General Thoracic and Cardiovascular Surgery Cases最新文献

{"title":"Translocation of aberrant left subclavian artery and resection of Kommerell's diverticulum by total arch replacement via median sternotomy.","authors":"Koki Yokawa, Taku Nakagawa, Makoto Kusakizako, Yosuke Tanaka, Tomonori Higuma, Kazunori Yoshida, Yoshihiro Oshima, Hidefumi Obo, Hidetaka Wakiyama","doi":"10.1186/s44215-025-00199-1","DOIUrl":"10.1186/s44215-025-00199-1","url":null,"abstract":"<p><strong>Background: </strong>Various methods for reconstructing the left subclavian artery and approaches to treat aortic aneurysms associated with Kommerell's diverticulum and an aberrant left subclavian artery arising from a right-sided aortic arch have been reported.</p><p><strong>Case presentation: </strong>The case involved a 69-year-old woman, in whom a right-sided aortic arch with Kommerell's diverticulum and a left subclavian artery originating from the diverticulum were incidentally observed. Severe stenosis was noted on the origin of the left subclavian artery, and the diameter of Kommerell's diverticulum had expanded to 64 mm, resulting in dysphagia. Therefore, a total arch replacement was performed via median sternotomy. For reconstruction, the left subclavian artery was anastomosed to the left common carotid artery. Kommerell's diverticulum was successfully resected through a median sternotomy. The postoperative course was uneventful, and the patient was discharged home without complications.</p><p><strong>Conclusion: </strong>Translocation of the aberrant left subclavian artery is a simple procedure and is effective during total arch replacement via a median sternotomy.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"4 1","pages":"12"},"PeriodicalIF":0.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mitral valve repair in severe mitral regurgitation due to Barlow's disease with concomitant mitral annular disjunction: a case report.","authors":"Koji Furukawa, Ayaka Iwasaki, Hirohito Ishii, Sakaguchi Shuhei, Kousuke Mori, Shohei Hiromatsu","doi":"10.1186/s44215-025-00196-4","DOIUrl":"10.1186/s44215-025-00196-4","url":null,"abstract":"<p><strong>Background: </strong>Mitral annular disjunction (MAD) is characterized by the detachment of the mitral valve-left atrial junction from the left ventricular myocardium. The association of MAD with Barlow's disease and its relevance to treatment are increasingly recognized.</p><p><strong>Case presentation: </strong>A 75-year-old male with a history of mitral regurgitation (MR) and ablation for paroxysmal atrial fibrillation was diagnosed with severe MR due to Barlow's disease, as confirmed by echocardiography. Imaging revealed disjunction at the mitral valve's posterior annulus. During surgery, the posterior leaflet was resected along the annulus with precise height adjustments. A 6-mm separation between the mitral valve-left atrial junction and the left ventricular myocardium was sutured using a four-stitch mattress technique. The procedure included leaflet repair, insertion of artificial chordae, and mitral annuloplasty. Postoperatively, the MAD was corrected successfully, eliminating the severe MR.</p><p><strong>Conclusions: </strong>Confirming the presence of MAD before surgery is essential for patients with MR. Surgical correction of MAD is imperative when present to address the disjunction effectively.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"4 1","pages":"11"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11881260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mitral valve infective endocarditis with spread of infection to the pulmonary valve via coronary artery pulmonary artery fistula: a case report.","authors":"Hiroharu Shinjo, Shoichi Takahashi","doi":"10.1186/s44215-025-00200-x","DOIUrl":"10.1186/s44215-025-00200-x","url":null,"abstract":"<p><strong>Background: </strong>In cases of left-sided infective endocarditis (IE) complicated by one or more lung abscesses, close examination should be performed with the additional presence of right-sided IE in mind. Pulmonary valve IE may occur via a coronary artery pulmonary artery fistula (CAPAF) even in the absence of vegetation at the tricuspid valve.</p><p><strong>Case presentation: </strong>A 76-year-old male was admitted to his local hospital with back pain and weight loss that had started 4 months previously. He was diagnosed with vertebral osteomyelitis, and antibiotic therapy was started. Subsequently, echocardiography revealed mobile vegetation at the mitral valve, and computed tomography (CT) showed multiple lung abscesses. The patient was then transferred to our hospital for urgent surgical intervention. Additional echocardiography revealed no visible vegetation at the tricuspid valve but did show thickening and moderate regurgitation of the pulmonary valve. These results indicated the presence of pulmonary valve IE. In addition, coronary CT angiography revealed CAPAF and intraoperative findings showed vegetation on the pulmonary valve. Therefore, mitral valve replacement (MVR), pulmonary valve replacement (RVR), and CAPAF closure were performed.