Left circumflex artery aneurysm with fistula to the coronary sinus.

A giant coronary artery aneurysm with arteriovenous fistula is a unique pathology having few surgical reports. An 82-year-old woman presented with a symptomatic giant left circumflex artery aneurysm with a fistula to the coronary sinus. The left coronary artery was dilated, and an aneurysmal change was visible from the left main trunk to the fistula. Surgery was performed to close the fistula and seclude all parts of the aneurysmal coronary artery. All coronary branches emerging from the aneurysm required bypass grafting. Herein, we present the history of this unusual case and our successful surgical strategy.

[Ascending-to-abdominal Aorta Bypass under Percutaneous Cardiopulmonary Support for Lower Body Organ Malperfusion Secondary to Acute Type B Aortic Dissection; Report of a Case].

A 66-year-old man was admitted to our hospital because of uncomplicated Stanford B acute aortic dissection. Antihypertensive therapy was initially started; however, he suddenly experienced vomiting, diarrhea, anuria, and paraparesis on the fourteenth hospital day. Contrast-enhanced computed tomography (CECT) revealed expansion of the false lumen and severe stenosis of the true lumen at the distal aortic arch, which caused malperfusion syndrome of the lower body. Percutaneous cardiopulmonary support (PCPS) was immediately initiated to restore lower body organ perfusion, and an extra-anatomic ascending-to-abdominal aorta bypass was performed with a 16-mm Dacron graft. Postoperative CECT revealed expansion and good patency of both of the true lumen and the bypass graft. His symptoms improved except for the paraparesis; he was eventually able to ambulate using a crutch after postoperative rehabilitation.

Prevailing Photocurrent Generation of D-π-A Type Oligo(phenyleneethynylene) in Contact with Gold over Dexter-Type Energy-Transfer Quenching.

Photocurrent generation is observed with D-π-A type oligo(phenyleneethynylene) (OPE) physically contacting gold substrate. The OPE is conjugated with helical peptides, which helps the OPE moiety orient vertically on gold surface. This configuration makes the Dexter energy transfer difficult to occur even though one end of the D-π-A type OPE physically contacts gold. The anodic photocurrent continuously increases with increment of applying bias voltage from -0.3 to 0.5 V. The first principle calculations reveal that the increase in photocurrent generation is attributed partly to the change in the electron distributions of HOMO and LUMO of the D-π-A type OPE to be more localized with applying the positive potential.

Mycotic abdominal aortic aneurysm caused by Campylobacter fetus: a case report and literature review.

Campylobacter spp. usually cause gastrointestinal infections, but among them, Campylobacter fetus is a well-known organism causing mycotic abdominal aortic aneurysm (MAAA), which requires proper surgical intervention and antibiotic therapy. We report a 65-year-old man who was successfully treated by an in situ operation using a rifampicin (RFP)-bonded J-Graft for C. fetus-induced MAAA. We performed a review of the English literature on MAAA caused by C. fetus and summarized the results of the cases (28 cases). All but 2 of the patients (92.9%) were men. Blood culture and arterial wall culture were positive in 63% and 73.1% of the cases, respectively. Aneurysm rupture was seen in half of the patients, and approximately half of those patients died. Among the 18 patients who underwent in situ graft replacement, only 1 patient (5.6%) died after surgery. Antibiotic therapy was performed for more than 1 month in most cases, and overall mortality rate was 25.9% (7 of 27 cases, 3 deaths before the operation and 4 deaths after surgery). Although extra-anatomic bypass has been conventionally performed after complete resection of an MAAA, the utility of in situ surgery has generally been recognized. Our review suggests that the in situ operation can be a choice also in cases of C. fetus-associated MAAA. Furthermore, our case suggested the clinical utility of a newly manufactured prosthetic graft, J-Graft, for such surgical treatment.

A case of vascular graft infection caused by Staphylococcus lugdunensis after femoropopliteal bypass operation.

A 79-year-old man who had undergone a right femoropopliteal (FP) bypass operation 6 weeks previously was diagnosed with vascular graft infection caused by Staphylococcus lugdunensis. Another FP bypass operation was performed, with long-term administration of antibiotics, and the patient eventually recovered well without any recurrences for over 2 years. Although S. lugdunens is classified as coagulase-negative Staphylococcus, its pathogenicity has been reported to be equal to that of S. aureus. Based on the literature review, the organism characteristically colonizes the inguinal area of human skin;thus, operations such as FP bypass grafting may place patients at a relatively high risk for infection by S. lugdunensis, a potentially high-pathogenicity organism.

Superior vena cava syndrome caused by a swollen absorbable haemostat after repair of ischaemic mitral regurgitation.

Surgicel, an absorbable haemostat, is widely used in cardiovascular surgery. An 81-year-old woman, who was diagnosed with ischaemic mitral regurgitation, underwent mitral valve plasty and coronary artery bypass grafting. On postoperative day two, her superior vena cava (SVC) pressure gradually rose to 38 mmHg and she developed low output syndrome. Emergent surgery revealed that the cause of SVC syndrome was external compression from a haematoma at the posterior surface of the SVC, which formed around the Surgicel.

