therapy. His CRP level became negative, and further prosthetic mitral valve detachment did not recur.