</p><p><strong>Conclusions: </strong>The present report is thought-provoking to describe the diagnosis of and surgical planning for IE. Firstly, when left-sided IE is complicated by lung abscess, a detailed evaluation of the right heart system and the potential for a left-to-right shunt should be performed, keeping in mind the possible presence of right-sided IE. Secondly, even if there is no vegetation at the tricuspid valve, there may be vegetation at the pulmonary valve, in which case an extracardiac left-to-right shunt that does not pass through the tricuspid valve may be present. CAPAF is a rare anomaly, but it causes pulmonary valve IE, which requires PVR.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"4 1","pages":"10"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11881242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thymic carcinoma recurring 11 years post-extended surgery: a case report.","authors":"Kiyoki Okamoto, Takashi Kanou, Sachi Kawagishi, Hideki Nagata, Eiichi Morii, Yasushi Shintani","doi":"10.1186/s44215-025-00190-w","DOIUrl":"10.1186/s44215-025-00190-w","url":null,"abstract":"<p><strong>Background: </strong>Thymic carcinoma is a rare type of tumor originating in the thymus, making up about 15-20% of all thymic epithelial tumors. It typically has a poor prognosis, especially in advanced stages, with low 5-year survival rates. Cases where the cancer recurs more than 10 years after surgery are extremely uncommon. Additionally, there are very few reports about the outcomes of patients who undergo aortic resection as part of their treatment for thymic carcinoma.</p><p><strong>Case presentation: </strong>A 68-year-old male was diagnosed with thymic squamous cell carcinoma classified as Masaoka stage III following the detection of an anterior mediastinal mass during a routine health examination. The patient underwent preoperative treatment, which included two cycles of chemotherapy (cisplatin and docetaxel) and 60 Gy of mediastinal radiotherapy, followed by an extensive surgical procedure comprising extended thymectomy, resection of the ascending aorta and superior vena cava, and wedge resection of the right upper lobe. Postoperative pathological examination revealed ypT3N0M0 disease, corresponding to ypStage IIIa disease, and the patient remained disease-free for 10 years. However, at 11 years after surgery, imaging revealed new nodules in the left lung. Surgical resection confirmed these nodules as metastatic lesions originating from the thymic carcinoma.</p><p><strong>Conclusions: </strong>This case highlights the critical need for long-term monitoring of thymic carcinoma patients, extending beyond the standard 5-year follow-up due to the potential for late recurrence, even in initially disease-free patients. Furthermore, our findings indicate that aortic resection, when carefully selected, can contribute to favorable long-term outcomes in advanced cases. This report enhances the limited literature on the long-term prognosis of thymic carcinoma, particularly following major vascular resection, and underscores the importance of a multidisciplinary approach to optimize patient management and improve outcomes.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"4 1","pages":"9"},"PeriodicalIF":0.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11863716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular repair of abdominal aortic aneurysm associated with residual type B aortic dissection utilizing iliac branch endoprosthesis: a case report.","authors":"Kunitaka Kumagai, Yuichiro Kishimoto, Takeshi Onohara, Rikuto Nii, Naoki Sumi, Nozomi Kishimoto, Yosuke Ikeda, Yuki Yoshikawa, Kazuma Yamane, Yasushi Yoshikawa","doi":"10.1186/s44215-025-00194-6","DOIUrl":"10.1186/s44215-025-00194-6","url":null,"abstract":"<p><strong>Background: </strong>Iliac branch endoprosthesis (IBE) can preserve the internal iliac artery. Endovascular aortic repair (EVAR) for abdominal aortic aneurysms associated with residual type B aortic dissection has been rarely reported, and IBE has not been utilized in any of the reported cases. Herein, we describe a rare case of EVAR using IBE for an abdominal aortic aneurysm and a common iliac artery aneurysm associated with residual type B aortic dissection after thoracoabdominal aortic replacement.</p><p><strong>Case presentation: </strong>A 70-year-old man underwent conservative treatment for acute type B aortic dissection 5 years ago. Contrast-enhanced computed tomography (CT) revealed type B aortic dissection and a thoracoabdominal aortic aneurysm, an abdominal aortic aneurysm, and an aneurysm in the right common iliac artery. Since the patient had a concomitant right common iliac artery aneurysm and reconstructing the right iliac artery would have been difficult in a one-stage operation, a two-stage surgical strategy for thoracoabdominal and abdominal aortic graft replacement, separately, was designed. Thoracoabdominal aortic graft replacement from the proximal descending aorta to the infrarenal abdominal aorta was performed using a triplex 24-mm prosthesis (Terumo Aortic, Inchinnan, UK) without any problem. We recommended abdominal aortic graft replacement; however, he preferred EVAR over abdominal aortic graft replacement. The risk of spinal cord ischemia was a concern because a conventional EVAR would require embolizing the right internal iliac artery. Therefore, EVAR was performed with IBE to preserve the right internal iliac artery. The postoperative course was uneventful, and no spinal cord injury was observed. Follow-up CT showed no enlargement of the aneurysms 1 year postoperatively.