When should a cardiologist refer a patient with aortic valve disease to a surgeon?

In general, aortic stenosis and regurgitation are the 2 main aortic valve diseases which require surgical treatment. Surgical indication for each has been described in detail in the guidelines established by the Japanese Circulation Society and American Heart Association/American College of Cardiology (AHA/ACC). Most of the cases we daily encounter in clinical practice can be managed within the guideline, although the patient's many other factors are needed to be taken into consideration. On the contrary, in those cases with the conditions which are not mentioned in the guidelines, diagnosis and decisions are always difficult to make. In this article, we are to discuss how to manage cases within and without the guidelines.     

Transaortic Mitral Valve Repair Combined with a Modified Bentall Procedure in a Patient with Marfan’s Syndrome: Report of a Case

We report a case of transaortic mitral valve repair combined with aortic root and arch replacement in a patient with Marfans syndrome. Preoperative computed tomography and echocardiography showed acute aortic dissection (DeBakey type 1), severe aortic regurgitation, annuloaortic ectasia, and mild mitral regurgitation (MR). We performed artificial chordae implantation to the anterior mitral leaflet (AML) through the aortic root, followed by insertion of an aortic composite graft and replacement of the aortic arch. The patient is well 55 months after the operation, with minimal MR. We think that the transaortic approach is a good alternative for exposure and correction of the AML and its apparatus in special circumstances.     

Partial spleen resection with a radiofrequency needle device—a pilot study

Introduction

Total splenectomy leads to an immunocompromised state, with an increased lifetime risk of infection. The lifetime risk of developing overwhelming postsplenectomy infection is 5 %, with a mortality rate of approximately 50 %. In addition to vaccination and antibiotic prophylaxis, partial splenectomy is believed to improve patient safety.

Methods

We performed partial splenectomy in seven patients using a radiofrequency (RF) technique with Habib® needles. In seven patients, an open access partial splenectomy was performed. In three patients, a partial splenectomy was performed simultaneously with intraabdominal tumour resection. In two patients, the upper pole of the spleen was removed due to tumours of the spleen. In one patient, a large symptomatic splenic cyst was resected and in another patient, a partial splenectomy was performed due to trauma. RF was applied using Habib® needles (AngioDynamics, Manchester, GA, 31816, USA).

Results

The partial splenectomy procedures were easy and safe in all seven patients. The RF application with the Habib® needles led to primary haemostasis. The blood loss was less than 50 ml in all cases. After a minimum follow-up of 1 year, there were no cases of infections or other adverse events related to the previous partial splenectomy.

Conclusion

In our experience, partial splenectomy with Habib® needles is easy to perform and safe for the patient. Thus, radiofrequency resection is a good alternative to total splenectomy in many patients and reduces the risk of postsplenectomy infections.     

Breast cancer in a male with ankylosing spondylitis treated with TNFα antagonists

A 72-year-old male with a 4-year history of TNFα antagonist therapy (infliximab and etanercept) for ankylosing spondylitis was diagnosed with breast cancer. He had a family history of breast cancer. The low incidence and considerable severity of breast cancer in males, genetic risk factors, and potential role for TNFα antagonist therapy are discussed.     

Successfully completed total cavopulmonary connection with a right-sided maze procedure after a modified Starnes’ operation in a neonate with Ebstein’s anomaly

The symptomatic newborn infant with Ebstein’s anomaly is in critical condition and is difficult to treat successfully. Furthermore, supraventricular tachyarrhythmia in patients with Ebstein’s anomaly may determine the early and late results. We report a successfully treated case of extracardiac total cavopulmonary connection with a right-sided maze procedure after a modified Starnes’ operation during the neonatal period.     

Reconstruction of an abdominal wall defect with biologic mesh after resection of a desmoid tumor in a patient with a Gardner’s syndrome

Introduction: Desmoid tumors are rare proliferative and invasive benign lesions. They can be sporadic, but in most instances, desmoid tumors develop in the context of Gardner’s syndrome with principal localization in the abdominal cavity and abdominal wall.

Case-report: We report the case of a 24-year-old female presenting Gardner’s syndrome with a symptomatic abdominal wall desmoid tumor. Lack of response to medical treatment led to surgical management consisting in a complete resection and parietal reconstruction with a biologic mesh. Postoperative course was uneventful and there was no evidence of recurrence at 12 months of follow-up.

Discussion: Conventional treatment of abdominal wall desmoid tumors consists in a wide and radical resection. However, complete resection is not always feasible because of difficulty to differentiate the desmoid tumor from adjacent tissues. The surgical approach may require different techniques to repair the parietal defect including prosthetic material such as synthetic or biologic meshes. Biological mesh is an ideal alternative to synthetic graft, mainly in case of infection.

Conclusion: We have encountered a case of a symptomatic growing desmoid tumor of the abdominal wall in a young patient with Gardner’s syndrome, successfully treated by complete resection and reconstruction with a biologic mesh to correct the parietal defect.     

Treatment of a Left Common Iliac Aneurysm with Endovascular Powerlink® Stentgraft in a Patient with an Occlusion of a Left Common Iliac Stent

Isolated iliac aneurysms are uncommon and account for only 2% of all abdominal aneurysms. Typically, patients presenting with this pathology are operated on surgically. In our patient, however, surgery could have been an option but the patient had undergone a laparotomy more than 50 years earlier because of a gun-shot wound, so we preferred an endovascular repair. Furthermore, regular endovascular repair with a straight tube stentgraft was impossible due to the absence of a proximal neck. Consequently, we opted for placing a bifurcated stentgraft to exclude the iliac aneurysm.     

Renal transplantation from a living related donor with a retrocaval ureter – a note of caution

In our study we describe a renal transplant from a living related donor who was found to have a retrocaval ureter. The retrocaval ureter is a rare congenital anomaly resulting from a defect in the embryological development of the ureter and the inferior vena cava (IVC). The compression of the ureter between the IVC and the vertebrae can result in progressive hydronephrosis. The non-dilated segment of the ureter was used for the uretero-neocystostomy. The patient presented with ureteric obstruction in the immediate post-transplant period, and at surgical exploration the uretero-neocystostomy was revised using the dilated portion of the ureter. We recommend that when transplanting a kidney with a retrocaval ureter, caution should be exercised in using the non-dilated portion of the ureter, since either the blood supply may be compromised or the peristalsis may be interrupted. Received: 30 June 1998 Received after revision: 26 January 1999 Accepted: 26 February 1999