A 77-year-old woman who had undergone mitral valve replacement (MVR) with a 29 mm Hancock standard (H-S) bioprosthesis (Model 242) and tricuspid annuloplasty (Kay's method) at the age of 44 years was admitted urgently with acute heart failure. Echocardiography showed severe transvalvular leakage of the prosthesis and moderate tricuspid regurgitation. The patient underwent reMVR with a 29 mm Carpentier-Edwards Perimount Magna Mitral bioprosthesis and tricuspid annuloplasty with a 30 mm MC3 ring. The explanted bioprosthesis showed mild calcification and a tear in the leaflet, dehisced commissures and pannus overgrowth. To our knowledge there are no reports describing H-S valves that were still functioning over 30 years after implantation. Herein, we report a case of reMVR in a patient with an H-S valve that had been implanted 33 years previously.
An 87-year-old woman developed a sudden disturbance of consciousness. Her physical findings included : E1M1M1 level of consciousness, GCS 3 points, pulse 50 per minute sinus rhythm, temperature 35.2 ℃ , respiratory rate > 30 per minute. Contrast enhanced CT scan showed an abdominal aortic aneurysm, 30 mm in size, and a left common iliac artery aneurysm, 60 mm in size ; based on the images it was not clear whether a rupture had occurred. There was an inflow of contrast media into the common iliac vein ; an iliac arteriovenous fistula through which a left common iliac artery aneurysm had penetrated to the left common iliac vein was diagnosed. The patient had acute heart failure caused by the iliac arteriovenous fistula ; emergency surgery was required. The area around the iliac aneurysm was opened up, and a bypass graft was placed from the right external iliac artery to the left external iliac artery. Lower limb artery circulation was assessed. Free wall ruptures to the peritoneal cavity often occur with abdominal aortic aneurysm ruptures and iliac aneurysm ruptures, but ruptures to an adjacent vein occur rarely. There are a few reports in the literature of fistula formation related to aneurysms. In these patients, dissecting around the aneurysm and rebuilding the lower limb artery circulation is thought to be effective.
Cardiac papillary fibroelastomas are rare but are still the second most common benign cardiac tumor ; after myxoma. While cardiac papillary fibroelastomas are benign, there is the potential for severe complications related to embolism. Consequently, a surgical treatment approach is generally recommended. Nevertheless, from the risk of the recurrence of tumor and the valve insufficiency, the excision range is still controversial, particularly with tumors arising from the valve. We report the case of a 66-year-old woman who underwent resection of cardiac papillary fibroelastomas arising from three leaflets of the aortic valves. We performed simple excision without valve surgery and obtained an uneventful prognosis. At 18 months after surgery, no recurrence of tumors was recognized. We consider that it is possible to resect cardiac papillary fibroelastomas without performing valve repair or replacement if they are removed carefully even if the tumors arise from three leaflets of an aortic valve.
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