Spontaneous Rupture of the Aortic Arch: A Case Report and a Review of Literature / 日本心臓血管外科学会雑誌

The extremely rare occurrence of a case of spontaneous rupture of the aortic arch is reported. The patient was a 55-year-old woman who underwent a medical examination at a hospital following a sudden onset of chest pain. After a diagnosis of having cardiac tamponade was established, she was transferred to our hospital. She was in a state of shock with systolic blood pressure recorded at 70mmHg. Computerized tomographic findings indicated cardiac tamponade and hematoma around the ascending aortic arch but no aortic dissection. She was diagnosed as having a ruptured aortic arch and an emergency operation was performed. Apertures were observed on the anterior arch and were closed by a suture under halted circulation. Transesophageal echography was used to correctly identify the aperture on the rupture during the operation. Pathologic findings also indicated only extramural hematoma on the ascending aortic arch without the dissection. The patient's postoperative progress was satisfactory, and she was discharged after spending 16 days in the hospital. Spontaneous rupture of the thoracic aorta is extremely rare; it cannot be accurately diagnosed and leads to poor prognosis. Even in a case without trauma and aortic aneurysm, this disease should be diagnosed through rapid and detailed examination using computed tomography, and aggressive surgical treatment should be performed.

Surgical Treatment of Internal Iliac Artery Aneurysms / 日本心臓血管外科学会雑誌

Between 1987 and 2002, 22 internal iliac artery aneurysms in 14 patients were repaired. In 13 we performed aneurysm excision or reconstruction. There were 3 cases in which simple proximal ligation of the internal iliac artery was performed; in 2 of these CT scans confirmed that the reduction of the internal iliac artery aneurysms was not recognized, but blood flow was not shown in the aneurysm. However, 6 years postoperatively 1 patient was confirmed with an expansion of the aneurysm, and blood flow was seen on a CT scan. In the 2 latest patients, the blood pressure of the internal iliac artery was measured before and after proximal clamping of the internal iliac artery, but the blood pressure of aneurysms could not be fully lowered by proximal ligation of the internal iliac artery. Therefore, endoaneurysmorrhaphy seemed to be the operative method of choice for treatment of the internal iliac artery aneurysms.

Coarctation of the Abdominal Aorta Associated with Aneurysm of the Descending Thoracic Aorta Probably due to Aortitis Syndrome / 日本心臓血管外科学会雑誌

A 67-year-old woman had left lateral chest pain. CT scan and digital subtraction angiography revealed coarctation of the abdominal aorta just distal from the renal artery and a fusiform aneurysm of the descending thoracic aorta with a maximum diameter of 60mm. The meandering mesenteric artery was significantly dilated as a collateral vessel from the superior mesenteric artery to the inferior mesenteric artery. Aortitis syndrome was suspected from the angiographic findings although inflammatory changes in laboratory data were not observed. She underwent aneurysmectomy followed by prosthetic graft replacement of the descending thoracic aorta under femoro-femoral bypass and an extraanatomical bypass grafting from the replaced graft to the abdominal aorta proximal to the aortic bifurcation via the retroperitoneal space. She was discharged on the 42nd day after operation without any complications and in the past year has returned to her usual daily life without any anastomotic site trouble.

Combined Monitoring of rSO2 and SSEP during Cardiopulmonary Bypass and Postoperative Changes in Plasma Levels of S-100.BETA.: Is Diagnostic Sensitivity for Detecting Brain Damage Improved? / 日本心臓血管外科学会雑誌

Combined monitoring of rSO₂ and SSEP is routinely performed during cardiopulmonary bypass (CPB), but it is not sensitive enough to detect focal lesions of the brain. Thus, we assessed whether simultaneous measurement of S-100β is able to enhance diagnostic sensitivity or not. Between September 1999 and February 2000, serial measurement of plasma levels of S-100β and SSEP and rSO₂ monitoring during CPB were simultaneously performed in 26 consecutive patients (19 men and 7 women). Ages ranged from 46 to 85 (mean 67±10 years). Neurological complications developed in 5 (19.2%). Among those patients, hemiplegia developed in 2, and dementia, temporary convulsion, and deep coma in 1 each. Three of them showed abnormally low rSO₂ levels during surgery, but no patient showed abnormal change in SSEP waves after surgery. There was no significant difference in S-100β level 1h after CPB between patients associated with or without neurological complications (1.98±0.48 vs. 1.89±1.65), however, its level 24h after CPB remained significantly higher in patients with neurological complications (1.01±1.14 vs. 0.22±0.24). S-100β level 24h after CPB appears to improve diagnostic sensitivity for detecting such focal brain damage lesions as those in which SSEP or rSO₂ are not efficient enough to make a diagnosis. However, further study is required to evaluate how fast it can differentiate patients with and without brain damage.

Mitral Valve Replacement in a Patient with a Patent Internal Thoracic Artery Graft after Coronary Artery Bypass Grafting / 日本心臓血管外科学会雑誌

A 63-year-old woman underwent coronary artery bypass grafting and mitral annuloplasty 4 years previously. She was readmitted owing to heart failure. Cardiac catheterization revealed worsened mitral regurgitation, although the internal thoracic artery (ITA) graft had good patency. Reoperation was performed by median resternotomy and continuous retrograde cardioplegia without clamping the ITA graft. The mitral valve had a perforation in the anterior leaflet, and was replaced by a 29mm Carbo-Medicus valve. The patient was discharged with transient myocardial ischemia. Although median resternotomy and continuous retrograde cardioplegia at reoperation provided on excellent view and myocardial protection, myocardial ischemia in the region perfused by the ITA graft may occur when the ITA graft cannot be clamped during continuous retrograde cardioplegia.

Clinical Experience with a Gelatin Sealed Dacron Prosthesis / 日本心臓血管外科学会雑誌

A gelatin-sealed knitted Dacron graft which has zero-porosity at implantation and does not require preclotting preparation has been developed. Gelatin-sealed aortic grafts were implanted into 39 patients and vascular surgery reconstruction was performed for thoracic aortic aneurysm (TAA) in 10, abdominal aortic aneurysm (AAA) in 19, and arteriosclerosis obliterans (ASO) and other conditions in 10. A total of 39 bifurcated or straight grafts were inserted. The Gelseal Dacron graft had superior handling characteristics and biocompatibility in comparison to conventional graft. There was no measurable blood loss from the body of the sealed graft at the time of implantation. The gelatin-sealed Dacron graft (<i>n</i>=10) was compared with an Intervascular Micron^® graft (<i>n</i>=10) implanted into the abdominal aorta. No problems were evident with regard to intraoperative bleeding, allogenic and autologous transfusion volume and blood parameters between the two groups. These results suggested that the Gelseal Dacron graft sealed with gelatin was a safe, zero-porosity implantable prosthesis for clinical use.

Congenital Bicuspid Aortic Stenosis in Siblings / 日本心臓血管外科学会雑誌

The authors encountered 22 cases of congenital bicuspid aortic valve, some of which occurred in siblings. In this paper, a 58-year-old brother and a 56-year-old sister cardiac valve disease was diagnosed first at the age of 51 in the brother and at the age of 15 in the sister. Aortic valve replacement using a 21mm Medtronic-Hall prosthesis was done in both cases. Additionally, pacemaker implantation was carried out in the sister. Both cases showed favorable progress after operation. Hereditary factors are involved in congenital bicuspid aortic valve. Therefore if congenital bicuspid aortic valve are found in any patients, thorough investigations including cardiac auscultation, ECG and ultrasound cardiogram should be carried out routinely among immediate family members and relatives to reveal whether any of them is suffering from this congenital anomaly.