Ascending aortic aneurysm following aortic valve replacement due to aortitis syndrome; report of a case

A 60-year-old woman had previously undergone aortic valve replacement for aortic regurgitation. As the aortic wall was elastic hard, inflammatory change was suspected; therefore, we undertook a partial biopsy of the ascending aortic wall and the intraoperative pathological specimens were compatible with aortitis syndrome. As there was no active inflammatory change, she was diagnosed as inactive aortitis syndrome and steroid therapy was not applied. Seven years later, a follow-up computed tomography (CT) showed an ascending aortic aneurysm of 65 mm in diameter. Aortic root replacement was planned based on a clinical diagnosis of an aneurysm of the ascending aorta. The patient was discharged without complication 21 days after surgery. It is possible that an inactive stage of aortitis may lead to late dilatation of the ascending aorta; therefore, careful postoperative follow-up is necessary in such cases.     

Etiology of left ventricular rupture following mitral valve replacement]

Two uncommon cases of left ventricular rupture that occurred during cardiac surgery were treated successfully. These cases may be useful in understanding the etiology of common left ventricular rupture following mitral valve replacement. One case occurred during coronary bypass surgery. The myocardium which is already abnormal seems to be weak to trauma such as bending, traction and torsion. In the other case, who underwent mitral valve replacement with preservation of the posterior leaflet with its attached chordae, the disruption was localized in the epicardial side of the left ventricular posterior wall, though direct injury by some instrument was excluded as a possibility, with a depth of half the thickness of the wall. In experiments using dogs, shape and movement of the mitral annulus were examined. The length of the annulus attached to the posterior leaflet in end-systole was shortened to 89.0 +/- 4.6% of that in late diastole. Furthermore, the annulus was distorted by the elevation of the heart. We approve of Cobbs' "untethered ventricle theory" and consider moreover as follows: In general, whether with or without preservation of the mitral loop, the mitral annulus and the left ventricular posterior wall after mitral valve replacement are severely constricted by the rigid prosthetic ring and become tense, which limits movement in both circular and longitudinal directions. Then even slight stress may cause a primary tear on the posterior wall of the left ventricle, resulting in rupture. In order to treat the rift, the prosthesis must be removed before the apex of the heart is lifted, to avoid excessive ventricular wall tension.     

Supravalvular aortic stenosis syndrome with advanced mitral regurgitation requiring extended aortoplasty and mitral valve replacement: a case report

This is a case report of a 28-year-old male, suffering from supravalvular aortic stenosis (systolic pressure gradient 60 mmHg) and severe mitral regurgitation associated with elfin face and mental retardation. Severely prolapsed mitral valve with elongated chordae tendineae was replaced with Bj?rk-Shiley mitral valve prosthesis. Simultaneously, extended aortoplasty was carried out using Doty's method. His postoperative course was uneventful. Catheterization study, carried on one month after surgery, revealed complete disappearance of supravalvular aortic stenosis and mitral regurgitation. In review of the literature, as far as we know, report of successful combined correction for supravalvular aortic stenosis and mitral regurgitation is extremely rare.     

Marfan's syndrome with annulo-aortic ectasia and ruptured mitral chorda--a case report of combined composite valve graft replacement of the aortic root and mitral valve replacement]

We report a case of Marfan's syndrome with acute heart failure caused by a ruptured mitral chorda that was successfully treated by one operation of combined composite valve graft replacement of aortic root and mitral valve replacement (MVR). A 23-year-old man was admitted to our hospital presenting severe dyspnea and chest pain. Echocardiography and cardiac catheterization studies demonstrated marked annulo-aortic ectasia, aortic regurgitation and significant mitral regurgitation due to a ruptured chorda. In operation, it was found that a chorda of the mitral posterior leaflet had been torn, with the leaflet completely prolapsed to the left atrium, and that the aortic root was dilated to 90 mm in diameter. The ascending aorta was extensively resected leaving those areas of aortic tissue involving the coronary ostia. Then the mobilized coronary arteries were reattached to the composite graft. MVR was performed with preservation of the whole anterior and posterior mitral valve apparatus except for that small part with the torn chorda. Histopathological findings of the aortic wall and mitral valve were compatible with those of Marfan's syndrome.     

Ruptured aortic dissecting aneurysm in Turner's syndrome: a case report and review of literature.

Cardiovascular malformations are frequently observed in Turner's syndrome. Bicuspid aortic valve and coarctation of the aorta are commonly associated with Turner's syndrome whereas aortic dissection is rare but its rupture results in death. We experienced a case of ruptured dissecting aneurysm (Stanford type A) in a 30-year-old female with Turner's syndrome. Emergent total arch replacement was performed successfully. A literature review revealed 32 cases of aortic dissection in patients with Turner's syndrome, including 15 cases of rupture. However, survival after rupture was reported only two cases. To our knowledge, this report descries the third known case of successful surgical management of ruptured aortic dissection in Turner's syndrome.     

