Utility of the Isolation Technique for Total Arch Replacement in Patients with a Shaggy Aorta / 日本心臓血管外科学会雑誌

Introduction : Prevention of embolic stroke is the key issue to perform aortic arch replacement in patients with a shaggy aorta. The aim of this study is to report the utility of the isolation technique for total arch replacement in patients with a shaggy aorta. Methods : Clinical results of seven patients (71.7 years old, all men) with a shaggy aorta who underwent total arch replacement between January 2017 and November 2018 were retrospectively reviewed. The operative indications were a distal arch or proximal descending aortic aneurysm in 6 patients and a thrombus inside brachiocephalic artery in one. A cerebral perfusion was established by inserting a cannula directly into all supra-aortic branches before starting systemic perfusion. Result : Utilizing the isolation technique with clamping of all branches in 4 patients and the functional isolation technique with clamping of two branches in 3, total arch replacement was performed in all patients (operation time : 513 min, selective cerebral perfusion time : 162 min). No operative death was observed and no newly developed stroke was encountered. Conclusion : The isolation technique is a useful method to prevent stroke during total arch replacement in patients with a shaggy aorta.

A Case of Acute Arterial Occlusion of the Lower Extremity Caused by Huge Vegetation of Prosthetic Valve Endocarditis / 日本心臓血管外科学会雑誌

A 79-year-old woman with prosthetic valve endocarditis (PVE) on aortic position underwent re-aortic valve replacement. Although emergency operation was indicated due to huge vegetation over 20 mm in diameter attached to the prosthesis shown by preoperative transesophageal echocardiography, intraoperative transesophageal echocardiography showed disappearance of the vegetation. The prosthesis was carefully removed and replaced by a new bioprosthesis, though only small vegetation was observed on the removed prosthesis. Sudden blue toe 11 h after the operation and diminished pulse on right pedal artery suggested an acute arterial occlusion of a right lower extremity, requiring an emergency thrombectomy. Pathology diagnosed bacterial embolus with fresh thrombus that was considered apart from the prosthesis at the time of operation.

Cerebral Infarction after Hybrid Arch TEVAR / 日本心臓血管外科学会雑誌

Among 62 patients who underwent hybrid arch TEVAR, which is a combination of supra-aortic bypass and TEVAR to treat arch aneurysm, 5 patients encountered postoperative cerebral infarction. In 2 patients, whose thoracic aorta were extremely shaggy, cerebral infarction were multiple and fatal. Other 3 patients, whose aorta were not shaggy, developed visual disturbance after TEVAR and minor cerebral infarction were detected in the area of vertebral artery. To prevent cerebral infarction after hybrid arch TEVAR, the blood flow from the left subclavian to vertebral artery is considered to be significant.

Two Cases of Combined Operation of Abdominal Aortic Aneurysm and Urinary Malignant Tumor / 日本心臓血管外科学会雑誌

We experienced 2 cases of abdominal aortic aneurysm (AAA) with malignant tumor of urinary organs. Case 1 was a 70-year-old man who was admitted for aortic dissection (De Bakey IIIb) with coexistence of AAA and left renal cancer. After the pseudolumen of the aortic dissection became thrombotic, the abdominal aortic aneurysmectomy and left nephrectomy were performed simultaneously. Case 2 was a 75-year-old man with AAA and prostatic cancer. He was treated by a one-stage operation consisting of aneurysmectomy, prostatectomy and castration. The postoperative courses were uneventful without prosthetic graft infection. Chemohormonal therapy could be induced one month after the operations. Concomitant resection of urinary malignant tumor and abdominal aortic aneurysmectomy may be feasible even in older patients.