In recent years, the number of MitraClip procedures has increased among high-risk patients for open-heart surgery with mitral regurgitation. However, surgical re-intervention is sometimes required after a MitraClip procedure, and this re-intervention carries high risks considering the patients' backgrounds. We report on two cases of surgical re-intervention after MitraClip procedures. Case 1: An 82-year-old man experienced repeated heart failure due to severe mitral regurgitation (MR) caused by chronic atrial fibrillation. He underwent the MitraClip procedure because of his advanced age and frailty. However, his heart failure became uncontrollable due to an acute exacerbation of MR caused by Clip detachment. He underwent mitral valve replacement (MVR) 10 days after the MitraClip procedure. Case 2: A 72-year-old man experienced heart failure due to severe ischemic MR. The MitraClip procedure was performed because of hemorrhagic cerebral infarction and emphysema. However, two years after the MitraClip procedure, his condition was worsened due to MR and mitral stenosis. He eventually underwent MVR. If surgical re-intervention is required after a MitraClip procedure, open-heart surgery such as valve replacement is essential. When performing valve replacement surgery, it is considered important to preserve the subvalvular apparatus as much as possible to prevent complications.

In acute Stanford type A aortic dissection, except for some thrombosed false-lumen types, graft replacement is a standard treatment. On the other hand, thoracic endovascular aortic repair (TEVAR) might be considered for high-risk patients with retrograde type A aortic dissection when entry is in the descending aorta, although its efficacy in a case of an extensive thrombosed false lumen without obvious entry is unknown. We report a case of successful zone 3 TEVAR using RelayPro NBS for Stanford type A aortic dissection with a localized CT-enhanced false lumen in the proximal descending aorta. An 83-year-old woman was admitted for acute Stanford type A aortic dissection with a thrombosed false lumen of the ascending thoracic aorta. She was initially treated conservatively because of being a high-risk patient for open surgery. One week after hospitalization, the ascending aorta diameter increased and the false lumen in the proximal descending aorta grew sporadically in a CT image. We suspected that the ascending aorta was enlarged due to a partially patent false lumen of the descending thoracic aorta, and performed zone 3 TEVAR using RelayPro NBS to close a possible entry in the proximal descending aorta even though there was no obvious entry. The patient had a good postoperative course and was discharged 15 days after TEVAR. Shrinkage of the false lumen in the ascending aorta was observed in CT images two months after TEVAR.

A 75-year-old man who presented with fever and cough was given a diagnosis with active pulmonary valve endocarditis and transferred to our institution. Blood cultures were positive for Enterococcus faecalis, and transthoracic echocardiography showed a mobile vegetation attached to the pulmonary valve. Despite an 8-week treatment with antibiotics, a relapse of the infection required surgery. During the surgical procedure, we found that the vegetation had destroyed all of the pulmonary valve leaflets. After excising the pulmonary valve leaflets, we implanted a bioprosthetic valve and closed the pulmonary artery with autologous pericardium. The patient completed a 6-week course of intravenous antibiotics and was discharged on postoperative day 68. Postoperative transthoracic echocardiography demonstrated an adequate effective orifice area index. Our case report of isolated pulmonary valve endocarditis without predisposing factors is rare. The implantation of a bioprosthetic valve and enlargement with an autologous pericardial patch is an effective option for achieving a satisfactory hemodynamic profile.

Cardiac angiosarcoma is a rare heart malignancy. The prognosis is reported to be very poor. Here, we report a case of cardiac angiosarcoma which was treated by postoperative conformal dynamic arc radiotherapy. The patient has been in good health with no recurrence for 18 months after surgery. The patient was a 71-year-old woman, who presented edema and general malaise. Echocardiography and computed tomography revealed a right atrial mass and massive pericardial effusion, which was thought to be the cause of tamponade. Intraoperatively, we found a large tumor arising from right atrial wall spreading and invading to the inferior vena cava, diaphragm, and right pericardium. We abandoned complete resection of the tumor. We only resected the part of the tumor under cardiopulmonary bypass. The subsequent defect of the right atrial wall was reconstructed with bovine pericardial patch. The pathological diagnosis was consistent with angiosarcoma, and the margin was positive for the tumor. In addition to reduction surgery, we adopted radiotherapy (conformal dynamic arc radiotherapy, 10MV-X-ray, 54 Gy/18 Fr/4.5 week, fractionated radiotherapy). The CT, one month after the radiation, showed a significant reduction in tumor size. Moreover, no tumor could be pointed out by echocardiography 18 months after surgery. Advances in technology and methodology has made tumor control possible without significant side effects. We conclude that reduction surgery accompanied with postoperative radiotherapy is promising in maintaining quality of life and in improving life expectancy.

The purpose of this study was to investigate the hypothesis that the reduction in walking ability is due to muscle atrophy in the lower limb muscles with aging using equational structure modeling as well as investigate the influence of muscle on walking ability. The subjects consisted of 127 persons (57 males and 70 females) aged 20-84 year, who were grouped into 6 age brackets of 20-39, 40-49, 50-59, 60-69, 70-74, and 75 or older. Using MRI, muscle cross-sectional area was measured on psoas major and thigh muscle (divided into extensor and flexor) . For walking patterns, each subject walked along a 7-m walking passage at normal speed for VTR-recording of the motion. The resulting pictures were used to analyze stride length, trunk inclination and walking speeds. Walking speeds showed a statistically significant decrease in value from the 50's age group in males and the 60's age group in females when compared with the 20-39 age bracket (p<0.05) . In males, a significant co-relationship was observed only between the muscle cross-sectional area of thigh extensor and walking speed (p<0.01) while in females, a significant co-relationship was found between the muscle cross-sectional area of psoas major (p<0.001) /thigh muscle extensor (p<0.01) and walking speed. These results indicate that the muscle atrophy with aging in psoas major and thigh muscle extensor is a factor responsible for the decrease in walking speed. Meanwhile, a difference in sex was observed between the muscle cross-sectional area of psoas major and walking speed. It was considered that the muscle atrophy rate of the female's psoas major being higher than the male's influenced this. Furthermore, it was suggested possibility that the decline of walking ability is due to decreased muscle mass of the lower limbs with aging.