Biomedical subjects
Publications and source records attributed to Junzo Iemura.
A 47-year-old female intentionally inserted needles through her chest wall, resulting in cardiac trauma. One week later, cardiac tamponade occurred. The needles were detected and removed successfully by thoracotomy. During the operation, fluoroscopy was used to locate the needles and greatly facilitated their successful removal.
Papillary muscle rupture complicating acute myocardial infarction leads to mitral regurgitation and is associated with significant mortality. We experienced a case involving massive mitral regurgitation caused by complete anterior papillary muscle rupture following acute lateral myocardial infarction. A 75-year-old woman developed heart failure shortly after her admission, and the diagnosis was confirmed by echocardiography and cardiac catheterization. Under intra-aortic balloon pumping, the patient underwent emergency mitral valve replacement and coronary revascularization. Her postoperative course was uneventful, and she was discharged on the 40th postoperative day. We believe that prompt surgical treatment should be performed even in stable patients with ischemic mitral regurgitation, given that deterioration may be sudden and unpredictable especially in cases involving complete papillary muscle rupture.
A free-floating ball thrombus in the left atrium is an unusual occurrence that may cause fatal systemic emboli or left ventricular inflow obstruction, often resulting in sudden death. The first of 2 cases was a 59-year-old female with mitral stenosis and chronic atrial fibrillation who presented with severe dyspnea. Transthoracic echocardiography revealed a free-floating ball thrombus and emergency thrombectomy and mitral valve replacement were performed successfully. A second thrombus, which was not found at preoperative examination, was attached to the anterior mitral leaflet and may have been the source of the free-floating ball thrombus. The second case was a 79-year-old female with chronic renal failure who underwent mitral valve replacement 11 years prior to admission. She had been dependent on hemodialysis for 10 years, and had suffered several recent transient cerebral ischemic attacks. Computed tomography showed a ring-shaped, high-density area in the left atrium and transthoracic echocardiography revealed a floating ball thrombus in the left atrium. Thrombectomy was performed, but the patient died as a result of postoperative pneumonia 2 months later. Case 2 appears to be the first reported case of a ball thrombus in a hemodialysis patient who had previously undergone mitral valve replacement.