Japanese Journal of Cardiovascular Surgery Vol.30, No.2

Originals

  • Surgery for Aortic Valvular Disease with Congenital Bicuspid Aortic Valve 　　S. Wariishi, et al.…59
    Surgery for Aortic Valvular Disease with Congenital Bicuspid Aortic Valve

    (Cardiovascular Surgery, Kochi Municipal Hospital, Kochi, Japan)
    Seiichiro Wariishi Naoki Kanemitsu Hironori Tenpaku
    Manabu Okabe Takasumi Nakamura
    An increase of aortic valvular disease associated with congenital bicuspid aortic valve is observed due to the relative decrease of rheumatic valvular diseases. A total of 24 patients with aortic valvular disease associated with congenital bicuspid aortic valve underwent surgical treatment at our institution during the period from January, 1997 to December, 1999. These 24 patients constituted 46.2% (24/52) of all cases of surgical operations for aortic valvular disease. The age of the patients ranged from 17 to 83 years (mean 62 years). They consisted of 16 men (66.7%) and 8 women. Two patients had infective endocarditis. The classification of congenital bicuspid aortic valve was right-left cusp type in 15 patients (raphe＋: 11), anterior-posterior cusp type in 9 patients (raphe＋: 9). We performed aortic valve replacement in 22 patients, aortic root replacement in 1 patient and aortic root remodeling in 1 patient in combination with mitral valve plasty in 3 patients, coronary artery bypass grafting in 3 patients and closure of the atrial septal defect (ASD) in 1 patient. We detected ASD in 1 patient, ventricular septal defect in 1 patient and high-posterior take-off right coronary artery in 1 patient. Patients with stenosis often have a small aortic annulus and severe post-stenotic aortic dilation. Preoperative and intraoperative evaluation is important in cases of aortic valvular disease associated with congenital bicuspid aortic valve.
    　Jpn. J. Cardiovasc. Surg. 30: 59-62 (2001)
  • Beneficial Effects of Preoperative Coronary Angiography and Coronary Artery Revascularization in Patients Undergoing Surgery for Abdominal Aortic Aneurysm 　　Y. Sasaki, et al.…63
    Beneficial Effects of Preoperative Coronary Angiography and Coronary Artery Revascularization in Patients Undergoing Surgery for Abdominal Aortic Aneurysm

    (Department of Cardiovascular Surgery, Osaka National Hospital, Osaka, Japan)
    Yasuyuki Sasaki Fumitaka Isobe Seiji Kinugasa
    Yoshiei Shimamura Hiroshi Kumano Keima Nagamachi
    Yasuyuki Kato Hideki Arimoto
    It is well known that patients with abdominal aortic aneurysms (AAA) have a high incidence of coronary artery disease (CAD), and that the major cause of death in patients undergoing aneurysmectomy is acute myocardial infarction. A total of 53 patients (mean age, 71 years) underwent elective repair of AAA between January 1991 and November 1999. In an attempt to reduce early and late mortality caused by myocardial infarction, coronary angiography (CAG) was performed in all cases. Significant CAD was found in 23 patients (43%), with triple vessel disease in 1 patient (2%), double vessel disease in 5 patients (9%), single vessel disease in 16 patients (30%) and left main in 1 patient (2%). Ten patients (19%) in whom CAD was detected by CAG had no history of CAD and displayed no ischemic findings on ECG. In 4 patients (8%), AAA repair was performed 2 (mean) months after coronary artery bypass grafting (CABG). Percutaneous transluminal coronary angioplasty (PTCA) was performed in 8 patients (23%) 19 days (mean) prior to AAA surgery. No patient had a perioperative myocardial infarction either following coronary revascularization (CABG and PTCA) or AAA resection. Moreover, there was only one operative death after abdominal aneurysmectomy (2%), in a patient who was 70 years old with chronic hemodialysis and who died due to multiple organ failure caused by uncontrollable adhesional ileus. The results of this study emphasize the importance of preoperative routine coronary angiography following coronary artery revascularization to enhance the operative outcome of AAA repair.
    　Jpn. J. Cardiovasc. Surg. 30: 63-67 (2001)

Case Reports

  • A Successful Anatomical Reconstruction for Mycotic Abdominal Aortic Aneurysm with Infectious Abcess 　　E. Suenaga, et al.…68
    A Successful Anatomical Reconstruction for Mycotic Abdominal Aortic Aneurysm with Infectious Abcess

