True Coronary Aneurysms after the Bentall Procedure in a Patient with Marfan Syndrome / 日本心臓血管外科学会雑誌

A 55-year-old woman underwent a Bentall operation and total arch replacement 18 years previously, because of chronic aortic dissection (CAD), annuloaortic ectasia (AAE), aortic valve insufficiency (AI), and Marfan syndrome. In 1996, at age 37 years, she was admitted to our hospital with diagnoses of CAD, AAE, AI, and Marfan syndrome. That same year, we performed the Bentall operation and total arch replacement (Carbomedics, 25 mm ; Hemashield, 28 mm). She then underwent Y-graft replacement for an abdominal aortic aneurysm in 2003, descending aorta replacement for a thoracic aortic aneurysm in 2007, and thoracoabdominal aorta replacement for thoracoabdominal aortic aneurysm in 2010. Afterward, both coronary arteries gradually dilated. The diameter of the left coronary artery was 17 mm, while that of the right coronary artery was 25 mm. Accordingly, in 2014, we surgically replaced both coronary aneurysms with the great saphenous vein. Pathological analysis showed that both coronary aneurysms were true aneurysms because the three-layered structure was preserved. We confirmed that the great saphenous vein grafts were patent by three-dimensional computed tomography. She was discharged 17 days postoperatively once her condition stabilized. We report a case of Marfan syndrome with both coronary true aneurysms, because we think this kind of report is very rare.

A Case of Tetralogy of Fallot with Endocardial Cushion Defect of the Intact Primary Septum / 日本心臓血管外科学会雑誌

The patient was a 15-month-old girl with Down's syndrome. She had a heart murmur on the first day after birth. The echocardiogram revealed that she had the tetralogy of Fallot (TOF) and mitral insufficiency (MI). She was observed because she had no heart failure or cyanosis. However, she developed heart failure with progressive MI. Then, she was admitted to our medical center for surgical treatment. During the operation, it was confirmed that the primary septum was intact and a large ventricular septal defect was located at the inlet to outlet portion with anterior malalignment. Each leaflet of the atrioventricular valve were attached to the same level and the ventricular septum was scooped out. TOF with endocardial cushion defect (ECD) without primary septal defect was diagnosed based on the operative findings. Surgical repair was performed through the right atrium and pulmonary artery. She was discharged 17 days after operation without any complications. This was a very rare combination of TOF with ECD without a primary septal defect. We discussed this rare condition with a review of the literature.

Infected Abdominal Aneurysm Caused by Bacteroides / 日本心臓血管外科学会雑誌

A 73-year-old man complained of pain in the right lower abdomen with hypotension. The result of abdominal computed tomography (CT) suggested a rupture of an abdominal aortic aneurysm. Emergency Y graft replacement was performed. During surgery, a perforation of about 1cm in diameter was found in the posterior wall of the abdominal aorta just above the iliac bifurcation. The patient developed postoperative complication of retroperitonitis. The cultures of blood clots collected during surgery grew <i>Bacteroides fragilis</i>, as did postoperative drainage fluid from the retroperitoneum. On the 10th day of illness, axillo-bifemoral bypass was performed and the Y graft was removed. Although continuous lavage of the retroperitoneum was performed, he did not recover from retroperitonitis and died of sepsis 2 months after surgery. Infected abdominal aneurysm is rarely caused by <i>Bacteroides</i>. We discussed the infectious route and treatment of this rare condition with a review of the literature.