Japanese Journal of Cardiovascular Surgery Vol.46, No5

Preface

Original

  • Current Status of Cardiovascular Surgery in Japan, 2013 and 2014:A Report based on the Japan Cardiovascular Surgery Database（JCVSD）
  • 1．Mission and History of JCVSD　S. Takamoto et al.…187
    JapanSCORE；National Clinical Database（NCD） Current Status of Cardiovascular Surgery in Japan, 2013 and 2014:A Report based on the Japan Cardiovascular Surgery Database（JCVSD）

    1. Mission and History of JCVSD
    Shinichi Takamoto＊1 Noboru Motomura1 Hiroaki Miyata1
    Hiroyuki Tsukihara1

    （the Japan Cardiovascular Surgery Database, the Japanese Society for Cardiovascular Surgery1, Tokyo, Japan）

    In the year 2000, the Japan Cardiovascular Surgery Database（JCVSD）was created with the support of the Society of Thoracic Surgeons（STS). STS database software was translated to Japanese with the same definitions and in 2001, the data entry of adult cardiac surgeries was initiated online using University Hospital Medical Information Network, UMIN. In 2008, entry of the data of congenital heart surgeries was initiated in the congenital section of JCVSD and preoperative expected mortality（JapanSCORE）in adult cardiovascular surgeries was first calculated using the risk model of JCVSD. In 2011, the Japan Surgical Board system merged with JCVSD and all cardiovascular surgical data could be registered in JCVSD from 2012. The reports resulting from the analyses of data from JCVSD（Current Status of Cardiovascular Surgery in Japan, 2013 and 2014:A report based on the JCVSD）will encourage further improvements in the quality of cardiovascular surgeries, patient safety, and medical care for patients in Japan.

     

    Jpn. J. Cardiovasc. Surg. 46:187-190（2017）

    Keywords：the Japan Cardiovascular Surgery Database（JCVSD）;JapanSCORE;National Clinical Database（NCD）


  • 2．Congenital Heart Surgery　Y. Hirata et al.…191
    Current Status of Cardiovascular Surgery in Japan, 2013 and 2014:A Report based on the Japan Cardiovascular Surgery Database（JCVSD）　

    2. Congenital Heart Surgery
    Yasutaka Hirata＊1,2 Norimichi Hirahara1,3 Arata Murakami1,4
    Noboru Motomura1,5 Hiroaki Miyata1,3 Shinichi Takamoto1,6

    （the Japan Cardiovascular Surgery Database, the Japanese Society for Cardiovascular Surgery1, Tokyo, Japan, Department of Cardiac Surgery, The University of Tokyo School of Medicine2, Tokyo, Japan, Department of Health Policy and Management, Keio University3, Tokyo, Japan, Kanazawa Cardiovascular Hospital4, Kanazawa, Japan, Department of Cardiovascular Surgery, Toho University Sakura Medical Center5, Chiba, Japan, and Mitsui Memorial Hospital6, Tokyo, Japan）

    Objectives:We analyzed the mortality and morbidity of congenital heart surgery in Japan by using the Japan Cardiovascular Surgery Database（JCVSD). Methods:Data regarding congenital heart surgery performed between January 2013 and December 2014 were obtained from JCVSD. The 20 most frequent procedures were selected and the mortality rates and major morbidities were analyzed. Results:The mortality rates of atrial septal defect（ASD）repair and ventricular septal defect（VSD）repair were less than 1%, and the mortality rates of tetralogy of Fallot（TOF）repair, complete atrioventricular septal defect（AVSD）repair, bidirectional Glenn, and total cavopulmonary connection（TCPC）were less than 2%. The mortality rates of the Norwood procedure and total anomalous pulmonary venous connection（TAPVC）repair were more than 10%. The rates of unplanned reoperation, pacemaker implantation, chylothorax, deep sternal infection, phrenic nerve injury, and neurological deficit were shown for each procedure. Conclusion:Using JCVSD, the national data for congenital heart surgery, including postoperative complications, were analyzed. Further improvements of the database and feedback for clinical practice are required.
    　　