    (Department of Cardiovascular Surgery, Nagasaki, Kouseikai Hospital, Nagasaki, Japan and Department of Thoracic Surgery, Saga Medical School*, Saga, Japan)
    Etsuro Suenaga Tsuyosi Itoh* Hisao Suda*
    Kazuyuki Ikeda*
    Mycotic aortic aneurysm is a rare disease which is caused by bacterial infection of the aortic wall, grows rapidly with subsequent rupture and has high mortality. We report a case of successful anatomical reconstruction for mycotic abdominal aortic aneurysm with infectious abcess. A 59-year-old man who was found to have an impending rupture of abdominal aortic aneurysm underwent emergency anatomical reconstruction. At operation, an active infectious abcess was noted around the abdominal aorta. Successful management of this disease depends on early accurate preoperative diagnosis, complete resection and debridment of infected tissues, anatomical graft replacement and adjuvant antibiotic chemotherapy.
    　Jpn. J. Cardiovasc. Surg. 30: 68-70 (2001)
  • A Case of True Atherosclerotic Intercostal Aneurysm Diagnosed by Medical Examination 　　Y. Nakao, et al.…71
    A Case of True Atherosclerotic Intercostal Aneurysm Diagnosed by Medical Examination

    (Department of Surgery, Keio University, Tokyo, Japan)
    Yoshihisa Nakao Toshihiko Ueda Katsumi Moro
    Tadashi Omoto Yoshito Inoue Yasunori Cho
    Shiaki Kawada
    Intercostal artery aneurysm is a rare disease, and is usually associated with aortic coarctation, trauma and infection. Until recently, diagnosis of the aneurysm had not been possible before rupture of aneurysm. However, recent advances in computed tomography (CT) and magnetic resonance imaging (MRI) have made it possible to diagnose this lesion. A 68-year-old man was admitted with an abnormal shadow on chest X-ray film. A chest CT scan showed an aneurysm beside the descending aorta, suggestive of intercostal artery aneurysm. Intraoperative inspection confirmed the diagnosis. The aneurysm was shown to be atherosclerotic in origin by postoperative histological examination.
    　Jpn. J. Cardiovasc. Surg. 30: 71-73 (2001)
  • Coronary Artery Bypass Grafting without Cardiopulmonary Bypass and Percutaneous Coronary Angioplasty in a Patient with Cerebrovascular Stenosis 　　S. Fukuda, et al.…74
    Coronary Artery Bypass Grafting without Cardiopulmonary Bypass and Percutaneous Coronary Angioplasty in a Patient with Cerebrovascular Stenosis

    (Division of Cardiovascular Surgery, Mitsui Memorial Hospital, Tokyo, Japan)
    Sachito Fukuda Atsushi Itoh Motoo Osaka
    Akinobu Sasaki Yoichi Yamashita Ikutarou Kigawa
    Yasuhiko Wanibuchi
    Complete revascularization of the coronary artery was performed in a 73-year-old man who had severe stenosis of the bilateral subclavian and left vertebral arteries and severe calcification of the ascending aorta. At first, we performed CABG (coronary artery bypass grafting) on the LAD (left anterior descending artery) and the RCA (right coronary artery) without cardiopulmonary bypass. In-situ GEA (gastroepiploic artery) was anastomosed to the LAD and SVG (saphenous vein graft) was anastomosed to 4PD (4 posterior descending artery) of the RCA. The right brachiocephalic artery was selected as the site of the proximal anastomosis of the SVG. A Palmaz-Schatz stent was then held in place in the LCX (left circumflex artery) postoperatively. The combination of CABG without cardiopulmonary bypass and PTCA was a safe method for preventing cerebrovascular complications in a patient with a severely calcified artery.
    　Jpn. J. Cardiovasc. Surg. 30: 74-76 (2001)
  • A Case of Surgical Treatment for Type A Aortic Dissection Associated with Proximal Descending Thoracic Aortic Aneurysm 　　T. Niino, et al.…77
    A Case of Surgical Treatment for Type A Aortic Dissection Associated with Proximal Descending Thoracic Aortic Aneurysm

