Japanese Journal of Cardiovascular Surgery Vol.40, No.3

Preface

  • S. Takamoto

Originals

  • The Hemodynamic Performance of Carpentier-Edwards PERIMOUNT Magna for Aortic Valve Stenosis D. Takahashi et al.……81
    The Hemodynamic Performance of Carpentier-Edwards PERIMOUNT Magna for Aortic Valve Stenosis

    （Department of Cardiovascular Surgery, Shizuoka City Hospital, Shizuoka, Japan）

    Daisuke Takahashi Mitsuomi Shimamoto Fumio Yamazaki
    Masanao Nakai Yujiro Miura Tatsuya Itonaga
    Tatsuji Okada Ryota Nomura Noriyuki Abe
    Yasuhiko Terai
    This study compared the hemodynamic performance of the Carpentier-Edwards PERIMOUNT Magna bioprosthesis（Magna）with the Carpentier-Edwards PERIMOUNT bioprosthesis（CEP）for aortic valve stenosis（AS). Between January 2005 and May 2010, 164 patients underwent aortic valve replacement for AS with either the Magna（n＝68）or the CEP（n＝96）at our institute. Patients undergoing a concomitant mitral valve procedure were excluded from this study. The 21-mm Magna and CEP prostheses were the most frequently used during this period. Transthoracic echocardiography was postoperatively performed within 2 weeks. The peak velocity（PV）of the Magna was significantly lower than that of the CEP（2.59±0.36 vs. 2.75±0.47m/s;p＝0.022). The mean pressure gradient（PG）was not significantly different. For the 19-mm prostheses, the mean PG and PV of the Magna were significantly lower than those of the CEP［16.4±4.5 vs. 19.7±6.4mmHg;p＝0.034（PG）and 2.70±0.36 vs. 3.03±0.49m/s;p＝0.008（PV）]. The effective orifice area（EOA）of the Magna was larger than that of the CEP［19mm:1.29±0.18 vs. 1.11±0.24cm2（p＝0.007）；21mm:1.46±0.23 vs. 1.42±0.18cm2（p＝0.370）;and 23mm:1.70±0.34 vs. 1.52±0.25cm2（p＝0.134）]. In this study, the EOA of the Magna was approximately 80% of that described in the manufacture’s description. Patient-prosthesis mismatch（PPM;EOA index≤0.85cm2/m2）was seen in 26.8% of patients with the Magna and in 47.2% of patients with the CEP（p＝0.018). Severe PPM（EOA index≤0.65cm2/m2）was not seen in any patients with the Magna. The EOA of the 19-mm Magna was significantly larger and the mean PG was lower than those of the 19-mm CEP. Compared with the CEP, the Magna significantly reduced the incidence of PPM, and had superior hemodynamic performance.
      Jpn. J. Cardiovasc. Surg. 40:81-85（2011）

    Keywords：aortic valve replacement, bioprosthesis, patient-prosthesis mismatch, effective orifice area, aortic valve stenosis
  • Treatment for Ischemic Heart Disease as a Comorbidity of Leriche Syndrome M. Shiraishi et al.……86
    Treatment for Ischemic Heart Disease as a Comorbidity of Leriche Syndrome

    （Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical School, Saitama, Japan）

    Manabu Shiraishi Atsushi Yamaguchi Koichi Yuri
    Kazunari Nemoto Kazuhiro Naito Kenichiro Noguchi
    Hideo Adachi
    The aim of this study was to clarify the comorbidities of patients with Leriche syndrome and ischemic heart disease. We enrolled 26 patients with Leriche syndrome and who had undergone preoperative coronary angiography were enrolled. The comorbidities of diabetes, hypertension, and coronary artery disease developed in more than half of Leriche patients with Leriche syndrome. Marked coronary artery disease was diagnosed in 14 patients, 7 of whom underwent coronary artery bypass surgery. The Revascularization procedures performed in patients with Leriche syndrome were anatomical aortofemoral bypass in 15 and an extra-anatomical axillofemoral bypass in 9. In 2 cases of extra-anatomical bypass, occlusion developed in the long-term.
      Jpn. J. Cardiovasc. Surg. 40:86-88（2011）