    Jpn. J. Cardiovasc. Surg. 46:191-194（2017）

    Keywords：the Japan Cardiovascular Surgery Database;JCVSD;congenital heart surgery

  • 3．Coronary Artery Bypass Surgery　A. Saito et al.…195
    Current Status of Cardiovascular Surgery in Japan, 2013 and 2014:A Report based on the Japan Cardiovascular Surgery Database（JCVSD）　

    3. Coronary Artery Bypass Surgery
    Aya Saito＊1,2 Norimichi Hirahara1,3 Noboru Motomura1,2
    Hiroaki Miyata1,3 Shinichi Takamoto1,4

    （the Japan Cardiovascular Surgery Database, the Japanese Society for Cardiovascular Surgery1, Tokyo, Japan, Department of Cardiovascular Surgery, Toho University Sakura Medical Center2, Chiba Japan, Department of Health Policy and Management, Keio University3, Tokyo, Japan, and Mitsui Memorial Hospital4, Tokyo, Japan）

    Objective and Methods:Data on isolated coronary artery bypass grafting（CABG）performed in 2013 and 2014, and registered in the Japan Cardiovascular Surgery Database were reviewed for preoperative characteristics, postoperative outcomes, and choice of graft material for the left anterior descending artery（LAD). Results:Isolated CABG was performed off-pump in 54.7% of cases, and graft material for the LAD was left internal thoracic artery in 74.3% and right internal thoracic artery in 15.6%. Operative mortality was 2.0% in elective cases, 8.2% in emergency cases, and 3.0% overall. In elective cases, operative mortality was 1.1% for off-pump CABG compared with 3.0% for on-pump CABG. Conclusions:Clinical results of our isolated CABG was reasonable and acceptable.

     

    Jpn. J. Cardiovasc. Surg. 46:195-198（2017）

    Keywords：off-pump coronary artery bypass grafting;on-pump coronary artery bypass grafting


  • 4．Valvular Heart Surgery　K. Nakano et al.…199
    Current Status of Cardiovascular Surgery in Japan, 2013 and 2014:A Report based on the Japan Cardiovascular Surgery Database（JCVSD）　

    4. Valvular Heart Surgery
    Kiyoharu Nakano＊1,2 Norimichi Hirahara1,3 Noboru Motomura1,4
    Hiroaki Miyata1,3 Shinichi Takamoto1,5

    （the Japan Cardiovascular Surgery Database, the Japanese Society for Cardiovascular Surgery1, Tokyo, Japan, Department of Cardiovascular Surgery, Tokyo Women’s Medical University Medical Center East2, Tokyo, Japan, Department of Health Policy and Management, Keio University3, Tokyo, Japan, Department of Cardiovascular Surgery, Toho University Sakura Medical Center4, Chiba, Japan, and Mitsui Memorial Hospital5, Tokyo, Japan）

    Objective:To demonstrate the mortality rate and the choice of surgical procedures, especially the selection of the valve prosthesis, in each position of the valve in each age of the patients and the effects of the preoperative complications to the mortality and prosthetic valve selection, the data from JCVSD in 2013 and 2014 are analyzed. Methods:The proportion of each surgical procedure is compared in each age of the patients in the aortic, the mitral and the tricuspid position. Results:The proportion of the mechanical valve prostheses was 23.1, 40.5 and 11.4% in the aortic, mitral and tricuspid position respectively and it was higher in hemodialysis patients than in non-hemodialysis patients. The operative mortality rate was 4.3, 11.7, 15.8 and 5.6% in all cases, the hemodialysis patients, the patients with liver dysfunction and the patients with atrial fibrillation and flutter, respectively in AVR, and 4.0, 14.4, 11.2 and 4.1%, respectively in each group listed above after mitral surgery. Conclusion:These results clarify the status of cardiac valvular surgery in Japan.

     

    Jpn. J. Cardiovasc. Surg. 46:199-204（2017）

    Keywords：prosthetic valve selection;mechanical valve;bioprosthesis;hemodialysis;liver dysfunction


  • 5．Thoracic Aortic Surgery　H. Shimizu et al.…205
    Current Status of Cardiovascular Surgery in Japan, 2013 and 2014:A Report based on the Japan Cardiovascular Surgery Database（JCVSD）　

    5. Thoracic Aortic Surgery
    Hideyuki Shimizu＊1,2 Norimichi Hirahara1,3 Noboru Motomura1,4
    Hiroaki Miyata1,3 Shinichi Takamoto1,5

