Delamination of Acuseal arteriovenous graft: Two case reports.

Acuseal arteriovenous graft is an early cannulation graft having a tri-layered structure with an elastomeric middle layer. However, delamination of Acuseal grafts has been reported recently. This article describes two cases with different characteristics of Acuseal delamination. In case 1, the delamination occurred 1 month after a percutaneous transluminal angioplasty (PTA); therefore, the PTA was suspected to be a trigger. The delamination was located between the outer expanded polytetrafluoroethylene (ePTFE) layer and the elastomeric middle layer. On the other hand, in case 2, the delamination was located between the luminal ePTFE layer and the elastomeric middle layer. A surveillance ultrasound examination detected the delamination unexpectedly in the uneventful course; however, the delaminating location corresponded to the cannulation puncture site and the intraoperative findings suggested the involvement of mis-needling as a possible cause. Interestingly, for the purpose of continued use on hemodialysis, specific treatments were required against the delamination itself in both cases. As we identified Acuseal delamination in 5.6% (2/36) of cases, concerns arise that numerous cases of Acuseal delamination may have been overlooked in general. Understanding and recognizing this phenomenon are important for adequate use of Acuseal graft.

The long-term follow-up results of elective surgical treatment for abdominal aortic aneurysms.

This study was aimed at evaluating early and long-term follow-up results of surgical reconstruction of infrarenal abdominal aortic aneurysms (AAA). A consecutive series of 392 patients who underwent elective abdominal aortic repair from 1974 to 2000 was reviewed retrospectively. The mean age was 69.8 years (range 34-90), with 329 males and 63 females. The hospital mortality rate was 3.8% (15/392). Of the 203 patients that died during the follow-up period, 28% (56/203) were due to atherosclerotic diseases and 25% (51/203) were malignancies. The Patients whom underwent AAA surgery associated with ischemic heart disease had a 5-, 10-, and 15-year survival rate of 62%, 30%, and 9%, respectively. On the other hand, a survival rate of those not associated with ischemic heart disease were 71%, 38%, and 16%. The patients associated with aortoiliac occlusive disease in AAA surgery had a 5-, 10-, and 15-year survival rate of 51%, 11%, and 0%; those without aortoiliac occlusive disease had a survival rate of 72%, 43%, and 18%, respectively. There were statistically significant differences between the ischemic heart disease and the non-ischemic heart disease, the aortoiliac occlusive disease and the non-aortoiliac occlusive disease in long-term survival rates respectively. These findings demonstrate that AAA patients associated with ischemic heart disease or aortoiliac occlusive disease are at a higher risk than those with AAA alone. Therefore, AAA patients with aortoiliac occlusive disease and or ischemic heart disease should be managed more intensively before, during and after the operation.

Angiosarcoma of the pericardium. Review of 9 reports from Japan.

A 35-year-old woman diagnosed with a cardiac tumor by echocardiography and cinecardiography underwent surgical excision in December 1988. The port-wine tumor had invaded from the surface of the right atrium to the anterior wall of the right ventricle, preventing us from removing it completely. Pathohistologically, it was diagnosed as angiosarcoma of the pericardium. She died due to lung metastasis on the postoperative day 107. To our knowledge, only 9 such cases have been reported in Japan.

Successful aortic valve replacement for severe aortic regurgitation combined with annular abscess due to active infected endocarditis: usefulness of gelatine-resorcine-formol biological glue in remodeling the new aortic annulus.

Two men, 58 and 72 years old, were diagnosed as severe aortic regurgitation complicated by aortic annular abscess due to active endocarditis infection diagnosed by echocardiography. We conducted aortic valve replacement using gelatine-resorcine-formol biological glue to close the abscess cavity and remodel the new aortic annulus. Although 1 man developed complete atrial-ventral blockage postoperatively and required that a permanent pacemaker be implanted, neither experienced recurrence of infectious peri-valvular leakage.

Accessory mitral valve associated with aortic regurgitation in an elderly patient: report of a case.

We encountered a 75-year-old man who complained of exertional dyspnea. An echocardiographic examination showed aortic regurgitation and a tumor in the left ventricular outflow tract. Under complete extracorporeal circulation, we surgically made an incision of the ascending aorta with a slight thickening of the aortic valve and an enlarged annulus. After excising the aortic valve, an examination of the subvalvular region revealed mitral valve-like tissue extending from the annular region of the right coronary cusp to the ventricular septum, while the chordae tendinae was attached to the septum. This issue was excised, and the aortic valve was replaced with a 27-mm SJM valve. The postoperative course was uneventful, and the patient was discharged in good condition on postoperative day 30. An accessory mitral valve is extremely rare. Since this indication for surgical treatment is associated with congenital heart disease or a left ventricular outflow tract obstruction, most patients are young. Our patient had no associated cardiac anomalies and no pressure gradient attributable to a left ventricular outflow tract obstruction. This accessory mitral valve was discovered during aortic valve replacement surgery. To our knowledge, our patient is the oldest reported with an accessory mitral valve to have undergone a surgical resection.

Long-term results of mitral valve replacement: biological xenograft versus mechanical valves.

We studied 279 patients who underwent mitral valve replacement at the Department of Thoracic and Cardiovascular Surgery, Hyogo College of Medicine, between November 1973 and December 1998. The patients were divided into two groups based on the type of replacement valve (154 patients in the biological xenograft group and 125 patients in the mechanical valve group), and the long-term results were compared. Clinically satisfactory results were obtained in both the biological xenograft group and the mechanical valve group according to the surgical results, long-term survival, and incidence of prosthetic valve endocarditis. At 15 years, fewer patients in the mechanical valve group than in the biological xenograft group were free of bleeding events (92.5 +/- 3.7% vs 100% P < 0.05). At 15 years, the biological xenograft group was lower than the mechanical valve group with respect to freedom from thromboembolism (72.2 +/- 4.6% vs 93.5 +/- 3.6% P < 0.01), freedom from valve failure (22.0 +/- 5.2% vs 87.0 +/- 4.1% P < 0.005) and freedom from cardiac events (16.5 +/- 3.9% vs 47.2 +/- 14.5% P < 0.01). Though it has previously been suggested that biological xenografts used in mitral valve replacement do not need anticoagulation, the current study suggests the need for anticoagulation with the use of biological xenografts. Mechanical valves require close monitoring of anticoagulation, but their use has decreased the incidence of valve failure and thromboembolism, as compared with the use of biological xenografts. Therefore, mechanical valves are currently the preferred choice for mitral valve replacement. We believe that biological xenografts are indicated only for the older patient (> or =65 years).