Autotransplantation for Threatened Cardiac Rupture After Left Ventricular Repair Hiroaki Hata, MD, PhD, Motomi Shiono, MD, PhD, Mitsuru Iida, MD, PhD,

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Autotransplantation for Threatened Cardiac Rupture After Left Ventricular Repair Hiroaki Hata, MD, PhD, Motomi Shiono, MD, PhD, Mitsuru Iida, MD, PhD, Akira Sezai, MD, PhD, Shunji Osaka, MD, PhD, Masashi Tanaka, MD, PhD The Annals of Thoracic Surgery Volume 103, Issue 2, Pages e163-e165 (February 2017) DOI: 10.1016/j.athoracsur.2016.07.025 Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Preoperative enhanced computed tomography. (A) Axial view. (B) Sagittal view. (C) Three-dimensional volume rendered image. The left ventricle is displaced anteriorly by the posterior wall abscess (*). Felt used for ventricular repair (arrowheads) is seen between the abscess cavity and the posterior wall. (LA = left atrium; LV= left ventricle; RA = right atrium; RCA = right coronary artery; RV = right ventricle.) The Annals of Thoracic Surgery 2017 103, e163-e165DOI: (10.1016/j.athoracsur.2016.07.025) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) Extraction of the heart by the bicaval technique. The IVC is occluded by a 20F balloon catheter (black arrow). The left atrium (**) is separated anterior to the left and right pulmonary veins, and the abscess cavity is seen (*). (B) Extracted heart before repair. The abscess wall (*) was reinforced by a felt strip (arrows), but communication with the ventricular cavity was observed. The abscess is covered by a pericardial patch (**). (C) Left ventricular repair and mitral valve re-replacement. The pericardial patch covering the abscess (*) was resected, and the abscess cavity was opened (**). Bovine pericardial patches were sutured sandwich-style (***) to reinforce the posterior wall. Then the annular ring stitch (black arrows) was threaded, and the mechanical was sutured. (Ao = ascending aorta; LA = left atrium; MV = mitral valve; PA = pulmonary artery; SVC = superior vena cava.) The Annals of Thoracic Surgery 2017 103, e163-e165DOI: (10.1016/j.athoracsur.2016.07.025) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig. 3 MRI at 19 months after operation. (A) Axial view. (B) Sagittal view. The abscess has resolved, and cardiac morphology is normal. (LV = left ventricle; RV = right ventricle.) The Annals of Thoracic Surgery 2017 103, e163-e165DOI: (10.1016/j.athoracsur.2016.07.025) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions