A Case of Aortic Root Remodeling for Aneurysm of the Noncoronary Sinus of Valsalva / 日本心臓血管外科学会雑誌

We report a case of aneurysm localized to the noncoronary sinus of Valsalva with moderate aortic regurgitation (AR). The patient was a 49-year-old woman who had been suspected to have some kind of connective tissue disorders. She underwent an aortic root remodeling procedure to replace the isolated, unruptured and extracardiac aneurysm and the ascending aorta. Postoperative angiogram showed no aneurysm and improved AR. This procedure was able to preserve her own aortic valve and normal sinuses of Valsalva and enable her to obtain better quality of life, although progression of the enlargement of the aorta or AR requires careful follow-up.

Two Cases of Acute Aortic Dissection after Y Graft Repair of the Abdominal Aortic Aneurysm / 日本心臓血管外科学会雑誌

We experienced two rare cases of acute aortic dissection with leg ischemia after Y graft repair of the abdominal aortic aneurysma. Case 1 was a 63-year-old woman who had received Y graft repair at age 55, and case 2 was a 28-year-old man with Marfan's syndrome who received a Y graft repair at age 21. Both patients sustained DeBakey type I dissections terminating at the suture line of the Y graft and had symptoms of acute arterial occlusion of bilateral lower extremities. Emergency operation was performed 8 hours after onset in case 1 and 6 hours after in case 2. Case 1 could not be weaned from cardiopulmonary bypass because of intraoperative rupture and acute heart failure, but case 2 underwent successfully aortic root replacement and total arch replacement under selective cerebral perfusion.

Complications and Prognoses of Patients Treated for Stanford Type B Aortic Dissection / 日本心臓血管外科学会雑誌

In the past 11 years, we treated 41 patients with Stanford type B aortic dissection. Principally, medical therapy was carried out and surgery was performed only when complications related to the dissection occurred. Twenty two patients (53.7%) had complications, including 5 (12%) with peripheral limb ischemia, 3 (7%) with rupture, 13 (32%) with dilatation of the aorta, 4 (10%) with extension of dissection (type A dissection). Seventeen patients received surgery including palliative operation. Among 41 patients, 3 died due to aortic rupture and 2 died at surgery for type A dissection, while 4 of them had developed proximal extension of the dissection. The 5-year survival rate for all patients was 86.7±6.6%. Long term survival will improve in patients with Stanford type B aortic dissection when the operative mortality for type A dissection is reduced and sound management policies are developed.