Japanese Journal of Cardiovascular Surgery Vol.31, No.4

Long-Term Results of Aortic Valve Replacement Using a 19mm Bileaflet Valve

Takashi Adachi Masayoshi Yokoyama Kunihiro Oyama Hiromi Kuwata Takako Matsumoto Yutaka Miyano Takamasa Onuki Sumio Nitta (Department of Surgery I, Tokyo Women's Medical University School of Medicine, Tokyo, Japan)

We studied cardiac function and outcome long after aortic valve replacement using a 19mm bileaflet valve. The subjects consisted of 10 of 12 patients living 10 or more years after the operation and 7 of 8 living 5-9 years after the operation. We measured the left ventricular ejection fraction (LVEF), %fraction shortening (%FS), left ventricular diastolic dimension (LVDd), systolic dimension (LVDs), PWT, IVST, and LV-aortic pressure gradient (PG) of in 6 patients each in 10 more years after the operation (Group I) and 5-9 years after the operation (GroupII) who underwent ultrasonography, and calculated the left ventricular mass index (LVMI). No statistically significant differences were seen in either parameter in either group. Prognosis was 1 cardiac 2 cancer deaths each in 10 or more years after the operation group. The cumulative survival rate was in 85.7% post operative 5-9 years and 72.7% in 10 years. Although cardiac function was maintained in both groups, more observation is needed from now on because the pressure difference or LVMI may increase. 　Jpn. J. Cardiovasc. Surg. 31：243-246 (2002)

Surgical Repair of Complications Following Acute Myocardial Infarction

Yasumi Maze Hidehito Kawai Yoshihiko Katayama Makoto Kimura Sekira Shomura (Department of Thoracic Surgery, Yamada Red Cross Hospital, Mie, Japan)

Sixteen consecutively seen patients underwent surgical repair for complications following acute myocardial infarction. There were two cases with acute mitral regurgitation due to posterior papillary muscle rupture, who underwent mitral valve replacement with a prosthetic valve. There were three cases of postinfarction left ventricular free wall rupture. In all cases, horizontal mattress suture with Teflon felt strip was used in order to close the myocardial tear. The two out of three who survived had been placed on percutaneous cardiopulmonary support prior to the operation. There were 11 cases of postinfarction ventricular septal perforation. The surgical procedures consisted of simple patch closure (Daggett's method) in 7 cases, direct closure in one case, apical amputation in one case and endocardial patch repair with infarct exclusion (Komeda-David method) in the most recent two cases. Six out of eleven survived. Early diagnosis and surgical treatment are mandatory to save these patients. Intraaortic balloon pumping and percutaneous cardiopulmonary support prior to the operation have been used to advantage in some patients. 　Jpn. J. Cardiovasc. Surg. 31：247-251(2002)

The Optimum Temperature of the Retrograde Continuous Blood Cardioplegia in Coronary Artery Bypass Grafting

Noritsugu Morishige Tadashi Tashiro Takashi Yamada Michio Kimura (Department of Cardiovascular Surgery, Fukuoka University School of Medicine, Fukuoka, Japan)

Myocardial oxidative stress during retrograde continuous blood cardioplegia (RCBC) was evaluated in 35 patients undergoing elective aortocoronary bypass surgery. The patients were divided into three groups: Group C (n=12) received cold (20°C) RCBC, Group T (n=11) received tepid (30°C) RCBC, and Group W (n=12) received warm (36°C) RCBC. Myocardial oxidative stress was assessed by measuring the release of oxidized glutathione (GSSG), malondialdehyde (MDA), and myeloperoxidase (MPO) in the coronary sinus plasma before aortic clamping, at 1, 5, and 10min after unclamping. Myocardial oxygen uptake and lactate release were assessed at the same times. Both the hemodynamic recovery and the creatine kinase MB (CKMB) activity were measured perioperatively until 24h after unclamping. In Group C, a significant coronary sinus release of GSSG was found in the early reperfusion period in comparison to Groups T and W. However, the peak CK-MB activity was significantly lower in Group T than in Group W. No significant difference in the release of MDA or MPO was noted in the three groups. The recovery of oxygen uptake after unclamping was rapid in Group T. The recovery in the left and right ventricular functions and the myocardial lactate release were similar in the three groups. In conclusion, tepid RCBC is considered to protect the myocardium from ischemia-reperfusion injury better than cold or warm blood cardioplegia under retrograde continuous perfusion. 　Jpn. J. Cardiovasc. Surg. 31：252-257(2002)