    Keywords：Leriche syndrome, arteriosclerosis obliterans, coronary artery bypass grafting
  • Endovascular Therapy for Aortic Emergency A. Aoki et al.……89
    Endovascular Therapy for Aortic Emergency

    （Department of Cardiovascular Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Japan, and Department of Cardiovascular Surgery, Matsuyama Municipal Hospital*, Matsuyama, Japan）

    Atsushi Aoki Takanori Suezawa Kenji Sangawa
    Mamoru Tago
    Aortic emergencies are surgically challenging and the mortality rate remains high. Since December 2003, we have performed endovascular treatment with a stent graft（EVT）in 15 cases of aortic emergency, including 8 cases of aortic rupture or traumatic aortic disruption, 1 case of traumatic iliac artery disruption, 3 cases of aortobronchial fistula（ABF), and 3 cases of aortoenteric fistula（AEF). In 9 cases of aortic rupture and traumatic aortic or iliac disruption, 1 patient died due to traumatic cerebral hemorrhage, but the remaining 8 patients were discharged without complications. While hemoptysis was resolved in all 3 patients with ABF, 1 patient with primary ABF died due to pneumonia, and 1 patient with secondary ABF died due to multiple organ failure. Furthermore, 1 patient with primary AEF progressed well without any evidence of postprocedural stent graft infection. In 2 patients with secondary AEF, both required secondary surgical graft excision, and 1 of these died due to the recurrence of infection. EVT has shown good results in hemostasis for aortic emergency. However, if a source of infection persists, secondary surgical intervention is required in some cases. Commercially available endovascular stent graft make it possible to treat tortuous segments of the thoracic aorta and the abdominal aorta, therefore we expect there to be more patients with aortic emergencies who require EVT.
      Jpn. J. Cardiovasc. Surg. 40:89-93（2011）

    Keywords：aortic emergency, stent graft, acute aortic dissection, ruptured aortic aneurysm, blunt injury of the aorta

Case Reports

  • Successful Repair of a Traumatic Aortic Isthmus Pseudoaneurysm Concomitant with Right Diaphragmatic Hernia T. Nakayama et al.……94
    Successful Repair of a Traumatic Aortic Isthmus Pseudoaneurysm Concomitant with Right Diaphragmatic Hernia

    （Division of Cardiovascular Surgery*, Division of Thoracic Surgery I**, Ehime Prefectural Central Hospital, Matsuyama, Japan, and Department of Cardiovascular Surgery, University of Tokushima Graduate School***, Tokushima, Japan）

    Taisuke Nakayama*,*** Masashi Kano* Shingo Isshiki*
    Takashi Tominaga* Hiroshi Ishitoya* Katsuhiko Hiratani*
    Takahiro Sawada** Hirotsugu Kurobe*** Tetsuya Kitagawa***
    Takaki Hori*
    A 24-year-old woman underwent successful repair of a traumatic pseudoaneurysm of the aortic isthmus concomitant with right diaphragmatic hernia which developed after a traffic accident, and the steering wheel of the crashed car was considered responsible for both lesions. Due to the right diaphragmatic hernia, she could breathe mainly with the left lung only. The aortic isthmus aneurysm was considered to be a pseudoaneurysm, and because of the potential risk of rupture, we performed urgent aortic surgery. Prior to a left thoracotomy, we anastomosed an 8-mm prosthetic graft to the right axillary artery. When the left lung was collapsed in order to perform a femoro-femoral bypass, the SpO2 level of her right index finger and her cerebral rSO2 markedly decreased. Therefore, we administered additional perfusion via the right axillary artery, which provided sufficient oxygen to the upper body and brain. The patient underwent Marlex mesh reinforcement of the right diaphragmatic hernia 30 days after grafting, and is doing well 1 year postoperatively.
      Jpn. J. Cardiovasc. Surg. 40:94-97（2011）