    （the Japan Cardiovascular Surgery Database, the Japanese Society for Cardiovascular Surgery1, Tokyo, Japan, Department of Cardiovascular Surgery, Keio University2, Tokyo, Japan, Department of Health Policy and Management, Keio University3, Tokyo, Japan, Department of Cardiovascular Surgery, Toho University Sakura Medical Center4, Chiba, Japan, and Mitsui Memorial Hospital5, Tokyo, Japan）

    Background:Although open aortic repair（OAR）is still considered to be a standard treatment for thoracic aortic diseases, recently the indication of thoracic endovascular treatment（TEVAR）/hybrid aortic repair（HAR）is expanding. The purpose of this study is to review the current status of treatment of thoracic aortic diseases. Methods:The data concerning surgery for diseases in thoracic/thoracoabdominal aorta in 2013 and 2014 are extracted from the Japan Cardiovascular Surgery Database（JCVSD). The number of cases and operative mortality are evaluated for pathology（acute dissection, chronic dissection, ruptured aneurysm, un-ruptured aneurysm), treatment modality（OAR, HAR, TEVAR), JapanSCORE（＜5%, 5 to 10%, 10 to 15%, 15%≦）and their combination. Results:The total number of cases included in this study was 30,271 and the overall operative mortality was 5.9%. Among 3 types of treatment, 73.2% of patients underwent OAR（root, 98.3%;ascending, 97.4%;root to arch, 95.5%;arch, 81.7%;descending, 34.2%;thoracoabdominal, 64.4%). Although the rate of OAR was in negative correlation with JapanSCORE（JS）in treatment for thoracoabdominal region（JS＜5%, 80.4%;5%≦JS＜10%, 67.6%;10%≦JS＜15%, 58.8%;15%≦JS, 55.7%), such relation was not observed in other regions. The operative mortality of OAR was well reflected by JS（JS＜5%, 2.1%;5%≦JS＜10%, 5.5%;10%≦JS＜15%, 10.2%;15%≦JS, 20.3%), however, those of TEVAR/HAR was less than the range of JS. Conclusions:The distribution of treatment differs depending on site of diseases and is not much influenced by JS. It has become clear that JapanSCORE is a reliable tool for estimating operative mortality in OAR. However, the observed operative mortality was lower than JS in TEVAR/HAR and a new risk score for TEVAR/HAR should be established.

     

    Jpn. J. Cardiovasc. Surg. 46:205-211（2017）

    Keywords：the Japan Cardiovascular Surgery Database（JCVSD）;JapanSCORE;aortic aneurysm;aortic dissection


Case Reports

  • ［Congenital Heart Disease］ Staged Repair for Transposition of the Great Arteries in a Premature Triplet Weighing 1,336g　S. Matsunaga et al.…212
    Staged Repair for Transposition of the Great Arteries in a Premature Triplet Weighing 1,336g

    Shogo Matsunaga＊ Satoshi Fujita＊ Osamu Matsuo＊＊
    Kouji Fukae＊

    （Department of Pediatric Cardiac Surgery＊, and Department of Pediatric Cardiology＊＊, Kumamoto City Hospital, Kumamoto, Japan）

    Cardiac surgery for very-low-birth-weight infants is rarely reported, especially for a triplet. We herein report the successful staged repair of a premature triplet accompanied with transposition of the great arteries. During pregnancy, the fetuses were diagnosed as dichorionic diamniotic triplets, and the mother entered a hospital for maternal protection and health care from 25 weeks’ gestation. The triplets were delivered by Caesarean section at 33 weeks and 5 days of gestation because of intrauterine growth retardation. One of the infants, weighing 1,336g, was diagnosed with transposition of the great arteries（type II). Since he was deemed unable to endure an intracardiac repair, he received balloon atrial septostomy on the 27th day of life and then bilateral pulmonary artery banding on the 29th day of life. However, further balloon atrial septostomy on day 69 and left pulmonary arterial de-banding on day 73 post-birth were needed because of the progression of hypoxia. He received prolonged intubation and inotropic support after temporary cardiopulmonary stability, and we ultimately decided to perform arterial switch operation on day 110, when he weighed 1,838g. The patient showed a good recovery. In the field of pediatric cardiac surgery, we occasionally select staged strategies for patients who cannot undergo radical operations all at once because of their general condition or low body weight. However, there are no established guidelines concerning the timing of palliative or radical operations in low-birth-weight infants. At present, we select medical strategies ourselves, on a case-by-case basis. In the present case, although our medical strategy had to be adapted, we still obtained a good recovery for this triplet with extremely low birth weight. We herein report this case with some references from the literature..

