Introduction: Unilateral vocal fold paralysis (UVFP) is a major voice disorder, caused in most cases by recurrent laryngeal nerve palsy. Several surgical methods have been described for the treatment of UVFP, including arytenoid adduction (AA), thyroplasty type I (TP1), and fat injection laryngoplasty (FIL). This study was aimed at clarifying the efficacy of the phonosurgery performed at our institution.

In cases of suspected perilymphatic fistula (PLF) as the cause of dizziness and/or acute sensorineural hearing loss, we instruct patients to rest for several days with the head raised. Thereafter, if the symptoms do not improve, surgery is performed. Between January 2016 and December 2019, we treated 28 cases of PLF by surgery at Kurume University Hospital, and examined the triggers and symptoms at onset, nystagmus pattern, surgical findings, and treatment outcomes. In most cases, there were no triggers for the symptom onset. Vestibular symptoms were observed in 92.9% of cases. Sensorineural hearing loss was observed in 82.1% of cases. Vestibular function tests showed positional nystagmus in 82.1% of cases. During surgery, fistulas were confirmed in 14.3% of cases and perilymphatic fluid leakage in 64.3% of cases. The hearing loss improved after the surgery in 26.1% of cases. The improvement rate of hearing loss was 80.0% for patients who underwent surgical treatment within 2 weeks of onset. The overall improvement rate of vestibular symptoms was 88.5%. Even in cases treated a long time after the disease onset, the rate of improvement of vestibular symptoms was good. Surgical treatment should be considered for cases of suspected PLF.

Background: Postoperative atrial fibrillation (POAF), a common complication of cardiac surgery, increases postoperative mortality, morbidity, and medical costs. POAF after coronary artery bypass grafting is well investigated; however, little is known about POAF after aortic valve replacement (AVR). This study aimed to investigate the efficacy of low-dose landiolol in preventing POAF after AVR. Methods: Thirty patients who underwent AVR were randomized into two groups, with or without administration of landiolol (Landiolol, N=15; Control, N=15). In Landiolol, continuous infusion of landiolol (3 µg/kg/min) was maintained for 48 h from admission to the intensive care unit. The occurrence of POAF during seven days after surgery, heart rate, blood pressure, cardiac index, and mixed venous oxygen saturation were compared between the two groups. Results: POAF occurred in one and seven patients in Landiolol (6.7%) and Control (46.7%), respectively, with significantly lower incidence in Landiolol than in Control (p=0.0352). The heart rate was significantly lower in Landiolol than in Control. No significant differences were observed in blood pressure, cardiac indices, and mixed venous hemoglobin oxygen between the two groups. Conclusions: The administration of low-dose landiolol following AVR significantly decreased the incidence of POAF without hemodynamic deterioration, suggesting that it may safely and effectively prevent POAF in patients undergoing AVR.

BackgroundSevere carotid and intracranial artery stenosis disease (CIAD) is major risk for perioperative stroke in coronary artery bypass grafting. Then, preoperative risk assessment is quite important.Case presentationA 58-years old Japanese woman with bilateral carotid stenosis and bilateral middle cerebral artery occlusion was suffered from worsening effort angina due to severe three coronary vessel disease. Magnetic resonance imaging angiography demonstrated severe carotid and intracranial vessel stenosis. Selective carotid/cerebral angiography also showed severe stenosis and delayed filling of the right internal carotid artery and moderate stenosis of the left internal carotid artery, with occlusion of the bilateral middle cerebral arteries. However, quantitative evaluation with brain perfusion, single-photon emission computed tomography (SPECT) with acetazolamide showed depleted cerebral perfusion volume and vascular responses, particularly in the left middle cerebral artery area. However, both sides of MCA reserve cerebral blood flow was maintained at >34ml/100g/min. So, we finally considered that her cerebral perfusion reserve was maintained a certain level and could tolerate open heart surgery. Then, she underwent off-pump coronary artery grafting. Before sternotomy, prophylactic intra-aortic balloon pump support was used to minimize possible perioperative stroke. As a result, hemodynamic status and brain regional oxygen saturation were stable throughout the operation, and recovered uneventfully.ConclusionsPreoperative quantitative evaluation using brain perfusion SPECT with acetazolamide is useful in assessing hemodynamic cerebrovascular risk in patients with severe obstructive CIAD. Off pump coronary artery bypass grafting with intra aortic balloon pump assist is a good option for prevention of cerebrovascular morbidity in ischemic heart disease with severe CIAD.

