No abstract

apillary fibroelastomas, which are generally found on the valvular endocardium, are relatively uncommon benign tumors and the next most common of the primary cardiac tumors after myxomas and lipomas. 1,2 However, they can cause lethal embolisms resulting in myocardial infarction, cerebral infarction and pulmonary embolism. 2 The number of patients diagnosed with papillary fibroelastomas has increased since the advent of echocardiography, but cases of recurrence have not been reported and multiple occurrence is rare. [3][4][5][6][7][8][9][10][11] We present a case of double papillary fibroelastoma of the aortic valve with aortic regurgitation and mitral periprosthetic leakage occurring 4 years after resection of an initial left ventricular papillary fibroelastoma with mitral and tricuspid valvular disease. Case ReportIn 1997, a 52-year-old man presented to hospital with dyspnea and a medical history that included atrial fibrillation in 1993. Cardiac catheterization revealed mild pulmonary hypertension of 45/22 mmHg, elevated wedge pressure of 22 mmHg, and obstruction of the posterior descending artery. Transthoracic echocardiography confirmed the presence of a left ventricular tumor (Fig 1A), and revealed moderate mitral stenosis and regurgitation, tricuspid regurgitation and trivial aortic regurgitation. Mitral valve replacement (29 mm Carbomedics Valve), tricuspid annuloplasty (32 mm Carpentier Ring) and tumor excision without blood transfusion were performed. The tumor, found on the anterior wall of the left ventricle near the apex of the heart, was pale yellow and 7 mm in maximum length. It was excised through the mitral valve (Fig 2A). Pathology showed papillary growth with myxoid stroma and the

Continuous hemofiltration was very easily set up with less interference to the hemodynamics. Using an arterial graft with off-pump bypass, an aortic no-touch technique and water control with conventional hemodialysis were possible.

The objective of this study was to investigate the difference between the closed circuit system and the open circuit system in clinical heparin-coated cardiopulmonary bypass (CPB) circuits with a centrifugal pump. We evaluated the coagulation, fibrinolysis, and inflammatory response in valvular heart surgery. Nineteen patients were assigned at random to a group for the closed circuit system or the open circuit system. This is the first report on the effect of a closed circuit in valvular surgery. We measured the platelet count, white blood cell count, plasma fibrinogen concentration, thrombin-antithrombin III complex, plasmin-Alpha2 plasmin inhibitor complex, D-dimer, interleukin-6, polymorphic neutrophil-elastase, and the plasma free hemoglobin. Blood samples were collected before the start of perfusion, 15 and 60 min after the start of perfusion, 60 min after the administration of protamine, and 1 day after the operation. During the perfusion, coagulation, fibrinolysis, and inflammatory responses were activated; however, no significant differences between the two groups were noted. In this clinical investigation with suction and the cell saving system, the closed circuit was not found to be superior to the open circuit with regard to biocompatibility.

A 72-year-old man suffering from congestive heart failure, swelling of the lower limbs and hematuria was transferred from another hospital with a diagnosis of large aneurysms of the abdominal aorta and the left common iliac artery.Iliac arteriovenous fistula (AVF) was definitively diagnosed preoperatively by contrast-enhanced CT and angiogaphy. At operation, an infrarenal abdominal aortic aneurysm of 8 cm and left iliac arterial aneurysm of 12 cm were identified. After proximal and distal aortic clamping, the aneurysm was entered and an AVF orifice of 1 cm communicating with the left common iliac vein was disclosed at the right posterior wall of the left common iliac artery. Venous blood reflux was controlled by inserting an occlusive balloon catheter to the fistula and intraoperative shed blood was aspirated and returned by an autotransfusion system. The AVF was closed from inside the iliac aneurysm by three interrupted 3-0 monofilament mattress sutures with pledgets. The aneurysms were resected and replaced with a bifurcated Dacron prosthetic graft. The patient had an uncomplicated postoperative recovery ; the lower limb edema subsided and heart failure improved rapidly. Preoperative identification of the location of the AVF is mandatory to make surgery safe. Moreover, easy availability or routine use of the devices for controlling undue blood loss such as an autotransfusion system and an occlusive balloon catheter are other important supplementary means to obtain good results of surgical treatment.