Successful weaning from a left ventricular assist device after surgical repair of a left ventricular free wall rupture

We present a case of an insertion of a left ventricular assist device for severe cardiac failure after the repair of a left ventricular free wall rupture. A 72-year-old man was admitted with chest pain and unconsciousness, and required emergency surgical repair of a left ventricular free wall rupture under percutaneous cardiopulmonary support. Severe cardiac failure occurred postoperatively, and weaning from percutaneous cardiopulmonary support was impossible. We implanted a left ventricular assist device, and this could be removed at one week after implantation. The left ventricular assist device was very useful as a "bridge to recovery".     

Surgical repair of acute left ventricular free wall rupture: report of a case.

We present a case of acute (blowout) left ventricular free wall rupture (LVFWR) that occurred on the third day after inferior myocardial infarction. Because electromechanical dissociation developed abruptly and pericardiocentesis was no effective, there was no time for establishing a cardiopulmonary bypass (CPB). Emergency thoracotomy and direct closure were successfully performed at the bed-side. We believe that acute type of LVFWR in which initial symptom is electromechanical dissociation without any preceding symptoms can be rescued by emergency thoracotomy and direct closure of the rupture with no aid of CPB provided that the rupture is a small tear located on the anterior, lateral, or even the inferior wall of the left ventricle, if hemodynamical stability is obtained.     

Successful repair of left ventricular aneurysm due to blunt trauma. A case report

The authors report the successful surgical treatment of their patient with posttraumatic aneurysm of the left ventricle. On the basis of the data reported in the literature and on their own experience, the authors consider this lesion absolute indication for surgery.     

Left ventricular pseudoaneurysm after sutureless repair of subacute left ventricular free wall rupture: a case report.

A 65-year-old woman presenting with a left ventricular pseudoaneurysm 27 months after sutureless repair of a subacute left ventricular free wall rupture complicating acute myocardial infarction is described. An autologous pericardial patch and gelatin resorcin formaldehyde (GRF) glue were used in the repair. A small pseudoaneurysm bulged out over the true aneurysm of the left ventricle. We performed a Dor operation and concomitant bypass grafting to the right coronary artery. Although sutureless repair is an effective procedure for subacute left ventricular free wall rupture, left ventricular pseudoaneurysm in the late postoperative period may be a rare problem after this repair.     

Giant cardiac lipoma: report of a case

Cardiac lipomas are extremely rare benign tumors. We report a case of a 41-year-old man who was admitted because of cardiomegaly and a feeling of discomfort in his chest. Computed tomography and magnetic resonance imaging studies showed a large mass occupying the mediastinum and pericardial space. The patient underwent resection of a lipoma which weighed 1100 g and had a pedicle 6 cm in diameter, connected to the epicardial surface of right ventricle infundibulum.     

Successful repair of a submitral left ventricular infected pseudoaneurysm

Aneurysms of the left ventricle may be congenital or may occur after a myocardial infarction, trauma, or endocarditis. Infective endocarditis can cause destructive injury to the heart in various ways. This report describes the formation of an aneurysm of the left ventricle from trauma of a bacterial vegetation of the mitral valve. Early recognition by echocardiography and magnetic resonance imaging led to successful repair and prevented a catastrophic result.     

左臀部软骨样脂肪瘤1例

正患者,男,56岁,因偶发左臀部肿物2周于2017年8月28日入院。患者2周前偶发左臀部肿物,1周前就诊于当地医院行彩超见:左臀部肌层探及低回声,大小30 mm×24 mm,形态规则,边界欠清,其内回声不均匀;CDFI:未见明显血流信号。为求进一步诊治,来我院治疗。既往胃溃疡史10年,9年前因上消化     

Successful repair of subacute left ventricular free wall rupture after acute myocardial infarction

A 67-year-old man sustained free wall rupture of the left ventricle following an acute myocardial infarction 8 hours after percutaneous transluminal coronary recannalization (PTCR). Echocardiography and pericardiocentesis which improved the hemodynamic state confirmed the diagnosis. Under extracorporeal circulation, direct closure was successfully accomplished following resection of ruptured and necrotic anterior left ventricular myocardium. The patient has remained well for 9 months after the operation. Clinical and therapeutic features of subacute cardiac rupture and affecting factors of PTCR were discussed.     

Successful repair of the left ventricular wall rupture after mitral valve replacement of an octogenarian; report of a case

The left ventricular wall rupture is not only a rare complication after mitral valve replacement, but also a high mortality disease. We have encountered a case of this complication after removal of the extracorporeal circulation in an octogenarian female after mitral valve replacement with Carpentier-Edwards (25 mm). It could be successfully repaired from outside the heart on the cardiopulmonary bypass without second cardiac arrest. Repair from inside the heart using extracorporeal circulation and cardioplesia is generally recommended because of the accuracy. However, second cardiac arrest might be a risk of postoperative complications in octogenarians. Hence, prevention is the most important. And operative strategy for the repair is also important in these patients.     

Successful resection of left ventricular myxoma in a toddler; report of a case

A 4-year-old girl was found to have large left ventricular myxoma without any tumor-related symptoms. She underwent an urgent surgery and the myxoma was successfully removed through a left ventriculectomy. Great care was taken to prevent tumor-embolization during surgery, and to resect the endocardium attaching directly to the tumor. Future surveillance of this case warrants our operative technique described in this report.     

Successful repair of penetrating cardiac injury with chopstick; report of a case

We used percutaneous cardiopulmonary support (PCPS) to resuscitate a 54-year-old man who had stabbed himself in the left anterior chest with a chopstick. Chest computed tomography showed that the chopstick had penetrated the heart. As he was in shock due to the development of tamponade while waiting for emergency surgery, we immediately decided to initiate PCPS. After cardiopulmonary bypass was established through a median sternotomy replacing PCPS, the chopstick was removed and the stab wounds were closed by mattress sutures. The postoperative course was uneventful.     