    (The Second Department of Surgery, Nihon University School of Medicine, Tokyo, Japan)
    Tetsuya Niino Motomi Shiono Yukihiko Orime
    Shinya Yagi Tomonori Yamamoto Syunichi Kimura
    Mitsumasa Hata Shinsuke Choh Nanao Negishi
    Yukiyasu Sezai
    A 63-year-old man suffered from type A acute aortic dissection associated with descending thoracic aortic aneurysm and coronary stenosis. He was treated surgically 49 days after onset of acute aortic dissection. Deep hypothermic selective cerebral perfusion was carried out for brain protection. It revealed the aneurysm, 51mm in diameter, located just distal to the aortic arch, and an intimal tear of the dissection located posterior wall of aneurysm. The total arch was replaced with 24mm vascular graft and CABG (LITA-to-seg.8) was carried out. The postoperative course was uneventful and he was discharged on the 18th postoperative day.
    　Jpn. J. Cardiovasc. Surg. 30: 77-79 (2001)
  • Successful Surgical Closure of a Coronary Sinus Atrial Septal Defect Using a Heart-Shaped Patch 　　A. Mizuno, et al.…80
    Successful Surgical Closure of a Coronary Sinus Atrial Septal Defect Using a Heart-Shaped Patch

    (Department of Cardiovascular Surgery, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan)
    Asatoshi Mizuno Shigeki Horikosh Hideto Emoto
    Yoshimasa Uno Hiroyuki Suzuki
    A 21-year-old man with coronary sinus atrial septal defect (ASD) was treated successfully. This case had been diagnosed as an ASD without a lower margin preoperatively but we confirmed this to be a coronary sinus ASD intraoperatively, and this case was classified as partially unroofed coronary sinus without PLSVC. The diagnosis of coronary sinus ASD before operation is sometimes difficult. Therefore we should pay attention to the location of the defect and the dilated coronary sinus in echocardiography, and the course of the cardiac catheter entering into the left atrium, for a correct diagnosis. In this case, the defect was located in the vicinity of the ostium of a large coronary sinus, therefore we could close the defect between the CS and the LA using a heart-shaped patch without any damage to the AV node.
    　Jpn. J. Cardiovasc. Surg. 30：80-82（2001)
  • A Case of Coarctation of Descending Mid-Thoracic Aorta Caused by Fibromuscular Dysplasia 　　J. Koizumi, et al.…83
    A Case of Coarctation of Descending Mid-Thoracic Aorta Caused by Fibromuscular Dysplasia

    (Department of Cardiovascular Surgery, National Obihiro Hospital, Obihiro, Japan)
    Junichi Koizumi Yoichi Kikuchi Taku Sakurada
    Katsuyuki Kusajima
    A rare case of descending thoracic aortic coarctation caused by fibromuscular dysplasia is reported. A 74-year-old woman was referred to our institution because of congestive heart failure, hypertension, acute renal failure and pressure gradient between upper and lower extremities. Aortography revealed 90% stenosis of the descending mid-thoracic aorta. Descending-descending aortic bypass was performed under femoro-femoral partial cardiopulmonary bypass. The post-operative course was uneventful and the pressure gradient across the coarctation was disappeared. The patient discharged on the 28th postoperative day without any problems. The pathohistological findings revealed fibromuscular dysplasia in the media and intima of the aortic wall.
    　Jpn. J. Cardiovasc. Surg. 30: 83-85（2001)
  • A Third CABG Procedure (Axillo-Coronary Bypass) Using the MIDCAB Technique 　　T. Abe, et al.…86
    A Third CABG Procedure(Axillo-Coronary Bypass) Using the MIDCAB Technique

    (Department of Surgery III, Nara Medical University, Nara, Japan)
    Takehisa Abe Tetsuji Kawata Yoichi Kameda
    Nobuoki Tabayashi Takashi Ueda Kazuhiko Nishizaki
    Hiroshi Naito Shigeki Taniguchi
    A 77-year-old man had undergone CABG (coronary artery bypass grafting) (SVGs (saphenous vein grafts) to LAD (left anterior descending coronary artery), OM (obtuse marginal) and RCA (right coronary artery)) 15 years previously. Three years previously, he underwent CABG again (LITA (left internal thoracic artery)-OM, RGEA (right gastroepiploic artery)-RCA) due to recurrence of angina pectoris, but there was no evidence of graft disease in the SVG to the LAD. Six months before the present procedure, graft disease developed in the SVG to the LAD and caused unstable angina pectoris. Therefore, the left axillary artery was bypass grafted to the coronary artery (LAD) using SVG without cardiopulmonary bypass by means of the MIDCAB (minimally invasive direct coronary artery bypass) technique. The patient has had no angina pectoris subsequently. Postoperative angiography revealed that the graft was patent. The axillo-coronary (LAD) bypass appears to be a useful procedure for re-revascularization to the LAD in patients with no available arterial graft, such as ITA (internal thoracic artery) or RGEA.
    　Jpn. J. Cardiovasc. Surg. 30: 86-88 (2001)
  • A Case of Descending Aortic Rupture due to Blunt Chest Trauma 　　M. Sakaguchi, et al.…89
    A Case of Descending Aortic Rupture due to Blunt Chest Trauma

