Redo Total Arch Replacement in Two Cases / 日本心臓血管外科学会雑誌

We performed redo total arch replacement for recurring aortic arch diseases in 2 patients. Case 1: A 76-year-old man with 3 prior surgical interventions for aortic arch diseases was referred to our hospital for the treatment of a ruptured aortic arch pseudoaneurysm. On admission, he frequently coughed up bloody sputum. Emergency total arch replacement was performed in this patient. Case 2: A 77-year-old man who had undergone total arch replacement 9 years previously recently experienced hoarseness. A CT-scan revealed distal aortic arch aneurysm, for which we decided to perform a redo total arch replacement. Surgical strategy was similar for both patients. Cardiopulmonary bypass was established and cooling was started before resternotomy. Redo total arch replacement assisted by antegrade selective cerebral perfusion was performed using 4-branched arch grafts. Although both patients were weaned from mechanical ventilator support, the first patient died of aspiration pneumonia on the 150th postoperative day, while the second one is currently undergoing rehabilitation at our hospital. Hospital mortality is high among patients undergoing redo thoracic aortic replacement requiring resternotomy. In these patients, it is important to pursue an appropriate operative procedure and to minimize pulmonary complications.

A Case of Coarctation of Descending Mid-Thoracic Aorta Caused by Fibromuscular Dysplasia / 日本心臓血管外科学会雑誌

A rare case of descending thoracic aortic coarctation caused by fibromuscular dysplasia is reported. A 74-year-old woman was referred to our institution because of congestive heart failure, hypertension, acute renal failure and pressure gradient between upper and lower extremities. Aortography revealed 90% stenosis of the descending mid-thoracic aorta. Descending-descending aortic bypass was performed under femoro-femoral partial cardiopulmonary bypass. The post-operative course was uneventful and the pressure gradient across the coarctation was disappeared. The patient discharged on the 28th postoperative day without any problems. The pathohistological findings revealed fibromuscular dysplasia in the media and intima of the aortic wall.

A Surgical Case of Aortic Arch Aneurysm Which Developed Five Years after CABG / 日本心臓血管外科学会雑誌

We report a successful case of graft replacement for ascending and aortic arch aneurysm which developed 5 years after CABG. A 75-year-old woman, who underwent emergency CABG (LITA-LAD, SVG-RCA) 5 years previously, was admitted to our hospital due to an abnormal shadow on chest roentogenogram. Aortogram and coronary angiogram revealed ascending and aortic arch aneurysm and patent LITA and SVG. Graft replacement of the ascending and total aortic arch was carried out using four branched grafts (Gelweave 26/10/8/8^*8). Cardiopulmonary bypass was established with right axillary arterial perfusion and bicaval cannulation. Cardiac arrest was obtained with cold blood cardioplegia using both retrograde and antegrade techniques. Selective cerebral perfusion was used for brain protection. The patient was discharged without any complication on the 27th postoperative day.

Clinical Experience of Gelatin-Impregnated Branched Vascular Graft(Gelseal) in Total Aortic Arch Replacement / 日本心臓血管外科学会雑誌

Gelatin-sealed branched knitted Dacron grafts (Gelseal^®, Vascutek, UK) were implanted in nine patients for surgical reconstruction of the toal aortic arch. Subjects included Stanford A type acute aortic dessection in five, distal aortic arch aneurysm in three, and aneurysm of the ascending aorta and aortic arch associated with aortic valve stenosis in one patient. There was no hospital death and a good postoperative course was obtained. This graft was soft, pliable and very useful for replacement of the aortic arch especially in emergency cases. However, intensive follow-up is necessary because it dilated about 20% in diameter one month after surgery.