Reoperation 22 and 18 Years after Radical Repair of the Tetralogy of Fallot: Report of Two Cases and Review of the Japanese Literature / 日本心臓血管外科学会雑誌

Two patients, a 32-year-old man and a 23-year-old woman, underwent successful reoperations 22 and 18 years after radical repair of the tetralogy of Fallot (TOF). The former patient had a diagnosis of pulmonary stenosis and aortic regurgitation due to infective endocarditis. Patch reconstruction of the right ventricular outflow tract (RVOT) and aortic valve replacement were performed. The latter patient was diagnosed as having pulmonary stenosis and a recanalized ventricular septal defect (VSD), followed by patch reconstruction of the RVOT and direct closure of a residual VSD. Reoperation 15 years or more after radical repair of TOF is rare. Only 15 such cases including the present two have been reported in Japan.

Reoperation for Starr-Edwards Ball Valve Insufficiency 21 Years after Replacement / 日本心臓血管外科学会雑誌

A 51-year-old woman, who had undergone mitral valve replacement with the Starr-Edwards ball valve 21 years ago, was hospitalized with cardiac failure. Preoperative cineangiograms showed delay of the ball movement during the early diastolic phase. Re-replacement of the mitral prosthetic valve with a CarboMedics prosthetic valve and tricuspid annuloplasty was successfully performed. The postoperative period after the initial implantation of the Starr-Edwards ball valve is the longest among patients reported in Japan. The cause of prosthetic valve insufficiency may have been granulomatous hyperplasia on the valve seat.

Surgical Treatment of Octogenarians with Abdominal Aortic Aneurysm / 日本心臓血管外科学会雑誌

Surgical results in eight octogenarians who were operated upon for abdominal aortic aneurysms were compared to those of 42 patients under 80 years of age. Seven of eight octogenarians were operated on an emergency basis, and four of them were ruptured aneurysms. The size of the ruptured aneurysms was over 6cm in all cases of both groups. Postoperative complications occurred more frequently and postoperative mortality were significantly higher in octogenarians than in patients under 80. Early surgical intervention is recommended for elderly cases with large abdominal aortic aneurysms.

Arterial Reconstruction for Aorto-Iliac Obstructive Disease / 日本心臓血管外科学会雑誌

Surgical interventions for aorto-iliac obstructive diseases were studied through the operative results. Eighteen patients underwent aorto-femeral bypass (AOF) and 23 who were over 70 years of age or who had serious preoperative complications had axillofemoral bypass (AXF). No perioperative death occurred in AOF patients, while the mortality rate of AXF patients was 8%. Postoperative ankle pressure indexes were significantly higher in AOF patients than in AXF patients. Follow-up graft patency rate was 100% in AOF patients at 54 months (mean), and 85% in AXF patients at 44 months respectively. AOF should be the first choice for patients with aorto-iliac obstructive disease, and AXF is suitable only for high-risk patients.