</p><p><strong>Conclusions: </strong>Despite anatomic limitations, EVAR for abdominal aortic and common iliac artery aneurysms associated with residual aortic dissection after thoracoabdominal aortic graft replacement can be safely performed by embolizing the branch to the false lumen and using IBE.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"4 1","pages":"8"},"PeriodicalIF":0.0,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11806783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143371259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A stage IIIA lung adenocarcinoma case achieving pathological response with only one cycle of preoperative nivolumab combination chemotherapy.","authors":"Shuhei Baba, Fumihiko Kinoshita, Yoshihiro Yamamoto, Yoshiyuki Nakanishi, Takaki Akamine, Mikihiro Kohno, Keigo Ozono, Tomoyoshi Takenaka, Tomoharu Yoshizumi","doi":"10.1186/s44215-025-00187-5","DOIUrl":"10.1186/s44215-025-00187-5","url":null,"abstract":"<p><strong>Background: </strong>Preoperative nivolumab combination chemotherapy has shown its efficacy in resectable stage II-III non-small cell lung cancer and become one of the standard treatments. While preoperative nivolumab combination chemotherapy is generally a regimen of three cycles, the efficacy of nivolumab combination chemotherapy when treatment is prematurely discontinued remains unclear.</p><p><strong>Case presentation: </strong>An 81-year-old man was diagnosed as lung adenocarcinoma (cT3N1M0, cStage IIIA). A computed tomography (CT) showed a 58 mm mass in left upper lobe with an intrapulmonary metastasis, and a positron-emission tomography/CT suggested metastatic lymph nodes at the left pulmonary hilum. Preoperative nivolumab + carboplatin + paclitaxel were administered; however, after the first cycle, the treatment was discontinued due to grade 3 anorexia, grade 1 body weight loss, and grade 4 neutropenia. It was affair that continuation of preoperative therapy made him unsuitable for surgery, and CT scan showed a reduction in the tumor size to 20 mm. Then, we decided to discontinue the preoperative therapy and perform surgery. Video-assisted thoracoscopic left upper lobectomy and lymph node dissection were performed, and the postoperative course was uneventful. The pathological examination revealed 15% of residual tumor cell in primary lesion and no metastatic lymph nodes was diagnosed. The patient did not undergo adjuvant chemotherapy, and no recurrence was observed 1.5 years after surgery CONCLUSIONS: In this case, preoperative nivolumab combined chemotherapy was discontinued only one cycle due to adverse events; however, a significant treatment effect was achieved. Therefore, even it is unable to continue preoperative nivolumab combined therapy, it is important not to miss the chance of surgery, as good treatment effect may have been achieved.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"4 1","pages":"6"},"PeriodicalIF":0.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143124263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidisciplinary surgical strategy for an invasive thymoma in an immunocompromised patient: a case of a successful resection and postoperative troubleshooting.","authors":"Tomonari Oki, Shuhei Iizuka, Toru Nakamura","doi":"10.1186/s44215-025-00192-8","DOIUrl":"10.1186/s44215-025-00192-8","url":null,"abstract":"<p><strong>Background: </strong>Robot-assisted thoracoscopic surgery has become prevalent as a feasible approach for anterior mediastinal tumor resections, while conventional open surgery, such as a median sternotomy, remains preferred for a combined resection of adjacent organs. However, an additional thoracotomy may be necessary when tumors extend into one hemithorax. This complex approach can cause significant damage to the osseous thoracic cage, increasing the risk of surgical morbidity especially in immunocompromised patients.</p><p><strong>Case presentation: </strong>A 77-year-old man presented with an anterior mediastinal thymoma measuring 71 mm, detected during an annual health check with suspected involvement of the left brachiocephalic vein and upper lobe of the left lung. The patient had a medical history of recurrent surgical site infections and fasciitis panniculitis syndrome requiring immunosuppressive therapy. To minimize any thoracic cage destruction, a multidisciplinary approach combining robotic surgery with open surgery according to vascular or pulmonary invasion was planned. The patient, initially placed in the supine position with the robot docked over the right side, underwent a thymic dissection, revealing a firm adhesion to the left brachiocephalic vein. The robot was then undocked, and a transmanubrial osteomuscular sparing approach was initiated, enabling a tumor dissection under the proximal and distal control