• Journal of Chest Surgery
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• v.36 no.5
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• pp.363-366
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• 2003

Background: Left ventricular rupture after acute myocardial infarction is a serious complication with high mortality. Emergency operation is usually the only available treatment. A 76-year-old female with persistent chest pain and syncopal attacks was admitted. Transthoracic echocardiography showed the pericardial effusion and generalized hypokinesia of the inferolateral wall of left ventricle. Coronary angiography revealed a total occlusion of the first diagonal branch. After percutaneous transluminal coronary angioplasty with coronary stent and insertion of intraaortic balloon pump, emergency operation was performed. Under cardiopulmonary bypass and cardiac arrest with cold blood cardioplegia, coronary artery bypass graft with saphenous vein, pericardial patch covering on the rupture area with 6-0 polypropylene running sutures, and fibrin glue compression under the patch were performed. We present a case of left ventricular (free wall) rupture after acute myocardial infarction.

• Journal of Chest Surgery
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• v.40 no.6 s.275
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• pp.448-450
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• 2007

The mortality of left ventricular free wall rupture after acute myocardial infarction is high; however, subactue myocardial rupture can be diagnosed by echocardiogram and the use of the intraaortic balloon pump reduces the incidence of re-rupture. Bleeding from subacute myocardial rupture can be managed by employing fibrin glue and several patches. We report here on a case of successfully managed case of subactue left ventricular free wall rupture after acute myocardial infarction with using the sutureless technique and fibrin glue.

• Journal of Chest Surgery
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• v.38 no.10 s.255
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• pp.717-720
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• 2005

Here we report a case of posterior left ventricular (LV) free wall rupture following postinfarct ventricular septal rupture (VSR). A 58-year-old man was transferred to the hospital under the impression of acute myocardial infarction. Posterior VSR was seen on echocardiographic examination. The intraaortic balloon pump catheter was introduced percutaneously and the emergent operation was proposed. Sudden circulatory collapse was developed shortly after the anesthetic induction and the patient's chest was hurriedly opened while on cardiopulmonary resuscitation. The acute cardiac tamponade was seen and the blood was seen pumping from the longitudinal tear at the mid-level of LV posterior wall, measuring 2 cm in length. The cardiopulmonary bypass was set and LV reconstruction was done. The postoperative recovery was delayed due to the brain injury presumably caused by preoperative cardiac arrest.

• Journal of Chest Surgery
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• v.40 no.12
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• pp.855-858
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• 2007

A left ventricular rupture might be one of the most disastrous complications after a mitral valve replacement. An acute atrioventricular groove rupture (type I) was detected in a 54-year-old female diagnosed with a mitral stenosis combined with severe tricuspid regurgitation. She had a prior medical history of an open mitral commissurotomy in Japan at 30 years ago. The surgical findings suggested that the previous procedure was not a simple commissurotomy but a commissurotomy combined with a posteromedial annuloplasty procedure. After a successful mitral valve replacement and a measured (De Vega type) tricuspid annuloplasty, the weaning from a cardiopulmonary bypass was uneventful. However, copious intraoperative bleeding from the posterior wall was detected and the cardiopulmonary bypass was restarted. Exposure of the posterior wall of the left ventricle showed bleeding from the atrioventricular groove 3 cm lateral to the left atrial auricle. Under the impression of a Type I left ventricular rupture, epicardial repair (primary repair of the Teflon felt pledgetted suture, continuous sealing suture using auto-pericardial patch and application of fibrin-sealant) was attempted. Successful local control was made and the patient recovered uneventfully. The patient was discharged at 14 postoperative days without complications. We report this successful epicardial repair of an acute type I left ventricular rupture after mitral valve replacement.

• Journal of Chest Surgery
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• v.32 no.7
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• pp.665-667
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• 1999

We report a case of ruptured sinus of Valsalva aneurysm in 48-year-old male, presenting the symptom of congestive heart failure. Echocardiography showing a hairpin-like sac ex tended from the left coronary sinus to the left ventricle adjacent to the anterior mitral valve leaflet, suggested ruptured sinus of Valsalva aneurysm or aorto-left ventricular tunnel. Operative findings revealed that left sinus of Valsalva aneurysm had multiple openings faced left ventricle, 7 mm in diameter, 20 mm in length. The proximal opening was closed with bovine pericardium and distal openings were closed with spaghetti pledgeted reinforced sutures. The patient was discharged on the 14th postoperative day, and follow up for 8 months uneventfully. This case was reported for its rarity and to describe the techniques of surgical repair.

