ABSTRACT
A 51-year-old man developed a high fever with congestive heart failure after treatment for his dental caries and was admitted to our hospital. Transesophageal echocardiogram showed severe aortic regurgitation with a bicuspid aortic valve where vegetation and perforation was identified on its leaflets. Infective endocarditis caused by <i>Streptococcus constellatus</i> was diagnosed by blood culture. A computed tomography scan of the chest showed enlargement of his ascending aorta with a maximum diameter of 5.0cm. After treatment with antibiotics and diuretics for 60 days, he underwent surgical treatment for his aortic valve and ascending aorta. After excising the diseased aortic leaflets with vegetation, a mechanical prosthetic valve (Carbomedicus 23mm) was implanted. His ascending aorta was also replaced separately with a woven Dacron tube graft. There was an anomalous origin of the right coronary artery which was detached from the ascending aortic wall as a button and was implanted on the tube graft. Histologically the aortic wall showed disappearance of elastic fibers with myxomatous degeneration in the media. Immunohistochemical staining also revealed that matrix metalloproteinase-2 (MMP-2) was strongly expressed in the aortic media. The postoperative course was uneventful and he was discharged on the 37th postoperative day.
ABSTRACT
Long-term results of surgery for abdominal aortic aneurysms in the over-80 age group were studied. Among nine survivors we found four of them to have had a late death. Their survivals ranged from 17 to 96 months. The ratio of life expectancy was poor (29-51%) in men but good (159%) in women. Long-term survival was not significantly influenced by any preoperative complication but by unexpected disease, such as pancreatic cancer and pneumonia. In postoperative general care, it is important to pay attention not only to preoperative complication but also to the unexpected disease in other organs for octogenarians to achieve a goal of normal Japanese postoperatial survival.
ABSTRACT
The infected arterial aneurysm has a fulminent infectious process frequently resulting in death if not properly treated. We reviewed 10 patients to identify the aneurysm location, etiology, bacteriology, and the mortality of surgical treatment. The abdominal and thoracic aorta was the most common site (6 cases). The primary causes were infected endocarditis, acute cholecystitis, abscess in the psoas muscle and depressed immunocompetence, but there was no case of iatrogenic trauma. Eight patients had positive blood or aneurysmal wall culture, <i>Staphylococcus aureus, Staphylococcus epidermidis</i> and salmonella being the most frequent bacteria identified. The proper treatment of infected arterial aneurysm remains controversial. Three methods of surgical treatment were performed; one, <i>en bloc</i> aneurysmal excision with <i>in situ</i> prosthetic graft replacement, two, open aneurysmal resection and irrigation with large amount of diluted popdon iodine solution followed by <i>in situ</i> prosthetic graft replacement with wrapping by an omental pedicle. Three, extraanatomical bypass grafting. Six of 7 patients in whom the infection subsided with antibiotic therapy showed good long term results. However, 3 patients with uncontrollable infection died 1 to 3 months after operation.