Japanese Journal of Cardiovascular Surgery Vol.42, No.1

Preface

• R. Sakata

Original

• Mitral Valve Plasty for Mitral Regurgitation in Hypertropic Obstructive Cardiomyopathy S. Hoshino et al.…1
  Mitral Valve Plasty for Mitral Regurgitation in Hypertropic Obstructive Cardiomyopathy

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

  Satoshi Hoshino	Toshiaki Ito	Atsuo Maekawa
  Sadanari Sawaki	Genyo Fujii	Yasunari Hayashi

  Mitral valve replacement（MVR）is an effective method to treat mitral valve regurgitation（MR）associated with hypertrophic obstructive cardiomyopathy（HOCM）because of systolic anterior movement（SAM）of anterior leaflet. We retrospectively investigated results of mitral valve surgery concomitant with septal myectomy for MR with HOCM. Between August 2008 to July 2009, 7 patients underwent septal myectomy. Among them, 6 patients who had moderate or severe MR preoperatively were objects of this study. Pre and post operative clinical conditions, findings of echocardiogram, and operative techniques employed in each patient were reviewed. Four patient successfully underwent mitral valve plasty（MVP）with septal myectomy. One patient needed only septal myectomy because MR subsequently disappeared with resolution of SAM. One patient resulted in MVR after attempted mitral valve plasty（MVP). SAM disappeared in all patients who had MVP, and residual MR was mild or less. Pressure gradient of left ventricular outflow significantly decreased in all cases. All patients discharged hospital uneventfully. Plication of posterior leaflet, anterior leaflet augmentation if necessary, and prudent use of annuloplasty ring seemed to be effective for successful MVP in HOCM patients. MVP is feasible even in patients with MR derived from HOCM.
    Jpn. J. Cardiovasc. Surg. 42:1-5（2013）
  
  Keywords：HOCM, myectomy, MR, MVP
• Initial and Mid-term Results of Thoracic Endovascular Repair（TEVAR） H. Midorikawa et al.…6
  Initial and Mid-term Results of Thoracic Endovascular Repair（TEVAR)―Management of Left Subclavian Artery（LSA）during Zone 2（Z2）Coverage―

  （Department of Cardiovascular Surgery, Southern Tohoku General Hospital, Koriyama, Japan）

  Hirofumi Midorikawa	Megumu Kanno	Takashi Takano
  Kouyu Watanabe	Kyohei Ueno

  Between August 2008 and June 2012, 17 TEVAR procedures for thoracic aortic aneurysms（TAA）requiring Z2 coverage were performed at our institution. Patient age ranged from 46 to 82 years old（mean 69.4), 16 were male. Criteria for LSA revascularization at our institution are defined as either:1）dominant left vertebral artery（VA), 2）absent or diminutive or occluded right VA, 3）no communication of bilateral VA, 4）bilateral carotid artery disease, 5）patent LIMA-coronary bypass, 6）if a long length of the thoracic aorta is covered. Devices utilized were Gore TAG（n＝12）and TX2（n＝5). Deployment of the stent-graft（SG）was successful in 17 cases（100%）and complete thrombosis of the aneurysm or complete entry closure was achieved in 16 cases（94.1%). Axillo-axillar cross over bypass（Ax-Ax B）was performed in 5 cases（29.4%). There was no instance of cerebrospinal ischemia or hospital death and the mean follow-up was 22.9 month（range 5 to 46). One case was converted to open surgery due to secondary type 1 endoleak. There was no instance of Ax-Ax B graft occlusion or aneurysmal rupture. The initial and mid-term results of TEVAR requiring Z2 coverage were satisfactory, and we believe that our criteria for LSA revascularization played an important role in providing the satisfactory results.
    Jpn. J. Cardiovasc. Surg. 42:6-10（2013）
  
  Keywords：thoracic endovascular aortic repair, left subclavian artery, zone 2
• Minimally Invasive Approach（Para-sternum Small Incision）for Aortic Valve Replacement G. Fujii et al.…11
  Minimally Invasive Approach（Para-sternum Small Incision）for Aortic Valve Replacement

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

  Genyo Fujii	Toshiaki Ito	Atsuo Maekawa
  Sadanari Sawaki	Satoshi Hoshino	Yasunari Hayashi