Surgical Treatment for Ruptured Abdominal Aneurysm

Kiyoaki Takaba Ario Yamazato Tomoyuki Yamada (Department of Cardiovascular Surgery, Takeda Hospital, Kyoto, Japan)

Elective resection of abdominal aortic aneurysms is now a safe operation, but mortality related to ruptured abdominal aortic aneurysm (rAAA) remains high. In many reports, there has been much discussion about the factors that affect the mortality rate of patients who had rAAA repair. Preoperative shock is the most frequently cited prognostic factor related to survival. At the induction of anesthesia in these patients it is not rare for hypotension to cause deep shock. To prevent these deep shock states, we make a mid-abdominal skin incision simultaneously at the induction of general anesthesia just after preparation. Forty-four cases of rAAA underwent emergency surgery with this technique between April 1993 and December 1999. We also reviewed medical records of these 44 consecutive patients to evaluate clinical factors in mortality after rAAA resection. The overall hospital mortality rate was 18.2% (8/44) in our series. Factors associated with poor prognosis were the duration of preoperative shock state (P＝0.031), an episode of cardiac arrest (P＝0.015), an episode of loss of consciousness (P＝0.018), systolic blood pressure of less than 60mmHg at the induction of anesthesia (P＝0.019), intraperitoneal rupture (P＝0.010) and intraoperative massive blood transfusion (P＝0.043). These findings suggest that these factors may be reflections of preoperative shock and intraoperative technical errors. The surgical results of rAAA have improved significantly due to the prevention of hypotension which may cause a state of deep shock at induction of anesthesia. Although the patient's outcome after rupture of AAA is partly determined before intervention by the surgeon, efforts for rapid diagnosis and prompt flawless surgery can increase survival. 　Jpn. J. Cardiovasc. Surg. 31：258-261 (2002)

Late Mortality after Reconstructive Surgical Treatment of Atherosclerotic Occlusive Disease

Hiroki Yoshida Yuichi Izumi Katsuaki Magishi Kazuyuki Tanaka Hiroshi Kubota (Department of Thoracic and Cardiovascular Surgery, Nayoro City Hospital, Nayoro, Japan)

We reviewed the clinical course of 127 patients who underwent treatment for atherosclerotic disease between June 1993 and January 2001. There were 108 men and 19 women. The ages ranged from 49 to 88 years with a median age of 71.2 at the time of the first operation. Major risk factors included ischemic heart disease (21%) and diabetes mellitus (20%). Ninety-five percent of the patients were followed successfully and the follow-up period ranged from 0 to 90 months with a mean of 33 months. Two patients died perioperatively due to myocardial infarction. There were 29 late deaths. The overall actuarial survival rate was 69.7% at 5 years. The 5-year actuarial survival rate and the mean survival time for men and women were 71.6%, 66.1 months and 62.3%, 58.9 months. The 5-year late survival rate and the mean survival time for patients with and without ischemic heart disease were 57.0%, 57.4 months and 74.2%, 68.5 months. The differences were not statistically significant. The 5-year late survival rate and the mean survival time for patients with and without diabetes mellitus were 65.5%, 59.1 months and 70.9%, 67.4 months. The differences were not statistically significant. Amputation was performed in 7 patients, the actuarial survival rate at 1 year and the mean survival time were 42.9%, 7.1 months for patients with amputation, and 93.0%, 69.5 months without amputation (P＜0.01). 　Jpn. J. Cardiovasc. Surg. 31：262-265 (2002)

