A Case of Severe Triple Vessel Disease Treated by Coronary Artery Bypass Grafting to the Proximal Circumflex Coronary Artery (Segment 11) / 日本心臓血管外科学会雑誌

A 74-year-old woman was first admitted to our hospital for orthopnea, and was given a diagnosis of severe congestive cardiac failure caused by myocardial infarction. Coronary angiography revealed severe triple vessel disease, with a totally obstructed left anterior descending artery (LAD) and right coronary artery. First diagonal branch (Dx1) was 90% stenotic, and left circumflex artery was also 90% stenotic in its proximal portion (segment 11; #11). There was no stenotic lesion in the obtuse marginal branch or posterolateral branch, which are the usual target branches for the left circumflex branch (LCx). But they were too small to be grafted. Left ventriculography showed severe left ventricular dysfunction (ejection fraction; 31%). Saphenous vein grafting (SVG) to the distal portion of #11 and sequential SVG to the LAD and Dx1 were performed. Postoperative angiography proved that these grafts were patent. The patient was discharged on the 46th postoperative day after an uneventful course.

A Successful Case of Surgical Repair for a True Aneurysm of the Brachial Artery Caused by Blunt Injury / 日本心臓血管外科学会雑誌

We present one case of true aneurysm of the branchial artery which is very rare among peripheral aneurysms. A 52-year-old woman developed a bruise on the right upper arm around June 1993, but did nothing about it because she felt no symptoms. A pulsating mass became palpable at this site around the following month. Digital subtraction angiography revealed an aneurysm formation of 1.5×1.5cm in size in the right brachial artery. Operative findings showed that the wall of the aneurysm joined the normal region and all the vascular layers in the aneurysm were maintained. After resection of the aneurysm, end-to-end anastomosis was carried out. A diagnosis of true aneurysm was confirmed by the pathohistological findings that the vascular three-layer structure was maintained, with few arteriosclerotic changes.

Successful Surgical Treatment for Multiple Mycotic Aneurysms of Abdominal Aorta / 日本心臓血管外科学会雑誌

A case of multiple mycotic aneurysms of the abdominal aorta is presented. A 62-year-old woman was admitted to our hospital complaining of left abdominal and back pain with persistent high fever. Although the blood cultures were negative during medical treatment, the patient status seemed septic by laboratory findings such as WBC (14, 000/μl), CRP (20.2mg/dl), and ESR (100 mm/h). Abdominal CT and aortography showed two saccular aneurysms in the abdominal aorta, and these aneurysms were considered as mycotic ones because of their rapid growth and clinical features. An urgent operation was performed. The three aneurysmal orifices were identified in infrarenal abdominal aorta and these seemed to be pseudoaneurysms. Although tight inflammatory adhesions were found around the aneurysms, no active infection was detected. After removal of the thrombi and intimal wall with meticulous irrigation, the <i>in situ</i> graft replacement was carried out. All the bacterial cultures of thrombi and intimal wall of aneurysms were negative. The infection had subsided after operation and she remained well without recurrence one year after operation. A few cases of mycotic aneurysm of abdominal aorta have been reported in Japan, but cases with multiple mycotic aneurysms are rare. The mechanism of aneurysmal formation in the present case might be lodgement of circulating organisms within the aortic wall during preceding prolonged antibiotic chemotherapy. The early surgical treatment consisted of <i>en bloc</i> aneurysmectomy, <i>in situ</i> graft replacement, and adjuvant antibiotic chemotherapy might provide good results.

A Successful Graft Replacement for Saccular Aneurysm of the Innominate Artery / 日本心臓血管外科学会雑誌

A 71-year-old man was successfully operated by a simple technique for a saccular aneurysm of innominate artery. The aneurysmectomy and graft replacement was carried out using simple clamping and caused no cerebral accident. The preoperative angiographic Matas' test showed good contralateral cross-filling. This simple technique can be useful in selected cases of innominate artery aneurysms for which surgical approaches are apt to be complicated.

Surgical Patch Treatment of SVC Syndrome Caused by Transvenous Pacemaker Lead / 日本心臓血管外科学会雑誌

A 56-year-old male had complained of serious facial edema 2 years after transvenous pacemaker implantation. Venography at admission showed complete occlusion of the left innominate vein and severe stenosis of the SVC. A 20mmHg pressure gradient was recognized between bilateral internal jugular veins and SVC. Various conservative therapeutic approaches had been ineffective, then surgical treatment was recommended. A median sternotomy was made, removing the pacing lead by a Locking Stylet easily and safely. The stenotic section was dilated, resecting the fibrous tissue in the thickened venous wall, and enlarged with a shaped pericardial patch. Symptoms diminished postoperatively. Histological findings revealed phlebosclerosis of the stenotic venous wall. This type of surgical approach is effective for lesions with irreversible occlusion or severe stenosis causing SVC syndrome and which do not respond to conservative therapy.