  Minimally invasive surgery is associated with a faster postoperative recovery because of reduced postoperative pain and improved respiratory function, especially in elderly patients. We began using a minimally invasive approach（small parasternal incision）for isolated aortic valve replacement（MICS AVR）from January 2011. Between January 2011 and February 2012, 32 patients underwent MICS AVR surgery. The mean age was 73 years（range 57-85 years）;69% were women. MICS AVR was performed through a skin incision of 6.5±0.5cm along the third intercostal space. Cardiopulmonary bypass was established through the right femoral artery and vein. The patients were cooled to 28℃, the aorta was crossclamped with a flex clamp, and antegrade cardioplegic solution was given into the aortic root or selectively into the coronary ostia. The aortic valve procedure was performed in a standard fashion. If the distance to the aortic valve was too far, we used surgical instruments for minimally invasive surgery. Conversion to a conventional approach was not necessary in any patient. Mean overall operative time was 250±49 min, cardiopulmonary bypass 140±34min, and crossclamp time 99±22min. Mean ICU stay was 1.2±0.5days and length of hospital stay was 10.3±2.2days. There was no re-operation for bleeding or surgical site infection. MICS AVR was safe and feasible with excellent outcome. The advantages of this procedure include reduced bed rest, decreased postoperative pain, avoidance of deep sternal wound infection, and cosmetically attractive results. We now use the minimally invasive approach whenever possible. We report an early outcome, experience, strategy, and surgical technique.
    Jpn. J. Cardiovasc. Surg. 42:11-15（2013）
  
  Keywords：parasternal small incision, minimal invasion, aortic valve replacement, MICS
• Evidence-Based Optimal Myocardial Revascularization A. Marui et al.…16
  Evidence-Based Optimal Myocardial Revascularization:Perspective from the CREDO-Kyoto Registry

  （Department of Cardiovascular Surgery¹, and Department of Cardiovascular Medicine², Kyoto University Graduate School of Medicine, Kyoto, Japan, Department of Cardiovascular Surgery, Iwate Medical University School of Medicine³, Morioka, Japan, and Department of Cardiovascular Surgery, Kurashiki Central Hospital⁴, Kurashiki, Japan）

  Akira Marui1,2	Hitoshi Okabayashi3	Tatsuhiko Komiya4
  Ryuzo Sakata1	The CREDO-Kyoto Investigators

  Although there have been several studies that compared the efficacy of percutaneous coronary intervention（PCI）and coronary artery bypass grafting（CABG), the impact of off-pump CABG（OPCAB）has not been well elucidated. Among the 9,877 patients undergoing first myocardial revascularization enrolled in the CREDO-Kyoto Registry（a registry of first-time PCI using bare-metal stents and CABG patients in Japan), 6,327 patients with multivessel and/or left main disease were enrolled in the present study（PCI 3,877/CABG 2,450). Median follow-up was 3.5 years. Propensity-score-adjusted all-cause mortality after PCI was higher than that of CABG（hazard ratio［95% confidence interval］:1.37［1.15-1.63], p＜0.01). The incidence of stroke was lower after PCI than that after CABG（0.75［0.59-0.96], p＝0.02). The predicted risk of operative mortality（PROM）of each patient of on-pump/off-pump CABG was calculated by the logistic EuroSCORE. Patients were divided into tertiles based on their PROM. The hazard ratio of the incidence of stroke in on-pump CABG compared with off-pump CABG in the high-risk tertile was 1.80（［1.07-3.02], p＝0.03). The adjusted overall mortality was not significantly different between the two procedures even in the high-risk tertile（1.44［0.98-2.11], p＝0.06). In patients with multivessel and/or left main disease, CABG was associated with better survival outcomes than PCI using bare-metal stents. Off-pump CABG as opposed to on-pump CABG is associated with short-and long-term benefits in stroke prevention in patients with higher risk as evaluated by the EuroSCORE. No survival benefit of OPCAB was shown, regardless of preoperative risk level.
    Jpn. J. Cardiovasc. Surg. 42:16-22（2013）
  
  Keywords：PCI, CABG, off-pump
• Surgeon-Modified Zenith Stent Graft System for Endovascular Repair of Abdominal Aortic Aneurysm with Short Proximal Neck A. Aoki et al.…23
  Surgeon-Modified Zenith Stent Graft System for Endovascular Repair of Abdominal Aortic Aneurysm with Short Proximal Neck

