Japanese Journal of Cardiovascular Surgery Vol.39, No.1

Review

Originals

  • Left Thoracotomy, Deep Hypothermia and Total Body Retrograde Perfusion for Descending Thoracic Aortic Disease K. Horiuchi et al.……9
    Left Thoracotomy, Deep Hypothermia and Total Body Retrograde Perfusion for Descending Thoracic Aortic Disease―A Ten-Year Experience

    （Division of Cardiovascular Surgery, Okazaki City Hospital, Okazaki, Japan）

    Kazutaka Horiuchi Kenzo Yasuura Takashi Terada
    Nobuhiko Hiraiwa Takeshi Yuasa Masahiko Hasegawa
    Since 1998, as a method of operating on descending thoracic aortic disease, especially distal aortic disease, a simple circulatory support technique, which uses the axillary artery or the ascending aorta as the aortic inflow, and the inferior vena cava for total body retrograde perfusion of cold oxygenated blood during circulatory arrest for open proximal anastomosis has been applied. This technique has been used in 25 consecutive cases over 10 years. In this report, we evaluate the efficacy of this support technique. From our experience, an atherosclerotic lesion in the ascending aorta required selection of the femoral artery as an aortic inflow site in 7 patients. Prolonged ventilatory support was unnecessary postoperatively unless neurological sequelae supervened, and no heart or visceral organ complications were occurred recognized. The hospital mortality rate was 16%. These results suggest our technique will continue to play an important role in operations on descending thoracic aortic diseases.
      Jpn. J. Cardiovasc. Surg. 39:9-13（2010）

    Keywords：thoracic aortic surgery, left thoracotomy, deep hypothermia, total body retrograde perfusion

Case Reports

  • Penetrating Aortic Root Injury T. Tokuda et al.……14
    Penetrating Aortic Root Injury

    （Department of Radiology, Kansai Medical University, Hirakata, Japan, and Division of Cardiovascular Surgery, Ishikiriseiki Hospital, Higashiosaka, Japan）

    Takanori Tokuda Noboru Tanigawa Hirofumi Fujii*
    Motohiko Osako* Takeshi Ikuta* Satoshi Sawada
    The patient was a 25-year-old man, who had been stabbed with a weapon siarilar to long ice pick. Thirty minutes later, he was admitted to our emergency center by ambulance. Anchocardiogram on admission revealed moderate pericardial effusion with normal heart function. Contrast medium enhanced computed tomography revealed that the weapon had entered from the left anterolateral chest wall and reached the posterior wall of the aortic root, approximately 1cm above the left coronary artery orifice, through the left lung. During examinations, he suddenly went into shock and emergency open pericardial drainage was performed immediately. Approximately 400ml of blood with a clot was removed from the pericardial cavity. After this procedure, there was no continuous bleeding. Subsequently, pseudoaneurysm developed at the aortic root injury site. Twenty seven days later, aortic surgery was performed. The injury site was resected and sutured directly, employing 4-0 polypropylene sutures with felt pledgets. He was discharged 14days after the operation without any complications.
      Jpn. J. Cardiovasc. Surg. 39:14-16（2010）

    Keywords：traumatic aortic injury, traumatic ascending aortic injury, cardiac tamponade, pericardial drainage, stab wound
  • A Case of Heparin-Induced Thrombocytopenia（HIT）with Postoperative Cerebral Infarction Following Surgical Repair of Acute Type A Aortic Dissection A. Morishima et al.……17
    A Case of Heparin-Induced Thrombocytopenia（HIT）with Postoperative Cerebral Infarction Following Surgical Repair of Acute Type A Aortic Dissection

    （Department of Cardiovascular Surgery, Nara Hospital Kinki University School of Medicine, Ikoma, Japan）

    Atsutomo Morishima Kouzou Kaneda Yuichi Yoshida
    Daisuke Heima Shingo Hirao Shigeo Nagasaka
    Shinya Yokoyama Noboru Nishiwaki
    A 61-year-old man with consciousness disorder was transferred to our hospital. Computed tomography found acute type A aortic dissection and cardiac tamponade, and an emergency operation was performed. Operation findings indicated dissection above the commissure between the left coronary cusp and the right coronary cusp, to the ostium of the right coronary. An ascending aorta replacement and coronary aorta bypass grafting were performed. The postoperative course was good, but he did not regain clear consciousness. Results of magnetic resonance imaging showed multiple cerebral infarctions. At the same time, the platelet count had decreased and we suspected heparin-induced thrombocytopenia（HIT). Following detection of an heparin-dependent antibody, administration of an heparin was discontinued. However, the platelet count still tended to decrease. Therefore, we started continuous administration of argatroban, which resulted in the gradual increase in platelet count to within normal limits on postoperative day 26. The results indicate that in patients continuously and repeatedly treated with heparin, there is a possibility of the development of HIT and thrombosis with HIT.
      Jpn. J. Cardiovasc. Surg. 39:17-20（2010）