    Keywords：traumatic aortic isthmus aneurysm, diaphragmatic hernia, separated pulmonary ventilation
  • Invited Commentary N. Shiiya et al.……98
  • A Case of Tricuspid Valve Repair with Artificial Chordae after Resection of Tricuspid Valve Myxoma A. Shibamoto et al.……100
    A Case of Tricuspid Valve Repair with Artificial Chordae after Resection of Tricuspid Valve Myxoma

    （Department of Cardiovascular Surgery, Osaka Police Hospital, Osaka, Japan）

    Ai Shibamoto Masayuki Sakaki Hiroshi Yamada
    Katsukiyo Kitabayashi Takuji Kawamura Kanta Araki
    Shigeaki Ohtake
    A 76-year-old-woman, who had undergone endoscopic resection of a gastric polyp 2 years previously, had a cardiac tumor incidentaly pointed out on an abdominal ultrasonographic image. Echocardiography showed a solid round mass（34×25mm in diameter), attached by a short stalk and which was floating on the right ventricular outflow tract and prolapsing over the pulmonary valve during systole. We suspected right ventricular myxoma. Urgent surgery was performed under cardiopulmonary bypass. After aortic clamping, the trunk of the pulmonary artery was opened near the right ventricule. The tumor was found under the pulmonary valve, attached to the anterior papillary muscle and chordae of the tricuspid valve. The tumor was completely excised with a piece of the papillary muscle and chordae. After right atriotomy, mild tricuspid regurgitation was seen on a water test. After we performed tricuspid annuloplasty and chordplasty with artificial chordae, a second water test did not show any tricuspid regurgitation. The postoperative course was uneventful, and she was discharged on the 13th postoperative day.
      Jpn. J. Cardiovasc. Surg. 40:100-103（2011）

    Keywords：right ventricular myxoma, tricuspid valve myxoma, tricuspid valve repair
  • A Simultaneous Operation for Abdominal Aneurysm Concomitant with a Very Large Ovarian Cyst H. Mori et al.……104
    A Simultaneous Operation for Abdominal Aneurysm Concomitant with a Very Large Ovarian Cyst

    （Department of Cardiovascular Surgery, Maebashi Red Cross Hospital, Maebashi, Japan）

    Hideaki Mori Masayuki Shibata
    A 77-year-old woman with a medical history of myocardial infarction had a medical check-up at a local clinic. She reported sensation of abdominal distension which had appeared 6months previously. Computed tomography demonstrated a very large ovarian tumor concomitant with an abdominal aortic aneurysm with a maximum diameter of 68mm, and she was referred to our hospital. We performed a simultaneous extirpation of the ovarian tumor and abdominal aneurysm prosthetic graft replacement. The patient was discharged 13days postoperatively after an uneventful postoperative course. The histopathological diagnosis of the ovarian tumor was mucinous cystadenoma. We reviewed the surgical procedures for similar cases of concomitant disease, and found that reports of surgical cases of simultaneous huge ovarian tumor extirpation and abdominal aneurysm prosthetic graft replacement are rare.
      Jpn. J. Cardiovasc. Surg. 40:104-107（2011）

    Keywords：abdominal aortic aneurysm, ovarian tumor, simultaneous operation
  • An Operative Case of Papillary Fibroelastoma of the Aortic Valve Y. Kise et al.……108
    An Operative Case of Papillary Fibroelastoma of the Aortic Valve

    （Department of Thoracic and Cardiovascular Surgery, and Department of Pathology and Cell Biology*, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan）