  （Department of Cardiovascular Surgery and Department of Radiology*, Kagawa Prefectural Central Hospital, Takamatsu, Japan, and Present address:Department of Thoracic and Cardiovascular Surgery, Showa University**, Tokyo, Japan）

  Atsushi Aoki**	Takanori Suezawa	Mitsuhisa Kotani
  Shu Yamamoto	Jun Sakurai*

  Endovascular repair for abdominal aortic aneurysm（EVAR）has become widespread in Japan because of its low invasiveness. However adequate proximal neck length is required for EVAR. Unfortunately the surgical mortality of para-renal aortic aneurysm cases has been higher than that of infrarenal aortic aneurysm cases, especially in high-risk patients. A manufacture-modified fenestrated Zenith stent graft system has already been developed, however this new device is not yet available in Japan. Furthermore this device could not be used in an emergency situation because it takes 2-3 weeks for preparation. Therefore we introduced a surgeon-modified fenestrated Zenith stent graft（fenestrated Zenith）system in December 2010 for patients with a proximal neck length of 5-10mm. The fenestrated Zenith was not indicated if the supra-renal angle and proximal neck angle exceeded 35°. From May 2007 to February 2012, abdominal aortic aneurysms（AAA）with a short neck were repaired with fenestrated Zenith in 11 high-risk patients（group Fene), and AAAs with a proximal neck length of more than 15mm were repaired with a standard Zenith in 43 patients（group IFU). There were two ruptured AAA in the Fene group. Proximal neck length was significantly shorter in the Fene group（5.5±1.4mm in the Fene group, 26.4±9.5mm in the IFU group, p＜0.0001）and proximal neck angle was significantly less in the Fene group（20±13° in the Fene group, 36±18° in the IFU group, p＝0.008). The Zenith stentgraft system was deployed successfully in all patients. The frequency of type Ia endoleak detected by angiography after stent graft deployment and balloon attachment did not differ significantly（36% in the Fene group 26% in the IFU group, p＝0.475）and the frequency of Palmaz stent requirement for type Ia endoleak which persisted after 10 min of additional balloon attachment also did not differ significantly（27% in Fene group, 9% in IFU group). All fenestrated renal arteries were shown to be patent by angiography. There was no hospital death despite 2 cases of ruptured AAA, nor were these major complications in either group. Serum creatinine levels at 1, 3, 6 and 30 days after EVAR did not differ significantly between the 2 groups. In 9 out of 11 patients, only type II endoleaks were detected and aneurysm shrinkage tended to be more in Fene group（9.9±5.7mm in Fene group, 5.4±6.1mm in IFU group, p＝0.062）on enhanced CT 6 months after EVAR. Also all fenestrated renal arteries were patent in these 9 patients. The surgeon-modified fenestrated Zenith system seemed to be effective for AAA patients with short proximal necks, but long term follow up is mandatory.
    Jpn. J. Cardiovasc. Surg. 42:23-29（2013）
  
  Keywords：pararenal abdominal aortic aneurysm, fenestrated stent graft, Zenith

Case Reports

• Aorto-left Ventricular Fistula with the Unruptured Aneurysm of the Sinus of Valsalva due to the Infective Endocarditis T. Higuchi et al.…30

  Aorto-left Ventricular Fistula with the Unruptured Aneurysm of the Sinus of Valsalva due to the Infective Endocarditis:A Rare Case Report

  （Division of Cardiovascular Surgery, National Hospital Organization Osaka Medical Center, Osaka, Japan） Takuya Higuchi Toshiki Takahashi Hitoshi Suhara Daisuke Yoshioka

  We reported a rare case of aorto-left ventricular fistula with the unruptured aneurysm of the Valsalva sinus due to the infective endocarditis. Preoperatively trans-echocardiographic examination revealed the ruptured left sinus of Valsalva aneurysm protruded toward the left ventricule. Aorto-left ventricular fistula contiguous to the unruptured aneurysm of the right valsalva sinus, however, was detected at operation. Granulation tissue resembling healed infective vegetation was detected in the margin among the orifices of this fistula and Valsalva aneurysm. Pathological examination showed excessive accumulation of white blood cells, which suggested infective endocarditis.   Jpn. J. Cardiovasc. Surg. 42:30-33（2013） Keywords：aorto-left ventricular fistula, sinus of Valsalva aneurysm, endocarditis

• Surgical Experience of Superior Mesenteric Venous Aneurysm J. Hayashi et al.…34

