Two operative cases of abdominal aortic aneurysm with isolated dissection of the abdominal aorta.

Objective: Isolated abdominal aortic dissection (IAAD) co-occurring with an abdominal aortic aneurysm (AAA) is rather rare. The objective of this report was to discuss the adequate timing and method of surgery for this condition. Patients: We encountered two operative cases, for which we carefully considered the timing and method of surgery. One patient underwent open repair 1 month after the onset, and the other patient underwent endovascular aneurysm repair (EVAR) 3 years after the onset. Results: Both patients had a good postoperative recovery and are doing well 8 months after the surgery. Conclusion: The presence of symptoms or an increase in the diameter of an AAA is important in determining the timing of intervention.

A case of deep femoral artery aneurysm found with superficial femoral artery aneurysm.

Objective: Deep femoral artery (DFA) aneurysms are extremely rare cases of aneurysms that are difficult to diagnose. The objective of this report was to discuss the timing and method of surgery for this disease. Patient: We encountered an asymptomatic left DFA aneurysm that was discovered along with a symptomatic aneurysm of the right superficial femoral artery (SFA). Both sides of the aneurysm were resected with Dacron knitted artificial vascular grafts (Gelsoft™ Plus, Vasctek, UK) simultaneously. Result: After the operation, the right SFA had good blood flow, but the graft of the left DFA was occluded. The occlusion was considered to be caused by insufficient blood flow in the graft. The patient was discharged without any complications. Conclusion: The coexistence of DFA aneurysms should be examined if other aneurysms are found. DFA aneurysms are at a high risk of rupture. Careful follow-up is required, and intervention is recommended when the diameter exceeds 35 mm.

[Simultaneous operation of off-pump coronary artery bypass grafting and Y-grafting through median laparotomy incision; report of a case].

A 57-year-old man with both coronary artery disease and iliofemoral occlusive lesions was successfully operated with a combined revascularization procedure. Through a median laparotomy incision, off-pump coronary artery bypass grafting (OPCAB) using the right gastroepiploic artery and aorto-bifemoral bypass were performed simultaneously. The patient recovered well and experienced neither angina nor intermittent claudication.

A case of cystic adventitial disease of the poplitealartery: selection of incision of the cyst wall overvessel replacement.

Cystic adventitial disease (CAD), a rare arterial disorder, can cause localized arterial stenosis or obstruction. A 55-year-old man presented with a 2-month history of left lower leg pain and paleness when bending the left knee. The patient was diagnosed with CAD of the left popliteal artery based on imaging examinations. Surgery was performed with the patient placed in the prone position using an S-shaped skin incision, and the left popliteal artery was exposed. A simple incision of the cyst wall was made. There was no sign of recurrence at 1 year postoperatively.

Pacemaker system replacement under local anesthesia allowing MRI access 7 years after the initial surgery: Two case reports.

Background: Older pacemaker systems, which are magnetic resonance imaging (MRI) incompatible, require replacement with compatible systems when patients are in need of MRI. Replacement involves extraction of the pacing lead, which is usually done with a laser sheath under general anesthesia. Case presentation: We report two cases of complete pacing system replacements allowing patient access to MRI. Both replacements were made under local anesthesia and without the use of special devices over 6 years after the initial surgery. Both replacements used retractable screw-in leads with a cut-down of cephalic or external jugular veins performed during the initial surgeries. Case 1 involved a 79-year-old man with cerebral ischemia, and case 2 involved a 70-year-old man with spinal canal stenosis. Conclusion: With careful management, it is possible to replace an entire pacing system under local anesthesia without additional devices.

Morgagni hernia treated by reduced port surgery.

INTRODUCTION: The laparoscopic repair of a rare diaphragmatic Morgagni hernia using the reduced port approach is described. PRESENTATION OF CASE: An 85-year-old female presented with a 2 days history of upper abdominal discomfort and loss of appetite. We diagnosed her condition as a Morgagni hernia by morphological studies and performed laparoscopic mesh placement with a multi-channel port and 12-mm port. This elderly patient had a rapid postoperative recovery. A 2-year follow-up CT showed no recurrence of the hernia. DISCUSSION: Recent trends in laparoscopic procedures have been toward minimizing the number of incisions to reduce invasiveness. This case indicated that the reduced port approach can be considered a suitable and safe procedure for treatment of Morgagni hernia. CONCLUSION: The reduced port approach is a good indication for Morgagni hernia.

