Debranching TEVAR with Left Vertebral Artery Transposition for Aortic Arch Aneurysm with Metal Allergy / 日本心臓血管外科学会雑誌

A 85-year-old man with an abnormal shadow on X-ray was given a diagnosis of aortic arch aneurysm by CT scan. Preoperative additional careful examinations revealed that his dominant vertebral artery was the left one and he had an allergy to metals such as platinum, tin and zinc. He underwent thoracic endovascular aortic repair (TEVAR) after revascularization of left vertebral artery by bypass grafting between bilateral axillary arteries and the left common carotid artery with a T-shape graft. Because of the position of the origin of the left vertebral artery from the left subclavian artery was comparatively proximal part, we made it transposition more distally to occlude the LSA by ligation. We selected conformable GORE® TAG® for zone-1 TEVAR because the stent graft, which was not composed of allergic metals, contained only less allergic metals than any other devices commercially available. More than two years have passed since his discharge and he was followed as an outpatient without any allergic symptom and other remarkable complications. Here, we report a rare case of 2 debranching TEVAR for aortic arch aneurysm with metal allergy.

Mitral Valve Plasty in Postinfarction Partial Rupture of a Posterior Papillary Muscle / 日本心臓血管外科学会雑誌

We report the successful treatment of an 81-year-old woman after a difficult diagnosis of mitral valve regurgitation resulting from partial rupture of the posterior papillary muscle. The patient, with a chief complaint of dyspnea, was admitted to our hospital in October, 2010. Echocardiography revealed severe MR and an oscillating abnormal mass attached to the mitral posterior leaflet was assessed as vegetation. Her general condition worsened and coronary angiography revealed 90% stenosis at #6 and 99% stenosis at #12. Partial papillary muscle rupture of post acute myocardial infarction was ruled out. Urgent surgery was performed. It is found that tissue we had assessed as vegetation was a part of the posterior papillary muscle with no signs of infection. MVP with quadrangular resection (P3), annuloplasty and CABG (LITA-LAD, SVG-OM) was performed. The patient was discharged on the 28th postoperative day. Echocardiography showed no MR for four years after the surgery.

Papillary Muscle Rupture of the Mitral Valve Caused by Traffic Accident / 日本心臓血管外科学会雑誌

A 59-year-old man was admitted to our hospital because of multiple traumas in a motorcycle accident. On admission, his vital signs were stable, however, 4 h later his respiratory condition suddenly worsened and be needed ventilatory support. Cardiogenic shock was suspected, however, the conventional echocardiograph findings were indistinct because of the presence of subcutaneous air. On the third day of hospitalization day, the Swan-Ganz catheter revealed high pulmonary arterial pressure. The subsequently performed trans-esophageal echocardiography showed severe mitral regurgitation. Therefore, semi-emergency mitral valve replacement was planned on the 5th hospital day. Operative findings showed that the anterolateral papillary muscle had torn off from the left ventricular wall and the associated strut chordae was also torn from the anterior leaflet. The post-operative course was uneventful, and the patient was discharged on the 40th postoperative day.

Surgical Treatment of Abdominal Aortic Aneurysm Coexisting with Coronary Artery Disease / 日本心臓血管外科学会雑誌

This study was designed to evaluate the optimal surgical treatment strategy for abdominal aortic aneurysm (AAA) coexisting with coronary artery disease (CAD). Twenty-six patients (21 men and 5 women with a mean age of 72.6±3.7 years old) who required surgical treatment of both conditions were examined. Eleven patients underwent a one-stage operation. Four of them had on-pump CABG and 7, including 3 high-risk-patients, underwent off-pump CABG. There were no operative mortalities, but 3 patients had severe morbidity (respiratory failure, acute renal failure, pneumonia). Fifteen patients underwent a two-stage operation. None of them had rupture of the AAA during the interval between the two operations, but 2 patients with large AAA (more than 6cm in diameter) required emergency operation due to impending rupture of the AAA. There was no operative mortality, but one patient suffered acute renal failure. One-stage operation for low-risk patients seems to be a safe and reasonable strategy. One-stage operation for high-risk patients should be performed cautiously, and off-pump CABG is especially useful in such patients.

A Case of Aortitis Syndrome with Annuloaortic Ectasia and Aortic Regurgitation Which Was Successfully Treated by Aortic Root Replacement with Freestyle Stentless Bioprosthesis / 日本心臓血管外科学会雑誌

A 34-year-old woman who was suffering from aortitis syndrome with annuloaortic ectasia (AAE) and severe aortic regurgitation (AR) from 18 years of age was admitted for an aortic root replacement. She has been on 5mg predonine daily. Aortography, CT and echocardiography examinations revealed dilated aortic annulus (D=30mm) and valsalva sinuses (D=43mm) and overstretched aortic valve leaflets. The ascending aorta was aneurysmal (D=50mm). Because of the patient's strong desire to have children, a Freestyle bioprosthesis was chosen for replacement. A collagen impregnated tube graft was interposed between the Freestyle and the proximal end of the transverse aorta. In order to reconstruct the coronary arteries, the Cabrol technique was utilized because of severe inflammatory adhesion of the aortic root. The patient had an uneventful postoperative course. This case shows that an aortic root replacement with Freestyle bioprosthesis offers a great benefit to those patients who are not suitable to receive postoperative anti-coagulation therapy to enable future pregnancy and child delivery.