  Surgical Experience of Superior Mesenteric Venous Aneurysm

  （Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan） Jun Hayashi Tetsuro Uchida Yukihiro Yoshimura Cheolsu Kim Yoshiyuki Maekawa Ryota Miyazaki Eiichi Ooba Mitsuaki Sadahiro

  Superior mesenteric venous aneurysm（SMVA）is rare and no standard treatment protocol has yet been established. We report our experience in performing surgical treatment for SMVA. A 64-year-old man was found to have a SMVA by computed tomography which had been performed during follow-up for gastrectomy. The SMVA was observed to gradually increase in diameter, and surgical treatment was therefore indicated. We successfully resected the aneurysm and then closed the defect with a bovine pericardial patch. Considering the potential risk of rupture, venous aneurysms that present with a saccular shape and an expanding tendency should be immediately surgically treated.   Jpn. J. Cardiovasc. Surg. 42:34-37（2013） Keywords：superior mesenteric venous aneurysm, operation, treatment

• Endovascular Treatment of Axillofemoral Bypass Graft Stump Syndrome K. Ishikawa et al.…38

  Endovascular Treatment of Axillofemoral Bypass Graft Stump Syndrome

  （Department of Cardiovascular Surgery, National Hospital Organization, Mito Medical Center, Ibaraki, Japan, Department of Cardiovascular Surgery, Hachinohe City Hospital*, Hachinohe, Japan, and Department of Cardiovascular Surgery, Cardiovascular Center, Sendai Kousei Hospital**, Sendai, Japan） Kazunori Ishikawa Shunichi Kawarai* Azumi Hamasaki** Kazuo Abe** Gen-ya Yaginuma**

  The use of axillofemoral bypass grafts（AxFG）has became a widely accepted treatment for high-risk patients with aortoiliac occlusive disease. On the other hand, AxFG has been associated with a variety of complications in the upper extremity. A symptom of upper extremity thromboembolism after AxFG occlusion is reported as axillofemoral bypass graft stump syndrome（AxFSS). We report the case of a 55-year-old man with repeated AxFSS after an AxFG occlusion. He underwent brachial artery exploration and embolectomy. Angiograms showed an embolus floating in the axillary artery, which originated from the occluded graft stump. The stump was obliterated with a metallic stent introduced through the same arteriotomy made for the embolectomy. The endovascular treatment of AxFSS is minimally invasive and is an effective modality in this condition.   Jpn. J. Cardiovasc. Surg. 42:38-41（2013） Keywords：peripheral arterial disease, thromboembolism, stent, arm

• Postoperative Progress of a Patient Who Underwent Massive Small Intestine Resection for NOMI after AVR H. Fujii et al.…42

  Postoperative Progress of a Patient Who Underwent Massive Small Intestine Resection for NOMI after AVR

  （Department of Cardiovascular Surgery, Osaka Kouseinenkin Hospital, Osaka, Japan） Hiromichi Fujii Takanobu Aoyama Katsuaki Hige Yoshikado Sasako

  Nonocclusive mesenteric ischemia（NOMI）after cardiac surgery is a rare and fatal complication. Although there are a few reports of successful treatment of NOMI, progress after treatment is not known. This case report describes the postoperative course of a 79-year-old male patient who underwent successful treatment of NOMI after aortic valve replacement（AVR). Plain abdominal computed tomography revealed gas in the small intestinal wall 14 days after AVR. Emergency massive small bowel resection was performed because wide and discontinuous necrotic changes of the small intestine were confirmed. Although the patient temporarily returned to normal life after discharge, sepsis due to urinary tract infection or acute cholecystitis and central venous route infection occurred repeatedly. The patient was intermittently admitted for a total of 14 of 25 months after the first discharge. The patient died of sepsis due to Candida infection and liver failure 52 months after AVR. Even if treatment for NOMI is successful, there is an unfavorable prognosis in terms of immunity and nutrition for short bowel syndrome. Because there are no symptoms or laboratory data specific to NOMI, it is considered important to immediately and adequately diagnose and treat NOMI without overlooking abnormalities after cardiac surgery.   Jpn. J. Cardiovasc. Surg. 42:42-45（2013） Keywords：cardiac surgery, NOMI, short bowel syndrome, postoperative progress

• A Case of Concomitant Surgery for Funnel Chest and Ventricular Septal Defect K. Kihara et al.…46