    Keywords：acute aortic dissection, cerebral infarction, HIT
  • Two Cases of Surgical Repair of Coronary Artery Fistulas in Children T. Igarashi et al.……21
    Two Cases of Surgical Repair of Coronary Artery Fistulas in Children

    （Department of Cardiovascular Surgery, Fukushima Medical University, Fukushima, Japan）

    Takashi Igarashi Hitoshi Yokoyama Hirono Satokawa
    Hiroki Wakamatsu
    We report two cases of coronary artery fistulas（CAF）in children with successful surgical repair. The first case was a 14-year-old boy with a continuous heart murmur. A fistula was diagnosed between the right coronary artery（RCA）and the right atrium by echocardiography. He was asymptomatic, but the pulmonary to systemic flow ratio was shown to be high by cardiac catheterization. He underwent surgical closure of the fistula and coronary artery bypass grafting to the RCA with the right interthoracic artery. The second case was a 5-year-old boy with a continuous heart murmur and cardiomegaly on the chest X-ray film. The CAF from the left coronary artery to the right atrium was revealed by echocardiography. The pulmonary to systemic flow ratio was shown to be high by cardiac catheterization. He was asymptomatic, but he also underwent surgical closure of CAF. Surgical repair was effective and safe in these cases. Echocardiography was very useful in the diagonosis of CAF. Surgical repair in the young is recommended because CAF is much more likely to cause congestive heart failure, angina, and infective endocarditis when growing.
      Jpn. J. Cardiovasc. Surg. 39:21-24（2010）

    Keywords：coronary artery fistula, coronary artery bypass grafting
  • Successful Endovascular Stent-graft Treatment of a Ruptured Isolated Internal Iliac Artery Aneurysm T. Hachimaru et al.……25
    Successful Endovascular Stent-graft Treatment of a Ruptured Isolated Internal Iliac Artery Aneurysm

    （Department of Cardiovascular Surgery, Tokyo Metropolitan Hiroo General Hospital, Tokyo, Japan）

    Tsuyoshi Hachimaru Masazumi Watanabe Satoru Kawaguchi
    Hideki Nakahara
    A 90-year-old man was referred to our hospital for lower abdominal pain and ecchymotic discoloration around the anus. A laboratory test revealed severe anemia（hemoglobin level, 5.7g/dl), and computed tomography（CT）showed a ruptured left internal iliac artery aneurysm（diameter, 60×44mm). Consequently, emergency endovascular stent-grafting treatment was performed. Under local anesthesia, the stent-graft was successfully inserted in the left common and external iliac arteries, covering the ostia of the internal iliac artery. A follow-up CT scan showed complete thrombosis of the left internal iliac artery aneurysm and no evidence of an endoleak. After the procedure, the patient was treated with hemodialysis for acute-on-chronic renal failure and was discharged after 2 months.
      Jpn. J. Cardiovasc. Surg. 39:25-28（2010）

    Keywords：isolated internal iliac artery aneurysm, ruptured aneurysm, stent-graft
  • Successful Implantations of Autologous Peripheral Blood-Derived Mononuclear Cells Pretreated by Erythropoietin and Blood Donation in a Patient with Buerger Disease and Intractable Finger Ulcers H. Kinoshita et al.……29
    Successful Implantations of Autologous Peripheral Blood-Derived Mononuclear Cells Pretreated by Erythropoietin and Blood Donation in a Patient with Buerger Disease and Intractable Finger Ulcers

    （Department of Cardiovascular Surgery, Department of Cardiovascular Medicine*, and Department of Medicine and Bioregulatory Sciences**, The University of Tokushima Graduate School, Tokushima, Japan）

    Hajime Kinoshita Tamotsu Kanbara Hirotsugu Kurobe
    Tatsuo Motoki Mikio Sugano Homare Yoshida
    Takashi Kitaichi Masataka Sata* Toshio Matsumoto**
    Tetsuya Kitagawa
    A 48-year-old man with Buerger disease and intractable finger ulcers underwent successful transplantation of autologous peripheral blood-derived mononuclear cells pretreated with erythropoietin and blood donation to activate bone marrow function. Clinical symptoms on his finger ulcers improved significantly within 1 month after mononuclear cell transplantation, however, one of the intractable ulcers reappeared 2 months later. In total three transplantations were performed. Every cell transplantation revealed similar effectiveness 1 month later, and the interval of the subsequent disappearance of finger ulcers ranged from 3-6 months. There were no adverse effects based on this new therapy. These findings suggest that autologous peripheral mononuclear cell transplantation pretreated with erythropoietin and blood donation might be a non-invasive and safe alternatives for patients with Buerger disease and intractable finger ulcers.
      Jpn. J. Cardiovasc. Surg. 39:29-33（2010）

    Keywords：Buerger disease, peripheral blood-derived, mononuclear cell transplantation, intractable ulcer, CD34-positive cell
  • Infectious Endocarditis due to Streptococcus bovis with Colon Cancer A. Yokota et al.……34
    Infectious Endocarditis due to Streptococcus bovis with Colon Cancer

