[Aortic root reconstruction with Edwards Prima PLUS stentless valve].

We report successful treatment of 3 aortic root aneurysm cases with Edwards Prima PLUS stentless valve which has recently been approved in Japan. The patients were 69, 77, and 69 year-old male. All patients showed Sellers' IV degree aortic valve regurgitation. The aortic annulus diameters were 28, 23, and 26 mm, the Valsalva sinus diameters were 46, 53, and 57 mm, and the sino-tubular junction diameters were 32, 50, and 43 mm, respectively by echocardiographical measurement. Aortic root reconstructions with Edwards Prima PLUS stentless valve were chosen for all patients, considering the patient's age, pathological change of the aortic valve, and concomitant cardiovascular procedures. Only root reconstruction was performed in case 1. Ascending aortic replacement and single coronary artery bypass were added in case 2, and pulmonary vein isolation with radiofrequency ablation device and mitral ring annuloplasty were added in case 3. Total surgical duration was 218, 275, and 266 minutes, respectively and their postoperative courses were uneventful. This operation can be an appropriate choice for the selected patient with aortic root aneurysm.

[Repair of postoperative residual shunt of postinfarction ventricular septal perforation: report of a case].

A 70 year-old man had the surgical repair of post-infarction ventricular septal perforation (VSP) with infarction exclusion technique. Five days after operation, residual shunt was observed by echocardiogram and he developed cardiac failure. Additional surgery for residual shunt was performed 1 month after 1st operation. The infracted myocardium was firm enough to closed directly, so the Xenomedica patch was sutured on the side of the perforated septum around VSP. The postoperative course was uneventful.

[Initial experience in endoscopic radial artery harvesting].

We report the initial experience of endoscopic radial artery (RA) harvesting (ERA) using Vasoview System. The expected advantages of ERA are superior cosmetic results and fewer wound complications to the conventional open technique. ERA was performed in 33 patients from September 2004 to September 2005. Preoperatively, Allen's test with Doppler imaging was performed in all patients. ERA was successfully performed within 50 minutes except in the first 3 patients (the mean time for harvest: 37 minutes). Direct injury of the RA occurred in 1 patient, but the RA could be used as a graft for coronary artery bypass grafting (CABG) by repairing with end-to-end anastomosis. Only 1 RA graft occluded as determined by the early postoperative angiography. Local dissection of the RA was observed in 2 patients, but no flow disturbance was observed. Delayed wound healing occurred in 1 aged patient. No significant nerve complications were encountered. ERA is easy to adopt and has greater cosmetic advantages.

Blood distribution to the anterior spinal artery from each segment of intercostal and lumbar arteries.

AIM: Prevention of paraplegia, a serious complication of surgery for thoracoabdominal aortic aneurysm, has been well documented. However no assured prophylaxis against this complication has yet been found. Spinal ischemia is believed to be the major cause of paraplegia. We conducted an experimental study to define the development of paraplegia with regard to the blood supply to the spinal cord. METHODS: A porcine model was used to evaluate blood distribution to the anterior spinal artery. Colored silastic agent was selectively injected into the intercostal and lumbar arteries, and distribution to the anterior spinal artery was evaluated on 50 animals. The intercostal and lumbar arteries were ligated in the segments where the blood supply to the anterior spinal artery would be interrupted. Whether or not paraplegia developed was checked 2 days later. RESULTS: Colored silastic agent arrived at the anterior spinal artery from all segments of the 8th intercostal to 4th lumbar arteries. Two of 9 pigs (22.2%) that underwent ligation of the segments from the 9th intercostal to 2(nd) lumbar artery suffered paraplegia. In 3 non-paraplegic pigs, colored silastic agent injected into the preserved arteries was found to have covered a wider range. CONCLUSION: All the intercostal and lumbar arteries supplied blood to the anterior spinal artery. When large segments of intercostal and lumbar arteries were ligated, the blood flow from the preserved segments acquired increased dominance. The possibility exists that any intercostal and lumbar artery can supply blood to the spinal cord and become collateral circulation to the anterior spinal artery.