Language：English   Publishing type：Research paper (scientific journal)  

We report a 50-year-old woman with pulmonary and tricuspid valve regurgitation who required redo pulmonary and tricuspid valve replacement (PVR, TVR). At age 8, she underwent right ventricular outflow tract reconstruction for pulmonary stenosis, and at 44 years she had PVR with a 19 mm Inspiris Resilia bioprosthesis and tricuspid annuloplasty with a 28 mm Physio ring. Three years later, she presented with palpitations and syncope. Echocardiography revealed severe tricuspid regurgitation and moderate pulmonary regurgitation due to dysfunction of a prosthetic leaflet. Redo PVR with a 29 mm Inspiris Resilia valve and TVR with a 27 mm Mitris valve was performed. Early structural valve deterioration of the initial Inspiris prosthesis was suspected. Our experience suggests that using a larger prosthesis may mitigate early degeneration and preserve the option of future transcatheter PVR.

DOI： 10.1093/jscr/rjaf898

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Language：English   Publishing type：Research paper (scientific journal)  

We report a case of a 74-year-old man with acute type A aortic dissection (AADA) complicated by bilateral lower limb and renal malperfusion. Due to preoperative motor and sensory deficits, bilateral axillo-bifemoral grafts were used for arterial cannulation to initiate cardiopulmonary bypass and enable immediate limb reperfusion. Total arch replacement with a frozen elephant trunk was performed. To maintain lower limb perfusion perioperatively, a prophylactic ascending aorta-to-bilateral femoral artery bypass was constructed using the same grafts. Although the aorta-to-bilateral femoral artery bypass occluded within 1 week postoperatively due to true lumen expansion, limb perfusion was preserved, and no further revascularization was required. Continuous renal replacement therapy was initiated immediately postoperatively to prevent myonephropathic metabolic syndrome, leading to full renal recovery. The patient was discharged without neurological deficits or limb loss. This case underscores the effectiveness of early cardiopulmonary bypass reperfusion, temporary bypass, and renal support in AADA with limb malperfusion.

DOI： 10.1093/jscr/rjaf837

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We report a case of an 80-year-old woman with severe mitral regurgitation, low ejection fraction, frailty, and acute decompensated heart failure. Due to her high surgical risk, transcatheter edge-to-edge repair using the MitraClip system (Abbott, Abbott Park, IL, USA) was attempted by the cardiology team. However, the procedure resulted in a posterior mitral leaflet tear with worsened severe mitral regurgitation. She was subsequently referred to our department, and owing to her clinical deterioration, urgent minimally invasive cardiac surgery mitral valve replacement was performed using a 29-mm bioprosthetic mitral valve (Epic; Abbott, Abbott Park, IL, USA). The patient had an uneventful recovery and was discharged on postoperative Day 13. Mitral valve surgery following failed MitraClip is considered high-risk, with elevated perioperative mortality. However, in frail patients with leaflet injury after MitraClip failure, minimally invasive cardiac surgery mitral valve replacement may represent a more appropriate and less invasive therapeutic option.

DOI： 10.1093/jscr/rjaf591

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Language：English   Publishing type：Research paper (scientific journal)  

Coronary artery fistulas (CAFs) are rare coronary anomalies. Among these, coronary artery-pulmonary artery fistulas can lead to myocardial ischemia through mechanisms such as coronary steal, stenosis, and vasospasm. We report a case of a 73-year-old male presenting with a coronary artery-pulmonary artery fistula and 75% stenosis of the right coronary artery. Despite negative findings for ischemia on myocardial scintigraphy and the absence of ST changes on a resting electrocardiogram (ECG), coronary steal syndrome was suspected following an exercise ECG that revealed diffuse ST depression. Surgical intervention to close the fistula was performed; however, the patient experienced intraoperative coronary spasms and ventricular fibrillation, necessitating the use of intra-aortic balloon pump and veno-arterial extracorporeal membrane oxygenation. The present case suggested that CAFs can be complicated by vasospasm, which may be overlooked at preoperative diagnostics. In patients with CAFs, careful evaluation regarding vasospastic angina should be done preoperatively.

DOI： 10.1093/jscr/rjaf173

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Publishing type：Research paper (scientific journal)   Publisher：Oxford University Press (OUP)  

Abstract

Herein, we report a case of transapical transcatheter aortic valve replacement and coronary artery bypass grafting performed in an on-pump beating fashion in an old woman with severe aortic valve stenosis, a porcelain aorta, severe calcified coronary artery disease, and a history of abdominal aortic replacement.

DOI： 10.1093/jscr/rjaf119

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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