    (Department of Cardiovascular Surgery, Nagano Red Cross Hospital, Nagano, Japan)
    Masayuki Sakaguchi Naobumi Fujii Kazunori Nishimura
    Nobuyuki Yanagiya
    We report a case of rupture of the thoracic descending aorta due to blunt chest trauma. An 18-year-old man was transferred to our hospital after a car accident. He was in a state of shock. The admission chest X-ray film demonstrated mediastinal widening and blurring of the aortic arch. Chest and abdominal helical CT scan showed left hemothorax, pseudoaneurysm, and hematoma of the cervix, mediastinum, and retroperitoneal space. We diagnosed rupture of the thoracic descending aorta without other injuries. An emergency operation was performed under partial cardiopulmonary bypass with systemic heparinization. The descending aorta had completely lost its continuity. Graft replacement was performed with a collagen-sealed woven Dacron graft. The postoperative course was uneventful. We suggest that high awareness and a systematic approach are needed to diagnose traumatic aortic rupture, and that enhanced helical CT scanning is helpful for diagnosis and management strategy.
    　Jpn. J. Cardiovasc. Surg. 30: 89-91 (2001)
  • A Case Report of Abdominal Aortic Aneurysm Associated with Crossed-Fused Ectopia of the Kidney 　　T. Mizuno, et al.…92
    A Case Report of Abdominal Aortic Aneurysm Associated with Crossed-Fused Ectopia of the Kidney

    (Department of Cardiovascular Surgery, Kameda Medical Center, Chiba, Japan and Department of Cardiovascular Surgery, Senpo Tokyo Takanawa Hospital*, Tokyo, Japan)
    Tomohiro Mizuno Masaaki Toyama Noriyuki Tabuchi
    Kazuyuki Kuriu Masanori Kato*
    A rare case of abdominal aortic aneurysm associated with crossed-fused ectopic kidney in a 74-year-old man is reported. On enhanced CT scans, the maximum diameter of his infrarenal aortic aneurysm was 55mm, and he lacked a right kidney. A crossed ectopic kidney was fused to the lower part of the left kidney. On preoperative examinations, only one feeding artery to the ectopic kidney separated from the right common iliac artery. However, laparotomy confirmed the presence of three aberrant renal arteries, the middle one of which was very slim. Aneurysmectomy and a bifurcated artificial graft replacement was performed. After proximal anastomosis, the two larger aberrant renal arteries were reconstructed under renal protection with intermittent infusion of cold Ringer's solution. The smallest aberrant renal artery was ligated. Postoperatively, this patient recovered without any complications. In operations for abdominal aortic aneurysm associated with renal anomaly including ectopic kidney, horseshoe kidney, and pelvic kidney, it is important to elucidate the anatomy of aberrant renal arteries preoperatively, and reconstruct as many of these arteries as possible. This report is apparently the fourth on abdominal aortic aneurysm associated with crossed ectopic kidney.
    　Jpn. J. Cardiovasc. Surg. 30: 92-94 (2001)
  • A Case of Non-Anastomotic False Aneurysm of Late Fiber Deterioration in Dacron Graft 　　A. Hariya, et al.…95
    A Case of Non-Anastomotic False Aneurysm of Late Fiber Deterioration in Dacron Graft

    (Department of Cardiovascular Surgery, Omiya Medical Center, Jichi Medical School, Omiya, Japan)
    Akifusa Hariya Atsushi Yamaguchi Hideo Adachi
    Seiichiro Murata Masahiko Okada Takashi Ino
    Dacron prostheses are the most widely used grafts in replacement procedures for abdominal aortic aneurysms, but they are not perfect grafts. We encountered a rare case of late graft complication. A 66-year-old man was admitted to our hospital with a pulsatile mass in an abdominal operation scar. He had received placement of a Y-shaped Cooley double velour knitted Dacron graft 18 years previously. Computed tomography and angiography demonstrated graft dilatation and an aneurysm. After resection of the graft aneurysms, the operative findings showed a non-anastomotic aneurysm formation due to longitudinal division near the graft guideline. In this case, this graft failure may have been due to the deterioration of the filter of the Dacron prosthesis itself. Therefore it is important to perform careful long-term follow-up in patients with implanted Dacron arterial prostheses.
    　Jpn. J. Cardiovasc. Surg. 30: 95-98 (2001)
  • A Case of Simultaneous Surgery for Distal Aortic Arch Aneurysm Complicated by Left Ventricular Aneurysm 　　I. Kitano, et al.…99
    A Case of Simultaneous Surgery for Distal Aortic Arch Aneurysm Complicated by Left Ventricular Aneurysm

