A 75-year old man presented with diuretic-resistant leg edema. He had a history of three cardiac surgeries: mitral valve plasty, mitral valve replacement with a stentless valve made of autologous pericardium, and mitral valve replacement with a mechanical prosthesis. Six years had passed since his last cardiac surgery. The tests revealed right heart failure due to a chronic expanding intrapericardial hematoma. The hematoma was removed via left thoracotomy, and which had been covered with the ePTFE pericardial membrane used in the previous chest closure was removed via left thoracotomy. The chronic expanding intrapericardial hematoma is a rare condition, and it was suggested that extensive coverage with the sheet may have been a contributing factor to its formation.

An 89-year-old woman was followed with a diagnosis of thoracoabdominal aortic aneurysm (TAAA) with a diameter of 40 mm. Computed tomography (CT) scans revealed that the TAAA had rapidly expanded to 55 mm in diameter in just two years. She was admitted to our hospital. Considering her advanced age, conventional graft replacement was thought to be quite a high risk. Thus, we selected endovascular treatment. As the TAAA was located just above the celiac artery, it was necessary to deploy the stent-graft just proximal to the origin of the superior mesenteric artery in order to secure a sufficient distal landing zone. In this case, we could secure the maximum landing zone by using the endowedge technique with the staged deployment of the conformable TAG with ACTIVE CONTROL System. The postoperative course was uneventful, and CT disclosed complete occlusion of the aneurysm.

Background/Aims: Recent studies suggested a favorable effect of indigo naturalis (IN) in inducing remission for refractory ulcerative colitis (UC), however, the maintenance effect of IN for patients with UC remains unknown. Therefore, we conducted a prospective uncontrolled open-label study to analyze the efficacy and safety of IN for patients with UC. Methods: Patients with moderate to severe active UC (clinical activity index [CAI] ≥ 8) took 2 g/day of IN for 52 weeks. CAI at weeks 0, 4, 8, and 52 and Mayo endoscopic subscore (MES) and Geboes score (GS) at weeks 0, 4, and 52 were assessed. Clinical remission (CAI ≤ 4), mucosal healing (MES ≤ 1), and histological healing (GS ≤ 1) rates at each assessment were evaluated. Overall adverse events (AEs) during study period were also evaluated. The impact of IN on mucosal microbial composition was assessed using 16S ribosomal RNA gene sequences. Results: Thirty-three patients were enrolled. The rates of clinical remission at weeks 4, 8, and 52 were 67%, 76%, and 73%, respectively. The rates of mucosal healing at weeks 4 and 52 were 48% and 70%, respectively. AEs occurred in 17 patients (51.5%) during follow-up. Four patients (12.1%) showed severe AEs, among whom 3 manifested acute colitis. No significant alteration in the mucosal microbial composition was observed with IN treatment. Conclusions One-year treatment of moderate to severe UC with IN was effective. IN might be a promising therapeutic option for maintaining remission in UC, although the relatively high rate of AEs should be considered.

We reviewed our experience of tricuspid valve surgery for tricuspid regurgitation in hypoplastic left heart syndrome (HLHS) in terms of surgical timing, surgical procedures and long-term results. From May 1991 to July 2010, 105 classic HLHS patients underwent cardiac surgery, 28 of whom underwent a total of 31 tricuspid valve surgical procedures. Tricuspid valve surgery was performed in cases of moderate or more tricuspid regurgitation (TR). Type of the first tricuspid valve surgery was as follows : Annuloplasty in 15 patients, annuloplasty+commissure closure in 7 patients, commissure closure in 2 patients, edge-to-edge repair in 2 patients, tricuspid valve replacement in 2 patients. Three patients underwent re-operation because of progression of TR. Two of them underwent tricuspid valve repair and one of them underwent tricuspid valve replacement. Follow-up was 60.1±53.0 months. Freedom from moderate or more TR after tricuspid valve surgery was 50.9% at 1 year, 42.0% at 3 years, 36.0% at 5 years. Among 17 patients who achieved total cavopulmonary connection procedure, 35.2% of patients had moderate or more TR, but central venous pressure (9.1±2.2 mmHg), cardiac index (3.5±6.8 l/min/m²), arterial oxygen saturation (94.2±1.7%) showed as good hemodynamics after a Fontan procedure as non-tricuspid valve surgery cases. Appropriately timed aggressive tricuspid valve surgery yielded as good long-term results as HLHS without tricuspid valve surgery.