    （Department of Surgery II, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan）

    Atsuko Yokota Mitsuhiro Yano Hiroyuki Nagahama
    Masakazu Matsuyama Koji Furukawa Masanori Nishimura
    Toshio Onitsuka
    Infectious endocarditis associated with Streptococcus bovis, which is rare in Japan, is a frequently reported complication of gastrointestinal tumors, especially in colon cancer. We report a patient who was successfully treated for the S. bovis-induced infectious endocarditis complication in colon cancer. A 60-year-old man was admitted to our hospital for detailed examination of high fever of unknown origin, that had lasted for 2 months. S. bovis was identified in the venous blood culture. An echocardiogram showed severe aortic valve regurgitation of the third degree and vegetation on the aortic valve. We therefore diagnosed infectious endocarditis. Colonoscopy revealed sigmoid colon cancer. After endoscopic mucosal resection of the lesion, the aortic valve was replaced. The postoperative course was uneventful and he was discharged from the hospital 36 days post operatively.
      Jpn. J. Cardiovasc. Surg. 39:34-36（2010）

    Keywords：Streptococcus bovis, infectious endocarditis, colon cancer
  • A Case of Infectious Anastomotic Aneurysm after Operation for Abdominal Aortic Aneurysm Associated with Post-Re-operative Paraplegia S. Choh and S. Tsukamoto……37
    A Case of Infectious Anastomotic Aneurysm after Operation for Abdominal Aortic Aneurysm Associated with Post-Re-operative Paraplegia

    （Department of Cardiovascular Surgery, National Hospital Organization Disaster Medical Center, Tachikawa, Japan）

    Shinsuke Choh Saeki Tsukamoto
    We encountered a case of an infectious anastomotic aneurysm after surgery, of an abdominal aortic aneurysm associated with postoperative paraplegia. A 63-year-old woman underwent a first operation for an impending ruptured abdominal aortic aneurysm, and was discharged. Six months later, re-operation was performed because of an anastomotic aneurysm. An anti-anatomical bypass was also performed due to finding pus near the graft. She then developed paraplegia. Spinal cord damage is a very rare complication in surgery for an abdominal aortic aneurysm. The prevention of spinal cord damage is necessary in the reconstruction of arteries such as the internal iliac artery or inferior mesenteric artery. We feel that it is important for prevention of spinal cord damage, to do a bypass operation to reduce the period of arterial ischemia from the collaterals.
      Jpn. J. Cardiovasc. Surg. 39:37-40（2010）

    Keywords：infectious anastomotic aneurysm, abdominal aortic aneurysm, paraplegia, Adamkiewicz artery, post-operative complications
  • Reoperation for Stanford B Aortic Dissection with Open Stent Grafting K. Tamura et al.……41
    Reoperation for Stanford B Aortic Dissection with Open Stent Grafting

    （Department of Cardiovascular Surgery, Hiroshima City Asa Hospital, Hiroshima, Japan）

    Kentaro Tamura Naomichi Uchida Akira Katayama
    Miwa Sutoh Naoki Murao Masatsugu Kuraoka
    A 65-year-old man had received closure of the entry and false lumen Stanford type B acute aortic dissection via left thoratectomy 23 years previously. The patient underwent emergency graft replacement for a ruptured aneurysm of the thoraco-abdominal aorta 10 years previously. Enhanced computed tomography（ECT）revealed that the residual aortic dissection of the distal arch and the descending aorta were dilated. Reoperation via left thoracotomy usually requires a long cardiopulmonary bypass time and intraoperative bleeding. So we selected to perform open stent-grafting through median sternotomy alone, avoiding a left thoracotomy.
      Jpn. J. Cardiovasc. Surg. 39:41-44（2010）

    Keywords：open stent, aortic dissection
  • A Case of Spontaneous Rupture of the Ascending Aorta N. Kashiyama et al.……45
    A Case of Spontaneous Rupture of the Ascending Aorta

    （Department of Cardiovascular Surgery, Rinku General Medical Center, Izumisano Municipal Hospital, Izumisano, Japan）

    Noriyuki Kashiyama Yasuhiko Kubota Dairoku Nishikawa
    Hironori Izutani
    The patient was a 69-year-old man brought to the emergency room with severe chest pain. A contrast chest CT scan revealed a hematoma around the ascending aorta and a notch in the aortic wall, suggesting an intimal tear. An emergency operation was performed via standard median sternotomy under deep hypothermic circulatory arrest. Upon operation, there was a 2.0cm intimal tear just above the right coronary leaflet, which was extended near the right coronary artery orifice. There was no specific evidence of aortic aneurysm or dissection, therefore a spontaneous rupture of the ascending aorta was diagnosed. The pathological finding was cystic medial necrosis Grade 2. His postoperative course was unremarkable and he was discharged 12 days after surgery.
      Jpn. J. Cardiovasc. Surg. 39:45-48（2010）

    Keywords：spontaneous rupture of aorta, acute aortic dissection