  A Case of Concomitant Surgery for Funnel Chest and Ventricular Septal Defect

  （Department of Surgery 2, Kochi Medical School, Nangoku, Japan, and Tokyo General Hospital*, Tokyo, Japan） Kazuki Kihara Masaki Yamamoto Hideaki Nishimori Seiichirou Wariishi Takashi Fukutomi Nobuo Kondo Motone Kuriyama Shiro Sasaguri* Kazumasa Orihashi

  A 10-year-old girl with heart murmur immediately after birth was found to have a ventricular septal defect（VSD). Although she had been followed up for an insignificant shunt, funnel chest became apparent and was referred to our hostpital at the age of 10. She was 133cm in height, 25.7kg in weight with a body surface area of 0.99m2. The VSD was the muscular outflow type with a Qp/Qs of 1.1, defect of 2.5mm in diameter, and pulmonary artery pressure of 24/10/15mmHg. Pectus excavatum was apparent with a CT index of 2.99. The preceding surgery for one was likely to interfere with the subsequent surgery for the other. Therefore we decided on concomitant surgery for both. Under median sternotomy, cardiopulmonary bypass was established and the VSD was closed with a patch. After the pericardium was sutured and closed, a tape was carefully passed through the chest wall under the guidance of direct vision and digital palpation. A metal bar was inserted guided by the tape, reversed with a rotator, appropriately shaped with a hand bender, and was fixed to the chest wall with the stabilizer bars at both ends. The sternum was sutured with 1-0 polyester sutures and two sternum pins made of particulate hydroxyapatite and poly-L lactide. The postoperative course was uneventful. After 2 years, the excavatum was adequately corrected and the bar was successfully removed under general anesthesia. Although the comorbidity of VSD and funnel chest is rare, concomitant surgery for both can be safely carried out and may be considered as an option for treatment.   Jpn. J. Cardiovasc. Surg. 42:46-49（2013） Keywords：VSD, funnel chest, Nass method, simultaneous surgery

• Successful Open Graft Replacement for Acute Stanford Type B Aortic Dissection with Bilateral Lower Limb Ischemia and Postoperative Myonephropathic Metabolic Syndrome T. Tarui and M. Ikeda…50

  Successful Open Graft Replacement for Acute Stanford Type B Aortic Dissection with Bilateral Lower Limb Ischemia and Postoperative Myonephropathic Metabolic Syndrome

  （Department of Cardiovascular and Respiratory Surgery, Toyama Red Cross Hospital, Toyama, Japan） Tatsuya Tarui Masahiro Ikeda

  A 52-year-old man suddenly felt severe back pain and numbness in the lower extremities. Enhanced CT revealed an acute Stanford type B dissection. The true lumen of the left common iliac artery was severely compressed by the thrombosed false lumen. We performed a femoro-femoral bypass and symptoms in the lower limbs disappeared. On day 4 of hospitalization, the patient suddenly presented with pain at rest and cyanosis in both lower extremities. CT revealed nearly total occlusion of the abdominal aorta due to severe compression of the false lumen. We performed emergency open graft replacement in the infrarenal aorta. Although ischemia in the lower extremities improved, the patient developed myonephropathic metabolic syndrome（MNMS）and received continuous hemodiafiltration to treat acute renal insufficiency. The patient’s ankle-branchial pressure index improved and he was weaned from continuous hemodiafiltration. The patient had no paralysis and was able to walk unassisted, so he was discharged on day 34 of hospitalization. In the event of acute aortic dissection and organ ischemia, emergency open graft replacement may be required and must be performed promptly as a lifesaving measure.   Jpn. J. Cardiovasc. Surg. 42:50-53（2013） Keywords：type B aortic dissection, leg ischemia, open graft replacement, MNMS

• Coronary Artery Bypass Grafting through Thoracoabdominal Spiral Incision in a Patient with Tracheotomy and Severe Obesity M. Hibino et al.…54

  Coronary Artery Bypass Grafting through Thoracoabdominal Spiral Incision in a Patient with Tracheotomy and Severe Obesity

  （Department of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan） Makoto Hibino Kazuyoshi Tajima Yoshiyuki Takami Ken-ichiro Uchida Kei Fujii Noritaka Okada Wataru Kato Yoshimasa Sakai

