Japanese Journal of Cardiovascular Surgery Vol.46, No2

Preface

Special Contribution

Case Reports

  • ［Congenital Heart Disease］ Modification of End-to-End Anastomosis for Long-Segment Coarctation of the Aorta　M. Nakao et al.…66
    Modification of End-to-End Anastomosis for Long-Segment Coarctation of the Aorta

    Mitsutaka Nakao Yoshihiro Ko Katsushi Kinouchi
    Takayuki Abe Koji Nomura

    Department of Cardiovascular Surgery, Saitama Children’s Medical Center＊, Saitama, Japan）

    Several problems have been reported following coarctectomy, especially in cases involving long-segment coarctation（COA). Although residual COA, proximal arch kinking, and airway compression may occur after coarctectomy, avoiding the use of artificial materials provides a better chance for the subsequent growth of the aorta. We successfully performed a modified end-to-end anastomosis with subclavian flap aortoplasty for a two-month-old boy with COA. A two-month-old boy was admitted to our hospital for nocturnal tachypnea and a feeding disorder. The initial echocardiography showed a preductal long COA beyond the left subclavian artery. A perimembranous VSD, a patent foramen ovale, and a patent ductus arteriosus were also noted. The left ventricular function was mildly depressed with an ejection fraction of 59%. Enhanced CT revealed a long-segment COA with a length of 15mm. The blood pressure gradient between the upper and lower limbs was 40mmHg. The operation was performed at the age of 2 months. The 4th intercostal space was opened through a posterolateral left thoracotomy incision. The distal end of the isthmus was so ligated as to maintain blood perfusion to the lower body through the PDA. The arch was clamped between the left carotid and the left subclavian artery（LSCA). The LSCA and the isthmus were divided as distally as possible, and the two distal ends were longitudinally incised and sutured to each other in a side-to-side fashion using a 7-0 polypropylene continuous suture. After complete resection of the ductal tissue, a newly created distal arch was anastomosed to the descending aorta. The left ventricular ejection fraction was increased to 74% at discharge. Catheterizations 3 years after the surgery did not reveal any stenosis or deformity in the aorta at normal PA pressure. The patient has been doing well and is free of complications 7 years after the surgery. At present, end-to-end anastomosis and aortic arch advancement with or without cardiopulmonary bypass are widely used procedures for coarctectomy;however, a modified end-to-end anastomosis is still a viable option for cases involving long-segment coarctation.
    　　

    Jpn. J. Cardiovasc. Surg. 46:66-69（2017）

    Keywords：long-segment coarctation;coarctectomy;modified end-to-end anastomosis;subclavian flap aortoplasty;thoracotomy

  • ［Acquired Cardiovascular Surgery］ Aortic Insufficiency Caused by a Leaflet Tearing of the Medtronic Freestyle Stentless Aortic Bioprosthesis Complicated by Rheumatic Multivalvular Heart Disease　H. Minamimura et al.…70
    Aortic Insufficiency Caused by a Leaflet Tearing of the Medtronic Freestyle Stentless Aortic Bioprosthesis Complicated by Rheumatic Multivalvular Heart Disease

    Hirokazu Minamimura Shinsuke Kotani Tadahiro Murakami
    Takumi Ishikawa

    （Department of Cardiovascular Surgery, Bellland General Hospital＊, Sakai, Japan）

    We report a case of an 85-year-old woman with severe aortic insufficiency caused by structural valve deterioration（SVD）of Medtronic Freestyle stentless aortic bioprosthesis（Freestyle valve）complicated by rheumatic multivalvular heart disease. The patient received an aortic valve replacement by using the modified sub-coronary method with a 21mm Freestyle stentless porcine valve（Medtronic Inc., Minneapolis, MN, USA), for severe aortic valve stenosis at of the age of 71. The patient developed severe heart failure 14.5 years after the surgery. She was admitted for severe aortic insufficiency caused by a leaflet injury（tear）of the Freestyle valve. She also had had rheumatic mitral stenosis and secondary tricuspid insufficiency with severe pulmonary hypertension. Therefore, treating her heart failure was difficult, but surgery was performed. The leaflets of the stentless bioprosthesis were resected. The insertion of the needle suture into the annulus of the stentless valve was difficult because of calcification of the tissue. An aortic root enlargement procedure was performed using a bovine pericardial patch, enabling the insertion of the needle suture into the Dacron cloth at the bottom of the stentless valve, with 2-0 Ethibond threads and single sutures. We successfully performed an aortic valve re-replacement using an Open Pivot Mechanical Heart Valve（OPHV）16mm AP（Medtronic, Minneapolis, MN, USA), which was implanted by using the partial valve-in-valve technique. Simultaneously, mitral valve commissurotomy and tricuspid annuloplasty were performed. The patient had an uneventful postoperative recovery.

