A Case of Buerger's Disease Associated with Angina Pectoris and Carotid Stenosis / 日本心臓血管外科学会雑誌

A 60-year-old male who had a history of Buerger's disease was admitted due to chest pain on exertion. Coronary angiography showed severe double vessel disease (the left anterior descending artery and the right coronary artery). Carotid angiography showed severe stenosis of the left internal carotid artery associated with brain ischemia. In addition, angiography of the lower extremities showed segmental occlusion and collateral arteries resembly a “corkscrew” appearance. We implanted a stent in the carotid artery followed by revascularization surgery of the left lower leg and simultaneous coronary artery bypass surgery. The postoperative course was excellent.

Simultaneous Surgery for Angina Pectoris and Abdominal Aortic Aneurysm with Bilateral Iliac Artery Occlusion in a Chronic Hemodialysis Patient / 日本心臓血管外科学会雑誌

A 74-year-old man with renal failure had been treated with maintenance hemodialysis for 1.5 years at another hospital. The patient had an abdominal aortic aneurysm, bilateral iliac artery occlusion and coronary artery stenosis with a lesion in the left main trunk, but had been under observation because of the high risk of surgery. The patient elected to have surgery and was admitted to our hospital. We performed simultaneous surgery for severe coronary artery stenosis and abdominal aortic aneurysm with a maximum diameter of 85mm. The postoperative course was generally uneventful, but the patient required treatment of arrhythmia. We conclude that simultaneous surgery for angina pectoris and abdominal aortic aneurysm is feasible even in hemodialysis patients. It is important to pay attention to arrhythmia in the management of such patients, especially those with decreased cardiac function.

Arteriosclerosis Obliterans with Huge Multiple Leg Ulcers in a Patient with X-linked Ichthyosis / 日本心臓血管外科学会雑誌

A 64-year-old man with arteriosclerosis obliterans with huge multiple ulcers of the left leg was admitted for surgery. He had ichthyosis, and was diagnosed as X-linked ichthyosis by reduced steroid sulfatase activity and clinical examinations. Angiography revealed occlusions of the left common and external iliac arteries, left femoral artery, and right femoral artery. Aorto-left femoral bypass with a gelatin impregnated Dacron prosthesis and left femoro-popliteal bypass with a reversed saphenous vein graft were performed. Postoperatively the leg ulcers gradually healed and the patient was discharged in good condition. Leg ulcers with arteriosclerosis obliterans in patient with X-linked ichthyosis should be treated by the arterial reconstruction in the same way as in case with normal skin.

Clinical Study on Peripheral and Visceral Aneurysms / 日本心臓血管外科学会雑誌

Clinical course and outcome of 34 patients with peripheral and visceral artery aneuryms, operated during 1975-1990, were analysed. There were 24 males and 10 females. Ages ranged from 14 to 87, with an average of 55 years. Peripheral aneurysms located most frequently in the lower extremity, and the incidence of various origin of the aneurysms were as follows: 14 in femoral, 5 in popliteal, 4 in internal iliac, 3 in subclavian, 2 in common iliac arteries, and 1 in each of vertebral, radial, splenic, renal and anterior tibial artery. Most common cause of aneurysm was arteriosclerosis. Multiple aneurysms were found in 59% of sclerotic type and in most of these with bilateral aneurysms in the iliac, femoral and popliteal. Ruptured aneurysms were seen in 26% of this series. Most of the aneurysms in the extremities were totally excised without difficulty, while the aneurysms in common iliac and internal iliac were opened with partial excision or obliterated with endoaneurysmorrhaphy. Arterial reconstruction was performed using saphenous vein graft or synthetic vascular graft, excepting that the internal iliac artery itself was not reconstructed. The early operative results were satisfactory, but late results showed two death and three complications of cardiovascular system. Therefore, careful follow up of the postoperative patients was recommended.

Long-term Results of Ligation of Patent Ductus Arteriosus in Premature Infants / 日本心臓血管外科学会雑誌

From January 1979 through May 1982, 36 premature infants less than 2.5kg and less than 35 weeks of gestation, including 24 patients with respiratory distress syndrome, underwent ligation of patent ductus arteriosus (PDA) due to being unresponsive to medical treatment. Ten patients died postoperatively mainly from intracranial hemorrhage and necrotizing enterocolitis. Surviving 26 patients were examined for developmental sequelae based on questionnaire survey. One infant died of respiratory failure secondary to severe bronchopulmonary dysplasia 28th month after operation. We found no evidence of recurrent ductal patency following ligation during the follow-up period. Twenty four patients exhibited normal motor and mental development to attend the ordinary elementary school everyday, but one patient shows mental retardation. Most of patients suffered from the frequent upper respiratory infection in childhood to require rehospitalization. There are no patients with hoarseness, but 2 patients developed funnel chest and one required the operation. One third of the patients had ophthalmological handicap (myopia or strabismus). Surgical ligation of PDA in premature infants seems to reduce the duration of postoperative mechanical ventilation and the incidence of bronchopulmonary dysplasia. Analyzing long-term follow-up indicates that infants who undergo PDA ligation grow almost normally and do not appear to be at increased risk for sensorineural handicaps. Therefore we emphasize that surgical ligation of PDA is an effective and appropriate treatment of choice for significant PDA in premature infants.