Successful Endovascular Stent-graft Treatment of a Ruptured Thoracoabdominal Aortic Aneurysm with Coverage of the Celiac Axis / 日本心臓血管外科学会雑誌

A 73-year-old woman was referred to our hospital for treatment of a ruptured thoracoabdominal aortic aneurysm (TAAA). Computed tomography (CT) showed a ruptured saccular TAAA (maximum diameter, 70 mm) located just above the celiac trunk. The patient chose to undergo endovascular repair because of the high risk associated with conventional repair, so an emergency endovascular stent-graft treatment was performed. The collateral pathway from the superior mesenteric artery (SMA) to the celiac branches via the pancreaticoduodenal arcades was confirmed by selective angiography of the SMA before stent-grafting. The stent-graft was successfully deployed just proximal to the origin of the SMA with intentional coverage of the celiac axis to achieve sealing. Postoperatively, the patient was free from abdominal organ disorder or paraplegia/paraparesis and was discharged from the hospital after 36 days procedure. Follow-up CT scans performed at 1 week, month and 6 months showed patency in the SMA and the celiac branches, and there was no evidence of an endoleak. A less invasive endovascular repair procedure such as this can be an alternative treatment of a ruptured TAAA.

Successful Endovascular Stent-graft Treatment of a Ruptured Isolated Internal Iliac Artery Aneurysm / 日本心臓血管外科学会雑誌

A 90-year-old man was referred to our hospital for lower abdominal pain and ecchymotic discoloration around the anus. A laboratory test revealed severe anemia (hemoglobin level, 5.7 g/dl), and computed tomography (CT) showed a ruptured left internal iliac artery aneurysm (diameter, 60×44 mm). Consequently, emergency endovascular stent-grafting treatment was performed. Under local anesthesia, the stent-graft was successfully inserted in the left common and external iliac arteries, covering the ostia of the internal iliac artery. A follow-up CT scan showed complete thrombosis of the left internal iliac artery aneurysm and no evidence of an endoleak. After the procedure, the patient was treated with hemodialysis for acute-on-chronic renal failure and was discharged after 2 months.

In Situ Replacement with Rifampicin-Soaked Vascular Prosthesis in a Patient with Abdominal Aortic Aneurysm Infected by Listeria monocytogenes and Presenting with Symptoms of Leriche Syndrome / 日本心臓血管外科学会雑誌

A 72-year-old man presented with low back pain, intermittent claudication, atrophy of the muscle of the lower extremities, and impotence. Laboratory tests revealed inflammation, and computed tomography showed an abdominal aortic aneurysm with severe stenosis of the terminal aorta. Consequently, we diagnosed an infected aortic aneurysm and antibiotics were administered intravenously. Bacterial culture of the blood on admission demonstrated <i>Listeria monocytogenes</i>. On day 27 after admission, <i>in situ </i>replacement with a rifampicin-soaked vascular prosthesis and omentopexy were performed. After the surgery, intermittent claudication, atrophy of the muscles of the lower extremities, and impotence improved dramatically. The postoperative course was uneventful. Antibiotics were administered for a long period, and the C-reactive protein levels decreased to a normal range. For 18 months thereafter, the patient has been doing well without any sign of infection.

<i>In Situ </i>Replacement with Rifampicin-Soaked Vascular Prosthesis in a Patient with Abdominal Aortic Aneurysm Infected by <i>Listeria monocytogenes </i>and Presenting with Symptoms of Leriche Syndrome / 日本心臓血管外科学会雑誌

A 72-year-old man presented with low back pain, intermittent claudication, atrophy of the muscle of the lower extremities, and impotence. Laboratory tests revealed inflammation, and computed tomography showed an abdominal aortic aneurysm with severe stenosis of the terminal aorta. Consequently, we diagnosed an infected aortic aneurysm and antibiotics were administered intravenously. Bacterial culture of the blood on admission demonstrated <i>Listeria monocytogenes</i>. On day 27 after admission, <i>in situ </i>replacement with a rifampicin-soaked vascular prosthesis and omentopexy were performed. After the surgery, intermittent claudication, atrophy of the muscles of the lower extremities, and impotence improved dramatically. The postoperative course was uneventful. Antibiotics were administered for a long period, and the C-reactive protein levels decreased to a normal range. For 18 months thereafter, the patient has been doing well without any sign of infection.