[Surgical treatment of traumatic aortic rupture].

This report focuses on 3 cases of traumatic aortic dissection or rupture at the isthmus. We selected 3 different methods of treatment. In the 1st case, we performed an emergency operation with graft replacement of the proximal descending aorta. In the 2nd case, we performed elective graft replacement 5 months after the rupture under careful blood pressure control. Thirdly, we performed emergency stent grafting at the isthmus, the rupture site. All cases were successfully treated, but it remains difficult to select the method of treatment for multisystem disorder. Our current strategy for traumatic rupture at the isthmus is immediate stent grafting. It will also be a very useful procedure for multisystem trauma.

[Aortic valve-sparing operation for chronic dissecting aneurysm of the sinus of valsalva associated with redissection in a young woman who experienced out-of-hospital cardiac arrest].

A 38-year-old woman was admitted to our hospital because she experienced cardiopulmonary arrest at her wedding;her cardiac beats were resumed 20 min after cardiopulmonary resuscitation performed by her relatives and hotel staffs. Enhanced computed tomography revealed acute aortic redissection in chronic dissecting aneurysm in the right sinus of Valsalva, which was believed to have occurred in the 4th month of pregnancy 2 years before. Echocardiography showed moderate aortic regurgitation. We performed aortic valve-sparing operation and ascending aortic replacement with partial remodeling of the right sinus of Valsalva. She returned to work 2 months later without high-order dysfunction.

Hypogastric and lumbar artery bypasses to restore gluteal perfusion after open aortoiliac aneurysm repair.

Gluteal ischemia is a rare but often fatal complication after open abdominal aortic aneurysm repair. A 67-year-old man with an aortoiliac aneurysm presented with a patent right internal iliac artery (IIA) and an occluded left IIA. A bifurcated graft replacement was performed with both limbs of the graft anastomosed to the external iliac arteries. The right IIA was ligated and the inferior mesenteric artery was reimplanted. Postoperatively, the patient developed right gluteal ischemia. Hypogastric and lumbar artery bypasses were immediately performed and the patient recovered without gait disturbance. This treatment prevented potentially fatal necrosis of the buttock.

[Coronary artery bypass grafting for simultaneous subacute stent thrombosis after sirolimus-eluting stent implantation].

An 82-year-old man developed simultaneous stent thrombosis 11 days after the implantation of a sirolimus-eluting stent (SES) in the proximal left anterior descending artery (LAD) and the proximal right coronary artery (RCA). The patient immediately underwent percutaneous coronary intervention; however, his condition became critical due to the development of recurrent stent thrombosis, and emergent coronary artery bypass grafting with saphenous vein grafts was performed. Postoperative angiography showed good patency of both grafts; thrombus formation in the LAD and RCA was negative. Since the patient had a history of liver dysfunction due to ticlopidine administration, the thienopyridine derivative was not administered; this was believed to be the main cause of subacute stent thrombosis. He was administered aspirin, cilostazol, and sarpogrelate instead. A good postoperative course was achieved only using aspirin. This case demonstrates that simultaneous SES thrombosis in multivessel lesions poses a life-threatening situation.

Clot formation between the folded graft layers in the reversed elephant trunk technique at the second stage of total arch replacement.

We operated on a 77-year-old woman with extensive thoracic aortic aneurysm by staged repair using the reversed elephant trunk technique. First, we performed descending aortic replacement with a 28-mm straight Dacron graft through a left lateral thoracotomy. Considering the high possibility of a proximal operation in the near future, the 10-cm invaginated proximal end of the graft was anastomosed to the aorta to facilitate subsequent operation on the upstream aorta. After a year of follow-up, a second-stage total arch replacement was performed because the aortic arch aneurysm had enlarged. The reversed elephant trunk was withdrawn under deep hypothermic circulatory arrest. Fibrin clots had formed within the folded graft, which could cause postoperative thromboembolism. After cleaning the inner surface of the withdrawn graft, the proximal branched conduit was anastomosed to it to complete the total arch replacement. We review this case and discuss possible mechanisms of and solutions for this condition.

Staged repair of a thoracoabdominal aortic aneurysm with mesenteric ischemia using the reversed elephant trunk technique.

Improvements in surgical techniques, and adjuncts for spinal cord protection and perioperative care have resulted in decreased morbidity and mortality in repair of thoracoabdominal aortic aneurysm (TAAA). However the surgical treatment of TAAA of extent II is still associated with high mortality, especially in patients with preoperative co-morbidities. We report a successful staged repair of extent II TAAA using the reversed elephant trunk technique for a patient with ischemic colitis.

Ascending aorta-abdominal aorta bypass with the reconstruction of superior mesenteric and bilateral renal arteries for mid-aortic syndrome.

