Successful Surgical Treatment of Incomplete Atrioventricular Septal Defect Associated with Pulmonary Stenosis in a 72-Year-Old Woman / 日本心臓血管外科学会雑誌

We report the surgical correction of an incomplete atrioventricular septal defect (AVSD) associated with pulmonary stenosis in a 72-year-old woman. She was given a diagnosis of atrial septal defect at the age of 19, but at that time surgery was not indicated. She had an uneventful pregnancy at age 28. She had received medical treatment for congestive heart failure since the age of 67. Four years later, she was admitted to another hospital due to edema of the leg and retention of massive ascites. After careful and precise evaluation, AVSD was diagnosed, associated with bilateral atrioventricular (AV) valve regurgitation, pulmonary stenosis, atrial fibrillation and significant stenosis of the left anterior descending (LAD) coronary artery. She was referred to our hospital for surgery, and intracardiac repair was determined to be necessary after clinical assessment. Prior to surgery, she underwent percutaneous coronary intervention with a bare-metal stent for an LAD lesion. Under antegrade cold blood cardioplegia and mild hypothermia, we performed closure of the ostium primum atrial septal defect using a heterologous pericardial patch with expanded polytetrafluoroethylene strip, and right side atrioventricular (AV) valvuloplasty and pulmonary valvotomy. The postoperative course was uneventful. The patient has been designated NYHA class I for 2 years since surgery, and has had mild regurgitation of both AV valves, but neither have affected her quality of life. Surgical correction should be considered in elderly patients with incomplete AVSD, even in those aged 70 and over.

Transfusion-Free Surgery for a Jehovah's Witness Patient with Dilated Cardiomyopathy Treated with Mitral Complex Reconstruction / 日本心臓血管外科学会雑誌

A 22-year-old man with dilated cardiomyopathy (DCM), who was a practicing Jehovah's Witness, was transferred to our hospital for surgical treatment of medically uncontrollable mitral regurgitation (MR). Our original mitral complex reconstruction procedure and permanent pacemaker implantation for biventricular pacing were successfully performed without transfusion of blood products. Blood conservation strategy included: 1) preoperative treatment with erythropoietin, 2) utilization of a shortened extracorporeal circuit and assisted venous drainage system, 3) the use of ultrafiltration to save the residual autoblood in the extracorporeal circuit. The preoperative hemoglobin level was 17.1g/dl and the postoperative lowest level was 9.5g/dl. MR decreased from grade III to none, and NYHA functional class improved from class II to class I postoperatively. He was moved to a cardiology ward on the 13th postoperative day without complications. Transfusion-free surgery for DCM should be performed before DCM advances and requires left ventriculoplasty at risk for major blood loss. A careful follow-up is needed to examine the long-term results of the operative procedure during his expected long survival.

A Report of Successful Treatment of an Infectious Pseudoaneurysm after Graft Replacement of the Ascending Aorta / 日本心臓血管外科学会雑誌

A 74-year-old woman was admitted to our hospital with a diagnosis of a pseudoaneurysm 5 months after graft replacement of the ascending aorta, and underwent re-replacement employing left ventricle venting through a left anterior thoracotomy. Culture of the thrombi in the pseudoaneurysm revealed Psuedomonas infection. On the 11th postoerative day, a single-stage procedure of irrigation, debridment, and immediate closure with omental transposition was performed. Although the chest CT scan 1 month after the omental transposition revealed a residual abcess, it was completely obliterated after 2 months without further operation.

Replacement of the Ascending Aorta and the Transverse Aortic Arch for Chronic DeBakey Type I Dissecting Aneurysm in a Patient with Aberrant Right Subclavian Artery / 日本心臓血管外科学会雑誌

We report a case of chronic DeBakey type I dissecting aneurysm with an aberrant right subclavian artery, in which replacement of the ascending aorta and the transverse aortic arch was performed under selective cerebral perfusion, resulting in complete obliteration of the false channel in the descending thoracic aorta. A 57-year-old female was admitted to our service complaining of chest and back pain. An aberrant right subclavian artery that originated from the descending thoracic aorta was identified. During operation, the dissected aortic wall of the aortic arch and the proximal descending thoracic aorta that involved more than half of its circumference was resected, the dissected intima was reapproximated at the distal stump, and the beveled distal end of the tubular ascending aortic prosthesis was secured to the cut edge. The postoperative course was uneventful, and she is leading a normal life now four years after surgery. It is rare to reconstruct the aortic arch for aortic dissection that occurred in a patient with aberrant right subclavian artery, and the technical details were reported.