Axillary Artery Perfusion in Arteriosclerotic Thoracic Aortic Aneurysm

Tetsuro Uchida Takashi Minowa Jun Hosaka Masataka Koshika Kiyoshige Inui Takao Watanabe Yasuhisa Shimazaki (Second Department of Surgery, Yamagata University School of Medicine, Yamagata, Japan)

Between 1996 to 2000, 12 patients with arteriosclerotic thoracic aortic aneurysm underwent surgery with cardiopulmonary bypass using the right axillary artery as an arterial inflow. All patients received total arch replacement with selective cerebral perfusion and deep hypothermic circulatory arrest. One patient with occlusion of the left carotid artery died of postoperative stroke. There were no postoperative complications or deaths related to axillary artery perfusion except for cerebrovascular accidents. Perfusion through the axillary artery, providing antegrade aortic flow, is a safe and effective procedure to avoid stroke owing to retrograde arterial perfusion. We believe that the axillary artery could be an alternative to conventional femoral artery cannulation in the setting of aortic arch operations. 　Jpn. J. Cardiovasc. Surg. 31：266-268(2002)

Combined Monitoring of rSO2 and SSEP during Cardiopulmonary Bypass and Postoperative Changes in Plasma Levels of S-100β: Is Diagnostic Sensitivity for Detecting Brain Damage Improved?

Hiroshi Ohtake Atsuyoshi Oki Yoshiharu Okada Masahiro Aiba Tadanori Kawada Toshihiro Takaba (First Department of Surgery, Showa University School of Medicine, Tokyo, Japan)

Combined monitoring of rSO2 and SSEP is routinely performed during cardiopulmonary bypass（CPB), but it is not sensitive enough to detect focal lesions of the brain. Thus, we assessed whether simultaneous measurement of S-100β is able to enhance diagnostic sensitivity or not. Between September 1999 and February 2000, serial measurement of plasma levels of S-100β and SSEP and rSO2 monitoring during CPB were simultaneously performed in 26 consecutive patients（19 men and 7 women). Ages ranged from 46 to 85（mean 67±10years). Neurological complications developed in 5（19.2%). Among those patients, hemiplegia developed in 2, and dementia, temporary convulsion, and deep coma in 1 each. Three of them showed abnormally low rSO2 levels during surgery, but no patient showed abnormal change in SSEP waves after surgery. There was no significant difference in S-100β level 1 h after CPB between patients associated with or without neurological complications （1.98±0.48vs. 1.89±1.65）, however, its level 24 h after CPB remained significantly higher in patients with neurological complications（1.01±1.14vs. 0.22±0.24）. S-100β level 24 h after CPB appears to improve diagnostic sensitivity for detecting such focal brain damage lesions as those in which SSEP or rSO2 are not efficient enough to make a diagnosis. However, further study is required to evaluate how fast it can differentiate patients with and without brain damage. 　Jpn. J. Cardiovasc. Surg. 31：269-273 (2002)

A Case of Bilateral Ureteral Stenosis due to Inflammatory Common Iliac Artery Aneurysms

Yasuhisa Fukada Yoshiro Matsui Tatsuzo Tanabe Keishu Yasuda* (Department of Cardiovascular Surgery, Nippon Telegraph and Telephone East Corporation Sapporo Hospital, Sapporo, Japan and Department of Cardiovascular Surgery, Hokkaido University*, Sapporo, Japan)

A 71-year-old man was admitted complaining of abdominal pain. Contrast enhanced CT scan showed bilateral inflammatory common iliac artery aneurysms and encasement of bilateral ureters with perianeurysmal fibrosis. Drip infusion pyelography（DIP）showed bilateral hydronephrosis. After insertion of ureteral stents, Y-graft replacement and bilateral ureterolysis were performed successfully in spite of adhesion of the ureters to the aneurysmal wall. Postoperative DIP showed good passage in ureters and improvement of hydronephrosis. We would like to emphasize the usefulness of preoperative ureteral stenting for identification and mobilization of ureters. 　Jpn. J. Cardiovasc. Surg. 31: 274-277 (2002)