BACKGROUND:In rare cases, echo findings of degenerative valve disease is similar to valvular mass.CASE PRESENTATION:A 56-year-old woman was evaluated for palpitation. Echocardiography revealed an 8- mm mass on the anterior mitral leaflet with minimal mitral insufficiency. Resection of the valve tumor was attempted to prevent a possible embolism. However, the lesion was not a tumor, but an aneurysm-like bulge on the anterior leaflet without chorda elongation. Triangular resection and ring annuloplasty were performed. The patient's postoperative course was uneventful. Pathological examination revealeddegenerative disease.CONCLUSIONS:This case illustrates that a valvular mass that looks like a tumor by echocardiography may actually be degenerative regardless of the presence of mitral insufficiency.

BACKGROUND:The durability of the Starr-Edwards (SE) mitral caged-disk valve, model 6520, is not clearly known, and structural valve deterioration in the SE disk valve is very rare. METHODS AND RESULTS:Replacement of the SE mitral disk valve was performed in 7 patients 23-40 years after implantation. Macroscopic examination of the removed disk valves showed no structural abnormalities in 3 patients, in whom the disk valves were removed at <26 years after implantation. Localized disk wear was found at the sites where the disk abutted the struts of the cage, in disk valves excised >36 years after implantation in 4 patients. Disk fracture, a longitudinal split in the disk along its circumference at the site of incorporation of the titanium ring, was detected in the valves removed 36 and 40 years after implantation, respectively, and many cracks were also observed on the outflow aspect of the disk removed 40 years after implantation. CONCLUSIONS:Disk fracture and localized disk wear were found in the SE mitral disk valves implanted >36 years previously. The present results suggest that SE mitral caged-disk valves implanted >20 years previously should be carefully followed up, and that those implanted >30 years previously should be electively replaced with modern prosthetic valves

症例は31歳男性.仕事中に胸部を圧縮機械にはさまれた際,意識消失し,近医へ救急搬送された.搬入時意識は改善し,胸部レントゲンで異常を認めなかったため,特に加療されることなく帰宅された.しかし,受傷2日後に施行された胸部CTでStanford A型急性大動脈解離を認めたため,精査加療目的で同日緊急入院となった.入院後安静,降圧療法にて経過観察され,受傷後35日目に自宅退院となった.しかしCTにて上行大動脈径は拡大傾向であったため,当院で上行部分弓部大動脈置換術を施行された.術後経過は良好であり,術後16病日に退院された.鈍的外傷後,Stanford A型大動脈解離を合併することは稀であるが,文献的考察を加えて報告する.

症例は61歳男性で，57歳時から慢性腎不全に対して透析を導入され，59歳時に大動脈弁輪拡張症に対して大動脈基部置換術を施行された．61歳時に発熱，胸部違和感を認め精査を行われた．造影CTにて大動脈基部周囲に仮性瘤，膿瘍の形成を認め感染性心内膜炎と診断された．この症例に対し，感染巣の十分なdebridementを行ったのち，健常な左室心筋に馬心膜ロールを縫着し左室流出路を再建した後，Freestyle弁を心膜ロールの末梢に吻合し大動脈基部再置換術を行った．術後14カ月を経過しているが感染の再燃や縫合部の異常を認めず経過している．本法は良好な視野で健常な左室心筋に心膜ロールを縫合でき，その心膜ロールに確実に人工弁を縫着することが可能である．また膿瘍腔と血流を隔離できるという点においても有用である．

重症心不全に対する治療として，Toyobo-LVASをbridge useで用いた場合，長期間の厳密なるワーファリンコントロールが必要である．しかも，血栓塞栓症やそれに起因する出血性の合併症がある場合，より正確にきめ細かくコントロールする必要がある．しかし入院治療が続く限り，採血検査を多く行うほど，「採血の痛み」という患者の苦痛も増すというジレンマが生じる．そこでCoaguChek XS® による簡易検査を用いて，従来法と比較検討した．それぞれは，非常によく相関し，相関係数は0.916で，回帰直線はY＝0.8027X＋0.3399であった．またCoaguChek XS® による採血は，患者の疼痛軽減にも非常に有用であった．