• Journal of Chest Surgery
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• v.41 no.1
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• pp.95-97
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• 2008

Ischemic ventricular rupture is one of the most fatal complications following myocardial infarction, and this requires prompt diagnosis and operation. A 75-year-old female was admitted to the ER in a semicomatous mentality with cyanotic extremities. Cardiac echography was carried out in the ER, and a $1.5{\sim}2\;cm$ thickness of effusion in the pericardium was seen. Because the patient's heart had declined to 35 times per min, an emergency operation was started while giving cardiac massage. After observing a 1 cm rupture on the right ventricular wall and a necrotic hemorrhagic scar with a rupture on the left ventricular apical wall, repair of the ruptured areas with a large Satinsky clamp was carried out to control bleeding without cardiopulmonary bypass. On the 28th day after surgery, she was discharged home with a minimal degree of dyspnea.

• Journal of Chest Surgery
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• v.42 no.1
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• pp.96-99
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• 2009

We report here on a case of a ruptured sinus of a valsalva aneurysm into the left ventricle with the rupture site communicating with both the left coronary sinus and the noncoronary sinus in a 37-year-old male who presented with symptoms of congestive heart failure. Echocardiography showed a sac-like structure around the sinus of valsalva, an enlarged left ventricle (LV) and severe aortic regurgitation, which all suggested a ruptured sinus of a valsalva aneurysm or an aortic-left ventricular tunnel. The operative findings revealed that both the left coronary sinus and the noncoronary sinus had an opening into the left ventricle. The proximal opening into the LV was closed with bovine pericardium and the aortic root was replaced with a composite graft (a 21 mm St. Jude Epic Supra tissue valve and a 24 mm Hemashild graft) by the modified Bentall procedure. The patient was discharged on the 15th postoperative day, and he was regularly followed up for 2 months. We report on this case due to its rarity and to describe the surgical repair techniques.

• Journal of Chest Surgery
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• v.42 no.4
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• pp.516-519
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• 2009

Ventricular septal defect (VSD) complicating an acute myocardial infarction is rather uncommon. However, the outcomes after the development of a VSD are poor with an in-hospital mortality of more than 90% for the medically treated patients. To prevent the recurrence of VSD, many techniques have been reported on for the closure of a postinfarction VSD. In this. report, we present a case of a patient who had a postinfarction VSD due to Prinzmetai's variant angina, and the rupture of the pseudoaneurysm of the left ventricle was successfully treated by the "Sandwich technique".

• Journal of Chest Surgery
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• v.43 no.3
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• pp.296-299
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• 2010

A right coronary artery to left ventricular fistula with a giant right coronary artery aneurysm is a very rare condition. This requires surgical treatment because of the possibility of rupture of aneurysm, heart failure and infective endocarditis. A 47 years old male patient with dyspnea on exertion for 3 months was diagnosed as having a right coronary artery to left ventricular fistula with a giant right coronary artery aneurysm according to the CT and coronary artery angiography. We resected the aneurysm and performed a coronary artery bypass graft.

• Journal of Veterinary Clinics
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• v.31 no.5
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• pp.367-370
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• 2014

The study was to observe hemodynamic alterations of cardiac function to design a model of canine mitral valve insufficiency (MVI) based on chordae tendinae rupture (CTR). Ten healthy beagles with normal heart function were used in this study. To measure hemodynamics, the patient monitor was equipped for invasive blood pressure and a Swan-Ganz catheter. Hemodynamic alterations were checked promptly during CTR procedures. MVI model was made by transection of the chordae tendinae with small arthroscopy hook knife through $5^{th}$ intercostal open chest. Color Doppler at the level of the mitral valve showed high-velocity regurgitant flow immediately after CTR at intraoperative echocardiography. In hemodynamic measurements, pulmonary capillary wedge pressure (PCWP) was significantly increased, while mean arterial pressure (MAP), venous pressure (VP), pulmonary arterial pressure (PAP), cardiac output (CO) and cardiac index (CI) were significantly decreased after CTR. It was known that the left atrium was overloaded by regurgitant volume from the left ventricle. In conclusion, the MVI model induced by CTR technique in this study should be used as suitable one for the effective research of canine mitral valve disease. Further study should be needed to measure the chronic alternation of mitral valve in the model.