One-Staged Operation for Stanford Type A Aortic Dissection, AAE, Mitral Valve Regurgitation and Pectus Excavatum in a Patient with Marfan's Syndrome

Chiho Tokunaga Tomoaki Jikuya* Wahei Mihara Jun Seita Kazuhiro Naito Yasushi Terada* Toshio Mitsui* (Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Japan)

A 22-year-old man was hospitalized due to severe back pain having being diagnosed as Stanford type A aortic dissection, AAE, mitral regurgitation and pectus excavatum associated with Marfan's syndrome. A single staged operation including ascending aortic replacement, mitral valve replacement and sternal turnover with a rectus muscle pedicle was carried out in order to keep the blood supply to the plastron to reduce the risk of infection during such a long operation. By this approach, it was found that the operative field was excellent and postoperative hemodynamics were stable. However, frail plastron occurred because of difficulties in keeping the patient stabilized because of severe pain thus re-fixation was required. The necessity of strong pain control after such an operation was also recognized.　 　Jpn. J. Cardiovasc. Surg. 31：278-281 (2002)

A Case of Marfan's Syndrome with Repeated Occurrence of Acute Aortic Dissection during Treatment

Shun-ichiro Sakamoto Masami Ochi Naoko Okubo Yosuke Ishii Ryuzo Bessho Shigeo Tanaka (Department of Surgery II, Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan)

A 26-year-old man with Marfan's syndrome suffered aortic dissection repeatedly during hospitalization. He was admitted with a diagnosis of annuloaortic ectasia with severe aortic regurgitation. A type A aortic dissection occurred after diagnostic angiography. Three weeks after the onset of the dissection, an aortic root replacement in combination with a total arch replacement was performed. Eight months later, residual dissection in the descending thoracic aorta was replaced with distal perfusion by a temporary bypass from the left subclavian artery to the descending thoracic aorta. At the termination of the operation, abdominal aortic dissection occurred with acute bilateral limb ischemia, which was treated with abdominal aortic intimal fenestration. He recovered uneventfully and was discharged 3 weeks after operation. In light of our experience, because of vascular fragility, great care should be taken in treating patients with Marfan's syndrome to avoid iatrogenic aortic dissection.　 　Jpn. J. Cardiovasc. Surg. 31：282-284 (2002)

A Case of Traumatic Popliteal Arteriovenous Fistula Resulting in a Giant Iliac Venous Aneurysm

　　　　　　　　 　　　　　　　　 　　　　　　　 　　　　　　　　 　　　　　　　　

Masato Yoshikawa	Yuji Miyamoto	Masataka Mitsuno
Masao Yoshitatsu	Kenji Onishi

(Department of Cardiovascular Surgery, Sakurabashi-Watanabe Hospital, Osaka, Japan)

A 70-year-old woman presented with extending varicose veins of her left lower extremity. Seventeen years previously she suffered a stab wound in her left lower extremity. She had a thrill in her left groin and a pulsatile mass in her lower abdomen on the left side. Venography showed ‘to and fro' sign in her popliteal vein. Arteriography and computed tomography (CT) scan revealed left popliteal arteriovenous fistula and dilated femoral artery and vein, in addition to a giant iliac venous aneurysm (9cm in diameter). The shunt ratio was calculated at 3.4. We separated the fistula using ringed ePTFE grafts. After the operation, her varicose veins remarkably diminished. CT scans showed that the iliac venous aneurysm diminished to 3.6cm with no internal thrombus at three weeks after the operation. Cases of traumatic arteriovenous fistula with venous aneurysm that occurred in parts other than the fistula are rare and there are only two cases in the international literature.　
　Jpn. J. Cardiovasc. Surg. 31：285-287 (2002)

Aortic Root Replacement for Annuloaortic Ectasia in Ehlers-Danlos Syndrome

Hiroshi Kumano Akimitsu Yamaguchi Tatsuya Kiji* Hiroyuki Maruhashi Satoshi Kato （Department of Cardiovascular Surgery, Ishinkai Yao General Hospital, Osaka, Japan and Department of Surgery III, Nara Medical College*, Nara, Japan)

