Surgical Treatment under Extracorporeal Circulation for Complicated PDA / 日本心臓血管外科学会雑誌

Various types of surgical techniques have been reported for the closure of complicated PDA, since Morrow first described an innovatory operative method. At our institute, extracorporeal circulation has been frequently used as a support measure for these operations to ensure the safety of the operation. Ten patients with complicated PDA were operated under extracorporeal circulation. All patients but one were adults. The reason for use of extracorporeal circulation included age, presence of atherosclerosis or calcification of the ductus, short neck ductus, ductal aneurysms, right sided descending aorta and recanalization after previous ligation. The ductus was approached through the left lateral thoracotomy in 8 patients and median sternotomy in 2. The Morrow procedure was performed in 2 patients. No hospital death occurred, although the mean duration of the hospital stay after the operation was longer in these cases than in cases with simple PDA. We conclude that the use of extracorporeal circulation is safe and effective for the closure of complicated PDA.

Dysfunction of Bioprosthetic Valve Presenting with Musical Cooing Murmur. Report of a Case / 日本心臓血管外科学会雑誌

A case of xenograft valve dysfunction presenting with musical cooing murmur is reported. The patient was a 47-year-old woman and had received mitral valve replacement with porcine xenograft (Carpentier-Edwards 31-M) 10 years before Preoperative echocardiogram showed vibration of a leaflet outside the stent of the bioprosthetic valve. Cardiac catheterization revealed stenosis as well as regurgitation of the bioprosthetic valve. The resected xenograft valve showed a tear which produced regurgitation and musical cooing murmur in one of three pliable leaflets and it also showed pannus formation which caused stenosis.

Successful emergency operation for a graft-enteric fistula with massive melena and sepsis: A case report / 日本心臓血管外科学会雑誌

A 44-year-old male, with past history of mitral valve re-replacement, tricuspid annuloplasty and re-replacement of aorto-biiliac prosthetic graft 4 years previously, was admitted to Asahi General Hospital because of massive melena, sepsis and shock. Angiography revealed a false aneurysm at the site of the anastomosis between the graft and the right external iliac artery. He was diagnosed as having graft-enteric fistula, and the emergency operation, including partial resection of the graft, excision of the false aneurysm and extraanatomic bypass, was performed successfully. Pathogenesis, diagnosis and treatment of graft-enteric fistula are discussed.