Circumferential dissection is a rare clinical condition of aortic dissection, which is also known as intimo-intimal intussusception. In patients with type A aortic dissection with intimo-intimal intussusception, disruption and prolapse of the intimal flap into the left ventricle may occur and cause severe aortic regurgitation or blockage of the coronary artery ostium. A 43-year-old man presented with sudden dyspnea. Echocardiography revealed severe aortic insufficiency. Acute coronary syndrome was also suspected, but coronary angiography showed normal coronary arteries. After medical treatment, elective surgery was performed. The distal aorta beyond the circumferential dissection was intact, and only the aortic root was dissected. The aortic valve could be preserved, because there was little degeneration of the cusps. Here, we report the case of a patient who underwent successful valve-sparing aortic root replacement for extremely localized aortic dissection with intimo-intimal intussusception.

BackgroundPrimary cardiac lymphoma (PCL) is extremely rare and progresses rapidly. The treatment of PCL has not yet been established. Unlike lymphoma that arises from other organs, PCL causes cardiovascular events. We report the complete remission (CR) of PCL after tumor resection using minimally invasive cardiac surgery (MICS) and chemotherapy.Case presentationThe patient was a 79-year-old man who visited our hospital with chief complaints of weight loss and leg edema. A 40 × 30 mm mobile pedunculated tumor continuous with the right ventricular heart muscle was present in the right atrium upon echocardiography and extended cardiac surgery was difficult to perform. Tumor embolism-induced sudden death was prevented and a pathological diagnosis was obtained by making a 4-cm skin incision, and tumor resection with MICS was performed through a right fourth intercostal thoracotomy with a cardiopulmonary system. The histopathological diagnosis was diffuse large B cell malignant lymphoma. Eight cycles of postoperative rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) therapy were performed. Three years after surgery, the tumor was not visible on imaging and CR was maintained.ConclusionsThis case highlights that tumor resection using MICS is effective for avoiding the risk of sudden death. This technique was useful for the diagnosis and treatment of a malignant cardiac tumor in an elderly patient that required a difficult extended cardiac surgery.Electronic supplementary materialThe online version of this article (10.1186/s13019-018-0778-6) contains supplementary material, which is available to authorized users.

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Background: Minimally invasive direct coronary artery bypass (MIDCAB) has been revived with new techniques and hybrid procedures for MIDCAB and percutaneous coronary intervention (PCI). We reviewed the midterm results of MIDCAB with a three-dimensional (3D) endoscope in our institution. Methods: Of the 359 patients who underwent off-pump coronary artery bypass grafting (CABG) from December 2013 to March 2017, 54 had MIDCAB with the left internal thoracic artery (LITA) to left anterior descending (LAD) artery through a small left thoracotomy with a 3D endoscope. The same intercostal space was used for the main surgical incision and the insertion site of the 3D endoscope. In all, 22 patients had hybrid coronary revascularization (HCR), combined PCI and MIDCAB. Results: There was no operative death. One patient had cerebral infarction without disability. No cases showed significant increases in CKMB. In all, 34 patients commenced ambulation on postoperative day 1. The postoperative hospital stay was 9.1 ± 5.0 days. In total, 37 patients had coronary computed tomography (CT), and their patency of LITA was 100%. In HCR, there was no mortality and major adverse cardiovascular event (MACE). Target lesion revascularization among 12 months was 1.6%. Conclusion: The midterm results of MIDCAB with 3D endoscope-assisted LITA harvesting were satisfactory. MIDCAB, including HCR, is a good alternative for selected high-risk patients.

Radial and femoral systolic artery pressure readings can differ significantly in minimally invasive cardiac surgery with retrograde perfusion. Intraoperative arterial pressure management based solely on radial systolic arterial pressure readings should be avoided.