No abstract

A 36-year-old man underwent direct closure of an atrial septal defect through median sternotomy at the age of 14. He also underwent a mitral valve replacement with tricuspid annuloplasty using the same approach at the age of 18. The patient also presented with pretibial edema and congestive liver disease at the age of 27 and the pretibial edema progressed at the age of 35. Hypoalbuminemia TP ; 3.6 g dl, Alb ; 1.6 g dl was also observed. Further examinations were performed, which revealed that the right ventricular pressure curve presented a dip and plateau pattern by cardiac catheterization. Computed tomography of the chest additionally revealed thickened and calcified pericardium in the left ventricle. Abdominal scintigraphy showed tracer accumulation in the transverse colon hepatic flexure 4 h after intravenous administration of technetium-99m-labelled human serum albumin. The patient was diagnosed with a protein-losing gastroenteropathy caused by constrictive pericarditis. He underwent pericardiectomy via left anterior thoracotomy without cardiopulmonary bypass. No complications were present after the surgery, and he was discharged after 46 postoperative days. Following his discharge from the hospital, the pretibial edema disappeared, and serum albumin levels gradually increased and normalized within 3 months after the surgery TP 7.1 g dl, Alb 4.2 g dl .

No abstract

We report two cases of penetrating cardiac injuries due to stab wounds, which are rare in Japan. The patients were brought to the emergency room for self-inflicted trauma to the chest with a knife. Case 1 was a 66-year-old female with multiple stab wounds in the chest and abdomen, a JCS score of 300, and shock vitality. CT showed liver injury, left internal thoracic artery injury, and suspected left ventricular anterior wall injury ; thus, an emergency surgery was performed. In the anterior wall of the left ventricle, damage extending to the cardiac cavity was noted, which was repaired by suture closure with felt pledgets and tissue adhesives. The patient was extubated on postoperative day 1 ; no abnormal neurological findings were observed. CT scan on postoperative day 11 showed no coronary artery injury or pseudoaneurysm formation ; the patient was then transferred to a psychiatric hospital on postoperative day 12. Case 2 was an 88-year-old man with a 2-cm-long stab wound in the anterior chest. CT scan showed pericardial effusion with suspected acute hemorrhage, suggesting cardiac injury. However, since there was no contrast agent leakage from the pericardial cavity and the patient was in stable condition with clear consciousness, we concluded that he had only pericardial injury and chose conservative treatment. A CT scan performed about 12 h later showed that the pericardial fluid had already decreased. The patient was transferred to a hospital specializing in psychiatry on postoperative day 18.

A 45-year-old man underwent mitral valve repair for degenerative mitral regurgitation and coronary artery bypass grafting for coronary artery stenosis at the age of 40 years. During this hospitalization, although he had methicillin-resistant Staphylococcus epidermidis(MRSE)sepsis, antibiotic treatment rapidly improved his condition. His improving condition was then reversed as his mitral stenosis gradually worsened. During surgical planning, it was elicited that he had had a stroke 4 years 8 months after his previous operation. Although it could have been cardiogenic cerebral infarction, further workup did not reveal any other embolic sources. He had two additional stroke episodes 4 months after the first stroke. Follow-up transthoracic echocardiography revealed vegetation-like lesions attached to the mitral annulus. Although there were no signs of inflammation, his blood culture was positive for MRSE, similar to his previous infection. Because these findings were consistent with the diagnosis of chronic infective endocarditis, the patient underwent open-heart surgery. Intraoperatively, the artificial mitral ring surface was not seen, as it was covered by pseudo-intima, excluding the three infected annular sutures. Furthermore, the mitral orifice was stenotic due to pannus formation seen to be continuous with the pseudo-intima. To address these, he underwent mitral valve replacement, tricuspid annuloplasty, and antibiotic therapy. The postoperative course was uneventful. The infection probably originated from the artificial mitral ring infection during the first surgery performed 5 years eariler.