     

    Jpn. J. Cardiovasc. Surg. 46:212-216（2017）

    Keywords：transposition of the great arteries;triplet;very-low-birth-weight infants;arterial switch operation


  • ［Acquired Cardiovascular Surgery］ Coronary-Pulmonary Artery Fistula Complicated with a Left Coronary Artery　M. Saito et al.…217
    Coronary-Pulmonary Artery Fistula Complicated with a Left Coronary Artery

    Masahiro Saito＊ Dai Kawashima＊ Satoru Maeba＊
    Minoru Ono＊＊

    （Department of Cardiovascular Surgery, Takeda General Hospital＊, Fukushima, Japan, and Department of Cardiac Surgery, The University of Tokyo＊＊, Tokyo, Japan）

    An 84-year-old woman was referred due to an abnormal shadow on her chest X-ray. Computed tomography and coronary angiography revealed a left coronary artery aneurysm associated with a complex coronary-pulmonary artery fistula. We present our surgical strategy used to treat this complicated pathology.

     

    Jpn. J. Cardiovasc. Surg. 46:217-221（2017）

    Keywords：coronary artery aneurysm;coronary-pulmonary artery fistula;surgical resection

  • Aortic Valve Replacement with Concomitant Coronary Artery Bypass Grafting for an Aortic Stenosis Coexisting with Anomalous Origin of the Coronary Artery　S. Akuzawa et al.…222
    Aortic Valve Replacement with Concomitant Coronary Artery Bypass Grafting for an Aortic Stenosis Coexisting with Anomalous Origin of the Coronary Artery

    Satoshi Akuzawa＊ Naoyuki Ishigami＊ Kazuchika Suzuki＊

    （Department of Cardiovascular Surgery, Fujieda Municipal General Hospital＊, Fujieda, Japan）

    Congenital anomaly of the coronary artery is rare. We have to care about the injury of the aberrant coronary artery and ischemic complication during and after the heart valve surgery. We experienced a good clinical course of aortic valve replacement（AVR）with concomitant coronary artery bypass grafting（CABG）for aortic stenosis coexisting with anomalous aortic origin of the right coronary artery. A 72-year-old woman had suffered from dyspnea and palpitation on effort, and we diagnosed severe aortic stenosis. Preoperative examination revealed the right coronary artery arising from the left coronary sinus with a stenotic lesion in the interarterial course between the aorta and main pulmonary artery. She underwent AVR and CABG using a saphenous vein graft. The peripheral anastomosis of the bypass grafting was performed before starting cardiopulmonary bypass and the blood cardioplegia was infused into right coronary artery through the bypass graft during cardiac arrest. The postoperative course was uneventful and the patent bypass graft was confirmed by computed tomographic angiography.

     

    Jpn. J. Cardiovasc. Surg. 46:222-225（2017）

    Keywords：anomalous coronary artery;aortic stenosis;aortic valve replacement;coronary artery bypass grafting


  • Suddenly Appearing Swinging Calcified Amorphous Tumor in the Left Ventricular Outflow Tract in a Patient with End-Stage Renal Failure　K. Tao and Y. Shigehisa…226
    Suddenly Appearing Swinging Calcified Amorphous Tumor in the Left Ventricular Outflow Tract in a Patient with End-Stage Renal Failure

    Koji Tao＊ Yoshiya Shigehisa＊

    （Cardiovascular Surgery, Fujimoto General Hospital＊, Miyakonojo, Japan）

    Calcified amorphous tumor（CAT）is a non-neoplastic cardiac mass composed of nodules of calcium with a background of amorphous fibrous material and was first described in 1997. This report describes a 61-year-old man, who had been on hemodialysis for 10 years and was referred to our hospital with a diagnosis of acute myocardial infarction. He had percutaneous coronary intervention（PCI）for stenosis of the left anterior descending artery（LAD). He was hospitalized and under medical treatment. A follow-up echocardiogram was performed and revealed a normal ejection fraction of 0.60. Moderate mitral annular calcification with mild-to-moderate mitral stenosis was seen. An ultrasound-mobile mass was visualized in the left ventricular outflow tract（LVOT). There was no hemodynamic evidence of LVOT obstruction on Doppler echocardiography. Transesophageal echocardiography showed a mobile mass attached to the LVOT in the mitral valve annulus that extended almost to the membranous septum. Due to the mobility of the mass and potential for embolism, surgical removal was advised. Concomitant procedures（coronary artery bypass grafting（CABG）and a full maze operation）were proposed because he still had symptoms of chest pain with myocardial ischemia and palpitations due to chronic atrial fibrillation. Surgery was performed through a median sternotomy on cardiopulmonary bypass. After aortic cross-clamping, the mass was approached through a horizontal incision in the ascending aorta. The white tumor was resected easily from the membranous septum. The operation was finished after CABG and a full maze procedure, and his clinical course was uneventful. Histological examination showed that the tumor contained many calcified nodules and fibrino-sanguineous deposits;these findings are compatible with CAT.