     

    Jpn. J. Cardiovasc. Surg. 46:70-75（2017）

    Keywords：aortic valve replacement;Freestyle valve;structural valve deterioration;reoperation;aortic root enlargement;rheumatic mitral stenosis.


  • Hemolytic Anemia due to Left Ventricular to Right Atrium Communication after Tricuspid Annuloplasty　W. Hashimoto et al.…76
    Hemolytic Anemia due to Left Ventricular to Right Atrium Communication after Tricuspid Annuloplasty

    Wataru Hashimoto Koji Hashizume Kazuyoshi Tanigawa
    Takashi Miura Seiji Matsukuma Ichiro Matsumaru
    Kazuki Hisatomi Kiyoyuki Eishi

    （Department of Cardiovascular Surgery, Okinawa Kyodo Hospital＊, Naha, Japan, and Department of Cardiovascular Surgery, Nagasaki University Hospital＊＊, Nagasaki, Japan）

    An 82-year-old man was referred to our hospital for heart failure due to severe mitral regurgitation and severe tricuspid regurgitation. We performed mitral annuloplasty and tricuspid annuloplasty（TAP). Three weeks after surgery, he developed hemolytic anemia（HA). Transesophageal echocardiography revealed a defect in the left ventricular outflow tract that communicated directly with right atrium, and the jet was striking with the TAP prosthetic ring. HA was not controlled, so we performed re-operation. The defect was found in the atrioventricular membranous septum. The defect was closed and TAP was performed using an autologous pericardial roll again. We report a rare case of acquired left ventricular to right atrium communication after TAP.

     

    Jpn. J. Cardiovasc. Surg. 46:76-78（2017）

    Keywords：tricuspid annuloplasty;left ventricular to right atrium communication;hemolytic anemia;autologous pericardium


  • An Adult Case of Acute Rheumatic Fever with Valve Destruction, Followed by Successful Valve Replacement　K. Muramatsu et al.…79
    An Adult Case of Acute Rheumatic Fever with Valve Destruction, Followed by Successful Valve Replacement

    Kenichi Muramatsu Masaaki Watanabe Yukitoki Misawa
    Hitoshi Yokoyama

    （Department of Cardiovascular Surgery, Aizu Central Hospital＊, Aizu-Wakamatsu, Japan, and Department of Cardiovascular Surgery, Fukushima Medical University＊＊, Fukushima, Japan）

    Thirty two years-old man with arthralgia in both hands was given with non-steroid anti-inflammatory drug and followed. The symptoms persisted, and hematuria and signs of infection were getting apparent. The patient was referred to our hospital with increasing dyspnea. The patient presented acute heart failure, acute renal insufficiency and respiratory failure. Echocardiography revealed vegetation and regurgitation in the aortic and mitral valve. Blood culture demonstrated α-Streptococcus. CT revealed enlargement of the aortic root. The patient was diagnosed with infectious endocarditis, and referred for surgery. At surgery, the aortic valve and mitral valve were severely destroyed. Aortic root and mitral valve replacement were performed. Pathological findings demonstrated valve destruction as a result of endocarditis due to active rheumatic fever. Clumps of bacteria were not noted around the valves. This is a rare adult case with valve destruction by acute rheumatic fever.

     

    Jpn. J. Cardiovasc. Surg. 46:79-83（2017）

    Keywords：acute rheumatic fever;rheumatic endocarditis;valve replacement


  • Two Cases of Extended Sandwich Patch Technique through Right Ventriculotomy for Ventricular Septal Perforation:Considerations in Postoperative Left Ventricular Remodeling　T. Kosuga et al.…84
    Two Cases of Extended Sandwich Patch Technique through Right Ventriculotomy for Ventricular Septal Perforation:Considerations in Postoperative Left Ventricular Remodeling

    Tomokazu Kosuga Ryo Kanamoto Eiji Nakamura
    Hiroshi Yasunaga Shigeaki Aoyagi

    （Department of Cardiovascular Surgery, St. Mary’s Hospital＊, Kurume, Japan）

    We report two cases of extended sandwich patch technique through right ventriculotomy for ventricular septal perforation（VSP). One was an 82-year-old woman. Preoperative coronary angiography showed occlusion of the left anterior descending artery proximal to the first major septal branch. Operative inspection revealed relatively extensive infarction of the anterior wall, a part of which had the appearance of free wall rupture. In the other case of an 85-year-old woman, the culprit lesion was occlusion of the left anterior descending artery distal to several septal branches and to the first diagonal branch. Despite their old age and emergency surgery in cardiogenic shock status, their postoperative recovery was uneventful. In the former case, however, echocardiography at the early postoperative phase revealed significant expansion and thinning of the infarcted anterior wall. Furthermore, serial observations showed deterioration of the left ventricular systolic function and mitral regurgitation due to leaflet tethering. In addition to secure VSP closure by transmural stitches, extended sandwich patch technique can offer geometric and functional preservation of postinfarction left ventricle. Although this can eliminate the risk of postoperative low output syndrome even if anterior infarction is extensive, late follow-up will be required because this technique can also allow postinfarction left ventricular remodeling.

