Surgical Treatment of Multiple Dissecting Aortic Aneurysms / 日本心臓血管外科学会雑誌

Four patients with multiple dissecting aortic aneurysms treated surgically from 1960 to 1996 were evaluated clinically. The incidence of multiple dissecting aortic aneurysms was 3.2% of all surgically treated cases of aortic dissection. Only one case suffered from Marfan's syndrome. Morphologically, all cases showed chronic DeBakey II+III type dissection. Case 1 was treated by Bentall's operation for DeBakey II type dissection and the residual aortic aneurysm was not treated surgically. Case 2 underwent a two-staged operation: Bentall's operation first, followed by entry closure with plication of the DeBakey III type aneurysm. Case 3 underwent a two-staged operation: graft replacement of the ascending aorta combined with coronary artery bypass grafting in the first operation and graft replacement of descending and abdominal aorta in the second. Case 4 was treated by graft replacement of the hemiarch, resuspension of the aortic valve and entry closure of the DeBakey III type dissection. Among them, two cases (Cases 1 and 2) whose aneurysms were treated incompletely showed a rapid growth and rupture of residual DeBakey III type aneurysm. In conclusion, one-staged aggressive and complete operation should be done for the patients with multiple dissecting aortic aneurysms. When a two-staged operation is selected, more intensive follow-up of the residual aortic aneurysm is needed.

Aortic Valvulo-annuloplasty for Insufficient Bicuspid Aortic Valve; Experience in 3 Cases / 日本心臓血管外科学会雑誌

We have experienced 3 successful repair surgeries for insufficient bicuspid aortic valve. The operative procedure consisted of combinations of suture placation, raphe triangular resection, commisural annuloplasty, and patch closure of perforation due to infectious endocarditis. The postoperative course was uneventful and postoperative echocardiography showed residual regurgitation as only trivial or mild. Retrospective study done on 19 previous cases with insufficient bicuspid aortic valve demonstrated that this operative procedure could have been applied in 15 (79%) of the cases. These results showed that repair surgery for insufficient bicuspid aortic valve is useful and has a wide application.

Successful Surgical Treatment for Aortic Regurgitation Associated with Aortitis Syndrome Presenting Severe Occlusive Lesions of Bilateral Carotid Arteries / 日本心臓血管外科学会雑誌

A 29-year-old female with aortic regurgitation associated with aortitis syndrome and severe stenosis of bilateral carotid arteries was reported. She had no symptom of brain ischemia, although an aortogram revealed complete occlusion of the left common carotid artery and the left subclavian artery, and severe stenosis of the right common carotid artery. The intracranial major arteries were perfused totally by the right vertebral artery via collaterals. The transcranial Doppler method and perfusion cintigraphy revealed normal cerebral perfusion. Therefore, we performed conventional aortic valve replacement without reconstruction of carotid arteries. During cardiopulmonary bypass, the mean systemic blood pressure was kept higher than 60mmHg under moderate-hypothermic (tympanic temperature: 25°C) pulsatile perfusion with monitoring of the left middle cerebral artery flow velocity. The patient did not develop any cerebral complications during or after the operation.

Successful Surgical Treatment for Multiple Mycotic Aneurysms of Abdominal Aorta / 日本心臓血管外科学会雑誌

A case of multiple mycotic aneurysms of the abdominal aorta is presented. A 62-year-old woman was admitted to our hospital complaining of left abdominal and back pain with persistent high fever. Although the blood cultures were negative during medical treatment, the patient status seemed septic by laboratory findings such as WBC (14, 000/μl), CRP (20.2mg/dl), and ESR (100 mm/h). Abdominal CT and aortography showed two saccular aneurysms in the abdominal aorta, and these aneurysms were considered as mycotic ones because of their rapid growth and clinical features. An urgent operation was performed. The three aneurysmal orifices were identified in infrarenal abdominal aorta and these seemed to be pseudoaneurysms. Although tight inflammatory adhesions were found around the aneurysms, no active infection was detected. After removal of the thrombi and intimal wall with meticulous irrigation, the <i>in situ</i> graft replacement was carried out. All the bacterial cultures of thrombi and intimal wall of aneurysms were negative. The infection had subsided after operation and she remained well without recurrence one year after operation. A few cases of mycotic aneurysm of abdominal aorta have been reported in Japan, but cases with multiple mycotic aneurysms are rare. The mechanism of aneurysmal formation in the present case might be lodgement of circulating organisms within the aortic wall during preceding prolonged antibiotic chemotherapy. The early surgical treatment consisted of <i>en bloc</i> aneurysmectomy, <i>in situ</i> graft replacement, and adjuvant antibiotic chemotherapy might provide good results.