We report a case of mitral valve replacement without aortic cross clamp in a patient with MitraClip failure. The patient is an 83-year-old man with a history of coronary artery bypass surgery 31 years earlier. He developed heart failure due to severe mitral regurgitation. He underwent MitraClip, but it caused mitral stenosis and hemodynamic instability. Considering the severe calcification of the ascending aorta and previous bypass grafts, typical median sternotomy surgery with cross clamp had to be avoided. We performed mitral valve replacement via right thoracotomy under ventricular fibrillation. The postoperative course was favorable. Mitral valve surgery with ventricular fibrillation could be undertaken safely for a patient with difficulty in aortic cross clamp.

BACKGROUND: Molar incisor hypomineralization (MIH) frequently occurs in children worldwide. However, MIH prevalence throughout Japan has not yet been investigated. The purpose of this study was to clarify MIH prevalence rates and to consider potential regional differences throughout Japan. METHODS: A total of 4496 children aged 7-9 years throughout Japan were evaluated in this study. MIH prevalence rates among children were evaluated in eight regions throughout Japan. A child's residence was defined as the mother's residence during pregnancy. The localization of demarcated opacities and enamel breakdown was recorded on a standard code form using a guided record chart. Logistic regression analysis was used to evaluate whether MIH prevalence rates differed among age groups, sex, and regions. RESULTS: The overall prevalence of MIH in Japan was 19.8%. The prevalence of MIH was 14.0% in the Hokkaido region, 11.7% in the Tohoku region, 18.5% in the Kanto Shin-Etsu region, 19.3% in the Tokai Hokuriku region, 22.3% in the Kinki region, 19.8% in the Chugoku region, 28.1% in the Shikoku region, and 25.3% in the Kyushu region. These regional differences were statistically significant. Moreover, MIH prevalence rates decreased with age. No significant sex differences in MIH prevalence rates were demonstrated. CONCLUSIONS To our knowledge, this is the first MIH study carried out in several regions throughout Japan. Regional differences existed in MIH prevalence rates; particularly, MIH occurred more frequently in children residing in southwestern areas than those in northeastern areas of Japan.
Child ; Dental Enamel Hypoplasia ; epidemiology ; etiology ; Female ; Humans ; Japan ; epidemiology ; Male ; Prevalence

Hemolysis, hemoglobinuria, skin eruption and hypotension were noticed following transfusion of 11 units of fresh blood during mitral valve replacement in a 57-year-old man. Irregular antibody incompatibility was suspected. Further investigation revealed anti Lewis-a antibody. Three of 11 units of transfused blood were positive for the indirect Coombs test. The patient recovered without renal failure, and was discharged. One year later, he had urgent re-MVR due to malfunction of the prosthetic valve. Hemolytic transfusion reaction had occured after the administration of donor blood which had been showed to be compatible by cross matching. This means that antibody titer diminishes with time, and that posttransfusion screening tests should minimize the unexpected hazards of incompatible blood transfusion. We recommend that antibody screening tests should be routinely performed after open heart surgery, to minimize the risk of hemolysis during future reoperation.

Problems with postoperative respiratory management of three patients after division of double aortic arch are described. Tracheomalacia was present in two of three cases with intracardiac anomalies of different types. Intracardiac anomalies of each patient were as follows: Patient 1, ventricular septal defect (VSD), atrial septal defect and pulmonary valve stenosis (PS); Patient 2, VSD, corrected transposition of the great arteries with PS; Patient 3, VSD with pulmonary hypertension (PH). In patient 1 and 2, no concomitant surgical intervention was performed for tracheomalacia. In these patients respiratory support had been continued for 41 and 60 days respectively. In patient 3, remaining VSD with PH was the cause of unexpected respiratory problem even after the successful division of the double aortic arch, and necessitated emergency VSD closure 49 days after the initial operation. The patient was extubated on postoperative day 12. Tracheomalacia is a life-threatening problem even after surgical division of the double aortic arch. Although prolonged respiratory support was needed, our two cases were successfully extubated without concomitant surgical intervention of tracheomalacia. Severe cases should be operated on simultaneously with the relief of vascular ring and tracheomalacia. Intracardiac anomalies are also the causes of prolonged intubation. Patient 3 should have been treated by pulmonary artery banding along with the division of aortic arch. In conclusion, precise evaluation of the existence and severity of the tracheomalacia and intracardiac anomalies is of utmost importance to overcome postoperative respiratory failure and for eventual satisfactory results.

A 63-year-old woman who was diagnosed a having impending rupture of abdominal aortic aneurysm underwent urgent anatomic reconstruction. Histopathological findings revealed abscess formation around the aneurysmal wall, and a definitive diagnosis of mycotic aneurysm was established. Successful management of this rare aortic disease depends on early accurate diagnosis, control of infection and careful surgical management.

From January 1979 through May 1982, 36 premature infants less than 2.5kg and less than 35 weeks of gestation, including 24 patients with respiratory distress syndrome, underwent ligation of patent ductus arteriosus (PDA) due to being unresponsive to medical treatment. Ten patients died postoperatively mainly from intracranial hemorrhage and necrotizing enterocolitis. Surviving 26 patients were examined for developmental sequelae based on questionnaire survey. One infant died of respiratory failure secondary to severe bronchopulmonary dysplasia 28th month after operation. We found no evidence of recurrent ductal patency following ligation during the follow-up period. Twenty four patients exhibited normal motor and mental development to attend the ordinary elementary school everyday, but one patient shows mental retardation. Most of patients suffered from the frequent upper respiratory infection in childhood to require rehospitalization. There are no patients with hoarseness, but 2 patients developed funnel chest and one required the operation. One third of the patients had ophthalmological handicap (myopia or strabismus). Surgical ligation of PDA in premature infants seems to reduce the duration of postoperative mechanical ventilation and the incidence of bronchopulmonary dysplasia. Analyzing long-term follow-up indicates that infants who undergo PDA ligation grow almost normally and do not appear to be at increased risk for sensorineural handicaps. Therefore we emphasize that surgical ligation of PDA is an effective and appropriate treatment of choice for significant PDA in premature infants.