Repair of ventricular rupture following mitral valve replacement

Left ventricular rupture is reported to occur in 0.5-2% of patients following mitral valve replacement and results in a high mortality rate. Three types of left ventricular rupture have been identified, each attributed to a different mechanism. Failure of repair has been due to repeated tearing of the ventricular muscle and resulting hemorrhage. We describe the repair of left ventricular rupture following mitral valve replacement with buttressed dacron patch. The repair is designed to eliminate the tension placed on the suture line. In addition, specific recommendations are made to avoid left ventricular rupture during mitral valve replacement.     

Successful mitral valve replacement in osteogenesis imperfecta--a case report]

A 34-year-old man with osteogenesis imperfecta who underwent successful mitral valve replacement due to mitral regurgitation was reported. Cardiac disease associated with osteogenesis imperfecta is very rare and only fifteen patients were operated under the extracorporeal circulation previously. While excessive hemorrhage due to tissue fragility was observed in 7 of 15 patients, perioperative course of the case reported here was completely uneventful. The difference of hemorrhagic tendency as well as etiology of osteogenesis imperfecta will be defined according to the advance of technology in collagen genetics and biochemistry in future.     

Testing of mitral valve competence following combined mitral valve repair and aortic valve replacement

A simple, effective technique for testing the results of repair and reconstructive procedures on the mitral valve apparatus is described. This technique can be used in the operative setting of combined aortic valve replacement and mitral valve repair where other reported techniques for testing the valve apparatus are rendered unfeasible.     

马凡综合征合并脊柱侧弯术后自发性气胸一例报告

马凡综合征 (Marfansyndrome ,MFS)是累及全身多系统的常染色体显性结缔组织遗传病 ,临床上以骨骼、心血管、眼组织、肺部、皮肤及硬脊膜病变为主要表现 ,其发病率占普通人群 1/ 5 0 0 0～ 1/30 0 0 [1～ 3] 。约 6 3%的MFS患者合并 >10°的脊柱侧弯畸形。MFS患者脊柱手术后常并发心血管疾病[4～ 7] ,而术后并发自发性气胸国内罕有报道。我科于 2 0 0 3年 9月治疗 1例MFS脊柱侧弯 ,术后早期发生自发性气胸 ,现报告如下。1　资料与方法1.1　临床资料患者 ,女 ,14岁。 10岁时家长无意中发现脊柱稍向右侧倾斜 ,无任何不适 ,未予治疗。 11…     

A case of mitral valve replacement and left atrial plication for infantile Marfan syndrome with giant left atrium due to mitral valve regurgitation]

In Marfan syndrome, there is a subset, called infantile Marfan syndrome, in which the disease is diagnosed during infancy and cardiac lesions including mitral regurgitation and aortic root dilatation tend to be deteriorated rapidly. In infantile Marfan syndrome, respiratory function is sometimes impaired when skeletal abnormalities such as scoliosis and pectus excavatum are severe. In this report, we describe a 2-year and 4-months old boy with infantile Marfan syndrome who presented with severe mitral regurgitation and the collapsed left lung. In addition to the impairment of respiratory function due to severe scoliosis, the left lung was collapsed because of the compression of the left bronchus by the enlarged left atrium. The patient required mitral valve replacement concomitantly with left atrial plication, resulting in the decompression of the left bronchus and the re-expansion of the left lung. Characteristics and surgical management of infantile Marfan syndrome are discussed in this report.     

A case report of aortic valve replacement following ruptured aneurysm of the sinus of valsalva with bicuspid valve

Only three cases of the combination of bicuspid aortic valve and ruptured aneurysm of the sinus of Valsalva, associated with previously repaired coarctation of aorta, have been reported. A twenty-year-old man with a sudden onset of CHF due to ruptured aneurysm of the sinus of Valsalva underwent intracardiac repair by direct closure of the sinus Valsalva in combination with patch closure of a subarterial VSD. Although, no AR was detected preoperatively, massive reguratitation occurred after the repair due to subsequent failure of aortic valve coaptation in the present of the bicuspid aortic valve, which was not diagnosed preoperatively. Aortic valve replacement with SJM 25 mm was successfully performed.     

A case report of perforated aneurysm of mitral valve with aortic regurgitation

The patient was a 71-year-old male who complained of palpitation and tachycardia. The echocardiogram showed a bulging of the anterior mitral valve leaflet toward the left atrium that persisted throughout cardiac cycle. The cine angiogram showed deformity of the anterior mitral valve leaflet with severe mitral regurgitation and mild aortic regurgitation. At operation, a perforated aneurysm was recognized at the anterior mitral valve leaflet without thrombus and vegetation. The size of aneurysm was 40 x 25 x 25 mm. The patient underwent MVR + AVR, and the postoperative course was uneventful. Pathological examination of the anterior mitral valve leaflet revealed scar-like fibrosis and old inflammatory change. It was judged a true aneurysm of mitral valve, because the structure of endocardium was kept.     

