An Inflammatory Pseudotumor Arising from the Mitral Valve / 日本心臓血管外科学会雑誌

We herein report a rare case of an inflammatory pseudotumor arising from the mitral valve. A 58-year-old man who was undergoing maintenance dialysis was referred to us due to the presence of a tumor mass attached to the mitral valve. It was asymptomatic and had been coincidentally found by echocardiography. The tumor mass was a sphere measuring about 1 cm in size, and it arose from the posterior mitral leaflet. A myxoma of the left atrium was suspected, and the tumor mass was resected along with part of the posterior leaflet by means of a right minithoracotomy (MICS). The tumor was postoperatively diagnosed to be an inflammatory pseudotumor based on the findings of a histopathological examination. During the follow-up period of 1 year and 2 months after surgery, there was no recurrence. An inflammatory pseudotumor is a tumorous lesion characterized by the infiltration of inflammatory cells and the growth of myofibroblasts. This tumor occurs most frequently in the lung, and the greatest number of intracardiac cases have been reported in small children. There are few reports of inflammatory pseudotumors occurring in adults, and only 4 cases originating in the mitral valve has so far been reported, which means that such tumors are extremely rare. For this reason, we reported the findings of this case, while adding a bibliographical survey.

A Case of Late Acute Type A Aortic Dissection after Coronary Artery Bypass Grafting / 日本心臓血管外科学会雑誌

Late acute type A aortic dissection after coronary artery bypass grafting (CABG) is rare, and only a few cases have been published in the literature. It is important to treat cases of living graft during reoperation. We report a successful surgical treatment in a case of late acute type A aortic dissection after CABG. A 68-year-old man underwent a triple CABG (to the left anterior descending artery with left internal thoracic artery, to the left circumflex artery with left radial artery, and to the right coronary artery with right gastroepiploic artery) beating heart procedure using a centrifugal pump and pulmonary assist with closed circuit due to unstable angina pectoris in December 2007 and had presented with sudden anterior chest pain, and was found to have an ascending aortic dissection (type A) on enhanced computed tomography in May, 2009. We performed ascending artery replacement, paying special attention to the living graft performed through a median sternotomy. The postoperative course was uneventful and he was discharged on the 22nd postoperative day.

Enhancement of Sternal Stability with Poly-L-lactide Costal Coaptation Pins for Patients Undergoing Coronary Artery Bypass Grafting Using the Internal Thoracic Artery / 日本心臓血管外科学会雑誌

We evaluated the efficacy of sternal coaptation pins used to improve the fixation of the transected sternum after coronary artery bypass grafting (CABG) with the internal thoracic artery (ITA). The subjects were 37 patients who underwent scheduled single CABG with ITA in our department and they were classified into two groups, i. e., Group A, without sternal pins (18 patients), and Group B, with sternal pins (19 patients). The efficacy was assessed by the following measurements : drain bleeding volume up to 12 and 24 h after ICU admission, the time until the removal of drain, surgical site infection (SSI) and the maximum split level between the sternal body and manubrium after surgery. Drain bleeding volume up to 12 and 24 h after ICU tended to be less in Group B. The time until the removal of drain was significantly shorter in Group B. SSI was 17% in Group A but 0% in Group B. The use of sternal coaptation pins reduced misalignment of the coapted sternum, and we belive that the use of sternal coaptation pins contributed to the early removal of drain, and SSI reduction.

Long-Term Results after Surgery for Abdominal Aortic Aneurysm / 日本心臓血管外科学会雑誌

We evaluated long-term survival and morbidity of 191 patients (161 non-ruptured and 30 ruptured) undergoing abdominal aortic aneurysm repair between 1980 and 1997. Thirty-day mortality rates of non-ruptured and ruptured aneurysms were 1.2% and 36.6%, respectively. Hospital death occurred in 3.1% of patients with non-ruptured aneurysms and 53.3% of those with ruptured aneurysms. Cumulative survival rates after successful AAA repair at 5 and 10 years were 76.3% and 42.3%, respectively. These were lower than survival rates in the age- and gender-matched general population. The most frequent cause of late death was cardiac problems (28.8%) including myocardial infarction. Other causes included stroke (19.2%), malignant neoplasm (17.3%), and ruptured recurrent aneurysms at or above the proximal anastomosis (9.6%) including aorto-enteric fistulas. Regarding late vascular complications, recurrent aneurysms at or above the proximal anastomosis were found in 10% of patients, including 3.5% of true aneurysms, 4.7% of anastomotic aneurysms, and 1.8% of aorto-enteric fistulas. Thoracic aortic aneurysms were found in 3.7% and aortic dissection in 4.2%. Cumulative graft patency rates at 10 and 15 years were 97.4% and 90.9%, respectively. Suppressive treatment for arteriosclerosis and continuous careful follow-up with an aggressive diagnostic approach may reduce morbidity and mortality from recurrent aneurysms or coronary artery disease, thereby improving late survival after AAA surgery.

A Case of Inflammatory Abdominal Aortic Aneurysm with Sealed Rupture / 日本心臓血管外科学会雑誌

A 71-year-old man was referred to the University Hospital because of left lumbago and a pulsating mass in his umbilical region. An inflammatory abdominal aortic aneurysm 5cm in diameter and left hydronephrosis were identified by enhanced computed tomography (CT). One month after admission, rapid expansion of the aneurysm with sealed rupture were detected by follow-up enhanced CT. The patient immediately underwent an emergency operation. We confirmed fissure on the posterior aneurysmal wall with a localized hematoma. We replaced the aneurysm with a straight prosthetic graft and the postoperative course was uneventful.

A Case of Local Disseminated Intravascular Coagulation Caused by DeBakey IIIb Aortic Dissection and Bilateral Iliac Aneurysm / 日本心臓血管外科学会雑誌

A 73-year-old man complained of sudden severe back pain and was admitted to a community hospital on February 2, 1994. DeBakey IIIb aortic dissection was diagnosed and he was treated conservatively. He noted a pulsating mass in his abdomen on June 7, 1995 and was referred to our hospital. Because of a decrease in platelet and fibrinogen and increase in FDP, local disseminated intravascular coagulation was diagnosed. Since abdominal pain continued, impending rupture was suspected. Computed tomogram showed abdominal aortic dissection and multiple iliac aneurysms. As coagulopathy did not improved by medical treatment, we performed prosthetic graft replacement of the aortio-iliac system on September 4, 1995. Before operation, the effectiveness of heparin was confirmed. After the operation local disseminated intravascular coagulation improved without drug therapy.