A 33-year-old woman underwent aortic root replacement for aortic regurgitation and an aneurysm of the ascending aorta due to annuloaortic ectasia. Ehlers-Danlos syndrome was diagnosed by skin biopsy when she was 23 years old. At operation, to avoid mechanical stress to the residual aorta, cardiopulmonary bypass was established via cannulation of the left femoral artery and we used the open distal anastomosis method under hypothermic circulatory arrest with selective cerebral perfusion. Moreover, the sutures of the aortic annulus were reinforced sewing the aortic wall together. Her postoperative course was uneventful. Despite the fragility of the cardiovascular tissues in Ehlers-Danlos syndrome, cardiac surgery could be performed safely with appropriate surgical procedures.　 　Jpn. J. Cardiovasc. Surg. 31：288-291 (2002)

A Case of Mediastinitis and Anastomotic Pseudoaneurysm after Replacement of the Ascending Aorta and Aortic Arch for Acute Type A Dissection

Toshihiko Sakao Nobuo Tsunooka* Hiromichi Nakagawa Yasuaki Kashuu (Department of Cardiovascular Surgery, Uwajima Municipal Hospital, Uwajima Japan and Department of Surgery II, Ehime University School of Medicine*, Ehime, Japan)

A 38-year-old man underwent replacement of the ascending aorta and aortic arch for acute type A dissection. On the 11th postoperative day he developed mediastinitis. Omental transposition was performed successfully. The patient was readmitted for bloody discharge from the wound. He suffered from back pain suddenly. Computed tomography and aortography revealed an anastomotic pseudoaneurysm of the ascending aorta. Emergency reoperation to replace the ascending aorta with a new prosthesis was performed. The postoperative course was uneventful.　 　Jpn. J. Cardiovasc. Surg. 31：292-295 (2002)

Off-Pump CABG and Ligation for Coronary Artery Pseudoaneurysm Occurring during the Chronic Post-PTCA Period

Keiji Oi Toshiyuki Maruyama （Department of Surgery, Cardiovascular Center, Yokosuka Kyosai General Hospital, Yokosuka, Japan)

Pseudoaneurysm after the rupture of a coronary artery is a rare complication of percutaneous transluminal coronary angioplasty（PTCA). We report a pseudoaneurysm of the left anterior descending artery（LAD）occurring 3 months post-PTCA, that was successfully treated by off-pump coronary artery bypass grafting（CABG）and ligation. An 84-year-old man underwent urgent PTCA for unstable angina. The LAD ruptured during this procedure, but bail-out was successfully performed by balloon catheter inflation. The patient left the hospital symptom-free. Three months later, he was rehospitalized complaining of angina. Coronary angiography revealed a 10-mm diameter pseudoaneurysm at the site of the LAD rupture as well as restenosis of the LAD and high lateral branch at the previous PTCA sites. Surgical treatment was indicated because of the difficulty in delivering a covered stent within the diffusely stenosed LAD. CABG to the distal LAD with the left internal mammary artery and ligation of the LAD pseudoaneurysm were performed. To reduce perioperative morbidity, CABG was performed without cardiopulmonary bypass. The postoperative course was uneventful, and follow-up angiography revealed a patent graft and no pseudoaneurysm. The patient has continued comfortably for 18 months postoperatively. Because off-pump CABG is less invasive than conventional surgery techniques, we believe it to be a valid option during coronary pseudoaneurysm ligation.　 　Jpn. J. Cardiovasc. Surg. 31: 296-299 (2002)

Successful Replacement of the Aortic Valve and Aortic Arch Using a Freestyle Valve for Postoperative Aortic Regurgitation after Reconstruction of Acute Aortic Dissection

Asatoshi Mizuno	Shigeki Horikoshi	Fumie Saitoh
Motohiro Oshiumi

(Department of Cardiovascular Surgery, Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Japan)

