Successful Open Surgical Repair and Postoperative Complications for Ruptured Abdominal Aortic Aneurysm Transferred with Intra-aortic Balloon Occlusion Catheter / 日本心臓血管外科学会雑誌

A 74-year old man, presented with dyspnea following acute abdominal pain, was admitted to an initial hospital. The plain computed tomography (CT) scan revealed a ruptured abdominal aortic aneurysm (AAA). Emergency insertion of intra-aortic balloon occlusion (IABO) catheter was carried out due to his unstable hemodynamic condition. The patient was transferred to our hospital after surgical consultation. Open surgical repair was carried out, and massive retroperitoneal hematoma and excessive bowel edema made it difficult to close the abdomen primarily. Delayed closure following Open Abdomen Management (OAM) was effective.

Two Cases of Reexpansion Pulmonary Edema after Cardiac Surgery / 日本心臓血管外科学会雑誌

A 54-year-old man with ischemic mitral regurgitation underwent surgical ventricular restoration, mitral valve plasty and a coronary artery bypass. A chest X-ray 7 days later revealed pleural effusion on the right side. A chest tube was inserted and about 1,000 ml of fluid was drained. However, re-expansion pulmonary edema (RPE) occurred 2 h later. Positive pressure ventilation and intravenous infusion with a diuretic improved the RPE. He was resuscitated on the following day to receive percutaneous cardiopulmonary support (PCPS) for unstable hypoxemia and hypotension. Oxygenation improved, PCPS was withdrawn 2 days later, and the endotracheal tube was removed. Re-expansion pulmonard. He was resuscitated on the following day to receive percutaneous cardiopulmonary support (PCPS) for unstable hypoxemia and hypotension. Oxygenation improved, PCPS was withdrawn 2 days later, and the endotracheal tube was removed. Re-expansion pulmonary edema might cause fatal short-term cardio-respiratory failure. We considered that RPE requires appropriate early diagnosis, early treatment and aggressive therapy, including PCPS.

A Case of Vasculo-Behçet Disease Diagnosed by Right Atrial Mass and Inferior Vena Cava Thrombosis / 日本心臓血管外科学会雑誌

We report a rare case of 16-year-old boy who was given a diagnosis vasculo-Behçet disease after removing a right atrial thrombus. He was admitted to our hospital with abdominal pain and fever. He was underwent appendectomy for suspected appendicitis, but the appendix was normal. Additional image examinations revealed a mobile right atrial mass and inferior vena cava thrombosis, and the patient was sent to reoperation urgently to prevent pulmonary embolism. Surgery revealed the mass to be a thrombus. Vasculo-Behçet disease was diagnosed based on the patient's history and examination data. He was discharged on the 17th postoperative day. Cardiac mass excision should be immediately considered in such cases, and the differential diagnosis of Behçet disease was important for this case.

A Case of Emergency Ascending Aorta Replacement for Paraplegia Caused by Stanford Type A Acute Aortic Dissection / 日本心臓血管外科学会雑誌

We report a rare case of type A acute aortic dissection with paraplegia which was cured immediately after an emergency operation. A 79-year-old woman was transferred to our institution with sudden back pain and paraplegia. Computed tomographic scans revealed a cardiac tamponade with an acute type A aortic dissection. She went into shock soon after arrival, and about 4 hours from onset we performed an emergency replacement of the ascending aorta. Three hours after the operation, her neurological deficit gradually resolved and could walk by postoperative day 3. This case suggests that early restoration of the blood flow to the spinal cord is mandatory to relieve paraplegia caused by type A aortic dissection.

