Surgery for Aortic Valvular Disease with Congenital Bicuspid Aortic Valve / 日本心臓血管外科学会雑誌

An increase of aortic valvular disease associated with congenital bicuspid aortic valve is observed due to the relative decrease of rheumatic valvular diseases. A total of 24 patients with aortic valvular disease associated with congenital bicuspid aortic valve underwent surgical treatment at our institution during the period from January, 1997 to December, 1999. These 24 patients constituted 46.2% (24/52) of all cases of surgical operations for aortic valvular disease. The age of the patients ranged from 17 to 83 years (mean 62 years). They consisted of 16 men (66.7%) and 8 women. Two patients had infective endocarditis. The classification of congenital bicuspid aortic valve was right-left cusp type in 15 patients (raphe+: 11), anterior-posterior cusp type in 9 patients (raphe+: 9). We performed aortic valve replacement in 22 patients, aortic root replacement in 1 patient and aortic root remodeling in 1 patient in combination with mitral valve plasty in 3 patients, coronary artery bypass grafting in 3 patients and closure of the atrial septal defect (ASD) in 1 patient. We detected ASD in 1 patient, ventricular septal defect in 1 patient and high-posterior take-off right coronary artery in 1 patient. Patients with stenosis often have a small aortic annulus and severe post-stenotic aortic dilation. Preoperative and intraoperative evaluation is important in cases of aortic valvular disease associated with congenital bicuspid aortic valve.

A Case of Vein Graft Bypass for Superior Mesenteric Artery Stenosis / 日本心臓血管外科学会雑誌

We report a case of successful saphenous vein bypass grafting for superior mesenteric artery stenosis. A 50-year-old man complained of abdominal pain which was not induced by either eating or defecation. He was admitted to our hospital and examinations of the gastrointestinal tract revealed no abnormality. Angiography showed stenosis of the superior mesenteric artery (SMA), but not of the celiac artery (CA) or inferior mesenteric artery (IMA). We speculated that his symptom was due to SMA stenosis and poor collateral circulations from the CA, IMA and internal iliac arteries. Saphenous vein bypass grafting for SMA was undertaken successfully and abdominal pain disappeared completely.