     

    Jpn. J. Cardiovasc. Surg. 46:84-89（2017）

    Keywords：acute myocardial infarction;ventricular septal perforation;extended sandwich patch;left ventricular remodeling


  • ［Aortic Disease］ A Case of Percutaneous Thoracic Duct Embolization for Chylothorax after Total Arch Replacement　K. Sato et al.…90
    A Case of Percutaneous Thoracic Duct Embolization for Chylothorax after Total Arch Replacement

    Kenichiro Sato Koichi Tamai Takehiro Shirasugi

    （Department of Cardiovascular Surgery, Kasukabe Chuo Hospital＊, Kasukabe, Japan）

    The patient was 70-year-old man. Distal aortic arch aneurysm of the maximum diameter of 55mm was pointed out by Computed tomography. He underwent total arch replacement with median sternotomy. The next day, white cloudy fluid was flowing out from his left thoracic drain, and the amount increased and chylothorax was diagnosis. We selected conservative therspy with fasting and octoleotide subcutaneous injection. After 19 days chylothorax did not improve. We performed percutaneous thoracic duct embolization which is minimam invasive therapy. After embolization, he could start the meal, and the chest drain was extubated. He was discharged in good condition 49 days after first operation.

     

    Jpn. J. Cardiovasc. Surg. 46:90-92（2017）

    Keywords：chylothorax;thoracic duct;percutaneus thoracic duct embolization;open heart surgery

  • ［Peripheral Artery Disease］ Endovascular Repair of a Common Iliac Artery Aneurysm and Arteriovenous Fistula with Congestive Heart Failure　N. Yabu et al.…93
    Endovascular Repair of a Common Iliac Artery Aneurysm and Arteriovenous Fistula with Congestive Heart Failure

    Naoto Yabu Ichiya Yamazaki Hiromasa Yanagi
    Shinichi Suzuki Munetaka Masuda

    （Department of Cardiovascular Surgery, Fujisawa City Hospital＊, Fujisawa, Japan, and Department of Surgery, Yokohama City University Hospital＊＊, Yokohama, Japan）

    We report a case of endovascular surgery in a patient of common iliac artery aneurysm with arteriovenous（A-V）fistula. A 60-year-old woman was admitted because of dyspnea. She had a clinical history of lumbar disk surgery at age of 40. On physical examination, we detected a pulsatile mass and pansystolic murmurs in her left lower abdomen. A chest X-ray film demonstrated severe cardiomegaly with 70% of cardiothoracic ratio. Contrast-enhanced CT revealed left common artery aneurysm with A-V fistula between the left common iliac artery and the left common iliac vein. Three-dimensional CT showed hyper-vascularity in the region from the pelvic vein to IVC. We considered that she had high risk of intraoperative massive bleeding for open abdominal surgery. We conducted endovascular repair for this iliac artery aneurysm with A-V fistula by the GORE EXCLUDER C3●R stent graft system. Postoperative contrast-enhanced CT showed complete exclusion of both left common iliac artery aneurysm and A-V fistula. After surgery, her symptoms improved significantly.

     

    Jpn. J. Cardiovasc. Surg. 46:93-96（2017）

    Keywords：common iliac artery aneurysm;arteriovenous fistula;endovascular surgery


  • A Case Report of Femoral Endarterectomy and Decalcification Using the Cavitron Ultrasonic Surgical Aspirator　Y. Kawase et al.…97
    A Case Report of Femoral Endarterectomy and Decalcification Using the Cavitron Ultrasonic Surgical Aspirator

    Yasuhiro Kawase Yosuke Ishii Atsushi Hiromoto
    Dai Nishina Ryuzo Bessyo Takashi Nitta

    （Department of Cardiovascular Surgery, Nippon Medical School＊, Tokyo, Japan, and Department of Cardiovascular Surgery, Nippon Medical School Chiba Hokusoh Hospital＊＊, Inzai, Japan）

    A 69-year-old male complained of intermittent claudication of the right leg. Computed tomography revealed a right femoral artery stenosis with severe calcification and intimal thickening extending to the superficial and deep femoral arteries. Femoral endarterectomy and decalcification was carried out using the Cavitron Ultrasonic Surgical Aspirator（CUSA). All arteries were repaired by an ePTFE Y-shaped patch. Postoperative CT showed no stenosis and progressive calcification of the common, superficial and deep femoral arteries 2 years after surgery.

     

    Jpn. J. Cardiovasc. Surg. 46:97-100（2017）

    Keywords：peripheral arterial disease;endarterectomy;decalcification;CUSA


Editor’s Post Script

  • Y. Matsui