The following paper describes mitral valve replacement in a 48-year-old man. He had been perfectly well until he was brought to the emergency room because of fever and impaired consciousness. Computed tomography revealed subarachnoid hemorrhage. Magnetic resonance imaging showed multiple cerebral infarctions. Echocardiography revealed a large vegetation (25×20 mm) under his mitral valve and mild mitral regurgitation. He was treated with adequate antibiotics for several days. On the 11th admission day, his condition worsened dramatically. We found acute mitral regurgitation due to ruptured chordae. After IABP was inserted, an urgent operation was performed. After the operation, he improved gradually. He was discharged 50 days postoperatively in a satisfactory condition without any critical complications. This report describes an experience of successful operation for acute mitral regurgitation due to ruptured chordae in a patient who suffered from infective endocarditis complicated with preoperative cerebral infarction and subarachnoid hemorrhage.

A 79 year-old woman was given a diagnosis of acute myocardial infarction and was immediately transferred to our hospital by a helicopter. Cardiologists successfully revascularized the occluded left anterior descending artery which was considered to be the care of this case. After that, they detected a large ventricular septal perforation by transthoracic echocardiography. We performed repair of the ventricular septal perforation 4 days later, with a modified infarct exclusion technique. Residual shunt flow was not seen by echocardiography after the operation. This patient recovered uneventfully and was discharged on postoperative day 55.

A 78-year-old woman underwent mitral valve replacement (MVR) with bioprosthesis in 1984. By 1997 the valve had become dysfunctional and was replaced with a Mosaic valve. Dyspnea on exertion occurred in 2005 and a systolic murmur was detected at that time. Echocardiography revealed severe mitral regurgitation (MR). The mitral valve was replaced for the third time. The explanted valve showed commissural dehiscence at the stent position and calcified leaflets. The mitral valve of a 70-year-old man was replaced with a bioprosthesis in 1986, and again with a Mosaic valve in 1997 because the original bioprosthesis had become dysfunctional. Seven years later, a systolic murmur appeared and echocardiography revealed severe MR. The valve was replaced for the third time. A leaflet tear was found in the removed valve. The Mosaic valve is a third generation porcine bioprosthesis that reportedly has excellent long-term durability. However, in these cases, the Mosaic valves deteriorated prematurely, and no obvious causes of this early structural deterioration could be identified. Continued long-term follow up is necessary, and the possibility of premature deterioration should be considered when selecting bioprostheses.

Vasculo-Behçet disease (VBD) is a special type of Behçet disease (BD) involving some vascular disorders like aneurysmal formation, arterial occlusion, and venous thrombosis in various vessels. VBD has a poor prognosis due to aneurysmal rupture or recurrence of vascular disorders despite optimal treatment. However, definite diagnosis in BD is made on the basis of clinical features, and early diagnosis is difficult. We report 2 patients whose first clinical symptoms were femoral-pseudoaneurysms. They received a diagnosis of VBD after surgery. The first patient was a 69-year-old man, who underwent autologous-vein patch closure of a perforated region in the left femoral artery. One year later, he had a pseudoaneurysm of the right profunda femoris artery, which was ligated. The second patient was a 51-year-old man, who underwent the interposition of the saphenous vein for defective artery due to left superficial femoral-pseudoaneurysm.

A 72-year-old woman underwent a double aortic valve replacement with the Freestyle aortic bioprosthesis and subcoronary implantation with the Mosaic mitral bioprosthesis because of rheumatic multivalvular heart disease in 2000. During her annual follow-up, her Sinotubular junction was observed to have gradually increased in diameter on echocardiography and computed tomography. Therefore, 9 years after surgery we performed a reoperation for severe aortic regurgitation. Intraoperatively, the stentless bioprosthesis was found to be structurally intact. We believe that the dilation of the Sinotubular junction associated with a stentless bioprosthesis in the subcoronary position have caused her severe aortic regurgitation.