    (Department of Cardiovascular Surgery, Kobe Rousai Hospital, Kobe, Japan)
    Ikuro Kitano Noboru Wakita Masahiro Sakata
    Hiroya Minami Yujiro Kawanishi
    A 72-year-old man consulted a local physician due to an episode of loss of consciousness. When chest CT was performed after amelioration of symptoms, aneurysmal dilation was detected at the distal aortic arch. On CT, a distal aortic arch aneurysm appeared to be a sacciform aneurysm measuring 55mm in maximum diameter. In addition, coronary arteriography demonstrated complete obstruction of left anterior descending branch ＃6, while left ventriculography demonstrated left ventricular aneurysm due to old myocardial infarction. The left ventricular end-diastolic volume was increased to 285ml, and the end-systolic volume was increased to 224ml. Moreover, the left ventricular ejection fraction was markedly decreased to 21%. The distal aortic arch aneurysm was treated by total aortic arch replacement. Considering the postoperative development of cardiac failure, the left ventricular aneurysm was simultaneously treated by endoventricular patch plasty, the so-called Dor operation. The postoperative course of this patient was satisfactory, because the end-diastolic volume was decreased to 241ml, and the end-systolic volume was also decreased to 147ml. Furthermore, the left ventricular ejection fraction was increased to 39%, demonstrating an improvement in left ventricular function. In Japan, there have not been any reports describing simultaneous surgery for thoracic aortic aneurysm complicated by left ventricular aneurysm. Therefore, the present study reports the course of this patient, including the indications of endoventricular patch plasty.
    　Jpn. J. Cardiovasc. Surg. 30: 99-102 (2001)
  • Management of Inguinal Vascular Graft Infection by Lateral Femoris Axillo-Popliteal Bypass 　　T. Tsukioka, et al.…103
    Management of Inguinal Vascular Graft Infection by Lateral Femoris Axillo-Popliteal Bypass

    (Department of Cardiovascular Surgery, Fukui Prefectural Hospital, Fukui, Japan)
    Toshihide Tsukioka Shinichirou Yamamoto Tamotsu Yasuda
    A 81-year-old man was referred to our hospital for treatment of a skin ulcer of the right anterior crus. After 2 months left common femoral artery-right popliteal artery bypass, graft infection was occurred and methicillin-sensitive Staphylococcus aureus was found in the bacterial culture. The wound was extended in order to decide the extent of graft infection, but graft healing was totally insufficient. All of the graft was excised, and right axillo-popliteal bypass using 8mm Bionit graft was performed. The graft was passed through lateral femoral. Thus, in this case the graft excision was necessary, but major amputation could be avoided by successful revascularization.
    　Jpn. J. Cardiovasc. Surg. 30: 103-105 (2001)
  • A Case of Simultaneous Operation for Unstable Angina and Leriche's Syndrome with a Large Arterial Collateral to the Lower Limb 　　T. Kugai and M. Chibana…106
    A Case of Simultaneous Operation for Unstable Angina and Leriche's Syndrome with a Large Arterial Collateral to the Lower Limb

    (Department of Cardiovascular Surgery, Prefectural Okinawa Naha Hospital, Okinawa, Japan)
    Tadao Kugai Mikio Chibana
    A 52-year-old male with unstable angina after acute myocardial infarction, and Leriche's syndrome was referred to our hospital for intensive care. He had a history of diabetes. Coronary angiography demonstrated a 75% stenosis of the LMT in association with a 90% stenosis of the LAD, 75% stenosis of the LCX and 99% stenosis of the RCA. Aortography revealed an arterial occlusion extending from the infrarenal aorta to both common iliac bifurcations. Both internal thoracic arteries were well developed as collateral pathways to external iliac arteries. With concomitant Y graft replacement of the abdominal aorta, two large internal thoracic arterial conduits and the right gastroepiploic artery were grafted to the coronary artery. This procedure was useful for protection of limb ischemia, in addition to producing a route for insertion of an intraaortic balloon pumping catheter.
    　Jpn. J. Cardiovasc. Surg. 30: 106-109 (2001)