  A 60-year-old man with type 2 diabetes mellitus and severe obesity（height 170cm, weight 160kg, BMI 55）was admitted to our hospital because of acute inferior wall myocardial infarction due to acute thromboembolism of the right coronary artery（RCA). Because of three-vessel coronary diseases, we planned coronary artery bypass grafting after the medical therapy. The patient was intubated, then suffered congestive heart failure and pneumonia, and had a tracheotomy because of obesity hypoventilation syndrome. When his general condition improved after 14 months of medical therapy, we performed the operation. At that time, his weight had decreased to 107.5kg, and BMI decreased to 37.2. We decided that tracheotomy was necessary to avoid respiratory complications. We chose a thoracoabdominal spiral incision for 2 reasons. Firstly we needed to avoid wound contamination by the tracheotomy stoma. Secondly we decided that the left internal thoracic artery（LITA）and the right gastroepiploic artery（RGEA）were sufficient for bypass grafts to the left anterior descending artery（LAD), the diagonal branches（D1), the posterolateral artery（PL）and the posterior descending artery（PD). Before the operation, epidural anesthesia was performed for postoperative analgesia to prevent respiratory dysfunction. In the right semi-lateral position at 30°, a 4th intercostal space thoracotomy was performed, and the LITA was harvested. The skin incision was extended to the midline of the abdomen and the RGEA was harvested. The end of the LITA was anastomosed with the free RGEA as I composite and the composite was anastomosed to the LAD, the D1, the 14PL and the 4PL without cardiopulmonary bypass. Without any perioperative blood transfusion, the patient was discharged with no perioperative complication, including mediastinitis. With this incision, we achieved secure prevention of wound contamination by the tracheotomy stoma, harvesting of a sufficient length of the LITA and RGEA and good visualization of the anastomotic sites with less cardiac displacement than median sternotomy.   Jpn. J. Cardiovasc. Surg. 42:54-58（2013） Keywords：CABG, tracheotomy, Thoracoabdominal Spiral Incision, obesity

• Importance of Selective Cerebral Perfusion（SCP）to Prevent Intraoperative Ischemic Spinal Cord Injury in Surgical Case of Acute Type A Aortic Dissection J. Fukada et al.…59

  Importance of Selective Cerebral Perfusion（SCP）to Prevent Intraoperative Ischemic Spinal Cord Injury in Surgical Case of Acute Type A Aortic Dissection

  （Department of Cardiovascular Surgery, Otaru Municipal Medical Center, Otaru, Japan） Joji Fukada Yukihiko Tamiya Yasuaki Fujisawa

  We report a rare case of surgical treatment for acute type A aortic dissection with expansion of the false lumen. The patient was a 72-year-old man without any motor paresis who underwent total aortic arch replacement with two-vessel perfusion of SCP and mild hypothermic circulatory arrest for the lower half of the body. Postoperatively, the patient had tetraparesis which was more severe than in his lower extremities, whereas the sensory function was preserved. It was assumed that the anterior horns of the spinal cord were injured longitudinally due to insufficient blood flow of the anterior spinal artery through the SCP. This case suggests that three-vessel perfusion of SCP is important in surgical treatment for acute type A aortic dissection for the prevention of intraoperative ischemic spinal cord injury.   Jpn. J. Cardiovasc. Surg. 42:59-62（2013） Keywords：acute type A aortic dissection, ischemic spinal cord injury, selective cerebral perfusion, anterior horn of the spinal cord, anterior spinal artery

• A Case of Right Sinus of Valsalva Aneurysm Dissecting into the Interventricular Septum N. Kanemitsu et al.…63

  A Case of Right Sinus of Valsalva Aneurysm Dissecting into the Interventricular Septum

  （Department of Cardiovascular Surgery, Japan Red Cross Society, Wakayama Medical Center, Wakayama, Japan） Naoki Kanemitsu Shingo Hirao Masaki Aota

  A 60-year-old man was referred to our hospital for surgical treatment of sinus of Valsalva aneurysm and aortic regurgitation. He had suffered from palpitation and leg edema since a month before. Echocardiography revealed right sinus of Valsalva aneurysm dissecting into interventricular septum complicated with aortic and mitral regurgitation. He successfully underwent patch closure of aneurysm, aortic valve replacement and ring annuloplasty of mitral and tricuspid valve. His postoperative course was uneventful.   Jpn. J. Cardiovasc. Surg. 42:63-66（2013） Keywords：sinus of Valsalva aneurysm, interventricular septum dissection, aortic insufficiency, patch closure

