Rupture of an aneurysm of a coronary arteriovenous fistula

Coronary arteriovenous fistula is a relatively rare congenital malformation. The course of this malformation is generally benign, and rupture of the fistula is thought to be very rare. We report a case of rupture of an aneurysm of a coronary arteriovenous fistula that originated from the distal left circumflex coronary artery and drained into the right atrium; this rupture was successfully treated with an operation.

Giant pseudoaneurysm of the right sinus of Valsalva

A pseudoaneurysm of the sinus of Valsalva is a very rare cardiac abnormality. We report a surgical case of the pseudoaneurysm of the right sinus of Valsalva in a 77-year- old woman. The histopathological examination of the resected aneurysmal wall revealed that it was a pseudoaneurysm without any specific inflammatory changes. Although we cannot identify the clear cause of the formation of the pseudoaneurysm, we believe it may have been a type of spontaneous rupture of the sinus of Valsalva.

[Extra-anatomic bypass from the ascending aorta to the supraceliac abdominal aorta--surgical option applied to reoperation for aortic coarctation or interruption]

The optimal approach for reoperation following repair of aortic coarctation (CoA) or interruption (IAA) remains controversial. Four patients underwent extra-anatomic bypass for restenosis after repair of CoA or IAA. The age ranged from 4 to 12 years. The initial repairs for two CoA, one type A-IAA, and one type B-IAA consisted of two grafting, one subclavian arterial turning-down aortoplasty, and one subclavian flap aortoplasty. All of them underwent during infancy. Preoperative right arm systolic pressure ranged from 140 to 190 mmHg ar rest. Through a midline sternotomy and an upper laparotmy incision, an extra-anatomic bypass from the ascending aorta to the supraceliac abdominal aorta was employed using a 12 to 18 mm tube graft. All patients survived surgeries, and their hypertension markedly improved. Our experience confirms safety and effectiveness of this option in selected young patients with re-stenosis of following repair of CoA or IAA.

Cardiac extension of intravenous leiomyomatosis with successful resection

A case of intravenous leiomyomatosis spreading to the right ventricle is described. A 28-year-old woman had been previously diagnosed as having a smooth muscle tumor of borderline malignancy after hysterectomy for a large uterine tumor, because of its unusual invasive character. Based on the above diagnosis, the patient had been managed clinically as having a uterine sarcoma. One year after her hysterectomy, a local recurrence in the pelvic cavity was detected. Two years later, the tumor appeared as a cardiac tumor causing syncope. The tumor was totally resected in two surgical stages, and the correct diagnosis of an intravenous leiomyomatosis was made. The diagnostic and operative considerations are reviewed and the preferred surgical procedure is discussed.

[A case report of postcoarctation mycotic aneurysm after surgical treatment for cerebral arterial aneurysms]

Postcoarctation mycotic aneurysm of the aorta is very rare. We present a case of a 55-year-old man with postcoarctation mycotic aneurysm of the aorta infected with methicillin resistant staphylococcus aureus (MRSA) after surgical treatment for cerebral arterial aneurysms. The operation was performed after negative conversion of MRSA in blood culture using antibiotics. The mycotic false aneurysm was completely resected following institution of an extra-anatomical bypass from the ascending aorta to abdominal aorta above celiac artery.

Detrimental effects of exogenous glutamate on spinal cord neurons during brief ischemia in vivo

BACKGROUND

Paraplegia remains a serious complication of thoracoabdominal aortic operations. However, despite growing in vitro evidence, it has been difficult to demonstrate glutamate neurotoxicity in vivo because of the reuptake activity that occurs. We hypothesized that glutamate can be toxic to the spinal cord under metabolic stress.

METHODS

Infrarenal aortic isolation was performed in New Zealand white rabbits. Group A animals (n = 7) then received a segmental infusion of glutamate (50 mmol/L) for 5 minutes. Group B animals (n = 7) received saline as a negative control. Group C animals (n = 6) were pretreated with a segmental infusion of 2,3-dihydroxy-6-nitro-7-sulfamoyl-benzo(f)-quinoxaline (4 mg/kg), a competitive alpha-amino-3-hydroxy-5-methylisoazole-4-propionic acid/kainate antagonist, followed by the segmental infusion of glutamate (30 mmol/L) for 4 minutes. Group D animals (n = 6) received the vehicle agents only, followed by the same glutamate infusion (30 mmol/L) as in group C as a control for group C. Neurologic status was assessed at 12, 24, and 48 hours after operation and scored using the Tarlov system.

RESULTS

Group A animals exhibited paraplegia or paraparesis with marked neuronal necrosis. Group B animals recovered fully. Group C animals had better neurologic function than group D animals (p = 0.0039).

CONCLUSIONS

Exogenous glutamate can have detrimental effects on spinal cord neurons during a brief period of ischemia. This model may be useful for the purpose of assaying a glutamate receptor antagonist in vivo.

[A case of partial atrioventricular canal with discrete subvalvular aortic stenosis worsened 3 years after the replacement of the mitral valve]

The extension of the left ventricular outflow tract is provoked by a partial atrioventricular canal, and is easy to cause stenosis after a radical operation and/or a replacement of the left atrioventricular valve because of its anatomical structure. This report shows a case of a partial atrioventricular canal with a discrete subvalvular aortic stenosis which was worsened three years after the replacement of mitral valve. In this case the left ventricular outflow tract obstruction (LVOTO) had been found before the replacement of mitral valve but it was kept observing without surgical treatment because the degree was judged slight. Subvalvular aortic stenosis was worsened three years after the replacement. It was suspected that the stenosis developed because of the proliferation of heterologous tissue by a turbulent flow of a site of stenosis. For this diagnosis, the transesophageal echocardiography was very effective, and in this case the cause of LVOTO is uncertain, so a careful observation is necessary for it.