Mitral valve surgeries for cases with mitral annular calcification MAC are challenging because of the operative complications. For a case of MS with MAC, we achieved mitral valve plasty by ultrasonic decalcification alone. An 82-year-old male with edema and dyspnea was diagnosed with AS and MS with MAC. MAC was so severe that MVR was challenging. There were calcifications at the anterior commissure and the anterior mitral leaflet AML , and removal of them was expected to improve the valve function. Therefore, anterior commissurotomy and ultrasonic decalcification of the anterior commissural annulus was performed using cavitron ultrasonic surgical aspiration CUSA. Following the resection of the aortic valve, we carried out decalcification of the AML through the aortic valve orifice. After AVR, a trans-esophageal echocardiogram showed MS was ameliorated. Two years after surgery, recurrence of MS was not recognized. Some mitral cases with MAC can be treated by only decalcification to avoid risky valve replacement.
International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. IJCRI publishes CASE REPORT OPEN ACCESSIntestinal perforation due to fish bone diagnosed preoperatively by computed tomography Yoshimasa Kishi, Atsuyoshi Iida, Kohei Tsukahara, Atsunori Nakao CASE REPORTA 73-year-old female was presented to emergency department with a one-day history of increasing lower abdominal pain. The patient had attended a wedding party of her grandson and ate baked red snapper. Her past medical history was unremarkable and she was taking medication for hypertension. Her vital signs included blood pressure 119/66 mmHg, pulse rate 80 beats/min, and body temperature 36.2°C. On examination, the patient had a slightly distended abdomen with significant right iliac fossa guarding and tenderness. Her white cell count and C-reactive protein levels were 11900/ mm 3 and 1.24 mg/dL, respectively, indicating systemic inflammation. Abdominal computed tomography demonstrated pneumoperitoneum and fluid within the abdominal cavity, as well as dilated intestine, suggesting diffuse peritonitis due to alimentary tract perforation (Figures 1 and 2). Under general anesthesia, the patient underwent diagnostic/therapeutic laparoscopy, which showed acutely inflamed ileum and purulent ascites. A foreign body, assumed to be a fish bone, was observed piercing through the small bowel wall at the ileum. As the site of perforation was not clearly determined via
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