Robotic aortic valve replacement: case report

We have developed a technique that enables robotic aortic valve replacement with port access via a small right anterior thoracotomy and minimally invasive aortic cross clamping. The procedure is performed under video guidance with all the annular sutures placed with the robot. In the case we report, the patient's postoperative course was extremely simple and pain was minimal. We believe that this is the first reported aortic valve replacement using robotic technology and that it opens a new field of application for robotic assisted surgery.     

Gluteal compartment syndrome following abdominal aortic aneurysm repair: a case report

Compartment syndromes occur when the elevated tissue pressure within a confined limb's myofascial compartment exceeds capillary pressure, with subsequent neurovascular compromise. In order to reduce disability and the consequences of ensuring ischemia, it is essential for early recognition and intervention. This is more commonly recognized in the calf. We report an unusual case of gluteal compartment syndrome after abdominal aortic aneurysm (AAA) repair.     

Successful surgical treatment of dissecting left atrial aneurysm after mitral valve replacement

Dissecting aneurysm of the left atrium is extremely rare. A patient with such an aneurysm, which developed after mitral valve replacement is described. The diagnosis was established by cineventriculography of the left ventricle and two-dimensional echocardiography. The aneurysm was successfully treated by closure of the communicating opening through the left thoracotomy incision.     

Report of a case which survived rupture in a hepatic artery mycotic aneurysm after aortic valve replacement

A case in which rupture of a hepatic artery aneurysm occurred 4 months after aortic valve replacement because of aortic regurgitation due to infective endocarditis (IE) is reported. The patient was a 41-year-old male who underwent aortic valve replacement and closure of an abscess cavity of the Valsalva's sinus because of aortic regurgitation and an abscess of the Valsalva's sinus complicated with active IE. His postoperative course was good with no fever. Four months postoperatively, rupture of an aneurysm of the left intrahepatic artery occurred suddenly, and the patient's life was saved by resection of the lateral segment of the left lobe of the liver. Histologically, the wall structure of the aneurysm was not preserved, infiltration of neutrophils was seen in part of the wall, and a mycotic aneurysm of the left hepatic artery within the liver cause by IE was diagnosed. In Japan, only four cases, including the present one, of mycotic aneurysm of the hepatic artery have been reported in the literature examined, and this was the first case in which the patient's life as saved after a rupture. It is essential when observing the course of IE patients to bear in mind at all times that such a complication might occur.     

Neuroleptic malignant syndrome after aortic valve replacement; report of a case

A 64-year-old male with treated Parkinson's disease underwent mechanical valve replacement for aortic valve regurgitation. The antiparkinsonian drugs for internal use were interrupted on the morning of the operative day. After the operation, the patient developed fervescence, muscle rigidity, hidropoiesis and a rise in creatine kinase. The patient was diagnosed as neuroleptic malignant syndrome and given medication dantrolene sodium and antiparkinsonian drugs on the 5th postoperative day. The symptom of neuroleptic malignant syndrome disappeared on 12 postoperative days. As the stress of open heart surgery with extracorporeal circulation trigger off neuroleptic malignant syndrome, the patient with Parkinson's disease need early beginning of antiparkinsonian drugs on account of prevention of neuroleptic malignant syndrome after operation.     

A re-operative case of bentall operation and aortic arch replacement using a stent graft for a Marfan syndrome, post sternum turnover and post mitral valve replacement

A 36-year-old male with Marfan syndrome succesfully underwent Bentall operation and aortic arch replacement using a stent graft as an elephant trunk. He had received MVR with sternum turn over 14 years previously. Median sternotomy was performed. Under circulatory arrest with rertograde cerebral perfusion we performed Bentall operation and aortic arch replacement using a stent graft. The sternum was cured well. Retractive breathing was not detected. This surgical procedure was effective for cardiovascular disease with Marfan syndrome.     

Intracardiac repair in left ventricular rupture following mitral valve replacement

Rupture of the left ventricle is one of the major lethal complications of mitral valve replacement. We have encountered 11 cases of this complication over a period of 19 years (1971, Apr.-1990, Mar.). Five of 8 cases of intraoperative rupture survived but no patient survived a delayed rupture. In the patients with intraoperative rupture external repair was performed in 6 cases, resulting in 3 survivors, two in type II and one in type I with formation of left ventricular false aneurysm. For selection of surgical treatment accurate recognition of types of rupture is important but the location and size of the endocardial and epicardial defects do not always correspond. Attempts to suture a ventricular rupture on the pressure-loaded beating heart were always unsuccessful and frequently extended the tear. Repair should be accomplished with aid of cardiopulmonary bypass on the decompressed and arrested heart. Recently, we chose internal repair with arrested heart in 2 cases of type I rupture, that is, reopening of the left atrial closure and repair from within the cardiac chamber with removal of the prosthetic valve. Both cases survived. In conclusion, we emphasized importance of intracardiac repair with removal of the replaced prosthetic valve in left ventricular rupture of type I and III following mitral valve replacement for better exposure, more secure repair, and prevention of injury to the circumflex artery.