    Yuya Kise Chisato Kamiya Ryoko Arakaki
    Tatsuya Maeda Yuji Morishima Katsuya Arakaki
    Satoshi Yamashiro Yukio Kuniyoshi Kazunari Arakaki*
    Seiya Kato*
    An echocardiogram revealed a mobile mass attached to the left coronary cusp of the aortic valve in an 81-year-old woman. The tumor was surgically removed without valve replacement. The tumor was whitish in color, with a sea anemone-like appearance, and it measured 10 mm in maximum dimension. It was histopathologically defined as papillary fibroelastoma（PFE), and the postoperative course was uneventful. Primary cardiac tumors are rare, and the majority are myxomas. However recent advances in noninvasive examination and surgery may increase the detection of PFE, which occurs most frequently on the endocardial surface of the cardiac valve. We report a case of cardiac PFE with a review of the pertinent literature.
      Jpn. J. Cardiovasc. Surg. 40:108-111（2011）

    Keywords：papillary fibroelastoma, cardiac tumor, aortic valve
  • A Case of Re-operation for Paravalvular Leakage after Mitral Valve Replacement Complicated by Heparin-Induced Thrombocytopenia H. Kato et al.……112
    A Case of Re-operation for Paravalvular Leakage after Mitral Valve Replacement Complicated by Heparin-Induced Thrombocytopenia

    （Department of General and Cardiothoracic Surgery, Kanazawa University, Kanazawa, Japan）

    Hiroki Kato Noriyoshi Yashiki Kenji Iino
    Shigeyuki Tomita Go Watanabe
    Anticoagulation management in cardiac surgery can be difficult in patients with heparin-induced thrombocytopenia（HIT). We report a patient who underwent reoperation of cardiopulmonary bypass（CPB）using argatroban in combination with nafamostat mesilate. A bolus of 0.25mg/kg argatroban was administered, followed by continuous infusion of 5-10μg/kg/min argatroban and 100 mg/h nafamostat mesilate. No complications such as thrombosis were observed during either CPB or the perioperative period. Although we used argatroban and nafamostat mesilate, which has a shorter half-life than argatroban, the anticoagulant effect was prolonged, and the patient had an uneventful postoperative course despite requiring substantial blood transfusion.
      Jpn. J. Cardiovasc. Surg. 40:112-114（2011）

    Keywords：heparin-induced thrombocytopenia, cardiopulmonary bypass, reoperation, argatroban, nafamostat mesilate
  • A Case of Vasculo-Behçet’s Disease Complicated by an Intracardiac Thrombus T. Igarashi et al.……115
    A Case of Vasculo-Behçet’s Disease Complicated by an Intracardiac Thrombus

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

    Takashi Igarashi Hirono Satokawa Shinya Takase
    Yoshiyuki Sato Tsuyoshi Yamabe Hitoshi Yokoyama
    We report a rare case of vasculo-Behçet’s disease complicated by an intracardiac thrombus. A 48-year-old woman with a history of Behçet’s disease and deep vein thrombosis in a lower limb, and who had been treated with colchicine and warfarin, was given a diagnosis of an appendectal tumor by colonoscopy. Preoperative examinations, including chest computed tomography, showed a pedunculated mobile tumor from her inferior vena cava（IVC）to the right atrium（RA). Urgent surgery was performed to prevent pulmonary embolism. We exposed the RA through a median sternotomy under cardiopulmonary bypass and extirpated the tumor that appeared macroscopically to be an organized thrombus attached to the IVC wall. The pathological diagnosis was organized thrombus. A month later, she underwent ileocecal resection and was given a pathological diagnosis of mucinous cystadenoma. Her postoperative course was uneventful. Intracardiac thrombus complicated by vasculo-Behçet’s disease is rare, and it is important in the differential diagnosis of intracardiac tumor.
      Jpn. J. Cardiovasc. Surg. 40:115-119（2011）

    Keywords：Behçet’s disease, intracardiac thrombus, pulmonary embolism, mucinous cystadenoma
  • Aspergillus Pseudoaneurysm and Endocarditis of the Aortic Valve after Coronary Artery Bypass Graft Surgery T. Ikuno et al.……120
    Aspergillus Pseudoaneurysm and Endocarditis of the Aortic Valve after Coronary Artery Bypass Graft Surgery

