This study aimed to evaluate the efficacy of preoperative computed tomography in assessing mitral annulus anatomy and the posterior annular plication rate in mitral valve repair with annuloplasty.
Esophageal perforation is a rare but serious complication of transesophageal echocardiography (TEE). An enlarged left atrium (LA), which is commonly associated with mitral stenosis (MS), is an under-recognized risk factor for esophageal perforation after intraoperative TEE. We describe a case of TEE-induced esophageal perforation after cardiac surgery in a 79-year-old woman with a giant LA due to MS. Esophageal perforation was detected on postoperative day 6. After surgical repair, the patient gradually recovered with prolonged conservative treatment. Retrospectively constructed three-dimensional chest computed tomography images revealed an unusually distorted esophagus that was possibly vulnerable to injury. A giant LA can markedly distort the esophagus. It should be recognized as a risk factor for TEE-induced esophageal perforation.
Abstract Objective We investigated the effect of morphological diversity of the tricuspid valve with multiple posterior leaflets on the technical outcomes of tricuspid valve repair. Methods From April 2016 to November 2020, 141 patients were diagnosed with secondary tricuspid regurgitation associated with left heart disease and underwent tricuspid valve repair. We retrospectively analyzed the clinical and echocardiographic data of patients who underwent both preoperative and postoperative transthoracic echocardiography. We divided the patients into two groups according to the surgical technique used to treat tricuspid regurgitation: ring annuloplasty alone (Group 1, n = 109) or additional approximation of leaflet edges (edge-to-edge repair) with ring annuloplasty (Group 2, n = 32). We measured the morphological diversity of the tricuspid valve during the operation in all patients. Results The preoperative tricuspid regurgitation score was higher in Group 2 than in Group 1 (2.1 ± 0.78 vs. 1.6 ± 0.7, respectively; p = 0.0046), and Group 2 contained more patients with two posterior leaflets than Group 1 [20 (63%) vs. 36 (33%), respectively; p = 0.003]. The univariate and multivariate logistic regression analyses showed that the presence of two posterior leaflets was an independent risk factor for additional procedures during tricuspid valve repair (odds ratio, 2.6; 95% confidence interval, 1.1–6.1; p = 0.033). Conclusions Additional procedures to reduce tricuspid regurgitation were required more frequently in patients with two posterior leaflets of the tricuspid valve. The morphological diversity of two posterior leaflets is a potential risk factor for a more complicated tricuspid repair.
A calcified amorphous tumor (a non-neoplastic tumor) with caseous calcification of the mitral annulus is a rare pathology that causes severe embolic events. We present a rare case of mitral valve surgery for a mitral annular caseous calcification-related calcified amorphous tumor found in cerebral infarction.
Coronary artery bypass grafting (CABG) in a patient with tracheostoma is challenging because the tracheostoma is a significant risk factor for surgical site infections (SSI). Bilateral internal thoracic artery (BITA) harvesting has been also considered as a risk factor. Other risk factors include hemodialysis (HD) and diabetes mellitus (DM). On the other hand, the superiority of BITA in terms of patency and long term results in CABG is generally accepted. It is still controversial issue whether we should choose BITA or single ITA CABG in patients with risk factors of SSI. We report a case of 64-year-old male with a permanent tracheostoma, HD and DM, who underwent CABG. We concentrated on complete revascularization and used BITA by full sternotomy for better long-term results. We used several anti-infection strategies in addition to routine perioperative wound management and there were no wound complications during hospitalization and after 24 months of follow-up.
Our study aims to examine the midterm outcomes of the loop technique for extended mitral valve (MV) prolapse patients.From October 2008 to August 2020, we performed MV repairs in 407 patients with severe mitral regurgitation (MR). Follow-up ranged in duration from 287 to 2899 days (median, 872 days). The prolapse extensiveness (p-score) was determined based on the ratio of prolapsing segment's areas to whole area. We divided the whole MV into 10 segments (A1, A2 medial, A2 lateral, A3, P1, P2 medial, P2 lateral, P3, AC, and PC). Patients were categorized into three groups according to the p-score: simple (0.1-0.2), intermediate (0.3-0.4), and extensive (0.5-0.9).All patients underwent MV repair with the loop technique. The rates of freedom from significant (moderate to severe or severe) MR at 5 and 7 years after surgery were 91% and 91%, respectively. There were 252, 115, and 40 patients in simple group, intermediate group, and extensive group, respectively. The following were significantly increased in extended group: Barlow disease (23/40 patients, p < .001), the number of loops (p for trend < .0001), and the technique score (p for trend < .0001). The rates of freedom from significant MR at 7 years after surgery were 92% in simple group, 87% in intermediate group, and 94% in extended group, respectively (p = .995). Receiver-operating characteristic curves showed a postoperative mild MR with a sensitivity of 86% and a specificity of 68% for predicting significant MR recurrence.MV repair using the loop technique was useful even in groups with extended prolapse.
A 4-year male was referred to our hospital for high fever. Incidentally, abnormally high blood pressure was detected. A thorough examination revealed severe stenosis at the origin of two left renal arteries and elevation of plasma renin activity as well as aldosterone level. Some lesions of previous asymptomatic brain bleeding were also revealed. Instead of using prosthetic materials, we transected renal arteries and directly anastomosed them to abdominal aorta, expecting subsequent growth of native vessels. The postoperative course was uneventful. The plasma renin activity and aldosterone level as well as the dose of antihypertensive drug decreased significantly after the operation.
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