Successful Re-intervention for Endograft Collapse after TEVAR / 日本心臓血管外科学会雑誌

<p>A 55-year old man was admitted to our hospital owing to endograft collapse after TEVAR. He had undergone total arch replacement for acute aortic type A dissection at age 39, and undergone thoracic endovascular aortic repair (TEVAR) for chronic aortic type B dissection at age 54. TEVAR was successfully performed and the false lumen was shrunk. However, one year after TEVAR, computed tomography showed endograft collapse. Technical success was not achieved by the balloon technique to treat endograft collapse, so we performed additional TEVAR. After this procedure, endograft collapse was repaired. The postoperative course was uneventful.</p>

Production and accumulation of xylooligosaccharides with long chains by growing culture and xylanase of a mutant strain of Bacillus pumilus X-6-19 / 生物工程学报

Bacillus pumilus X-6-9 isolated from soil and subsequently identified, produced xylooligosaccharides with long chains from xylan and accumulated them in the culture. By improving the culture conditions and mutating the bacterium, a 3.2-fold increase in the production of the xylooligosaccharides was established, when compared to the original culture conditions of B. pumilus X-6-19. The addition of D-glucose to the culture of the mutant strain U-3 of B. pumilus X-6-9 repressed the synthesis of beta-xylosidase, but not xylanase. Thus, it was revealed that strain U-3 was a good organism for the production and accumulation of xylooligosaccharides with long chains from xylan by a microbial culture. Xylanase produced by strain U-3 was purified to homogeneity and characterized. The hydrolyzates generated by the purified xylanase contained xylobiose, xylotriose, xylotetraose, and xylopentaose, but not xylose.

A Ruptured Anterior Tibial Artery Aneurysm in a Patient with von Recklinghausen's Disease / 日本心臓血管外科学会雑誌

A 41-year-old woman with neurofibromatosis (NF) was admitted to our hospital for severe pain and right leg swelling of 5 days duration. Paralysis of the right leg due to compartment syndrome was also recognized. She had been diagnosed as von Recklinghausen's neurofibromatosis, previously. 3 D-computed tomography showed a ruptured anterior tibial artery aneurysm. There was a normal patent posterior tibial artery. Since her complaint of pain was severe, we performed an emergency operation. Under the pneumatic tourniquet technique, the aneurysm was resected, and both the proximal and distal sides of the anterior tibial artery were ligated. A massive hematoma was completely removed. Postoperatively, the dorsalis pedis and posterior tibial pulses remained palpable. The paralysis improved considerably and she was given an ambulatory discharge from our hospital 21 days after the operation. Histological examination revealed proliferating wavy spindle cells infiltrating between the adventitia and mesothelium of the aneurysmal wall and staining positively for S 100 immunoperoxidase.

Graft Infection in Femorofemoral Crossover Bypass, First Presenting as Septic Distal Emboli / 日本心臓血管外科学会雑誌

We report a case of graft infection long after femorofemoral crossover bypas grafting (FFBG), first presenting as septic distal emboli without any infective signs in the groin. A 71-year-old man who had undergone FFBG visited our hospital because of sudden pain in his right foot. No infective signs were found in the graft route from physical examination. However, computed tomography demonstrated perigraft fluid and graft thrombi. Graft excision and extra-anatomic revascularization were successfully done. Light micrography showed <i>Staphylococcus aureus</i> extensively infiltrating in the expanded polytetrafluoroethylene graft wall.

Preoperative Risk Factors for Residual Aortic Regurgitation after Valve Re-Suspension Procedure in Acute Type A Aortic Dissection / 日本心臓血管外科学会雑誌

This study evaluated factors influencing residual aortic regurgitation (AR) after valve re-suspension surgery for acute type A aortic dissection. From January 1996 through December 2002, 63 patients were treated for acute type A dissection at our institution. Among these 63 patients, pre-and postoperative echocardiograms were available in 38 patients who underwent surgery combined with native aortic valve re-suspension. These 38 patients were divided into 2 groups according to the postoperative AR grade, i. e.: AR group: AR grade≥II (<i>n</i>=6), no-AR group: AR grade≤I (<i>n</i>=32). The severity of pre and postoperative AR was assessed by transthoracic or transesophageal echocardiography. The preoperative diameters of mid ascending aorta and sinotubular junction, and the percentage of the circumference of the dissection at the sinotubular junction level was measured by enhanced CT scan. Preoperative patient backgrounds were similar in both groups. The preoperative AR grade in the AR group was significantly greater than that of the no-AR group (2.25±1.17: 0.69±0.91, <i>p</i><0.001). The tear was more frequently located in the ascending aorta in the AR group than in the no-AR group (66.7%: 37.5%, <i>p</i><0.05). The percentage of circumference of the dissection at the sinotubular junction level did not affect the preoperative AR grade, but it did show a tendency to influence the severity of postoperative AR, though the difference was not significant. Three patients (7.9%) had AR grade III at the time of discharge, but did not clinically require further surgical intervention. Preoperative significant AR and the location of the tear in the ascending aorta are associated with postoperative residual AR after aortic valve re-suspension. The percentage of circumference of the dissection at the sinotubular junction level might influence the severity of postoperative AR.

Coronary Artery Bypass Grafting in Situs Inversus Totalis / 日本心臓血管外科学会雑誌

Cardiovascular surgery in situs inversus totalis (SIT) is unusual. We report a case of coronary artery bypass grafting (CABG) in SIT. A 67-year-old man with unstable angina pectoris was admitted to our hospital. Coronary arteriography demonstrated three-vessel disease in the mirror-image heart. CABG with 4 distal anastomosis was carried out with conventional methods. Careful observation based on complete understanding for preoperative images could minimize operative difficulties caused by mirror-image heart.

Tricuspid and Mitral Valve Replacement in a Patient with Atrioventricular Discordance Long after Functional Biventricular Repair / 日本心臓血管外科学会雑誌

In atrioventricular (AV) discordance, a morphologic tricuspid valve functioning as a systemic AV valve often becomes incompetent and needs to be replaced. However, mitral valve replacement concomitant with tricuspid valve replacement is unusual in the disease. Here, we report a case of successful double AV valve replacement long after functional biventricular repair in AV discordance. A 32-year-old man with AV discordance was admitted with orthopnea. He had undergone the Rastelli procedure at age 10 and removal of the deteriorated conduit valve at age 24. Preoperative examinations revealed not only tricuspid but also mitral regurgitation. Both deteriorated valves were replaced with mechanical valves. In AV discordance after Rastelli procedure, a non-valved conduit may accelerate mitral deterioration because pulmonary hypertension from tricuspid regurgitation increases the afterload of the pulmonary ventricle.

Aortic Valve Replacement with MRSA-Infected Osteoradionecrosis of the Chest Wall / 日本心臓血管外科学会雑誌

A 75-year-old woman required aortic valve replacement for aortic stenosis. She had undergone radical mastectomy and irradiation for left breast cancer 25 years previously, and had chest wall infection secondary to osteoradionecrosis. In spite of preoperative infection controls including surgical debridement, the chest wall was not healed well and colonized with MRSA. However, she was too ill with severe heart failure to wait until the chest wound was negative for MRSA for a valve operation. With the infection remaining, the aortic valve was approached through a right parasternal incision, to exclude the infected sternum from the surgical site, and successfully replaced with a mechanical valve. An internal mammary retractor was useful to avoid fractures of the infected sternum and provided excellent exposure of the aortic root. No mediastinitis or prosthetic valve infection was encountered postoperatively.