    （Department of Cardiovascular Surgery, Okamoto Memorial Hospital, Sunto, Shizuoka, Japan）

    Takeshi Ikuno Sakae Enomoto Kenji Yamamoto
    Taizo Sakamoto
    Aspergillus pseudoaneurysm of the ascending aorta is rare in patients who have undergone coronary artery bypass graft surgery（CABG), and there are few cases reports of patients with AIDS, or after transplantation. A 76-year-old man underwent CABG due to unstable angina in 2002;in 2005 and 2006, he suffered 3 episodes of pseudoaneurysm formation in the ascending aorta. The aneurysm was resected and the defect was repaired with a Dacron patch twice. Finally, aortic root replacement with the modified Bentall technique was performed, but pathological examination of the wall of the pseudoaneurysm showed Aspergillus. On day 13, the Aspergillus infection developed into septicemia, and he died.
      Jpn. J. Cardiovasc. Surg. 40:120-124（2011）

    Keywords：Aspergillus, pseudoaneurysm, infective carditis
  • A Stent Graft Infection after Abdominal Aortic Aneurysm Repair M. Aoki et al.……125
    A Stent Graft Infection after Abdominal Aortic Aneurysm Repair

    （Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan）

    Masakazu Aoki Kenichi Kamiya Shinji Ogawa
    Hiroshi Baba Yasuhide Okawa
    We present a rare case of stent graft infection. A 69-year-old man, who had undergone endovascular repair of an abdominal aortic aneurysm with an Inoue stent graft 5 years previously, was admitted with high-grade fever. An abscess around an abdominal aortic aneurysm was found on abdominal computed tomography（CT）and he was given a diagnosis of stent graft infection. The stent graft was removed and vascular reconstruction was performed using a Gelweave graft bonded with rifampicin. The graft was then covered with the greater omentum, and he was discharged on the 27th postoperative day.
      Jpn. J. Cardiovasc. Surg. 40:125-129（2011）

    Keywords：abdominal aortic aneurysm, stent graft infection, rifampicin-bonded graft
  • Aortic Root Replacement for Bicuspid Aortic Valve and Annuloaortic Ectasia in a Patient with Ankylosing Spondylitis H. Takahashi et al.……130
    Aortic Root Replacement for Bicuspid Aortic Valve and Annuloaortic Ectasia in a Patient with Ankylosing Spondylitis

    （Department of Cardiovascular Surgery, Yodogawa Christian Hospital, Osaka, Japan）

    Hideki Takahashi Takashi Azami
    A 48-year-old man was admitted with shortness of breath. He had been given a diagnosis of ankylosing spondylitis by an orthopedic surgeon 20 years previously. A grade III/VI to-and-fro murmur was audible at the left sternal border. Echocardiography revealed moderate to severe aortic regurgitation with annular dilatation. He had also suffered complained rigidity of the neck muscles and back pain for 20 years. He underwent aortic root replacement and his postoperative course was uneventful. Aortic valve regurgitation with ankylosing spondylitis in Japan has been seldom reported, compared with European or American. We discuss surgical problems and the management of these lesions are discussed.
      Jpn. J. Cardiovasc. Surg. 40:130-134（2011）

    Keywords：ankylosing spondylitis, bicuspid aortic valve, annuloaortic ectasia, aortic regurgitation, aortic root replacement
  • Anterior Small Thoracotomy Drainage and Intermittent Lavage in 2 Cases of Prosthetic Graft Infection after Arch Replacement Surgery M. Sunada et al.……135
    Anterior Small Thoracotomy Drainage and Intermittent Lavage in 2 Cases of Prosthetic Graft Infection after Arch Replacement Surgery

    （Department of Cardiovascular Surgery, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan）

