Evaluation of the Palmaz Stent in Iliac Artery Stenosis Using Intravascular Ultrasound / 日本心臓血管外科学会雑誌

We determined cross sectional area of stent and lumen of iliac arterial lesions before and after deployment of Palmaz stents using intravascular ultrasound (IVUS). Stent deployment was performed in 43 patients with 47 lesions. Cross sectional images were recorded using IVUS in the proximal (P), center (C), and distal portion (D) of the stent in the iliac lesions before, immediately after, and 6 months after the deployment of stent. The initial success rate was 100%. Ultrasound images were analyzed for lumen, intra-stent and intimal proliferation area.The lumen area dilated significantly from 9.9±7.1mm² to 32.7±9.4 after the stent deployment. The intra-stent cross sectional area right after the treatment did not show any difference among the 3 portions. The mean stent area after 6 months was 32.8±8.4mm², without significant stent recoil. The lumen (=intra-stent) area after stent deployment were P: 338±9.7mm², C: 30.9±9.0, and D: 32.7±8.6. The lumen of the center portion had a tendency to be smaller than that of the proximal or distal portions. After 6 months, the intra-stent area was P: 33.5±9.2mm², C: 31.5±7.7, and D: 33.3±8.3 and the lumen area was P: 31.3±10.4mm², C: 28.2±8.9, and D: 29.4±10.5. Stent recoil was not observed but minimal dilatation was noted in the center and distal portions. The lumen area after 6 months became smaller than that immediately after the treatments due to intimal proliferation and stent deformation. The lumen area in the center portion had a tendency to be smaller than that of the proximal portion. The rates of change in the lumen area were P: -6.7±5.6%, C: -98±6.4% and D: -12.4±9.9. This showed a tendency for the lumen of the distal portion to be smaller than that of the proximal portion due to intimal proliferation. The intimal proliferation rates showed a tendency to be higher toward distal sites, but the narrowest portion in the stent was its center. The long-term patency diagnosed by angiography was 92.3% in 6 months and 89.5% in 12 and 24 months. IVUS is useful for evaluation of iliac stent deployment. The Palmaz stent was a very effective treatment for the iliac arterial lesions, protecting against vascular recoil.

Y-graft Replacement for Ruptured of Abdominal Aortic Aneurysm in an Elderly Patient / 日本心臓血管外科学会雑誌

Y-graft replacement was successfully performed in a patient aged 93 years with ruptured infrarenal abdominal aortic aneurysm. The patient was in shock on arrival and underwent an emergency operation with the administration of cathecholamines. The ruptured infrarenal abdominal aortic aneurysm with a large hematoma, which was located in the area of the left common iliac artery, was 10cm in the maximum diameter. The bilateral common iliac arteries were strongly calcified and occluded. The distal end of the graft was anastomosed to the external iliac artery. The patient's postoperative course was uneventful.

Non-anastomotic False Aneurysm after the Replacement Using a Double Velour Knitted Dacron Graft: A Case Report / 日本心臓血管外科学会雑誌

A non-anastomotic false aneurysm occurred in a 77-year-old male 11 years after bypass grafting between the left external iliac artery and the right femoral artery using a Cooley double velour knitted Dacron graft. The false aneurysm was caused by rupture of an artificial graft. A partial resection of the graft and its replacement using a Hemashield^® graft were successfully performed. It was speculated that the mechanical stress by the inguinal band degenerated graft fibers and developed aneurysmal formation.

Long-term Results of Surgical Treatment of Abdominal Aortic Aneurysm / 日本心臓血管外科学会雑誌

A follow-up study of 98 patients undergoing abdominal aortic aneurysm (AAA) repair for 44 months, ranging 2 to 113 months, revealed no difference in 5-year actuarial survival between patients aged 75 or older and patients aged less than 75. The 5-year actuarial survival of ruptured and nonruptured AAA cases was 469% and 71.2%, respectively (<i>p</i><0.01). Late deaths after the repair of ruptured AAA were all due to atherosclerotic diseases. During a follow-up period after AAA repair, 9 patients were diagnosed as having malignant diseases with a fatal outcome in 6. Careful attention to atherosclerotic and malignant diseases is indispensable for follow-up management after AAA repair.

A Case of Aortic Stenosis Secondary to Bicuspid Aortic Valve Associated with Klippel-Feil Syndrome Treated by Aortic Valve Replacement / 日本心臓血管外科学会雑誌

A 52-year-old male was diagnosed as having aortic stenosis secondary to a bicuspid aortic valve associated with Klippel-Feil syndrome. Aortic valve replacement was successfully performed without any problems in the surgical or anesthesiological management. Only five such cases including ours, who underwent cardiac surgery have been reported. It is possible to perform cardiac surgery for patients with Klippel-Feil syndrome of their cardiac function can be well preserved.

Reoperation 22 and 18 Years after Radical Repair of the Tetralogy of Fallot: Report of Two Cases and Review of the Japanese Literature / 日本心臓血管外科学会雑誌

Two patients, a 32-year-old man and a 23-year-old woman, underwent successful reoperations 22 and 18 years after radical repair of the tetralogy of Fallot (TOF). The former patient had a diagnosis of pulmonary stenosis and aortic regurgitation due to infective endocarditis. Patch reconstruction of the right ventricular outflow tract (RVOT) and aortic valve replacement were performed. The latter patient was diagnosed as having pulmonary stenosis and a recanalized ventricular septal defect (VSD), followed by patch reconstruction of the RVOT and direct closure of a residual VSD. Reoperation 15 years or more after radical repair of TOF is rare. Only 15 such cases including the present two have been reported in Japan.