Surgical resection of a lupus-related left ventricular aneurysm in a patient with normal coronary arteries: case report

A 52-year-old woman with systemic lupus erythematosus (SLE) presented with shortness of breath. Echocardiography and cardiac catheterization demonstrated a discrete left ventricular aneurysm (LVA) with normal coronary arteries. Although her heart failure symptomatically improved with medical therapy, she suffered an embolic stroke from a thrombus within the LVA. She was treated with anticoagulation and rehabilitation for 6 weeks. Reevaluation with echocardiography demonstrated persistent depressed LV function and mural thrombus within the LVA. Surgical resection of the LVA was performed with evacuation of the thrombus and local repair of the LV.     

Early operation for postinfarction ventricular septal perforation; report of three cases

Three patients underwent surgery for postmyocardial infarction ventricular septal perforation (VSP) within 3 to 21 days after onset of infarction. The hemodynamic stabilization was not obtained despite aggressive medical treatment including Intra-aortic Balloon Pumping (IABP) in one patient. The others had sudden hemodynamic deterioration during IABP support. In two of the three cases, the VSP were closed via transinfarct ventriculotomy with double Dacron patch, and ventricular wall reconstruction was performed to sandwich the double septal patch between ventricular free walls with Dacron felt strips. Two of the three patients survived. Our experience suggests that early surgical intervention is essential unless medical therapy results in clinical improvement and the double patch method may provide a successful operative repair and comeout.     

Modified Komeda-David operation for postinfarction ventricular septal perforation

The infarct exclusion technique with a xeno-pericardial patch which Komeda and associates firstly reported in 1990 is one of the best procedure to close ventricular septal perforation. A large patch can protect the perforation and the surrounding weak tissue from the internal left ventricular pressure. However, suturing this large patch to the left ventricular wall through the small incision is not technically easy because of the patch design in the ventricle. We modified the design of the patch. This round shaped bovine pericardial patch was sutured continuously to the left ventricular wall. Then, excessive part of the patch was trimmed to make a corn shape. Finally, the corn shaped patch fit the left ventricular wall naturally.     

Dor operation for left ventricular aneurysm with sustained ventricular tachycardia

A 60-year-old woman was admitted to our hospital because of syncope attack due to sustained ventricular tachycardia (VT). She was treated medically after cardiopulmonary resuscitation. Coronary arteriography revealed a 99% stenosis of right coronary artery (posterior descending artery: # 4 PD), a 90% stenosis of left descending artery (# 6) and left akinetic aneurysm was demonstrated. The patient successfully underwent Dor operation with endocardial cryoablation. The postoperative course was uneventful and the recurrence of VT was never recognized clinically.     

Off-pump coronary artery bypass and right ventricular branch translocation for coronary aneurysm; report of a case

The successful surgical treatment for a coronary artery aneurysm was reported. A 38-year-old female presented with angina pectoris due to right coronary artery stenosis. Angiography revealed a right coronary artery aneurysm and 90% stenosis at a site just proximal to the aneurysm, accompanied by the relatively large right ventricular (RV) branch originating from a mid portion of the aneurysm. Off-pump coronary artery bypass grafting (CABG) to the right coronary artery (RCA) #3, translocation of RV branch to RCA #3, and ligation of RCA proximal and distal to the aneurysm were successfully performed. Post-operative course had been uneventful with satisfactory angiographic results. Coronary translocation with CABG could be a treatment option for coronary artery aneurysms.     

Combined approach for postinfarction ventricular septal defect treatment: a case report

Postinfarction ventricular septal defect is an uncommon condition with a poor prognosis. We report a case of successful early percutaneous closure of postinfarction ventricular septal defect using an occluder device followed by delayed off-pump revascularization.     

Dor operation for a young male with left ventricular aneurysm due to spontaneous left anterior descending coronary artery dissection

Surgical cases for myocardial ischemia due to spontaneous coronary artery dissection have rarely been reported. We describe a young male who had a myocardial infarction with left ventricular aneurysm due to spontaneous left anterior descending coronary artery dissection. He was successfully treated with Dor's left ventriculoplasty without coronary artery revascularization. The Dor procedure was a simple and effective treatment. To our knowledge, this is the first report in which the Dor procedure was used to treat spontaneous coronary artery dissection with left ventricular aneurysm.     