A 61-year-old man had undergone reconstruction of the ascending aorta for acute aortic dissection（DeBakey type I). He had aortic valve regurgitation at 10 months, and cardiac failure at 18 months respectively after his previous operation. Cardiac failure can progress relatively fast in cases of postoperative aortic regurgitation due to redissection, so early surgical intervention should be considered. In this case, redissection of the aortic root at the site of non-coronary sinus was noted intraoperatively, and intraoperative findings suggested necrosis of the aortic wall related to the use of GRF glue. The aortic root replacement using a Freestyle valve was performed, which was followed by arch replacement. The Freestyle valve provided good haemodynamic function and low thrombogenicity. The use of this valve in this case which had residual dissection of the descending aorta might be useful because of the excellent haemodynamic function without anticoagulant therapy and long-term durability.
　Jpn. J. Cardiovasc. Surg. 31: 300-303 (2002)

A Successfully Treated Case of Abdominal Aortic and Iliac Aneurysms Associated with Iliac Arteriovenous Fistula

　　　　　　　

Makoto Funami	Takashi Narisawa	Shigeaki Sekiguchi
Hiroyuki Tanaka	Makoto Yamada	Tadanori Kawada
Toshihiro Takaba

(First Department of Surgery, School of Medicine, Showa University, Tokyo, Japan)

A 72-year-old man suffering from congestive heart failure, swelling of the lower limbs and hematuria was transferred from another hospital with a diagnosis of large aneurysms of the abdominal aorta and the left common iliac artery. Iliac arteriovenous fistula (AVF) was definitively diagnosed preoperatively by contrast-enhanced CT and angiogaphy. At operation, an infrarenal abdominal aortic aneurysm of 8cm and left iliac arterial aneurysm of 12cm were identified. After proximal and distal aortic clamping, the aneurysm was entered and an AVF orifice of 1cm communicating with the left common iliac vein was disclosed at the right posterior wall of the left common iliac artery. Venous blood reflux was controlled by inserting an occlusive balloon catheter to the fistula and intraoperative shed blood was aspirated and returned by an autotransfusion system. The AVF was closed from inside the iliac aneurysm by three interrupted 3-0 monofilament mattress sutures with pledgets. The aneurysms were resected and replaced with a bifurcated Dacron prosthetic graft. The patient had an uncomplicated postoperative recovery; the lower limb edema subsided and heart failure improved rapidly. Preoperative identification of the location of the AVF is mandatory to make surgery safe. Moreover, easy availability or routine use of the devices for controlling undue blood loss such as an autotransfusion system and an occlusive balloon catheter are other important supplementary means to obtain good results of surgical treatment.
　Jpn. J. Cardiovasc. Surg. 31: 304-307 (2002)

A Case of Aortitis Syndrome with Annuloaortic Ectasia and Aortic Regurgitation Which Was Successfully Treated by Aortic Root Replacement with Freestyle Stentless Bioprosthesis

　　　　　　　

Haisong Wu	Masaaki Toyama	Tomohiro Mizuno*
Susumu Manabe	Tomoya Yoshizaki

(Department of Cardiovascular Surgery, Kameda Medical Center, Kamogawa, Japan and Department of Cardiovascular Surgery, Graduate School of Medicine, Tokyo Medical and Dental University*, Tokyo, Japan)

A 34-year-old woman who was suffering from aortitis syndrome with annuloaortic ectasia (AAE) and severe aortic regurgitation (AR) from 18 years of age was admitted for an aortic root replacement. She has been on 5mg predonine daily. Aortography, CT and echocardiography examinations revealed dilated aortic annulus（D＝30mm）and valsalva sinuses（D＝43mm）and overstretched aortic valve leaflets. The ascending aorta was aneurysmal (D=50mm). Because of the patient's strong desire to have children, a Freestyle bioprosthesis was chosen for replacement. A collagen impregnated tube graft was interposed between the Freestyle and the proximal end of the transverse aorta. In order to reconstruct the coronary arteries, the Cabrol technique was utilized because of severe inflammatory adhesion of the aortic root. The patient had an uneventful postoperative course. This case shows that an aortic root replacement with Freestyle bioprosthesis offers a great benefit to those patients who are not suitable to receive postoperative anti-coagulation therapy to enable future pregnancy and child delivery.
　Jpn. J. Cardiovasc. Surg. 31：308-310 (2002)

