[Beating heart surgery for ischemic mitral regurgitation: report of a case]

A 51-year-old man was admitted to our hospital because of dyspnea. Coronary angiography revealed triple vessel disease and echocardiography demonstrated severe mitral regurgitation with poor left ventricular function. Under a diagnosis of ischemic mitral regurgitation, on-pump beating mitral annuloplasty and coronary artery bypass grafting using the normothermic retrograde continuous coronary sinus perfusion of oxygenated blood was performed in order to prevent reperfusion injury. The patient was easily weaned from cardiopulmonary bypass and his postoperative course was uneventful. Because of the advantages of this procedure (e.g., no reperfusion injury, testing of the mitral valve repair is done in real physiologic conditions with beating tonus), on-pump beating heart surgery seems a good surgical option for ischemic mitral regurgitation with poor left ventricular function.

[One-staged operation for mitral regurgitation and annuloaortic ectasia without aortic regurgitation with Marfan syndrome; report of a case]

A 32-year-old man with Marfan syndrome was admitted to our hospital for detail examination of congestive heart failure. Doppler echocardiography showed severe mitral regurgitation due to prolapse of posterior mitral leaflet. Annuloaortic ectasia without aortic regurgitation was also detected by aortography. Considering the future operative need for aortic root and ascending aorta, we performed mitral valve replacement with a mechanical valve and preventive concomitant aortic root replacement with a composite valve graft. His postoperative course was uneventful. Optimal surgical treatment of mitral regurgitation and annuloaortic ectasia in Marfan syndrome is controversial because the underlying connective tissue defect theoretically might compromise repair durability. Several surgical options for mitral regurgitation and annuloaortic ectasia in Marfan syndrome are discussed.

Acute pulmonary thromboembolism with a floating right-heart thrombus. 4 surgical cases

OBJECTIVE

We determined the efficacy of surgery for acute pulmonary thromboembolism with a floating right-heart thrombus.

METHODS AND RESULTS

Thrombi were diagnosed by transthoracic echocardiography and electron beam computed tomography in 4 patients with acute pulmonary thromboembolism with a floating right-heart thrombus, and thromboembolectomy was done in all patients. Surgical procedure included intermittent deep hypothermic circulatory arrest. One patient died of endobronchial hemorrhage and 3 survived.

CONCLUSION

Because acute pulmonary thromboembolism with a right-heart thrombus is life-threatening, immediate thromboembolectomy is required to decrease mortality.

[A case of left ventricular rupture and left ventricular-right atrial communication after mitral valve re-replacement]

We report a case of left ventricular rupture and left ventricular-right atrial communication after mitral valve re-replacement. A 53-year-old man was admitted to our hospital for a primary tissue failure of mitral xenograft. On June 4, 1997, he underwent mitral valve re-replacement. At 12 post operative day, he was suffered from unexpected dyspnea. The transesophageal echocardiography showed floated mitral valve and left ventricular-right atrial communication. The emergent operation was done. At the operation, posterior mitral annulus was disrupted and the disruption reached to a membranous septum. A communication was directly closed, mitral annulus was repaired with perigard and one size smaller mitral valve was implanted. The patient was discharged and returned to social life.