Our aim was to evaluate the long-term results of implantation of the Carpentier–Edwards pericardial (CEP) valve in the aortic position. Between January 1996 and December 2007, 244 patients who underwent aortic valve replacement using the CEP valve were enrolled in this study. A 19-mm valve was used in 39 patients, a 21-mm valve in 94 patients, a 23-mm valve in 81 patients, and a 25-mm valve in 30 patients. The early and the late results were evaluated. Furthermore, echocardiographic examination was performed at follow-up. There were 5 early deaths, with an early mortality rate of 2.0%. Follow-up was performed in 95.4% of the survivors of the operation for a mean period of 4.1 years. Actuarial survival rates at 5, 10, and 12 years were 85.3 ± 2.8, 80.0 ± 3.7 and 70.0 ± 9.8%, respectively. Thromboembolism was observed in 6 patients, endocarditis in 2 patients, reoperation in 4 patients, and structural valve deterioration in 2 patients. Actuarial freedoms from thromboembolism, endocarditis, and reoperation at 10 years were 96.9 ± 0.14, 97.7 ± 0.16, and 97.0 ± 0.16%, respectively. Echocardiographic examination revealed that the pressure gradients across the valve prosthesis for valves of each size were acceptable. Left ventricular mass index decreased significantly in all valve sizes. The long-term results of implantation of the CEP bioprosthesis in the aortic position were satisfactory. The CEP bioprosthesis maintained its hemodynamic performance even as late as 10 years after implantation.

We herein describe a rare case of a concurrent submitral left ventricular (LV) aneurysm and an aneurysm of the sinus of Valsalva in a 65-year-old Japanese woman. The patient had a history of mitral valve replacement (MVR) for mitral regurgitation caused by a submitral LV aneurysm at the age of 58. At the time of the MVR, the orifice of the submitral LV aneurysm without thrombi was beneath the posterior leaflet, but surgical repair of the submitral LV aneurysm was not attempted. Although the patient was asymptomatic, when she underwent an echocardiogram at 65 years of age an aneurysm of the noncoronary sinus of Valsalva was detected. However, echocardiography performed before the initial operation had shown that the aneurysm of the sinus of Valsalva was coexistent with the submitral LV aneurysm. Since the submitral LV aneurysm revealed no progressive enlargement during the 7 years, patch closure of the aneurysm of the sinus of Valsalva alone was successfully performed.

The abnormal origin of the left circumflex artery from the proximal right coronary artery (RCA) is considered a coronary artery anomaly. Most of the coronary artery anomalies are diagnosed incidentally by coronary artery angiography, and several considerations are needed to avoid fatal complications in patients undergoing aortic valve replacement (AVR). We report a case of AVR with anomalous origin of the left circumflex artery from a common ostium of the RCA, and discuss the use of a smaller prosthesis to avoid compression of the anomalous left circumflex artery.

We report a case of recurrent mitral regurgitation due to calcification of the expanded polytetrafluoroethylene sutures. According to pathologic findings, it was believed that due to the dystrophic calcification of the fibrous tissue covering the expanded polytetrafluoroethylene sutures, there was increased hyalinization, leading to sclerosis and shortening of the chordae. Calcification of expanded polytetrafluoroethylene sutures after mitral valve repair is a rare complication; however, careful follow-up should be needed because such change may occur in long-term periods after implantation. (Ann Thorac Surg 2010;89:955-7) (C) 2010 by The Society of Thoracic Surgeons

Patent ductus arteriosus is the third most common congenital cardiovascular anomaly, however, it is rarely found in the elderly. We describe a case of patent ductus arteriosus in a 72-year-old woman in whom patent ductus arteriosus was successfully managed by transcatheter coil embolization. The patient had been diagnosed with a heart murmur for the first time 1 year earlier at the age of 71. She was asymptomatic but a continuous murmur was heard. Cardiac catheterization revealed migration of a catheter from the main pulmonary artery into the descending aorta through a patent ductus arteriosus and a significant step-up of oxygen saturation in the main pulmonary artery with a pulmonary-to-systemic flow ratio of 1.68. Aortograms demonstrated a communication between the aorta and the pulmonary artery through a patent ductus arteriosus with a minimal diameter of 3.7 mm. Transcatheter coil embolization of the patent ductus arteriosus was successfully carried out with two 0.052-inch-diameter Gianturco coils. Doppler echocardiographic study confirmed no residual shunt in the main pulmonary artery after the procedure. Non-surgical transcatheter occlusion using coil embolization appears to be an effective and minimally invasive technique for treatment of patent ductus arteriosus in the elderly.

In order to clarify the relationship between hyperamylasemia and clinical states in chronic pancreatitis, serum amylase isozymes were studied in 39 cases of chronic pancreatitis including 13 cases of alcoholic pancreatitis.

Comparative assessments of the endocrine and exocrine functions of the pancreas associated with gallstone pancreatitis or alcoholic pancreatitis were performed in a series of 86 patients, 20 with cholelithiasis, 12 with chronic alcoholism, 24 with chronic gallstone pancreatitis and 30 with chronic alcoholic pancreatitis and 32 healthy subjects were served as controls.