     

    Jpn. J. Cardiovasc. Surg. 46:226-230（2017）

    Keywords：calcified amorphous tumor;mitral annular calcification;end-stage renal disease


  • Mitral Valve Replacement in a Patient with Severe Atrial Calcification　Y. Yoshida et al.…231
    Mitral Valve Replacement in a Patient with Severe Atrial Calcification

    Yuri Yoshida＊ Fumiaki Kimura＊ Natsuya Ishikawa＊
    Hiroto Kitahara＊ Hiroyuki Kamiya＊

    （Department of Cardiovascular Surgery, Asahikawa Medical University＊, Asahikawa, Japan）

    A 70-year-old woman, who had a history of a percutaneous transvenous mitral commissurotomy for rheumatic heart disease 34 years previously, was admitted with progressive right heart failure. Massive calcification of the left wall was observed on multidetector CT. She underwent a mitral valve replacement, tricuspid annuloplasty and permanent pacemaker implantation. Massive calcification of the left atrial wall is a rare condition, and constitutes a major complication and risk to mitral valve surgery because of the difficulty in entering the left atrium, potential embolization, and impaired hemostasis.

     

    Jpn. J. Cardiovasc. Surg. 46:231-234（2017）

    Keywords：atrial calcification;rheumatic heart disease;mitral valve stenosis;mitral valve replacement


  • Mitral Valve Repair after Sternal Turnover with a Rectus Musclar Pedicle　D. Takahashi et al.…235
    Mitral Valve Repair after Sternal Turnover with a Rectus Muscular Pedicle

    Daisuke Takahashi＊ Norihiko Shiiya＊ Katsushi Yamashita＊
    Naoki Washiyama＊ Naoko Sakagami＊ Ken Yamanaka＊
    Kayoko Natsume＊

    （First Department of Surgery Hamamatsu University School of Medicine＊, Hamamatsu, Japan）

    A 58-year old man without Marfan syndrome was referred to our hospital for congestive heart failure due to severe mitral regurgitation. He had undergone sternal turnover with a rectus muscular pedicle for pectus excavatum 36 years previously. We were able to perform mitral valve repair via median sternotomy using a usual sternal retractor. There was no adhesion in the pericardium and the exposure of the mitral valve was excellent. We closed the chest in ordinary fashion without any problems in the fixation of the sternum or costal cartilage. There were no complications such as flail chest or respiratory failure.
    　　

    Jpn. J. Cardiovasc. Surg. 46:235-238（2017）

    Keywords：sternal turnover with rectus muscle pedicle;sternal turnover;pectus excavatum;mitral regurgitation;cardiac surgery

  • Totally Thoracoscopic Transatrial Thrombectomy in Two Patients with Left Ventricular Thrombus　T. Umeno et al.…239
    Totally Thoracoscopic Transatrial Thrombectomy in Two Patients with Left Ventricular Thrombus

    Tadashi Umeno＊,＊＊ Hidenori Sako＊ Tetsushi Takayama＊
    Masato Morita＊ Hideyuki Tanaka＊ Keiji Oka＊
    Shinji Miyamoto＊＊

    （Department of Cardiovascular Surgery, Oita Oka Hospital＊, Oita, Japan, and Department of Cardiovascular Surgery, Oita University Hospital＊＊, Ufu, Japan）

    Left ventricular thrombus is a complication of left ventricular dysfunction, including acute myocardial infarction, cardiomyopathy, and severe valvular heart disease. Surgical removal should be considered when a thrombus is mobile, when thromboembolism occurs, and when cardiac function has the potential to improve. Two patients with left ventricular thrombus underwent totally thoracoscopic transatrial thrombectomy. A thrombus developed in the apex of the left ventricle after acute myocardial infarction in one patient（Case 1）and during treatment for congestive heart failure in the other（Case 2). The minimally-invasive transatrial approach requires no sternotomy or left ventriculotomy and is thus particularly beneficial for treating left ventricular dysfunction. Moreover, totally endoscopic surgery confers the advantage of a deep and narrow visual field. Therefore, we consider that this strategy is highly effective for treating left ventricular thrombus.