Coronary Artery Bypass Grafting in a Man with Myocardial Ischemia and Left Ventricular Noncompaction / 日本心臓血管外科学会雑誌

Noncompaction of the left ventricular myocardium (NCLV) is a rare congenital cardiomyopathy resulting from an arrest in normal endomyocardial embryogenesis. The prognosis of NCLV is poor, including progress on to heart failure. However, some cases of NCLV in adults have been recently reported. To the best of our knowledge, there are only 3 cases of cardiac operations reported in patients with NCLV in adults. We describ a 54-year-old man with NCLV and severe coronary artery disease. Echocardiography demonstrated NCLV and low LVEF (25%). Coronary angiography (CAG) showed triple vessel disease with total occlusion of vessels #1 and #6. Tl-cintigraphy and magnetic resonance imaging (MRI) demonstrated viability from the base to the middle of the anterior wall. Coronary artery bypass grafting (CABG) was done after controll of the heart failure. The postoperative course was uneventful and the patient was discharged 7 days after operation. LVEF improved to 52% after surgery. Careful observation of cardiac function is vital because of the possibility of progression to heart failure.

Successful Surgical Treatment of Pentacuspid Aortic Valve with Severe Aortic Regurgitation / 日本心臓血管外科学会雑誌

A 38-year-old woman was admitted due to an abnormal ECG and dyspnea on effort. Transoesophageal echocardiography and cardiac computed tomography (CT) showed severe aortic regurgitation (AR) due to pentacuspid aortic valve, which consisted of 4 relatively equal cusps and 1 larger cusp. Mild mitral regurgitation, atrial septal defect (ASD) and coronary-pulmonary artery fistula were complicated for her. She underwent aortic valve replacement, mitral valve annuloplasty, direct closures of ASD and coronary-pulmonary artery fistula. The pathophysiology of the resected aortic valve showed 4 equal size cusps and a large one with mild myxomatous change. Aortic valve regurgitation due to pentacuspid aortic valve is extremely rare and there was little report concerning it in the literature. We reported the surgical repair of this rare case of severe AR due to pentacusupid aortic valve.

A Case Report of Type A Dissecting Aneurysm Occurring after Aortic Valve Replacement / 日本心臓血管外科学会雑誌

We report a case of type A dissecting aneurysm occurring after aortic valve replacement (AVR). The patient was a 67-year-old man with a history of AVR 4 years previously. Preoperative CT scan revealed a type A dissecting aneurysm 10cm in diameter, close to the sternum. Under preparation for selective cerebral perfusion (SCP), re-do median sternotomy was safely performed using partial extracorporeal circulation (ECC) via a femoral artery and vein. Because of severe adhesion in the upper part of the ascending aorta and aortic arch, a graft replacement of the ascending aorta was impossible. Under SCP via bilateral common carotid arteries exposed in the neck, the entry of the dissection, which was located in the previous aortotomy line, was closed with an ePTFE patch. SCP via bilateral common carotid arteries exposed in the neck appeared to be very useful and safe for such patients at risk for injury to the aorta during re-do median sternotomy and with severe adhesion, which made it difficult to establish SCP via the usual operative field. Although graft replacement is the standard operation for the treatment of the ascending aortic dissection, patch closure of the entry should be considered as a second-choice method in some case.

Aortic Root Replacement with a Freestyle Porcine Valve in a Young Woman with Systemic Lupus Erythematosus and Antiphospholipid Antibodies / 日本心臓血管外科学会雑誌

Aortic root replacement with a Freestyle^TM stentless porcine valve (Medtronic Inc.) was performed on a 32-year-old woman for aortic root aneurysm. The patient had been given a diagnosis of systemic lupus erythematosus and had been maintained on steroid therapy for 15 years. Lupus anticoagulant was present and the anticardiolipin antibody titer was abnormal as follows: IgG, 2.0IU/ml (normal<1.0IU/ml). For the patient requiring aortic root reconstruction, many options are available. The use of a biological valved conduit should be considered for patients in whom anticoagulation is not desirable. The Freestyle^TM stentless porcine valve offers an acceptable alternative to mechanical prostheses, especially for cases with contraindication for anticoagulant therapy, associated with antiphospholipid antibodies.