    Masatoshi Sunada Toshiaki Ito Atsuo Maekawa
    Genyo Fujii Tomo Yoshizumi Satoshi Hoshino
    Prosthetic graft infection after arch replacement surgery is a serious complication that is often resistant to antibiotics. However, graft replacement is difficult and is very invasive. We performed anterior small thoracotomy drainage and intermittent lavage in 2 patients. First, the prosthetic graft was approached via a left third intercostal thoracotomy. After the ablation of infected tissues and cleansing with saline, drains were placed both proximally and distally to the vascular graft. An irrigation withdrawal drain was then implanted in the left thoracic cavity. After surgery, diluted povidone iodine solution, pyoktanin solution, and saline were used for pleural lavage. Case 1:An 82-year-old man underwent arch replacement for a ruptured aortic arch aneurysm in November 2005. He suffered from high-grade fever from March 2008 and was referred to our hospital from another hospital with a diagnosis of vascular graft infection. A small anterior thoracotomy and drainage were performed on April 9. Pleural lavage with povidone iodine solution was performed 9 days after surgery, then was performed with saline from days 10-13 after surgery. The patient was discharged on postoperative day 30. Case 2:A 58-year-old man complained of high-grade fever from March 16, 2009. He had undergone arch replacement for an aortic arch aneurysm in 1997. He consulted a physician and was referred to our hospital with a diagnosis of vascular graft infection. Methicillin-sensitive Staphylococcus aureus（MSSA）was identified by blood culture. A small anterior thoracotomy and drainage were performed on March 24. Immediately after surgery pleural lavage was performed with pyoktanin blue solution changing to povidone iodine on postoperative day 10. Pleural lavage was continued until day 34, and the patient was discharged on postoperative day 64. In both cases, drainage and pleural lavage with antibiotic solutions improved the patients’ general condition. The infections have not recurred since discharge. Small anterior thoracotomy for graft infection after arch replacement, in addition to being minimally invasive, can avoid the need for a second median sternotomy, and can provide an adequate view of the full length of the arch prosthetic graft.
      Jpn. J. Cardiovasc. Surg. 40:135-139（2011）

    Keywords：prosthetic graft infection, anterior small thoracotomy drainage, intermittent pleural lavage
  • A Case of Repeated Pacemaker Implantation to Treat Pacemaker Dermatitis Y. Seto et al.……140
    A Case of Repeated Pacemaker Implantation to Treat Pacemaker Dermatitis

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

    Yuki Seto Hiroyuki Satokawa Yoichi Sato
    Shinya Takase Hiroki Wakamatsu Hiroyuki Kurosawa
    Eitoshi Tsuboi Takashi Igarashi Akihiro Yamamoto
    Hitoshi Yokoyama
    An 84-year-old man, who had been given a diagnosis of advanced aortoventricular block 2 years previously, underwent implantation of a pacemaker（PM）through the left subclavian vein. However, 7 months later a skin ulcer developed at the implantation site, but without any evidence of bacterial infection. Therefore, a PTFE-covered PM battery was reimplanted at the same site. Three months later, the skin ulcer recurred and he received a third implantation in the right side. However, another skin ulcer with infection developed in the right side. He was then transferred to our hospital for another PM reimplantation. We covered the battery and the entire lead with PTFE, then placed the PM lead directly into the cardiac muscle, and implanted the PM battery below the rectal muscle under general anesthesia. A patch test 4 months later revealed a positive reaction to nickel and silicon. Finally, we diagnosed pacemaker dermatitis. The patient has remained free of skin ulcers for over 1 year.
      Jpn. J. Cardiovasc. Surg. 40:140-143（2011）

    Keywords：pacemaker dermatitis, polytetrafluoroethylene, contact sensitivity
  • Surgical Treatment for Kommerell Diverticulm S. Mieno et al.……144
    Surgical Treatment for Kommerell Diverticulm

    （Department of Thoracic and Cardiovascular Surgery, Osaka Medical College Hospital, Takatsuki, Japan）

