記述言語：英語   掲載種別：研究論文（学術雑誌）  

A sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly that may remain silent until rupture, often leading to acute heart failure. Surgical intervention is advised for unruptured SVAs when large, progressive, or associated with aortic regurgitation (AR). We report a 72-year-old woman with a 25-mm right coronary SVA and severe symptomatic AR. Transthoracic echocardiography confirmed severe AR with preserved ventricular function. A Bentall procedure using a bioprosthetic valve and Valsalva graft was performed, with coronary button reimplantation with the Carrel patch technique. The postoperative course was uneventful, and the patient remained free of recurrence at 2-year follow-up. This case highlights the Bentall procedure as a durable option for unruptured SVA with root distortion and valve involvement, offering reliable prevention of late AR and reintervention.

DOI： 10.1093/jscr/rjag038

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We report a 70-year-old woman (body surface area 1.42 m2) undergoing redo double valve replacement with extensive annular enlargement using the Commando procedure. Thirteen years earlier, she received aortic valve replacement (St. Jude Medical 19 mm), mitral repair (Physio Ring 24 mm), and tricuspid annuloplasty. She presented with progressive heart failure; echocardiography showed severe mitral stenosis (mitral valve area 0.96 cm2) and moderate aortic stenosis with moderate paravalvular leak. To avert patient-prosthesis mismatch (PPM), both annuli were enlarged with bovine pericardium, permitting implantation of an Epic 27 mm mitral and an Inspiris 23 mm aortic bioprosthesis. Postoperative echocardiography demonstrated excellent hemodynamics (aortic effective orifice area 1.76 cm2, mean gradient 6 mmHg; mitral mean gradient 3 mmHg). Recovery was uneventful, and she remains asymptomatic. Commando surgery enabled safe, simultaneous enlargement of both annuli, minimizing PPM, and preserving options for future valve-in-valve therapy.

DOI： 10.1093/jscr/rjaf1025

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Ascending aortic mural thrombus (AMT) is an exceptionally rare condition. Diagnosis is often difficult because non-ECG-gated contrast-enhanced CT is susceptible to motion artifacts, and the distal ascending aorta can sometimes be challenging to evaluate using transesophageal echocardiography. A standardized surgical strategy for ascending AMT has not been established. CASE PRESENTATION: A 61-year-old man presented with transient left hemiplegia caused by embolic stroke. A non-ECG-gated contrast-enhanced CT scan revealed a thrombus-like structure in the ascending aorta; however, ECG-gated contrast-enhanced CT clearly demonstrated a thin-stalked and mobile thrombus, prompting urgent surgery. Cardiopulmonary bypass (CPB) was established using bilateral axillary artery cannulation and bicaval venous drainage. To minimize the risk of cerebral embolization during CPB initiation, the left common carotid artery (LCCA) was temporarily clamped under near-infrared spectroscopy monitoring. After cooling to 26°C, circulatory arrest with brachiocephalic artery and LCCA clamping and unilateral selective cerebral perfusion (uSCP) was performed. A highly mobile thrombus-like mass located just proximal to the brachiocephalic artery was excised with an adequate margin, followed by partial arch replacement with reconstruction of two arch branches. The postoperative course was uneventful, and pathology confirmed atherosclerosis with fresh thrombi and early organization. CONCLUSIONS: ECG-gated contrast enhanced CT is essential for accurate diagnosis of ascending AMT, particularly when small lesions mimic motion artifacts. The combination of bilateral axillary cannulation, LCCA occlusion, and a modified brain isolation strategy using uSCP may provide a safe and effective approach for surgical treatment of ascending AMT without neurological complications.

DOI： 10.70352/scrj.cr.25-0768

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Younger patients with acute aortic dissection (AAD) are thought to present with distinct anatomical and hemodynamic features compared with older patients. This study evaluated the association between age, dissection extent, and false-lumen flow characteristics in AAD. METHODS AND RESULTS: We retrospectively analyzed 400 consecutive patients with radiologically confirmed AAD from April 2014 to April 2024, categorizing them into a younger group (<76 years, n = 229) and an older group (≥76 years, n = 171). The distribution of Stanford type A vs. B dissections was similar between groups. However, younger patients more frequently demonstrated DeBakey type I dissection, whereas older patients more commonly had type II. Regarding false-lumen morphology, younger patients showed a higher prevalence of communicating false lumen, while non-communicating patterns predominated in the elderly. Although overall sex distribution of false-lumen types was not significantly different, younger males were more prevalent within each subtype. Preoperative malperfusion occurred more often in younger patients, whereas 30-day mortality did not differ significantly between age groups. CONCLUSIONS: Younger AAD patients typically exhibit more extensive dissection and patent false-lumen flow, while older patients more often present with localized dissection and thrombosed false lumen. These age-related distinctions may reflect progressive aortic wall stiffening and should be considered in clinical assessment and management strategies.

DOI： 10.3389/fcvm.2026.1762060

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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J-GLOBAL

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J-GLOBAL

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