Résumé
<p>We report a case of chronic mesenteric ischemia associated with severe aortic valve regurgitation and stenosis (ASR). The patient was a 76-year-old man who had been given a diagnosis of ASR in his 40s. He gradually developed heart failure and chronic kidney disorder due to deterioration of ASR. He had started hemodialysis 1 year before admission and had complained of abdominal pain after meals and weight loss during that period. He was admitted to the Department of Cardiology in our hospital for evaluation of ASR. Severe ASR with low output syndrome (C. I. 2.00 L/min/m<sup>2</sup>) were confirmed by cardiac catheter examination. In addition, abdominal angiography revealed total occlusion of the superior mesenteric artery (SMA) and severe stenosis of the celiac artery (CA). We considered that low cardiac output due to severe ASR had exacerbated the mesenteric ischemia. We performed AVR and abdominal aorta-SMA bypass at the same time to prevent acute mesenteric ischemia in the perioperative period. The combination of valvular disease and CMI is very rare. This is the first report in Japan of simultaneous valve replacement and mesenteric artery revascularization.</p>
Résumé
A 68-year-old woman with multiple gastric ulcers was admitted to our hospital due to post-prandial abdominal pain. Multirow detector computed tomography (MDCT) showed severe stenoses of both the celiac trunk and superior mesenteric artery (SMA) ; therefore, we decided to operate based on the presumed diagnosis of abdominal angina. We bypassed the stenoses using a saphenous vein graft from the right external iliac artery to the SMA, distal to the stenosis. The patient was symptom-free postoperatively. In summary, this case of abdominal angina was accurately evaluated preoperatively with MDCT and the flow meter<sup>®</sup>. Thereafter, a focal stenosis in the superior mesenteric artery was successfully treated with an external iliac-SMA bypass using a saphenous vein graft.
Résumé
A 61 y. o. male was admitted as a diagnosis of Stanford type A dissecting aortic aneurysm 6 day after the occurrence. An urgent operation was performed next day and the ascending aorta was replaced. Oral intake was initiated after uneventful postoperative 6 day-period. However, paralytic ileus became obvious associated with spiked fever over 38°C. Second trial after the suspension of oral intake also failed in the same result and turned out sepsis caused by <i>Enterococcus faecium</i>. The angiogram revealed the intact celiac axis and superior mesenteric artery (SMA), and the remarkably narrowed true lumen of the aorta. Although the clinical symptom was not typical, we thought that the ileus was induced by abdominal angina. At 78th postoperative day the fenestration of the abdominal aorta and the bypass grafting with saphenous vein between SMA and the abdominal aorta were performed. The symptom and sign of ileus subsided after the operation.