Five patients with vascular graft infections were surgically treated over a 16-year period. Primary diseases were arteriosclerosis obliterans in 3 cases and invasion of malignant diseases in 2 cases. The most common site of infection was the groin (3 of 5). Staphylococcus aureus was the most common pathogen. Administration of antibiotics, drainage and lavage with povidone iodine solution were performed in 4 patients (40-64 days). All patients underwent graft resection and reconstruction. Infected parts of the previous grafts were removed. Total removal of the previous graft was performed in 2 cases and partial removal was performed in 3 cases. To avoid re-infection, long extra-anatomical bypass was performed in 4 cases. The post operative courses of the five patients were uneventful.

Our aim was to study the scan protocol of 16 DAS (Data Acquisition System) multidetector-row CT (MDCT) and to ascertain whether we could reduce radiation exposure and scanning time, while maintaing image quality in the Virtual endoscopy (VE).We made a mimic gastrointestinal tract and examined the result by changing a scan protocol of 16 DAS MDCT.We found that a reduction of radiation exposure and scanning time depended on slice width, angle of the table, rotation time, table speed, mAs/slice and resolution.The study confirmed that it was possible to use the scan protocol of MDCT with a radiographic dose of 40% and scanning time of 50%, without changing image quality in the VE.
Radiation ; amsonic acid ; Protocols documentation ; Endoscopy ; Accident due to exposure to weather conditions

Background: SOLO SMART (SOLO) was introduced in Japan as a new stentless tissue valve in April 2016. Postoperative thrombocytopenia has been reported to occurs after aortic valve replacement (AVR) using SOLO. Methods: The aim of our study was to evaluate the difference in incidence and clinical impact of postoperative thrombocytopenia in patients receiving AVR between SOLO group and stented bioprosthetic valve (Stented) group. We evaluated 67 patients who underwent AVR with bioprosthetic valve for AS between April 2017 and March 2020. Severe thrombocytopenia was defined as the lowest postoperative platelet count of < 5.0×104/μl. We divided patients with AVR into SOLO and Stented groups, and compared the surgical results, prevalence of thrombocytopenia, and changes in platelet count. Results: Postoperative aortic valve area (AVA) and peak pressure gradient (P-PG) were significantly improved in the SOLO group. The lowest postoperative platelet count was significantly lower in the SOLO group. Severe thrombocytopenia was observed in 75% of the patients in the SOLO group and 7% of those in the Stented group. As a factor that causes postoperative thrombocytopenia, use of SOLO, age at surgery, and body surface area (BSA), showed significant differences (p＜0.05). Although the platelet count had the lowest value on the 2nd to 4th day after the operation, then recovered spontaneously, and at 1 month after the operation, the platelet level improved to normal values. However, in the Stented group, the platelet level recovered to the preoperative platelet level 1 week after operation, but in the SOLO group, the preoperative platelet level didn't recover even after 3 months, and as a result, it suggest that platelet recovery was prolonged in the SOLO group. Conclusion: Use of SOLO was an independent risk factor of severe thrombocytopenia after AVR. Although no clinically serious hemorrhagic complication was observed, use of SOLO may prolong postoperative platelet recovery. In consideration of the risk of thrombocytopenia, it was considered to be advantageous to select the SOLO for SAVR in cases with a narrow annulus diameter.

In poststernotomy redo cardiac surgery, injury to cardiac structures during sternal division can lead to untoward results in the operation. These days, Minimally Invasive Cardiac Surgery (MICS) such as the right anterolateral thoracotomy approach is becoming popular. By using MICS technique in redo cardiac surgery, it may be possible to reduce the risk of injury to the vital structures because of avoiding full sternotomy with the reduction of the dissection area. Six redo cardiac surgery cases in which innominate vein or bypass graft was in close contact with the sternum were is considered difficult to perform via the right thoracotomy approach. We report the cases in which operations were safely conducted through the lower hemi-sternotomy.