    Shigetoshi Mieno Hideki Ozawa Masahiro Daimon
    Tomoyasu Sasaki Eiki Woo Takahiro Katsumata
    We report 3 surgical cases of aortic graft replacement with reconstruction of an aberrant subclavian artery（ASA）for Kommerell diverticulum（KD）and ASA. Cases 1 and 2 both had a right aortic arch, KD and a left ASA. In these 2 cases, we performed distal aortic arch replacement and in-situ reconstruction of the left ASA via a right thoracotomy. Case 3 had an aortic arch aneurysm, KD and a right ASA. In this patient, we chose median sternotomy and total aortic arch replacement, using 2 pieces of artificial grafts with 1 and 4 branches, respectively. The right ASA was reconstructed by end-to-side anastomosis between the right axillary artery and the side branch of the graft with 1 branch. In all 3 cases, cardiopulmonary bypass and deep hypothermia with a rectal temperature under 18℃ were used in aortic graft replacement. In addition to deep hypothermia, either antegrade or retrograde cerebral perfusion was introduced, depending on the surgical situation, to provide additional brain protection. Selective ASA perfusion was performed in all patients during aortic graft replacement. In Case 1, aortic anastomosis was achieved while clamping, and cerebral perfusion was maintained via a cannula for aortic return at the ascending aorta. In Cases 2 and 3, aortic anastomosis was performed under deep hypothermic circulatory arrest, using retrograde and antegrade cerebral perfusion respectively in Cases 2 and 3. The postoperative course was uneventful in all 3 patients.
      Jpn. J. Cardiovasc. Surg. 40:144-149（2011）

    Keywords：aortic surgery, Kommerell diverticulum, aberrant subclavian artery
  • A Case of Infective Endocarditis of the Aortic Valve due to Peptostreptococcus spp. Y. Narahara et al.……150
    A Case of Infective Endocarditis of the Aortic Valve due to Peptostreptococcus spp.

    （Department of Cardiovascular Surgery, Kikuna Memorial Hospital, Yokohama, Japan）

    Yutaka Narahara Atsushi Bito Noboru Murata
    A 66-year-old man was given a diagnosis of urinary-tract infection and hospitalized for 2 weeks in another hospital in late August 2009. In late October of that year he was transferred to our hospital by ambulance because he was unable to ingest anything orally. Echocardiography showed that a vegetation of about 10mm in maximum dimension was attached to the aortic valve, causing severe aortic stenosis and regurgitation. The patient’s general condition was poor, and sepsis and disseminated intravascular coagulation syndrome developed. The next day, an urgent operation was performed, and an abscess was observed occupying one-third of the aortic valve annulus. The abscess was completely excised and the abscess cavity was covered with an equine pericardium patch. We then performed aortic valve replacement using a bioprosthetic valve followed by tricuspid valve annuloplasty. Peptostreptococcus spp. was detected in a culture of the abscess. Infective endocarditis due to Peptostreptococcus spp. is rare. There has been no recurrence of infection for 7 months postoperatively.
      Jpn. J. Cardiovasc. Surg. 40:150-154（2011）

    Keywords：aortic valve endocarditis, aortic perivalvular abscess, Peptostreptococcus spp.
  • A Case of Abdominal Aortic Aneurysm Associated with Horseshoe Kidney Y. Nishimura et al.……155
    A Case of Abdominal Aortic Aneurysm Associated with Horseshoe Kidney

    （Department of Cardiovascular Surgery, Mie Heart Center, Mie, Japan）

    Yoshiyuki Nishimura Toshiharu Ishii Yasuhide Ookawa
    We describe the case of an 80-year-old man who underwent surgical repair for abdominal aortic aneurysm with horseshoe kidney. We performed open surgery by a transperitoneal approach via a standard median laparotomy, and noted that the right accessory renal artery had 1 branch and the left accessory renal artery had 2. We safely dissected these arteries using a Harmonic scalpel. The aneurysm was successfully replaced using a Dacron straight graft, and all renal arteries were preserved. Renal infarction and renal dysfunction did not occur during the uneventful postoperative course.
      Jpn. J. Cardiovasc. Surg. 40:155-158（2011）

    Keywords：horseshoe kidney, abdominal aortic aneurysm, harmonic scalpel