A stand-up collar around the saphenous vein graft.

We present a technique of a stand-up collar around the saphenous vein graft using a pedicled fat pad flap. This procedure is simple and effective to avoid kinking in a graft that was proximally anastomosed with an automatic device and to maintain the graft in its natural position.

Visualization of atrial excitation by magnetocardiogram.

We tried to visualize normal atrial excitatory process by magnetocardiogram (MCG) measured from both anterior chest and back using our newest multi-channel SQUID system. Twenty normal subjects were studied. After measuring the normal (B(z)) component of the magnetic field, we constructed an isomagnetic and vector arrow map from spatial derivatives of the normal (B(z)) component in the tangential direction. By the MCG measurement from the anterior chest, current arrows were recognized in the right upper portion which were directed to the left lower from the beginning of the P wave to the P-wave peak. By the measurement from the back, current arrows were able to be visualized in the right to middle upper portion which were directed to the left or left lower just before the P-wave peak. We conclude that we successfully recognized the right atrial excitation and its spread to the left atrium and observed the time course of normal atrial excitatory process by the MCG measurement from not only anterior chest but also back using 64-channel SQUID system.

Evaluation of myocardial ischemia in Kawasaki disease using an isointegral map on magnetocardiogram.

The authors have recently reported on the usefulness of the isointegral mapping technique using magnetocardiography (MCG) for the diagnosis of adult ischemic heart disease. This study evaluated myocardial ischemia in patients with Kawasaki disease (KD). The ischemia has been considered difficult to diagnose with a standard ECG. The study included 32 patients (age 3 +/- 22 years, mean 12.9 +/- 4.1 years, +/- SD) with a history of KD and 21 age-matched healthy children. Coronary arterial lesions were present in 13 patients of the KD group, MCG was carried out at rest with a multichannel superconducting quantum interference device (SQUID) system. The integral value was computed for each channel and isointegral maps were constructed during depolarization and repolarization processes. In all subjects of the control group, the integral value of repolarization was higher than that of depolarization and the isointegral map of these two processes showed similar patterns. However, the integral value of repolarization in four cases with KD (one with a history of myocardial infarction, two with a stenotic lesion in the left coronary artery, one with an aneurysmal and stenotic lesion in the right coronary artery) was lower than that of depolarization, and abnormal patterns were evident in the isointegral map. All but the case with myocardial infarction showed only mild abnormalities or almost normal on the ECG. Although sensitivity of the method for detection of myocardial ischemia was not fully assessed because of the small number of cases with significant coronary arterial stenosis, noninvasive isointegral mapping technique using the MCG could be useful for evaluation of myocardial ischemia in patients with KD.

Detection of repolarization abnormalities in patients with cardiomyopathy using current vector mapping technique on magnetocardiogram.

OBJECTIVES: We have previously developed current vector maps of tangential components on the magnetocardiogram (MCG) to obtain cardiac current distribution images. The present study was conducted to detect repolarization abnormalities in patients with cardiomyopathy using the current vector map. SUBJECTS AND METHODS: Thirteen patients with cardiomyopathy (nine males and four females aged 7-16 years, mean, 11.5 +/- 3.1 years, +/- SD), and 15 age- and sex-matched normal subjects were studied. Normal components (Bz) of MCG were measured at rest with a multi-channel superconducting quantum interface device (SQUID) system, and differentiated in the tangential direction to obtain current vector maps. Homogeneity of current in the heart during repolarization was investigated. The direction of the maximum current vector was also calculated in each case. RESULTS: In all normal subjects, the current vector consistently showed a left downward direction on the frontal chest plane during the repolarization process. On the other hand, 8 out of 13 patients with cardiomyopathy showed different patterns; four of these patients showed multi-dipoles, and the other four showed a shift in the current vector direction. One of the eight cases showed no abnormality on electrocardiogram (ECG). CONCLUSIONS: Repolarization process in patients with cardiomyopathy was apparently different from those in normal subjects on the current vector map. It was easy to visualize the repolarization process as a projection to the frontal plane, including regional abnormalities, by the current vector maps, which might be more useful for early detection of repolarization abnormalities than ECG.