     

    Jpn. J. Cardiovasc. Surg. 46:239-242（2017）

    Keywords：left ventricular thrombus;thrombectomy;endoscopic surgery


  • A Surgical Case of Infective Endocarditis with Annular Abscess into Mitral Annulus Calcification　M. Fujii et al.…243
    A Surgical Case of Infective Endocarditis with Annular Abscess into Mitral Annulus Calcification

    Masahiko Fujii＊ Kenji Mogi＊ Manabu Sakurai＊
    Anan Nomura＊ Tomoki Sakata＊ Yoshiharu Takahara＊

    （Division of Cardiovascular Surgery, Heart and Vascular Institute, Funabashi Municipal Medical Center, Funabashi, Japan）

    A 79-year-old man, who had undergone aortic valve replacement due to severe aortic stenosis 2.5 years previously and permanent pacemaker implantation for sick sinus syndrome 2 months after aortic valve replacement, was admitted for congestive heart failure and suspicion of prosthetic valve endocarditis. However, he had a fever in spite of medical therapy, and transthoracic echocardiography revealed a 20mm vegetation on the posterior mitral valve leaflet. He underwent emergency surgery on a diagnosis of infective endocarditis. The intraoperative examination showed annular abscess on the calcified mitral annulus, and a part of abscess had disintegrated, from which the vegetation arose. We performed maximal possible debridement of the infected tissue and mitral annulus reconstruction with a bovine pericardium. Subsequently, mitral valve replacement and annulus reinforcement with a prosthetic valve collared with a bovine pericardium were performed to prevent perivalvular leakage. The patient showed no recurrence of infection and perivalvular leakage at 1.5 years of follow-up.

     

    Jpn. J. Cardiovasc. Surg. 46:243-246（2017）

    Keywords：infective endocarditis;mitral annular calcification;annular abscess


  • Bjo¨rk-Shiley Prosthetic Valve Dysfunction Caused by Complete Disc Fracture　K. Terazono et al.…247
    Bjo¨rk-Shiley Prosthetic Valve Dysfunction Caused by Complete Disc Fracture

    Kazuya Terazono＊ Takayuki Ueno＊ Kenji Toyokawa＊
    Yoshihiro Fukumoto＊ Masafumi Yamashita＊ Yukinori Moriyama＊

    （Division of Cardiovascular Surgery, Kagoshima Medical Center, National Hospital Organization＊, Kagoshima, Japan）

    We present herein a case of disc fracture of a Bjo¨rk-Shiley valve prosthesis in the mitral position. A 69-year-old woman was admitted to our hospital with a sudden onset of dyspnea followed by deep shock. An echocardiography showed a severe degree of mitral regurgitation and moderate degree of tricuspid regurgitation. Forty-three years previously she had undergone a mitral valve replacement（MVR）for stenosis with the original version of a Bjo¨rk-Shiley valve prosthesis in another institute. Emergency redo MVR was performed with a bioprosthesis and tricuspid annuloplasty with a semirigid ring. The disc of the extracted Bjo¨rk-Shiley valve was found to have escaped from the metal housing with two intact struts. Although Bjo¨rk-Shiley valve dysfunction due to Delrin disk abration has been rarely reported, complete disk fracuture is extremely rare. The important role of regular echocardiographic follow-up should be emphasized to prevent fatal valve fracture.

     

    Jpn. J. Cardiovasc. Surg. 46:247-250（2017）

    Keywords：prosthetic valve dysfunction;Bjo¨rk-Shiley valve;disc fracture


  • ［Aortic Disease］ Successful Treatment of Aortobronchial Fistula due to Distal Aortic Arch Aneurysm Using Emergency Thoracic Endovascular Repair　T. Kondo et al.…251
    Successful Treatment of Aortobronchial Fistula due to Distal Aortic Arch Aneurysm Using Emergency Thoracic Endovascular Repair

