Open Repair without Esophagectomy for an Aortoesophageal Fistula after Thoracic Stent Grafting / 日本心臓血管外科学会雑誌

An aortoesophageal fistula is a critical condition with high operative mortality. A case of aortoesophageal fistula following thoracic endovascular aneurysm repair is reported. The patient was a 72-year-old man complaining of dysphagia who underwent stent grafting for a saccular aneurysm of the descending aorta that was compressing the esophagus four months earlier. Endoscopic examination showed perforation of the aneurysm into the esophagus with severe stenosis. The aneurysmal sac was filled with thrombus. Aortography demonstrated a type I endoleak from the lesser curvature of the aortic arch, draining into the aneurysmal sac. The patient was afebrile with moderate elevation of C-reactive protein, and the white blood cell count was normal. The patient underwent closure of the aneurysmal entry with healthy aortic wall and replacement of the descending aortic aneurysm with a prosthetic graft. The graft was isolated from the fistula by an omental flap. The patient's postoperative course was uneventful. Computed tomography performed 4 years after the surgery showed shrinkage of the aneurysmal sac. The patient has had a healthy life for 9 years since the operation.

A Surgical Case of Infective Endocarditis with Annular Abscess into Mitral Annulus Calcification / 日本心臓血管外科学会雑誌

<p>A 79-year-old man, who had undergone aortic valve replacement due to severe aortic stenosis 2.5 years previously and permanent pacemaker implantation for sick sinus syndrome 2 months after aortic valve replacement, was admitted for congestive heart failure and suspicion of prosthetic valve endocarditis. However, he had a fever in spite of medical therapy, and transthoracic echocardiography revealed a 20 mm vegetation on the posterior mitral valve leaflet. He underwent emergency surgery on a diagnosis of infective endocarditis. The intraoperative examination showed annular abscess on the calcified mitral annulus, and a part of abscess had disintegrated, from which the vegetation arose. We performed maximal possible debridement of the infected tissue and mitral annulus reconstruction with a bovine pericardium. Subsequently, mitral valve replacement and annulus reinforcement with a prosthetic valve collared with a bovine pericardium were performed to prevent perivalvular leakage. The patient showed no recurrence of infection and perivalvular leakage at 1.5 years of follow-up.</p>