[A case of acute myocardial infarction complicated with left ventricular pseudoaneurysm and ventricular septal rupture]

An 87-year-old woman was admitted to another hospital with acute inferior myocardial infarction on May 31, 1991. On the 6th hospital day she suddenly developed transient complete A-V block and ventricular tachycardia. She was transferred to our hospital for the treatment of intractable heart failure on the 18th hospital day. Two-dimensional echocardiography showed a saccular chamber with a narrow-necked connection to the left ventricle. Color Doppler echocardiography showed bidirectional blood flow between the left ventricle and saccular chamber during systole and diastole. There was 35% left to right shunt in the ventricular level on right heart catheterization. Acute myocardial infarction complicated with left ventricular pseudoaneurysm and ventricular septal perforation was diagnosed. She died on the 26th hospital day without aggressive medical treatment. Autopsy demonstrated the pseudoaneurysm in the posterior wall of the left ventricle and the connection to the right ventricle. The so-called double rupture could be diagnosed before death.

[Successful surgical treatment in a case of complete rupture of the posterior papillary muscle of the mitral valve caused by infective endocarditis]

Forty three year-old male who had cough and easy fatigability since three weeks prior to admission was diagnosed to have acute pulmonary edema with severe mitral regurgitation caused by active infective endocarditis. Transesophageal echocardiograms under the endotracheal intubation for controlled respiration suggested rupture of the posterior papillary muscle of the mitral valve and the emergency surgical treatment was performed. Intraoperatively the total rupture of the posterior papillary muscle was confirmed and mitral valve replacement was carried out with a SJM prosthetic valve. Histological examination of the ruptured papillary muscle revealed hemorrhage, muscle necrosis and small cell infiltration suggesting the presence of active inflammation with bacteria on it. Staphylococcus epidermidis was demonstrated by the bacteriological studies of the ruptured papillary muscle.

Differences in immunomodulating effects between wild and cultured Panax ginseng

The different effects between wild and cultured Panax ginseng on immunological activity were investigated. The extracts of hot water soluble fraction from wild Panax ginseng showed the mitogenic activity to lymphocytes but that from cultured Panax ginseng did not. The mitogenic activity of wild Panax ginseng (100 micrograms/well) was almost equal to Concanavalin A (0.1 microgram/well) which was well-known as one of T cell mitogens. The percentages of Thy 1.2-(pan T cells), L3T4-(helper T cells) and Lyt2-(cytotoxic T cells) positive cell population were significantly increased in the mice orally administered hot water soluble fraction from wild Panax ginseng as compared to control by 31.2, 17.9 and 30.1 percent, respectively.

[A case of coronary artery bypass grafting after unsuccessful PTCA in a patient with systemic lupus erythematosis]

For angina of effort in a 69-year-old male patient who had been on steroid for SLE for 7 years we performed PTCA. However, with no dilation obtained we were compelled to perform CABG. The left internal thoracic artery was anastomosed with seg. 12 and the left great saphenous vein was anastomosed sequentially with seg. 14 and seg. 4PL. Through coronary angiography performed at postoperative 2 months, the vein graft was found well patent but in the left internal thoracic artery 90%-stenosis was observed at the anastomosed part, for which PTCA was performed to have it dilated up to 25%. In patho-histological examinations, intimal hypertrophy was observed in both grafts, which seemed to suggest a possible risk factor to determine long-term prognosis. In cases of SLE, the frequency of occurrences of ischemic heart diseases is high, indicating probabilities to be taken up as serious complication from now on. Until now, however, there are few instances reported on performing CABG for patients with SLE. We are reporting here our studies of this particular case of SLE, discussing the involvement of steroids, angitis and lupus anticoagulants as causative factors of ischemic heart diseases and related issues of surgical treatments.

A case of congenital dyserythropoietic anemia type II associated with hemochromatosis

A 54-year-old woman with anemia, diabetes mellitus and liver dysfunction was admitted to our hospital. Numerous binucleated erythroblasts in the bone marrow, a positive serum acidified test, and the presence of anti I and anti i antigens on the surface of her erythrocytes indicated that she had congenital dyserythropoietic anemia (CDA) Type II. Hemochromatosis was confirmed by a liver biopsy. This case is a sibling of a patient with CDA Type II reported by Omine et al in 1981 (Acta Haematol Jpn 44:1). They report that no physical or hematological abnormalities were found when she was examined at the age of 29 years. Twenty-five years later, she developed CDA Type II and hemochromatosis. This case indicates that long-term observation of the family members of a patient with CDA Type II is necessary.

[Cardiac operation in patients older than 70 years]

To clarify the predictors of operative risk in the elderly, preoperative clinical features and postoperative short term outcome were retrospectively evaluated in 328 consecutive patients. Patients underwent coronary artery bypass or valvular surgery from July 1988 to December 1990 in our hospital: 78 patients were 70 years or older (elderly group) and 250 were younger than 70 years old (control group). Preoperative renal and respiratory function were slightly depressed in the elderly group than in the control group. Prolonged ventilatory support and the administration of inotropic agent were required in some elderly patients with renal or respiratory dysfunction. Neurological complications occurred more frequently in the elderly group than in the control group. Prolonged ventilatory support was needed in almost all the elderly patients with neurological complications. The operative mortality rate was similar in the two patient groups. In contrast, the hospital mortality rate was significantly higher in the elderly group than in the control group. The main causes of the higher hospital mortality in the elderly group was pulmonary infection and sepsis. These results suggest that the prolonged intensive care induces lethal infection and high hospital mortality in the elderly patients undergoing cardiac surgery.