A Calcified Amorphous Tumor from the Aortic Valve to the Tricuspid Valve with Aortic Valve Stenosis / 日本心臓血管外科学会雑誌

We report a rare case of a hemodialysis patient with calcified amorphous tumor (CAT) originating from aortic valve cusp that continues to tricuspid valve, which may be related to aortic annular calcification and aortic valve stenosis. A 79-year-old female with chronic kidney disease on hemodialysis for 16 years was transferred to our hospital with loss of consciousness. Echocardiography revealed aortic valve stenosis and presence of tumor on the aortic valve and tricuspid valve. We suspected the presence of a cardiac tumor or vegetation. We underwent tumor resection of tricuspid valve and aortic valve replacement and coronary artery bypass grafting (SVG-RCA). Pathological findings of the tumor was CAT.

RELATIONSHIP BETWEEN RIDING POSTURE AND MUSCLE ACTIVITIES DURING PHYSICAL EXERCISE ON HORSEBACK-RIDING SIMULATION EQUIPMENT / 体力科学

This study examined the relationship between riding posture and muscle activities during passive exercise on horseback-riding simulation equipment. The effects of passive training on the prototypes were also determined. Three prototypes with tilted seat (A110, A130, and A140) were developed with an attempt to change the angle between trunk and leg to 110, 130, and 140 degrees, respectively. Twelve female aged 42.7±2.3 years performed passive exercise on the three prototypes and isometric maximal voluntary contraction (MVC) tests. Electromyogram of nine muscles in the trunk and lower limb were recorded. On A110, back muscle showed the largest activity (22%MVC ; p<0.01 ; repeated measures ANOVA). Contrastingly on A140, abdominal muscle and knee extensor showed the largest activity (40%MVC and 26%MVC ; p<0.01). Passive training on the prototypes for 30 minutes/day, 4 times/week, 8 weeks produced enhancement of muscle strength in trunk and hip. Riding posture is an effective factor to control physical effects without increasing the velocity on horseback-riding simulation equipment.

A Case of Surgical Treatment for Type A Aortic Dissection in a Patient with Tracheostomy / 日本心臓血管外科学会雑誌

The approach for the heart and proximal aorta in a patient with a tracheostomy poses difficult problems such as mediastinitis and inadequate operative exposure. We report a case of successful surgical treatment for type A aortic dissection in a patient with tracheostomy using a Y shaped skin incision and median full-sternotomy. A 63-year-old woman with a tracheostomy was referred to our hospital because of type A thrombosed aortic dissection and cardiac tamponade. At first we treated the patient conseservatively, but follow-up CT taken on the 20th day after onset revealed that false lumen of the ascending aorta was patent and the size of ascending aorta had increased to 6cm in diameter. We therefore performed hemiarch replacement (24mm Hemashield gold graft) through a Y shaped skin incision and median full-sternotomy. The postoperative course was uneventful and she was discharged on the 19th postoperative day.

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

We reviewed 223 cases of surgical treatment for abdominal aortic aneurysm in octogenarians in this hospital between 1981 and 2000, and investigated the characteristic features, complications, and indications of the operation. The cases were divided into two age groups. Group O included 23 cases of octogenarians, and Group Y included 200 cases of patients under 80 years old. The average age was 68.6 years old in group Y (33-79 years old), and 83 years old in group O (80-93 years old). The hospital mortality rate was 0% in elective operation cases. In emergency operation case, Group O had a hospital mortality rate of 57.1%, significantly higher than the 6.1% for group Y. The hospital mortality rate was 17% in group O and 0.5% in group Y. The rate of emergency operation case was significantly higher in group O (30.4%) compared to group Y (16.5%). As for the preoperative complications, group O had more cases of renal dysfunction, COPD and gastrointestinal complication. As for the coronary artery disease and other cardiovascular complications, there were no significant differences between the groups. In the postoperative complication, group O had more cases of ileus, pneumonia, and cardiovascular disease. These complications were fatal in group O. These results suggest that surgical treatment for abdominal aortic aneurysm was performed safely in both groups for elective operations. Because the results of emergency operations are poor, early diagnosis and treatment seem to be important for the improvement of operative results.

Off-pump CABG and Right Axillo-bifemoral Artery Bypass in a Patient with Totally Calcified Ascending Aorta and Leriche's Syndrome / 日本心臓血管外科学会雑誌

A 40-year-old man was admitted because of coronary heart disease with a totally calcified ascending aorta and Leriche's syndrome. Establishing a cardiopulmonary bypass seemed to be difficult because neither the ascending aorta nor femoral artery was suitable as a cannulation site. It was not until a prosthetic conduit for revascularization of the lower extremities was anastomosed to the right axillary artery in preparation for the conversion from off-pump to on-pump that off-pump CABG was performed. Subsequently revascularization of the lower extremities was completed. The patient had a satisfactory postoperative course. Off-pump CABG is useful for patients with a severely calcified ascending aorta and occlusive lesions below the descending aorta.