Treatment of an Iliac Artery Anastomotic Pseudoaneurysm Managed with a Stent-Graft / 日本心臓血管外科学会雑誌

A 85-year-old man was admitted to our hospital with a right iliac artery anastomotic pseudoaneurysm after aorto-biiliac Y-shaped graft replacement for the treatment of abdominal aortic and biiliac aneurysms. We performed an endovascular intervention of this anastomotic pseudoaneurysm with an ePTFE-covered stent-graft. This method seemed to be very useful even in such a high-risk patient, because it can be done under local anesthesia.

A Report of Successful Treatment of an Acute Aortic Dissection Associated with a Long-Term Steroid Therapy for Hypopituitarism / 日本心臓血管外科学会雑誌

A 58-year-old man was admitted with a diagnosis of an acute Stanford type A aortic dissection after 20-year-long steroid therapy for hypopituitarism. The graft replacement of the ascending aorta was performed as an emergency procedure under deep hypothermic selective cerebral perfusion. We administered 1, 000mg of methylprednisolone during cardiopulmonary bypass, injected 500mg/day of hydrocortisone during postoperative day 1 to 4, and then administered orally 40mg/day of hydrocortisone. Then 200μg of levothyroxine sodium was given orally from postoperative day 6. There are some reports about acute aortic dissection associated with long-term steroid therapy in SLE or aortitis syndrome, but reports involving hypopituitarism are very rare.

A Case of Successful Surgical Repair of Ventricular Septal Perforation Following Acute Myocardial Infarction in an 88-Year-Old Woman / 日本心臓血管外科学会雑誌

We report on an 88-year-old woman who underwent successful repair of ventricular septal perforation (VSP) following acute myocardial infarction. She was admitted as an emergency case to our hospital with acute myocardial infarction. Color Doppler echocardiogram revealed anterior VSP. Right heart catheterization was conducted under intraaortic balloon pumping and showed a Q_P/Q_S of 3.0. She also had acute renal failure for which continuous hemodialysis and filtration was started. In spite of intensive medical therapy, her hemodynamic condition was gradually worsened. An emergency operation was performed on the 6th day after the onset. A single porcine pericardial patch was sutured on the left side of the septum around the perforation and the left ventricular free wall was closed including the patch with two felt strips. She suffered from various complications through the postoperative course. However, she recovered and was discharged on the 77th postoperative day. She was, to the best of our knowledge, the oldest among the reported cases of successful surgical repair of VSP in Japan.

A Case of Successful Treatment for Graft Infection after Abdominal Aortic Aneurysm Repair / 日本心臓血管外科学会雑誌

We report a case of successful medical treatment for graft infection after abdominal aortic aneurysm repair. A 63-year-old man with a ruptured abdominal aortic aneurysm underwent a prosthetic graft replacement via a retroperitoneal approach. He became febrile on the 26th postoperative day (POD). A CT scan demonstrated fluid collection around the grafts. Re-operation was performed and gross pus was found around the prosthetic graft. After all pus and nonviable tissue were removed, two irrigation tubes and a drainage tube were placed adjacent to the graft for continuous irrigation with 0.5% povidone-iodine and super-acidic solution. Inflammatory reactions were gradually improved, and the patient discharged on the 88th POD.

Impending Rupture of Iliac Aneurysm in a Patient with Rare Blood Type / 日本心臓血管外科学会雑誌

A 62-year-old man with chronic renal failure had impending rupture of a right internal iliac aneurysm. He had a rate blood type (Type:AB and Rh+. Antibody: anti-Fya, anti-E, and anti-P1), so homologous blood transfusion seemed impossible. While blood pressure was reduced by bed rest and drug administration, 800ml of autologous blood was obtained within four weeks before operation. Furthermore the intraoperative autotransfusion method was used. Aneurysmectomy was successfully performed without homologous blood transfusion.