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Left atrial dissection is a rare complication of cardiac surgery. We present a case of left atrial dissection that occurred during a partial arch repair for Stanford acute type A aortic dissection. Because no entry was found in the left atrium by transesophageal echocardiography, and there were no issues weaning from cardiopulmonary bypass, we decided that no surgical intervention was necessary. Transthoracic echocardiography and computed tomography showed the remaining dissection on postoperative day 7; however, on postoperative day 14, it had completely disappeared.

Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disease in which the number of platelets decreases due to auto-antibodies against platelets. We report that thoracic endovascular aortic repair (TEVAR) was successfully performed for a thoracic aortic aneurysm complicated by ITP. The patient was a man of 77 years of age. He had a history of splenectomy due to ITP. He was admitted to our hospital with an aneurysm of the aortic arch that enlarged to a maximum minor axis of 63 mm. An operation was planned. Because of ITP, it was judged that replacement of the aortic arch using a cardio-pulmonary pump would be associated with a high risk of bleeding. Thus, 2-debranching TEVAR was selected and performed with no hemorrhagic complications. He was discharged from the hospital on the 12th day after surgery. We believe that 2-debranching TEVAR is effective for reducing perioperative bleeding in patients with ITP.

Treatment by thoracic endovascular aortic repair (TEVAR) for type B dissection has improved outcomes. We tried the procedure named "Full Petticoat technique" in which the proximal entry tear was excluded with a covered stent and extended bare metal stents were placed to the aortic bifurcation for three complicated type B dissection cases with dynamic obstruction of the common iliac artery. Follow-up computed tomography revealed favorable aortic remodeling in which the true lumen was expanded. The short-term result of this procedure has shown acceptable aortic remodeling. The significance of this procedure is still unknown in the long term; hence long-term follow-up is necessary to completely understand the usefulness of this technique.

We describe a patient with reexpanded pulmonary edema after atrial septal defect closure through a right-sided minithoracotomy. After reexpansion of the right lung after weaning from cardiopulmonary bypass, a large amount of serous slight-hemorrhagic bronchial secretions spilled out from the right bronchus. Positive pressure ventilation and differential ventilation were used. We found no bleeding and decreased secretions 24 hours after the onset of reexpanded pulmonary edema. The patient was extubated 42 hours after the operation. To the best of our knowledge, this is the first case report of the development of reexpansion pulmonary edema during a routine minimally invasive operation for atrial septal defect.

Background: Reports on the efficacy of tolvaptan, which is a selective vasopressin V2 antagonist, in infants who undergo cardiac surgery are rare. We evaluated the efficacy and safety of tolvaptan to manage early fluid retention in infants following open heart surgery. Methods: Pediatric patients under the age of 1 year who underwent biventricular repair with CPB were received conventional diuretics. Additionally, tolvaptan was administered in 18 patients two days after the administration of conventional diuretics when conventional diuretics did not effectively control fluid. For the evaluation of the effect of tolvaptan, the cumulative 24-h urine volume was measured. Changes in laboratory values, cardio hemodynamic factors, and all adverse events were also evaluated. Results: The cumulative 24-h urine volume after 1st tolvaptan administration increased significantly compared with the urine volume before the administration (Day 3 vs. Day 4, 56.0 ± 15.0 vs. 84.2 ± 20.6 mL/kg; p=0.0002). Similarly, the cumulative 24-h urine volume after 2nd tovaptan administration were significantly larger than that before the tolvaptan administration (Day 5 vs. Day 3, 85.9 ± 32.2 vs 56.0 ± 15.0 mL/kg; p=0.003). There were no significant differences in hemodynamical factors and laboratory values on the tolvaptan administration. We also found that no adverse events were present. Conclusions: The addition of tolvaptan to conventional diuretics increases urine volume without major adverse events, and could be beneficial to control fluid in infants who underwent open heart surgery.

The patient was diagnosed with tetralogy of Fallot associated with absent pulmonary valve syndrome and a low birth weight of 1,912 g. He suffered from respiratory distress on day 14 and received non-invasive positive pressure ventilation. At 5 months of age and 4.1 kg, he underwent intracardiac repair including right ventricular outflow repair with a monocusp patch, patch closure of the ventricular septum defect and right pulmonary transposition to the anterior of the ascending aorta following the Lecompte maneuver for airway decompression. He was subsequently discharged to home and exhibited an uneventful clinical course with non-invasive positive pressure ventilation for 5 months postoperatively. However, right pulmonary artery and supra-aortic stenosis was noted 2 years after the operation. Computed tomography (CT) and angiography showed ascending aorta strangulation by the right pulmonary artery with right ventricular outflow regurgitation. Right pulmonary artery reconstruction using polytetrafluoroethylene graft interposition and repeat right ventricular outflow repair with bicuspid hand-sewn valves was therefore performed;the postoperative course was uneventful. Pre- and post-operative management using non-invasive positive pressure ventilation and airway decompression with pulmonary artery translocation is a useful strategy in patients exhibiting symptomatic tetralogy of Fallot associated with absent pulmonary valve syndrome in the neonatal period.

We herein report the case of a splenic artery aneurysm with a hepatosplenomesenteric trunk that presented in a pregnant woman. Catheter embolization was not performed due to the wide neck of the aneurysm and its close location to the trunk indicates a high risk of mesenteric trunk thrombosis. We instead performed surgical resection of the aneurysm after successful delivery of the infant by Caesarian section. The splenic artery was reconstructed by side-to-end anastomosis with the common hepatic artery.