A Case of Descending Graft Replacement of the Anastomotic Aneurysm Using Simple Hypothermic Retrograde Cerebral Circulation 9 Years after Surgery of the Distal Aortic Arch

　　　　　　　

Akihiko Sasaki	Junichi Sakata	Hiroki Satou
Teruhisa Kazui*

(Department of Cardiovascular Surgery, Sunagawa Medical Center, Sunagawa, Japan and Department of Surgery I, Hamamatsu Medical College*, Hamamatsu, Japan)

Anastomotic aneurysm was diagnosed in a 77-year-old man following graft replacement of the distal aortic arch aneurysm using the inclusion method in 1991. Enhanced CT demonstrated the aneurysm of the distal anastomotic site with a maximum diameter of 5cm between the graft and the aneurysmal wall. On left thoracotomy the aneurysm was found to severely adhere to the lung, so it was difficult to dissect its adhesion and clamp the proximal aorta. The rectal temperature was cooled to 18°C with the aid of femoro-femoral bypass. We anastomosed the previous graft-end to the new graft with one side branch during simple hypothermic retrograde cerebral circulation (RCC). RCC time was 16min and the distal end was anastomosed to the descending thoracic aorta. Though it took a long time to undertake systemic cooling and rewarming, intraoperative bleeding was small and the postoperative course was satisfactory without cerebral complication.
　Jpn. J. Cardiovasc. Surg.31：311-313 (2002)

A Case of Abdominal Aortic Aneurysm Associated with Horseshoe Kidney

　　　　　　　

Junichi Murayama

Masaru Yoshikai

Keiji Kamohara

(Cardiovascular Surgery, Shin Koga Hospital, Kurume, Japan)

A 69-year-old man developed abdominal aortic aneurysm (AAA) during treatment for chronic renal failure at another hospital. On admission, CT revealed infrarenal AAA associated with horseshoe kidney. The aneurysm was exposed through a transperitoneal approach, and aorto-iliac reconstruction was performed preserving the renal isthmus. Two accessory renal arteries were reconstructed. Postoperatively, both reconstructed arteries were patent on angiography, and postoperative renal function was not impaired. In surgery for AAA with horseshoe kidney, preservation or reconstruction of renal feeding arteries is important to maintain renal function.
　Jpn. J. Cardiovasc. Surg. 31: 314-316 (2002)

A Case of Successful Surgical Repair of Ventricular Septal Perforation Following Acute Myocardial Infarction in an 88-Year-Old Woman

　　　　　　　

Yasuhiro Furutani

Nobuo Sakagoshi

(Department of Cardiovascular Surgery, Kawachi General Hospital, Osaka, Japan)

We report on an 88-year-old woman who underwent successful repair of ventricular septal perforation (VSP) following acute myocardial infarction. She was admitted as an emergency case to our hospital with acute myocardial infarction. Color Doppler echocardiogram revealed anterior VSP. Right heart catheterization was conducted under intraaortic balloon pumping and showed a Q_P/Q_S of 3.0. She also had acute renal failure for which continuous hemodialysis and filtration was started. In spite of intensive medical therapy, her hemodynamic condition was gradually worsened. An emergency operation was performed on the 6th day after the onset. A single porcine pericardial patch was sutured on the left side of the septum around the perforation and the left ventricular free wall was closed including the patch with two felt strips. She suffered from various complications through the postoperative course. However, she recovered and was discharged on the 77th postoperative day. She was, to the best of our knowledge, the oldest among the reported cases of successful surgical repair of VSP in Japan.
　Jpn. J. Cardiovasc. Surg. 31：317-319 (2002)