• Successful Replacement of the Dissecting Aneurysm of the Brachiocephalic Artery T. Suzuki et al.…67

  Successful Replacement of the Dissecting Aneurysm of the Brachiocephalic Artery

  （Department of Cardiovascular Surgery, Sakakibara Heart Institute, Fuchu, Tokyo, Japan） Tomoyuki Suzuki Toshihiro Fukui Shigefumi Matsuyama Minoru Tabata Shuichiro Takanashi

  A brachiocepharic artery aneurysm is relatively rare in comparison with other peripheral artery aneurysms. A 62-year-old woman who had had a sudden chest pain 1 year previously was referred to our hospital because of a right upper mediastinal mass on a chest roentgenogram. Computed tomography demonstrated the dissection and dilatation of the innominate artery. The dissection extended to the right carotid artery and right subclavian artery. Furthermore, the ascending aorta was dilated. We performed reconstruction of the innominate artery with a Y-shaped composite graft and replacement of the ascending aorta and total aortic arch. Her postoperative course was uneventful with no neurological event. We describe our surgical strategy in this report with a review of the literature because operative methods and plans are various according to the shape and extent of the aneurysm of the brachiocepharic artery.   Jpn. J. Cardiovasc. Surg. 42:67-70（2013） Keywords：dissecting aneurysm, brachiocephalic artery

• A Case of Acute Type A Aortic Dissection Complicated with Cerebral Malperfusions A. Omura et al.…71

  A Case of Acute Type A Aortic Dissection Complicated with Cerebral Malperfusion

  （Department of Cardiovascular Surgery, Kobe University Hospital, Kobe, Japan, Department of Cardiovascular Surgery, Sumitomo Hospital*, Osaka, Japan, and Department of Cardiovascular Surgery, Takatsuki Hospital**, Osaka, Japan） Atsushi Omura Keiji Ataka* Kazuhiro Mizoguchi* Nobuhiro Tanimura**

  A 59-year-old man with a history of hypertension who suddenly developed back pain and apoplexy was transferred to our hospital 20 min after the clinical onset. Physical examination showed right conjugate deviation of the eyes and left paralysis, suggesting disorder of the right cerebral hemisphere. Enhance computed tomography showed an aortic dissection from the ascending aorta to bilateral iliac arteries, and the right common cranial artery was compressed by a false lumen. Acute type A aortic dissection complicated with cerebral malperfusion was diagnosed, and an emergency operation was performed 2.5h after the onset. Cardiopulmonary bypass was established with right femoral artery inflow and bicaval venous drainage. We found the dissection entry at the ascending aorta using the distal open technique, and performed hemiarch graft replacement with selective cerebral perfusion. The postoperative course was uneventful without deterioration of neurological function. Postoperative computed tomography showed no evidence of cerebral bleeding. He was given on ambulatory discharge on the 22nd postoperative day.   Jpn. J. Cardiovasc. Surg. 42:71-75（2013） Keywords：acute aortic dissection, malperfusion, stroke

Miscellaneous

• Study of Event Database for Improving Efficiency and Reliability of Data Input to JACVSD S. Wakui et al.…76

  Study of Event Database for Improving Efficiency and Reliability of Data Input to JACVSD

  （Department of Cardiovascular Surgery, Nihon University School of Medicine, Itabashi Hospital, Tokyo, Japan） Shinji Wakui Noriaki Yoshikai Mitsumasa Hata Akira Seizai Ayako Takasaka Kenji Akiyama Motomi Shiono

  The Japanese adult cardiovascular database（JACVSD）contains details of all adult cardiovascular surgeries performed in Japan. This database has the potential to make data from all of Japan available to the world in the future. However, it is time consuming to enter several items from an individual terminal for all cases;adding further pressure to already busy routine work. In our facilities, an original system using Filemaker Pro has been developed and used since 2004. This system has various functions integrated into it, and currently, the input system of JACVSD has been added. As a result, it becomes possible to automatically enter more than half the data of JACVSD, and excellent results can be reported. Intellectual property rights have been owed by Nihon University since 2007.   Jpn. J. Cardiovasc. Surg. 42:76-81（2013） Keywords：JACVSD, data base, Filemaker Pro

Editor's Postscript

• H. Arai