of the left brachiocephalic vein. As invasion into the proximal upper pulmonary vein and extensive dorsal adhesions were observed, the patient was repositioned to the right lateral decubitus position, and a thoracoscopic left upper segmentectomy with adhesiolysis was performed, achieving an R0 resection. The patient was extubated on day 1 but required non-invasive ventilation until day 5. Mediastinitis, likely due to a sternal wire infection, developed on day 9, necessitating debridement, sternal wire removal, and negative pressure wound therapy. After 17 days of treatment, the infection subsided, allowing for a sequestrectomy and chest wall reconstruction with a pedicled pectoralis major myocutaneous flap. By avoiding a total sternotomy, the extent of the mediastinitis was localized, allowing for a limited sequestrectomy. Wound healing was satisfactory, with no recurrent infection at 12 months and minimal functional impairment.</p><p><strong>Conclusions: </strong>A multidisciplinary approach offers a feasible option for managing an invasive thymoma to minimize postoperative morbidity, particularly in immunocompromised patients. Preoperative surgical planning is essential for guiding intraoperative decision-making and ensuring optimal outcomes.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"4 1","pages":"7"},"PeriodicalIF":0.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143124266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effective management of nonconvulsive status epilepticus following cardiac surgery: a case report.","authors":"Yusuke Yanagino, Taro Yamasumi, Takayuki Miyauchi, Koichi Inoue, Haruhiko Kondoh","doi":"10.1186/s44215-025-00189-3","DOIUrl":"10.1186/s44215-025-00189-3","url":null,"abstract":"<p><strong>Background: </strong>Epileptic seizures following adult cardiovascular surgery occur in 0.9-3% of patients, with the condition in 3-12% of these patients progressing to status epilepticus (SE). SE is a severe condition that significantly impacts prognosis and necessitates early diagnosis and treatment. However, the diagnosis of nonconvulsive status epilepticus (NCSE) is challenging due to its subtle clinical symptoms. Herein, we report a case of NCSE that was diagnosed early by aggressive electroencephalogram (EEG) and treated effectively following cardiac surgery, resulting in discharge without sequelae.</p><p><strong>Case presentation: </strong>A 44-year-old man with a history of meningitis-induced intellectual disability since childhood underwent aortic valve replacement and grafting of the ascending aorta for a bicuspid aortic valve, severe aortic regurgitation, and ascending aortic dilatation. We observed repeated tonic-clonic seizures on the day of surgery and the following day when the sedation was reduced. On the first postoperative day, an EEG revealed sharp, high-amplitude waves during the tonic-clonic seizure and 2-Hz rhythmic delta activity after motor symptoms disappeared. Based on these findings, the patient was diagnosed with NCSE. Under EEG monitoring, we initially used propofol at 4 mg/kg/h, but owing to a decrease in blood pressure, we achieved deep sedation and burst suppression by combining propofol at 1.5 mg/kg/h with midazolam at 0.18 mg/kg/h. We also administered levetiracetam and fosphenytoin as antiseizure medications. Levetiracetam was administered at 1000 mg/day and fosphenytoin at 20.5 mg/kg, followed by maintenance at 7.2 mg/kg/day. The patient's consciousness improved upon cessation of sedation on postoperative day 6. Postoperative magnetic resonance imaging revealed no abnormalities. Fosphenytoin was discontinued, and the patient was discharged on postoperative day 32 without any sequelae. The patient continues to take levetiracetam orally at a dose of 1000 mg/day and has been followed up in the outpatient clinic for 4 years without any seizure recurrence.</p><p><strong>Conclusion: </strong>Postoperative seizures following cardiac surgery may occur with NCSE, even after visible seizures have ceased. This case highlights the importance of thorough EEG monitoring in cases of prolonged disturbance of consciousness, indicating that early diagnosis and treatment of NCSE can improve the prognosis.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"4 1","pages":"5"},"PeriodicalIF":0.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11762878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143044043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Redo mitral valve replacement with annular reconstruction of left atrial dissection following mitral valve replacement for infective endocarditis: a case report.","authors":"Hiroki Tada, Junya Yokoyama, Akinobu Otani, Keiwa Kin, Yukitoshi Shirakawa","doi":"10.1186/s44215-025-00188-4","DOIUrl":"https://doi.org/10.1186/s44215-025-00188-4","url":null,"abstract":"<p><strong>Background: </strong>Left atrial dissection is a rare and occasionally fatal complication of cardiac surgery and is defined as the creation of a false chamber through a tear in the mitral valve annulus extending into the left atrial wall. Some patients are asymptomatic, while others present with various symptoms, such as chest pain, dyspnea, and even cardiac arrest. Although there is no established management for left atrial dissection, surgery should be considered in patients with hemodynamic disruption. Herein, we report a case of left atrial dissection managed using redo mitral valve replacement (MVR) with annular reconstruction.