    Taichi Kondo＊ Satoru Makita＊ Joji Hoshino＊
    Toshiyuki Maruyama＊

    （Yokosuka Kyosai Hospital, Cardiovascular Surgery＊, Yokosuka, Japan）

    Aortobronchial fistula is a rare but fatal condition, if not treated surgically. Conventional graft replacement is usually recommended for eradication of the fistula and infection, but mortality and morbidity remain high. Recently the effectiveness of endovascular repair for such cases has been reported. We encountered a case of an 83-year-old man with aortobronchial fistula due to a distal aortic arch aneurysm. The computed tomography（CT）scan showed severe calcification and stenosis in the abdominal aorta and iliac artery, indicating inadequacy for use as access vessels. The patient presented with hemoptysis, and was treated successfully by endovascular repair via the descending aortic conduit. Although the patient had a history of heavy smoking, he fully recovered after surgery and was discharged without any complication. There are potential risks of recurrence of aortobronchial fistula and infection, and we plan to continue close follow-up.

     

    Jpn. J. Cardiovasc. Surg. 46:251-254（2017）

    Keywords：aortobronchial fistula;distal arch aneurysm;emergency thoracic endovascular aortic repair;poor access vessels


  • A Surgical Case of Right Coronary Ostial Stenosis, Aortic Regurgitation, and Annuloaortic Ectasia Associated with Syphilitic Aortitis　M. Sakai et al.…255
    A Surgical Case of Right Coronary Ostial Stenosis, Aortic Regurgitation, and Annuloaortic Ectasia Associated with Syphilitic Aortitis

    Mari Sakai＊ Saori Nagura＊ Masaya Aoki＊
    Shigeki Yokoyama＊ Katsunori Takeuchi＊ Toshio Doi＊
    Akio Yamashita＊ Kazuaki Fukahara＊ Naoki Yoshimura＊

    （Department of Thoracic and Cardiovascular Surgery, University of Toyama＊, Toyama, Japan）

    We report a case of syphilitic aortitis（SA）associated with severe right coronary ostial stenosis, aortic regurgitation（AR), and annuloaortic ectasia（AAE). A 48-year-old man presented to a regional hospital with easy fatigability and nocturnal dyspnea. Echocardiography revealed Seller’s grade 3 AR. A computed tomography scan showed AAE, dilatation of the ascending aorta, and calcification of both coronary ostia. Coronary angiography demonstrated that the left coronary artery was intact;however, the right coronary artery was obscure. Active syphilis was detected on routine blood tests on admission. Therefore, the patient was started on a course of ampicillin/sulbactam（ABPC/SBT). Subsequently, he underwent the Bentall procedure and coronary artery bypass grafting with the right internal thoracic artery. The intraoperative findings showed degeneration of the aorta and severe right coronary ostial stenosis. The pathological findings of the aortic wall and aortic valve were consistent with SA. The postoperative course was uneventful. The patient continued receiving ABPC/SBT for 3 weeks postoperatively, and was then switched to oral amoxicillin.

     

    Jpn. J. Cardiovasc. Surg. 46:255-259（2017）

    Keywords：syphilitic aortitis;aortic regurgitation;annuloaortic ectasia;coronary ostial stenosis

  • A Case of Infectious Pseudoaneurysm Caused by Delayed Onset Osteomyelitis of the Sternum　Y. Oda et al.…260
    A Case of Infectious Pseudoaneurysm Caused by Delayed Onset Osteomyelitis of the Sternum

    Yoshimasa Oda＊ Yuji Katayama＊ Shugo Koga＊
    Kiyokazu Koga＊

    （Department of Thoracic and Cardiovascular Surgery, Fukuoka Tokushukai Hospital＊, Fukuoka, Japan）

    We report a case of an infected aortic pseudoaneurysm caused by delayed sternal osteomyelitis. A 79-year-old man underwent combined surgery comprising aortic valve replacement（AVR), coronary artery bypass grafting（CABG）and permanent pacemaker implantation at our department due to aortic insufficiency（third degree), coronary sclerosis, and sick sinus syndrome（type 1). The subject was discharged home on postoperative day（POD）27. Sternal osteomyelitis developed on POD 50, and the subject was re-hospitalized. However, on day 6 of readmission, auscultation revealed a new systolic murmur（Levin IV/VI）in the second right intercostal space sternal border and transthoracic echocardiography showed abnormal blood flow from the base of the aorta to the left front. Contrast-enhanced computed tomography（CT）revealed an infected pseudoaneurysm of the ascending aorta that was not detected by CT at readmission. An infected aortic pseudoaneurysm caused by delayed sternal osteomyelitis was diagnosed. On day 8 of readmission, the pseudoaneurysm was excised and the ascending aorta was replaced. Intraoperative findings revealed that the aortic pseudoaneurysm had formed from the site of the ascending aorta anastomosis at the time of performing AVR and that part of the aneurysm had perforated into the right ventricular outflow tract. In the present case, the new cardiac murmur identified on auscultation and consequently performing echocardiography at the bedside led to the definitive diagnosis.

