A Successful Case of Treatment of Graft Infection by Using Allografts after Ascending Thoracic Aortic Reconstruction / 日本心臓血管外科学会雑誌

Thoracic graft infection is a serious complication and has high mortality. We report a case of successful treatment of graft infection after ascending thoracic aortic reconstruction. A 66-year-old woman underwent surgery for DeBakey type I aortic dissection in June 2007. The ascending aorta was replaced with a prosthetic graft. Although her postoperative course was complicated with Methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) mediastinitis, the infection was conservatively controlled by mediastinal lavage and antibiotics. However, she was readmitted in April 2008 due to lumbar pain and high fever, and was diagnosed with infectious spondylitis. Lumbar plastic surgery was performed. During hospitalization, she underwent total systemic examination. The results indicated aneurysm of the ascending aorta. MRSA was detected from culture fluid of her blood. Taken together, the presence of an infected aortic aneurysm was considered possible. Consequently, reconstruction of the ascending aorta using two allografts was performed after removing the prosthetic graft. The postoperative course was uneventful, and she was discharged on the 71st postoperative day. The patient continues to thrive 9 months after the operation. This case of an infected aortic aneurysm repaired with the use of allografts will be reported together with references to the literature.

A Case of Chronic Contained Rupture of an Abdominal Aortic Aneurysm / 日本心臓血管外科学会雑誌

A 72-year-old man was referred to our hospital because of lumbago and an abdominal aortic aneurysm (AAA). Computed tomography revealed the AAA to be 5cm in diameter with a retroperitoneal hematoma. A diagnosis of chronic contained rupture of an AAA was made, and an operation was performed. At laparotomy, a punched-out defect (10×20mm) that was thought to connect the thrombosed aneurysm to an organized retroperitoneal hematoma was discovered on the right side of the aorta. The aneurysm was replaced with a Y-shaped prosthetic graft. The patient's postoperative course was uneventful. This case of chronic contained rupture of an AAA was distinctly different from cases of acute rupture. Although patients with chronic contained rupture of an AAA are hemodynamically stable, such cases should be assessed and treated as quickly as possible because of the risk of re-rupture.

A Case of Myxoma Originating from the Anterior Leaflet of the Mitral Valve / 日本心臓血管外科学会雑誌

We reported a rare case of myxoma originating from the anterior leaflet of the mitral valve. A 65-year-old woman was admitted with sympotomes of easily fatigability and palpitation. On auscultation, a grade II/IV systolic murmur was audible at the apex. Echocardiography demonstrated a dense mass arising from the anterior mitral leaflet. The tumor (16×13×10mm in size) was resected from the anterior leaflet of the mitral valve. There was no definite evidence of a tumor stalk on the mitral valve nor valve regurgitation after the operation. Microscopically, polyhedral cells were recognized, indicating myxoma. The postoperative course was uneventful and no recurrence has been noticed during the past 6 years.

A successful case report of the total correction of tetralogy of fallot after the right ventricular outflow tract construction / 日本心臓血管外科学会雑誌

The total correction of tetralogy of Fallot (TOF) after the right ventricular outflow tract construction without ventricular septal defect closure which is called central palliation is rarely reported. A case of TOF had been undergone the central palliation because of left ventricular hypoplasia in a 30 year-old woman, 19 years after Blalock-Taussig's shunt. She was performed successfuly on the total correction of TOF and pulmonary valve replacement at 35 years old, 5 years after the central palliation.