Surgical treatment for left ventricular false aneurysm caused by infective endocarditis; report of a case

A 24-year-old man who had left ventricular (LV) false aneurysm, which is caused by mitral valve infective endocarditis, underwent aneurysmectomy, direct closure of aneurysmal mouth and concomitant mitral valve replacement. Post-operative course was uneventful. It has been reported that the etiology of this false aneurysm was due to the vegetations' friction, which could have caused an initial endocardial ulceration that progressively expanded into the myocardium. The false aneurysmal wall should be completely removed in order to eliminate the possibility of recurrence of the infective endocarditis. We believe that the surgical treatment should be carried out as soon as possible after completion of diagnosis because the aneurysmal wall is usually quite thin and could rupture easily.     

Mitral regurgitation with concomitant atrial septal aneurysm; report of a case

A 64-year-old female was admitted to our hospital because of severe dyspnea. Echocardiography revealed mitral valve regurgitation and atrial septal aneurysm (ASA). After instituting medical treatment for congestive heart failure, euvolemic status was achieved, and the patient underwent; (1) prosthetic patch repair for ASA; (2) mitral valvuloplasty with partial quadrangular resection of the posterior mitral leaflet; and (3) mitral annuloplasty using Physio ring. Pathological examination revealed myxomatous degeneration of the mitral valve, but the resected atrial septum was without any abnormality. ASA can lead to cerebral or pulmonary embolism even in the absence of an atrial septal defect. However, ASA without atrial septal defect is typically asymptomatic and rarely requires surgical correction. By contrast, ASA with concomitant mitral valve prolapse is associated with a high risk of cerebral or pulmonary embolism. Aspirin therapy is indicated for the prevention of thromboembolism in patients with ASA who do not undergo surgical management, and these patients also require careful observation.     

A surgical case of ventricular septal perforation after repairing left ventricular free wall rupture.

A 78-year-old woman with diagnosis of acute myocardial infarction (AMI) in the anteroseptal area fell into cardiogenic shock suddenly just before starting percutaneous coronary intervention (PCI). Echocardiography showed left ventricular free wall rupture, then an emergent operation was performed by sutureless patch repair using collagen fleece with fibrinogen-based impregnation. Eight days later from the initial operation, the onset of ventricular septal perforation (VSP) was recognized. Fifteen days after, the infarct exclusion technique with endocardial patch was performed. She has been doing well 4 months after the operation without residual shunt. To our best knowledge, this is the first surgical case report that free wall rupture of left ventricle and VSP which are serious complications after myocardial infarction happened in succession.     

Mitral subannular left ventricular aneurysm. A case report

A mitral subannular left ventricular aneurysm in an Ovambo man is described. This condition should be suspected in patients of negroid descent presenting with mitral incompetence and a localised bulge on the left heart border on chest radiography. Mitral and aortic subannular aneurysms are discussed, including the diagnostic use of ECG gated cardiac blood pool imaging.     

Rapidly enlarging giant left ventricular pseudo-false aneurysm after myocardial infarction; report of a case

A 71-year-old man was admitted to our hospital with acute myocardial infarction and cardiac tamponade. After pericardial drainage, his hemodynamics was improved. Because more than 3 days had been passed after the onset of myocardial infarction and he had severe renal dysfunction, emergent coronary angiography (CAG) was not performed. After improvement of his general status, coronary angiography and percutaneous catheter intervention was carried out, and his course was uneventful. But transthoracic echocardiography before discharge revealed a giant posterior psudoaneurysm. Patch closure and coronary artery bypass grafting was carried out under cardiopulmonary bypass, and postoperative course was uneventful. Postoperative left ventriculogram revealed disappearance of pseudoaneurysm, but relatively large akinetic area of posterior-inferior wall was left around a patch. Pseudo-false aneurysm was diagnosed by histological examination.     

