Successful Open Surgical Repair and Postoperative Complications for Ruptured Abdominal Aortic Aneurysm Transferred with Intra-aortic Balloon Occlusion Catheter / 日本心臓血管外科学会雑誌

A 74-year old man, presented with dyspnea following acute abdominal pain, was admitted to an initial hospital. The plain computed tomography (CT) scan revealed a ruptured abdominal aortic aneurysm (AAA). Emergency insertion of intra-aortic balloon occlusion (IABO) catheter was carried out due to his unstable hemodynamic condition. The patient was transferred to our hospital after surgical consultation. Open surgical repair was carried out, and massive retroperitoneal hematoma and excessive bowel edema made it difficult to close the abdomen primarily. Delayed closure following Open Abdomen Management (OAM) was effective.

Single-Stage Repair of Thoracic Aortic Aneurysm Associated with Aortic Stenosis and Pseudocoarctation by Means of the Clamshell Approach / 日本心臓血管外科学会雑誌

A 64-year old man was admitted to our hospital with a diagnosis of aortic stenosis. Pre-operative chest CT revealed pseudocoarctation of the aorta with a hypoplastic aortic arch, elongation and kinking of the aortic arch and proximal descending aorta. There was also a large aneurysm from the distal arch to descending aorta. We performed a single-stage repair of the aortic lesion from the ascending to the descending aorta with aortic valve replacement. For the surgical approach, transverse clamshell incision was applied safely. Concomitant aortic valve replacement in surgical repair of pseudocoarctation and thoracic aneurysm was rare, and clamshell incision seemed beneficial in such single-stage repair from the aortic root to the descending aorta.

Initial Experience with the MC³ Annuloplasty Ring for Tricuspid Regurgitation : Comparison to the Cosgrove-Edwards Ring / 日本心臓血管外科学会雑誌

The Edwards MC³ tricuspid annuloplasty system has recently become available commercially. Its anatomically correct design conforms to the three-dimensional tricuspid orifice and minimizes stress on sutures. We handled 71 patients with functional tricuspid regurgitation by open heart surgery and tricuspid valve repair between May 2005 and April 2007 in our institute. Cosgrove-Edwards annuloplasty rings were used for tricuspid regurgitation in 33 patients before October 2006. Among them, there were 30 mitral valve surgeries, 6 aortic valve surgeries, and 2 cases of atrial septal defect. Since then, we used the MC³ system in 38 cases, consisting of 30 mitral valve surgeries, 9 aortic valve surgeries, and 2 cases of atrial septal defect. Three patients died postoperatively with the Cosgrove-Edwards system, but there was no fatality with the MC³ system. The degree of tricuspid regurgitation was reduced from 2.6±0.58 to 0.34±0.46 (regurgitation severity scale: 0 to 4) in the patients with the MC³ ring at discharge. In the 33 patients with the Cosgrove-Edwards ring, it was from 2.8±0.67 to 0.92±0.99. The severity of tricuspid regurgitation in patients with the Cosgrove-Edwards ring and the MC³ ring about nine months postoperative was 1.5±1.2 and 0.42±0.50, respectively. The MC³ (rigid ring) system was more effective than the Cosgrove-Edwards (flexible band) system for decreasing tricuspid regurgitation in immediate and short-term postoperative periods.