Axillo-bilateral Iliac Artery Bypass for Atypical Coarctation of the Aorta with Severe Calcification / 日本心臓血管外科学会雑誌

A 66-year-old woman had hypertensive heart failure and intermittent claudication due to coarctation of the aorta with severe calcification. Consequently, axillo-bilateral iliac artery bypass was performed. Postoperatively, the difference in blood pressure between the upper and lower limbs decreased, the heart failure improved, and the intermittent claudication disappeared. The postoperative course was uneventful and the patient was discharged without complication 15 days after surgery. There are many case reports of aorto-aortic bypass for this disease ; however, axillo-bilateral iliac artery bypass is an effective and less-invasive procedure. On the other hand, from the perspectives of long-term graft patency and abdominal visceral perfusion, careful postoperative follow-up of upper and lower limb blood pressure and renal perfusion is necessary.

Cardiac Surgery in Patients with Chronic Dialysis / 日本心臓血管外科学会雑誌

This study was designed to evaluate the perioperative outcome of dialysis patients undergoing cardiac surgery, who were managed with our perioperative dialysis program. Between April 1994 and August 1999, 11 patients (7 men and 4 women with a mean age of 57.3±10.3 (36-73)) with hemodialysis (HD, <i>n</i>=8) and peritoneal dialysis (PD, <i>n</i>=3) underwent cardiac surgery. The duration of dialysis was 5.6±4.3 years. Operation included mitral valve replacement (<i>n</i>=1) and isolated coronary artery bypass grafting (<i>n</i>=10). Patients with HD had single hemodialysis on the day before operation. Patients with PD were maintained on PD in the usual manner until the day before surgery. Intraoperative hemofiltration during extra-corporeal circulation and normokalemic non-depolarizing cardioplegic solution were used in all patients to avoid post-operative hyperkalemia. All HD patients had dialysis on the first post-operative day (POD 1), and then every other day. PD patients had PD soon after arriving at the ICU. Levels of serum creatinine, urea nitrogen, acid-base balance were successfully controlled within acceptable ranges. No patients required emergency HD or any post-operative managements for hyperkalemia in the ICU. Six of 8 HD patients required an increase in vasopressor because of a tendency toward hypotension and 4 of 8 patients suffered from atrial fibrillation during the initial HD on POD 1. Eight of 11 patients could be extubated on the first POD. No hospital death occurred. The use of normokalemic cardioplegic solution was useful to avoid post-operative hyperkalemia. Our perioperative dialysis programme successfully managed the perioperative clinical course of dialysed patients undergoing cardiac surgery.

Simultaneous Cholecystectomy and Dor Operation with Encircling Endocardial Cryoablation for Ventricular Aneurysm with Malignant Ventricular Tachycardia and Acute Cholecystitis / 日本心臓血管外科学会雑誌

A 68-year-old man underwent percutaneous transluminal coronary angioplasty (PTCA) to left anterior descending artery (LAD) seg 7 after acute anteroseptal myocardial infarction 8 years previously. He was admitted because of syncope attack due to sustained ventricular tachycardia and subsequent fibrillation. He was treated medically in the ICU after cardiopulmonary resuscitation. Medical treatment with amiodarone and lidocaine was not successful and he was transferred to our hospital for surgical treatment of malignant ventricular tachycardia (VT) associated with left ventricular aneurysm and acute cholecystitis that occurred during admission. Left ventriculogram showed left ventricular aneurysm (ejection fraction: 35%) without any significant coronary lesions. The patient successfully underwent a Dor operation (left ventriculoplasty), double encircling endocardial cryoablation without endocardial resection, and preoperative and intraoperative endocardial mapping. Cholecystectomy was simultaneously performed after complete closure of the median chest incision. The recurrence of VT was never recognized clinically or electrophysiologically. The extended encircling endocardial cryoablation without endocardial resection and preoperative and intraoperative electrophysiological study, was a simple and effective method for ventricular tachycardia.