A case of cardiac lipoma in the ventricular septum

Lipom in the ventricular septum is very rare. Our review of the English literature revealed that our case is the sixth of removal of lipoma in the ventricular septum. A 60-year-old male was admitted because a mass in the ventricular septum was found incidentally in abdominal CT taken following type B hepatitis. CT scanning of the heart showed 2 cm diameter of tumor in the ventricular septum. The tumor had very low radiodensity, so it was thought to be identical to fat tissue. The tumor was more clearly visualized by MR imaging and the signal intensity was high on the T1-weighted image. The tumor was suspected to be lipoma. The intraoperative histological diagnosis showed the tumor was lipoma. The tumor adhered strictly on the myocardium of the septum, and it was located near the left anterior descending coronary artery. It could not completely resected, in these reasons. Postoperative course was uneventful, and echocardiogram taken 9 months after the operation showed no evidence of enlargement of the resaidual tumor. It is necesary to follow-up rigidly for the potential of enlargement of the residual tumor.     

A case of cardiac lipoma in the ventricular septum]

A 45-year-old man was admitted because of systolic murmur after routine medical checking. Echocardiography and cardiac catheterization revealed a large mass in the ventricular septum which bulged into right ventricular cavity with pressure gradient of 29 mmHg. The diagnosis of cardiac lipoma was made by CT scanning which showed the mass with attenuation values of -94 Hounsfield units. MR imaging demonstrated the mass with high signal intensity which corresponded to that of subcutaneous fatty tissue. The tumor was resected through the right ventricular incision with the use of cardiopulmonary bypass. It was yellow, elastic soft, sized 6.5 x 4.3 x 3.5 cm, and weighed 44.7 g. On histological examination, the tumor was composed of mature fatty tissues contained with myocardial fibers. After operation, he had split of the ventricular septum, which was closed primarily after removal of the lipoma, and left-to-right shunt. Patch reinforcement was performed at the right ventricular side of the septum on the postoperative 18th day. Postoperative electrocardiogram showed left axis deviation and complete right bundle branch block. This finding seems to be resulted from injury to the anterior branch of left bundle. The postoperative course was uneventful. This patient is the second case of removal of cardiac lipoma in the ventricular septum on review of the literature in Japan.     

Successful resection of a symptomatic right ventricular lipoma

We report the case of a 31-year-old woman with a 4-year history of recurrent palpitations, presenting with an increased frequency of paroxysms caused by ventricular tachycardias during pregnancy. A cardiac tumor of unknown origin infiltrating the right ventricle was diagnosed. Three weeks after prophylactic abrasion the tumor was totally excised with the use of cardiopulmonary bypass including restoration of the right ventricular wall and the tricuspid valve. Histology confirmed diagnosis of a benign cardiac lipoma. The postoperative course was uneventful and the patient was discharged 7 days after surgery. There was no episode of ventricular tachycardias during the 6-month follow-up.     

Survival following free rupture of left ventricular aneurysm: report of a case.

A 50-year-old man sustained free rupture of the left ventricle four weeks following a massive anterior myocardial infarction. The rupture occurred at the junction between a bulging left ventricular aneurysm that was not yet fibrotic and normal myocardium without evidence of fresh myocardial infarction. Accurate preoperative diagnosis aided by echocardiography and right heart catheterization made possible a planned surgical approach. Postoperative support with intraaortic balloon pumping appeared to be beneficial in maintaining statisfactory cardiac function until an adequate stroke volume could be reestablished, presumably by an increase in left ventricular volume.     

A case of giant left ventricular lipoma: unusual presentation

Primary cardiac tumors are rare and usually benign. The incidence of cardiac lipomas is 8 % of benign cardiac tumors [1]. Several surgical options have been reported to obtain an appropriate operative view because of their poor visualization when the tumors are located in the Left Ventricle (LV). We report a rare case of massive left ventricular lipoma occupying pericardial space. A 23-year-old female had back pain since 6 months. She visited a local orthopedician, who ordered for computed tomography scan of chest and back. Computed tomography showed a large epicardial mass located along the anterior surface of the heart, from the diaphragm level through the aortic arch level. The mass showed an attenuation value identical with that of subcutaneous adipose tissue and contained some areas with high density. The mass was not enhanced by contrast media. Percutaneous biopsy was done, histologic examination of the specimen demonstrated mature adipose tissue. An encapsulated adipose mass weighing 865 g, which originated from the left ventricle anteriorolateral surface without any invasion to the pericardium, was near completely excised, except for a small portion which was encasing obtuse marginal artery. Microscopic examination revealed mature adipose tissue with partial necrosis, confirming the diagnosis of lipoma.     

Surgical repair of left ventricular free wall rupture using layered fibrin glue sheet and fibrin glue; report of a case

A 57-year-old man with acute myocardial infarction (#13:90%, #6-#8:75%) was admitted to our hospital after the administration of tissue plasminogen activator. Three hours' after emergent percutaneous transluminal coronary angioplasty, he developed left ventricular free wall rupture in the left circumflex artery area. After bleeding was completely controlled by aortic cross clamping, a three-layered of fibrin glue sheet (TachoComb) with fibrin glue was extensively applied to the ruptured site including the infarcted area. He was discharged on the 25th postoperative day and underwent coronary artery bypass grafting to the left anterior descending artery three weeks later. This experience suggests that the layered TachoComb and fibrin glue are effective for left ventricular free wall rupture.