Gallbladder Infarction Complication after Total Arch Replacement / 日本心臓血管外科学会雑誌

A 73-year-old man was referred to our hospital for treatment of a sacral aneurysm of the distal aortic arch with a maximum dimension of 66 mm. He underwent total arch replacement (TAR) with cardiopulmonary bypass (CPB), moderate hypothermia, circulatory arrest (CA) of the lower body and antegrade selective cerebral perfusion (SCP) via a median sternotomy. Through the aneurysm, the descending aorta was divided and distal anastomosis was performed using the stepwise technique. After the inserted tube graft was extracted, a four-branched arch graft was anastomosed. The arch vessels and the proximal aorta were then anastomosed to the four-branched graft. The operation time was 515 min, CPB time was 305 min, aorta cross clamp (ACC) time was 213 min, SCP time was 143 min, and CA of the lower body was 97 min. On postoperative day (POD) 5, right-upper abdominal pain suddenly developed, with low grade fever. Acute cholecystitis was suspected and antibiotic therapy was started. On POD 6, his abdominal pain shifted to the lower-right region. His blood examination results were unchanged. Acute peritonitis was suggested by abdominal-enhanced computed tomography (CT), and emergency open cholecystectomy was then performed. There was no evidence of gall stones, and a bacterial culture of the ascites was negative. The pathological diagnosis was thromboendarteritis of the gallbladder artery, accompanied with thrombophlebitis and thrombosis, causing massive infarction at the neck of the gallbladder wall. His postoperative course was uneventful and he discharged in an ambulatory state on POD 16. In TAR, the risk of gastrointestinal ischemia is considerable because of prolonged circulatory arrest of the lower body and debris embolism. It is necessary to recognize possible gallbladder infarction, although it is rare, as a differential diagnosis of acute abdomen after TAR.

A Case of Mitral Valve Plasty without Autologous Pericardium for Active Infective Endocarditis / 日本心臓血管外科学会雑誌

In recent treatment of mitral regurgitation due to active infective endocarditis, significant attempts have been made to repair as much of the mitral valve as possible. In cases where the leaflet is damaged extensively because of infection, valve repair generally becomes difficult unless the defect is reinforced by glutaric aldehyde-preserved autologous pericardium. We report a case in which mitral valve plasty for mitral regurgitation was performed under these circumstances. A 27-year-old man was admitted to our hospital because of headache and persistent fever. Transthoracic echocardiography revealed a 13-mm friable vegetation attached to the anterior leaflet of the mitral valve with severe mitral regurgitation. Urgent surgery was performed based on a diagnosis of active infective endocartitis. After cardiopulmonary bypass was performed and the aorta was cross-clamped, a left atriotomy was carried out on the interatrial groove. Much vegetation was attached to the damaged mitral leaflet from A3 to P3, and prolapse of the commissural leaflet was observed. The vegetation and damaged leaflet were then removed. Removal of the superficial vegetations enabled preservation of more than half of the A3. The valve was repaired by the resection-suture technique without using the autologous pericardium, as glutaric aldehyde solution was not available. Mitral annuloplasty using a 28-mm physio ring was performed thereafter. The postoperative course was uneventful and without any residual regurgitation. Nine months after surgery, no recurrence of infection or mitral regurgitation was not observed.

Coronary Aneurysms in an Elderly Man Presumed to Be due to Childhood Kawasaki Disease / 日本心臓血管外科学会雑誌

A 60-year-old man was admitted to our institution with abnormal ECG findings. Coronary CT and angiography showed coronary aneurysms from the left main trunk to the bifurcation of the left anterior descending artery, and the left circumflex artery, with severe stenosis and complete obstruction of the proximal right coronary artery. Morphological evaluation findings strongly suggested that the coronary aneurysms were highly related to childhood Kawasaki disease. We successfully performed triple vessel coronary artery bypass grafting. Here, we report a very rare case of coronary aneurysms presumed to be due to childhood Kawasaki disease in an elderly man.