Influence of left ventricular aneurysm on survival following the coronary bypass operation

Patients having coronary bypass and aneurysm resection (N = 40) or aneurysm plication (N = 32) were compared with patients having coronary bypass without aneurysm (N = 2782). Unlike other series, the primary indication for surgery in the aneurysm patients was angina pectoris, with heart failure playing a secondary role. Multivessel disease was present in 83% of the patients with aneurysm. Total occlusion of the anterior descending coronary artery was more prevalent in the group of patients who had aneurysmectomy (75%) than in rhe group of patients who had plication (38%), and more grafts/patient could be performed in the plication group (2.6 vs 2.0). Location of the aneurysm was most often anteroapical (N = 55) and infrequently inferior (N = 6). Septal wall motion was akinetic or aneurysmal in 47% of the aneurysmectomy group, and 10% of the plication group. Postoperative requirements for inotropes or intra-aortic balloon assist was much higher in the aneurysm group (aneurysmectomy or plication) than in patients without aneurysm having bypass. Hospital mortality for aneurysm patients was 2.7% versus 1.4% in patients without aneurysms having coronary bypass. The actuarial survival rate at 42 months for all aneurysm patients was 90%. Improvement in anginal symptoms after plication and coronary bypass (96%) was more frequent than with aneurysmectomy and coronary bypass (76%) and this was attributed to larger viable muscle mass and greater revascularization. Although two-thirds of patients having surgery for aneurysms had improvement in heart failure symptoms after operation, 30% of those having aneurysmectomies and 35% of those having plications said they were unimproved after surgery. However, this could be explained by the finding that a significant number (35% of the aneurysmectomy and 45% of the plication group) were in heart failure Class I prior to operation. Hospital mortality has been progressively reduced and late survival increased by the surgical treatment of left ventricular aneurysm, primarily through early operation at a time when coronary bypass can be used as an adjunct to aneurysm resection or plication.     

Left ventricular reconstruction on the beating heart with retrograde coronary perfusion for repair of a left ventricular aneurysm associated with aortic regurgitation: report of a case

A 67-year-old male was undergoing hemodialysis for renal failure. He had carotid stenosis, multiple liver cysts with impaired liver function, and mild aortic regurgitation in addition to a left ventricular aneurysm with reduced left ventricular function. We used intraaortic balloon pumping with a view to maintaining cerebral and hepatic blood flow during extracorporeal circulation. However, this procedure risked increased regurgitation at the aortic valve. Therefore, after aortic cross-clamping, we performed the left ventricular reconstruction while cardiac pulsation was maintained by retrograde coronary perfusion using normothermic oxygenated blood. Coronary artery bypass grafting followed after the cross-clamp was released. The patient's postoperative progress was smooth and he was discharged on 14th postoperative day.     

Repair of postoperative residual shunt of postinfarction ventricular septal perforation: report of a case

A 70 year-old man had the surgical repair of post-infarction ventricular septal perforation (VSP) with infarction exclusion technique. Five days after operation, residual shunt was observed by echocardiogram and he developed cardiac failure. Additional surgery for residual shunt was performed 1 month after 1st operation. The infracted myocardium was firm enough to closed directly, so the Xenomedica patch was sutured on the side of the perforated septum around VSP. The postoperative course was uneventful.     

Post-traumatic coronary occlusion and left ventricular aneurysm

Left ventricular aneurysm is a rare complication of blunt chest trauma. We now report a case of left ventricular aneurysm following blunt chest trauma associated with an acute coronary occlusion.     

Bentall operation for a 90-year-old man with root aneurysm; report of a case

Open heart surgery in nonagenarians is not common. We reported a successful Bentall operation in a 90-year-old man with aortic root aneurysm and aortic regurgitation. He has lived healthfully and independently without a big problem. He was referred to our hospital for acute heart failure. The aortic root enlarged as a diameter of 60 mm and moderate aortic regurgitation were recognized by echocardiography and aortogram. We excised the aneurysm, implanted a composite graft, directly attached the coronary arteries to the aortic graft (Carrel patch technique), and made the distal anastomosis to the divided aorta. Postoperative course was uneventful. To our knowledge, this is the first successful case of Bentall operation for nonagenarians in Japan. If selective criteria identifying risks and benefits for individual patients is applied, the nonagenarian can safely undergo cardiac surgery.