</p><p><strong>Case presentation: </strong>A 60-year-old man presented to our hospital with bilateral lower-extremity purpura and cognitive decline. Blood tests showed an elevated inflammatory response, and blood culture revealed Streptococcus mitis. Transesophageal echocardiography (TEE) revealed severe mitral regurgitation with vegetation on both the anterior and posterior leaflets, and infective endocarditis was diagnosed. We performed minimally invasive cardiac surgery-MVR through a right mini thoracotomy using Epic mitral valve 29 mm (Abbott Laboratories, Green Oaks, IL, USA). On postoperative day (POD) 2, the patient was discharged from the intensive care unit (ICU). On POD 3, sudden cardiac arrest occurred; we started cardiopulmonary resuscitation and urgently inserted a peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) cannula. Contrast-enhanced computed tomography revealed extravasation from the posterior wall of the left atrium. Therefore, we performed an emergency median sternotomy, controlled the bleeding from the posterior wall of the left atrium, and returned the patient to the ICU with gauze packing under VA-ECMO. Two days later, when the gauze was removed, TEE revealed a false lumen on the left atrial wall, and left atrial dissection was diagnosed. Accordingly, we performed annular reconstruction with bovine pericardium to close the entry point and, in succession, redo MVR with a bioprosthetic Epic mitral valve 27 mm. The postoperative course was uneventful. The patient was transferred to a rehabilitation hospital on POD 74.</p><p><strong>Conclusion: </strong>We report a case of left atrial dissection following MVR. The complex lesion was successfully repaired using redo MVR with annular reconstruction.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"4 1","pages":"4"},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11734570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aortic valve repair with sinus plication for a regurgitant bicuspid aortic valve: a case report.","authors":"Atsutaka Aratame, Takashi Kunihara, Toshio Baba, Masanori Sakaguchi, Yosuke Sumii, Mikado Fukuda, Yosuke Takahashi","doi":"10.1186/s44215-024-00184-0","DOIUrl":"10.1186/s44215-024-00184-0","url":null,"abstract":"<p><strong>Background: </strong>Repair of the regurgitant bicuspid aortic valve is an attractive alternative to valve replacement. Although good long-term outcomes have been reported, postoperative aortic stenosis remains a major late cause of repair failure in bicuspid aortic valves. Sinus plication is effective for creating a more symmetrical commissural angle, leading to a decrease in the mean transvalvular pressure gradient. Herein, we report a successful case of aortic valve repair with sinus plication for a regurgitant bicuspid aortic valve.</p><p><strong>Case presentation: </strong>The patient was a 34-year-old man with bicuspid aortic valve, severe aortic regurgitation, and left ventricular dilatation. Echocardiography revealed an eccentric aortic regurgitation jet caused by a fused cusp prolapse. The commissural angle was approximately 136°, classified as asymmetrical. The patient underwent surgery via median sternotomy. Cardiopulmonary bypass was initiated using the ascending aortic and single two-stage atrial cannulation with left ventricular venting via the right superior pulmonary vein. After the ascending aorta was cross-clamped, transection was performed 5-10 mm above the sinotubular junction. Based on the valve configuration, annuloplasty, sinus plication, and ascending aortic replacement were planned in addition to triangular resection of the bulking raphe tissue with central cusp plication. Mattress sutures of 4-0 polypropylene, reinforced with autologous pericardium, were placed outside the fused cusp for sinus plication. The sutures extended from the basal ring to the sinotubular junction, reducing the sinus circumference by approximately 15 mm. Intraoperative transesophageal echocardiography revealed trivial aortic regurgitation and modified commissural angulation. The operation, cardiopulmonary bypass, and aortic cross-clamping times were 311, 129, and 95 min, respectively. The clinical course was uneventful, without major complications. Postoperative echocardiography demonstrated an improved commissural angle. Follow-up echocardiography demonstrated trivial aortic regurgitation and a decreased mean transvalvular pressure gradient.</p><p><strong>Conclusions: </strong>Sinus plication may be one of the most effective repair techniques for asymmetrical bicuspid aortic valves, especially in cases without Valsalva sinus dilation. This technique helps avoid postoperative aortic valve stenosis.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"4 1","pages":"3"},"PeriodicalIF":0.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11731531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}