     

    Jpn. J. Cardiovasc. Surg. 46:260-263（2017）

    Keywords：infectious pseudoaneurysm;osteomyelitis of the sternum;ascending aorta replacement


  • An Idiopathic Pulmonary Artery Aneurysm, Treated by Aneurysmectomy and Graft Replacement　T. Watanabe et al.…264
    An Idiopathic Pulmonary Artery Aneurysm, Treated by Aneurysmectomy and Graft Replacement

    Tatsuya Watanabe＊ Kentaro Tamura＊ Arudo Hiraoka＊
    Toshinori Totsugawa＊ Genta Chikazawa＊ Hidenori Yositaka＊
    Taichi Sakaguchi＊

    （Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan）

    A 61-year old man was referred to our institute under a diagnosis of pulmonary aneurysm. Contrast computed tomography revealed a huge pulmonary aneurysm of 70mm in maximal dimension at the main pulmonary trunk. No congenital heart disorders were identified on trans-thoracic or trans-esophageal echocardiography. No significant signs of pulmonary hypertension were demonstrated on right heart catheterization. Laboratory findings on admission included positive results for syphilitic antibodies. T-shaped graft replacement of the pulmonary arteries using a cardiopulmonary bypass was scheduled. The main and left pulmonary arteries were replaced with a J-Graft 26 mm in size（Japan Lifeline, Tokyo, Japan). Then, the right pulmonary artery was reconstructed with the rest of the J-Graft, and anastomosed to the side of the newly reconstructed main and left pulmonary arteries. His postoperative course was generally uneventful. Pathological findings of the excised aneurysmal walls revealed true aneurysmal formation with no specific inflammatory changes. This case was considered to be an idiopathic pulmonary aneurysm without congenital heart disorders, pulmonary hypertension, and pathologically inflammatory reactions of aneurysmal walls.

     

    Jpn. J. Cardiovasc. Surg. 46:264-266（2017）

    Keywords：pulmonary aneurysm;idiopathic;true aneurysm;artificial graft replacement;syphilis

  • Efficacy of the Plug Attachment Technique in a Patient Undergoing EVAR for Ruptured Abdominal Aortic Aneurysm　M. Morita et al.…267
    Efficacy of the Plug Attachment Technique in a Patient Undergoing EVAR for Ruptured Abdominal Aortic Aneurysm

    Masafumi Morita＊ Yasuyoshi Yoshii＊ Shuhei Azuma＊
    Sho Mano＊

    （Cardiovascular Surgery, Kyoto Katsura Hospital＊, Kyoto, Japan）

    The objective of this case report was to evaluate the efficacy of the Plug Attachment Technique（PAT）with the Amplatzer Vascular Plug（AVP）in endovascular aneurysm repair（EVAR）in a case of ruptured abdominal aortic aneurysm（rAAA). An 84-year-old woman was taken by ambulance to our hospital. The enhanced CT scan showed an rAAA of 90 mm（Fitzgerald classification 3). The patient was immediately transferred to the operation room and treated with EVAR followed by the closing of the rupture cite using AVP, the Plug Attachment Technique（PAT). The total operation time was 158 min. The patient recovered uneventfully after the operation and was discharged 30 days after the onset. EVAR has been recognized as an efficient acute therapy in cases of rAAA internationally. However, in comparison with the conventional open surgery, we are often facing the critical complications after EVAR in case of rAAA, continuous bleeding thorough the rupture cite and acute compartment syndrome. Our Plug Attachment Technique（PAT）with the Amplatzer Vascular Plug（AVP）may not cause such complications and lead to improved results for EVAR in case of rAAA.

     

    Jpn. J. Cardiovasc. Surg. 46:267-271（2017）

    Keywords：Amplatzer Vascular Plug;Plug Attachment Technique


Editor’s Post Script

  • K. Komori