We report the surgical repair of a case of mid-aortic syndrome (MAS) in a 17-year-old female patient. She was initially diagnosed with renovascular hypertension at the age of 12 years. Aortitis syndrome was suspected, and she has been treated with antihypertensive drugs since then. Angiography revealed severe stenosis of the abdominal aorta and left renal artery and occlusion of the right renal artery and superior mesenteric artery (SMA); this confirmed the diagnosis of MAS. Due to progressive, uncontrollable hypertension, we performed an ascending aorta-abdominal aorta bypass with revascularization of SMA and both renal arteries. Her blood pressure normalized following the operation.

Impact of collagen-coated and gelatine-impregnated woven Dacron branched grafts on the early postoperative period.

To investigate the impact of two different sealed Dacron vascular branched prostheses on the early postoperative period, 30 patients whose aortic arch was replaced by either a collagen-coated (n=18) or a gelatine-impregnated (n=12) branched prosthesis were retrospectively studied. The patients who received a collagen-coated branched prosthesis required longer chest drainage (11.9+/-5.2 vs. 7.9+/-4.6 days, p<0.05). On the other hand, higher white cell count on 7th postoperative day (9,406+/-3,485 vs. 11,810+/-4,378/microL, p<0.05) was observed in the patients with a gelatine-impregnated branched prosthesis. Biocompatibility of the prostheses could affect the early postoperative course, therefore these specific impacts should be considered to manage the patients with these prostheses.

Late aortic root redissection following surgical treatment for acute type A aortic dissection using Gelatin-Resorcin-Formalin glue.

OBJECTIVES: Although Gelatin-Resorcin-Formalin (GRF) glue is widely used in surgery for acute aortic dissection, late complications possibly due to the glue, such as late aortic root redissection, have also been reported. We have experienced similar complications, some of which required redo surgeries, and these cases are reviewed. METHODS: Twenty-six consecutive patients who underwent surgery for acute type A aortic dissection using GRF glue, from December 1996 to February 2001, were retrospectively studied, with a special focus on any late complications and any reoperation. RESULTS: Of the 21 patients who survived and were followed as outpatients, false aneurysms were found in 5 patients (21%) at 24-42 (mean 34) months following the initial surgery. Of these, 2 patients required resternotomy because of the increasing aneurysm diameter. In both cases, the aortic root was redissected at the site of the GRF glue use where the anastomosis between the aortic root and the prosthesis had widely opened and had become the aneurysm entry point. Significant aortic regurgitation was noticed in 3 patients (14%, 1 of whom showed a false aneurysm), and 2 of these underwent reoperation for aortic root redissection. CONCLUSIONS: A high incidence of aortic root redissection with false aneurysm and/or aortic insufficiency was found following the surgery for acute aortic dissection using GRF glue. These patients should be carefully followed for years after surgery.

Minimally invasive vascular surgery for repair of infrarenal abdominal aortic aneurysm with iliac involvement.

PURPOSE: A minimally invasive vascular surgery (MIVS) technique for repair of infrarenal abdominal aortic aneurysm (AAA) with iliac involvement was evaluated, and its outcome was compared with conventional open repair. METHODS: Twenty patients with AAA with iliac involvement underwent treatment with bifurcated graft replacement with the MIVS technique. The procedure was performed via minilaparotomy, with the incision length determined according to the extent of the AAA obtained with ultrasound scanning and with the small intestine confined completely within the abdominal cavity. The proximal and distal operating fields were obtained with changing the patient position and arranging for the abdominal incision to be retracted cephalad and caudad. Perioperative courses in these 20 patients (the MIVS group) were analyzed in comparison with 14 patients who underwent conventional open repair, which was performed through the full midline laparotomy with the intestine simply covered with moistened towels (the conventional group). RESULTS: The MIVS technique for AAA repair was performed with a mean abdominal incision length of 8.4 cm and a range from 6.5 to 11.2 cm. The patients in the MIVS group showed earlier resumption of oral intake and ambulation in comparison with those patients in the conventional group (liquid diet: 1.1 +/- 0.3 days versus 2.9 +/- 1.4 days; P <.01; solid diet: 2.0 +/- 0.2 days versus 3.9 +/- 1.4 days; P <.01; ambulation: 2.1 +/- 0.8 days versus 4.3 +/- 2.3 days; P <.01), with comparable mortality and morbidity rates. Accordingly, the patients in the MIVS group were discharged earlier (20.7 +/- 6.3 days versus 33.9 +/- 12.6 days; P <.01), and total hospitalization charges were significantly decreased (2,232,791 +/- 200,747 Japanese yen versus 2,640,441 +/- 243,889 Japanese yen; P <.01). CONCLUSION: The MIVS technique allowed earlier postoperative recovery with comparable morbidity and mortality rates with the conventional technique and, therefore, saved hospital stay length and total hospitalization charges. Thus, the MIVS technique is considered as a new and effective minimally invasive technique for open AAA repair.