Tracheoplasty for Tracheal Collapse after the Tracheoinnominate Fistula Repair / 日本心臓血管外科学会雑誌

A 13-year-old boy underwent tracheostomy due to post-cardiac arrest encephalopathy in our hospital. During the second postoperative month, massive bleeding from the tracheostomy tube lumen was observed; tracheoinnominate artery fistula was diagnosed. Two weeks postoperatively, the trachea collapsed; tracheoplasty with VA-ECMO was performed. The patient was placed in respiratory distress and the tracheostomy cannula was removed. The damaged part of the trachea was trimmed to form a fusiform structure, while the horizontal mattress suture technique was used for tracheoplasty. An endotracheal tube was then placed just above the tracheal bifurcation and the tracheoplasty site was rested. On postoperative day 15, the tube was changed to a tracheostomy one; 3 months postoperatively, no tracheostomy-related complications or rebleeding were observed. Therefore, VA-ECMO assisted tracheal repair is considered a useful treatment option for patients with tracheal disruption, where suturing a prosthesis to the tracheostomy stoma site is difficult.

Internal Hernia Incarceration Mimicking Impending Rupture of an Abdominal Aortic Aneurysm / 日本心臓血管外科学会雑誌

A 68-year-old man visited a family physician with a complaint of epigastric pain lasting several hours. Computed tomography revealed an abdominal aortic aneurysm that was 60 mm in length and a small amount of ascites, resulting in a tentative diagnosis of impending rupture of the abdominal aortic aneurysm. The patient was referred to our hospital and underwent emergency surgery. Intraoperative findings ruled out rupture and inflammatory changes in the abdominal aortic aneurysm. We observed the abdominal cavity and detected an internal hernia. The 15-cm-long ileum was incarcerated by an abnormal cord between the vesicorectal fossa and peritoneum. The cord was dissected to release the internal hernia. Intestinal peristalsis and pulsation of the marginal artery were maintained, allowing us to avoid intestinal resection. The patient reported that his epigastric pain disappeared soon after surgery. On the 24th postoperative day, the patient underwent abdominal aortic replacement. Our case suggests that internal hernia incarceration is an important differential diagnosis of impending rupture of an abdominal aortic aneurysm, even in cases with no history of laparotomy.

Open Repair without Esophagectomy for an Aortoesophageal Fistula after Thoracic Stent Grafting / 日本心臓血管外科学会雑誌

An aortoesophageal fistula is a critical condition with high operative mortality. A case of aortoesophageal fistula following thoracic endovascular aneurysm repair is reported. The patient was a 72-year-old man complaining of dysphagia who underwent stent grafting for a saccular aneurysm of the descending aorta that was compressing the esophagus four months earlier. Endoscopic examination showed perforation of the aneurysm into the esophagus with severe stenosis. The aneurysmal sac was filled with thrombus. Aortography demonstrated a type I endoleak from the lesser curvature of the aortic arch, draining into the aneurysmal sac. The patient was afebrile with moderate elevation of C-reactive protein, and the white blood cell count was normal. The patient underwent closure of the aneurysmal entry with healthy aortic wall and replacement of the descending aortic aneurysm with a prosthetic graft. The graft was isolated from the fistula by an omental flap. The patient's postoperative course was uneventful. Computed tomography performed 4 years after the surgery showed shrinkage of the aneurysmal sac. The patient has had a healthy life for 9 years since the operation.

Concomitant Valve Surgery and Long Distal Bypass for Severe Mitral Regurgitation and Critical Limb Ischemia / 日本心臓血管外科学会雑誌

<p>A 75-year-old man with underlying arteriosclerosis obliterans presented with acute heart failure secondary to rest pain of the right lower extremity. Echocardiogram showed severe mitral regurgitation, moderate tricuspid regurgitation and a low cardiac function (ejection fraction : 27%). Right toe gangrene developed in association with continuous acute heart failure. He underwent mitral valve replacement, tricuspid annuloplasty, right common femoral artery-posterior tibial artery bypass and amputation of the right toes in single-stage surgery. There were no major complications during his hospital stay. After surgery, his symptoms significantly improved.</p>

Cardiac Surgery for a Patient with CD36 deficiency and Aortic Valve Regurgitation / 日本心臓血管外科学会雑誌

We describe a case of cardiac surgery for a patient with CD36 deficiency. A 56-year old man had progressive dyspnea on effort for 1 year. On admission, echocardiography revealed severe aortic valve regurgitation. He required medical treatment for heart failure, and subsequently elective aortic valve replacement was planned. Pre-operative cardiac scintigraphy (¹²³I-BMIPP) showed total defect of myocardial uptake. CD 36 deficiency was diagnosed based on the characteristic findings. CD 36 deficiency could cause transfusion related complication by donor blood transfusion. We prepared 1,200 ml autologous blood preoperatively in a two week period. The operation was performed successfully without donor blood transfusion. He was discharged uneventfully.

Cardiac Surgery in Homozygous Familial Hypercholesterolemia / 日本心臓血管外科学会雑誌

Homozygous familial hypercholesterolemia is a rare metabolic disorder with characteristic clinical presentations, such as tendon xanthomas, hypercholesterolemia, and significant cardiovascular disease including premature coronary artery disease. We describe a case of a 56-year-old woman with homozygous familial hypercholesterolemia. She had been treated with low-density lipoprotein apheresis for 23 years. Preoperative echocardiography and coronary angiography showed severe aortic valve stenosis and right coronary artery stenosis. Aortic valve replacement with patch enlargement of the aortic valve annulus, and coronary artery bypass grafting were successfully performed. She was discharged uneventfully.