Aortic Valve Replacement with Concomitant Coronary Artery Bypass Grafting for an Aortic Stenosis Coexisting with Anomalous Origin of the Coronary Artery / 日本心臓血管外科学会雑誌

<p>Congenital anomaly of the coronary artery is rare. We have to care about the injury of the aberrant coronary artery and ischemic complication during and after the heart valve surgery. We experienced a good clinical course of aortic valve replacement (AVR) with concomitant coronary artery bypass grafting (CABG) for aortic stenosis coexisting with anomalous aortic origin of the right coronary artery. A 72-year-old woman had suffered from dyspnea and palpitation on effort, and we diagnosed severe aortic stenosis. Preoperative examination revealed the right coronary artery arising from the left coronary sinus with a stenotic lesion in the interarterial course between the aorta and main pulmonary artery. She underwent AVR and CABG using a saphenous vein graft. The peripheral anastomosis of the bypass grafting was performed before starting cardiopulmonary bypass and the blood cardioplegia was infused into right coronary artery through the bypass graft during cardiac arrest. The postoperative course was uneventful and the patent bypass graft was confirmed by computed tomographic angiography.</p>

A Case of Infective Thoracoabdominal Aortic Aneurysm with Rapid Expansion during Steroid Therapy for Retroperitoneal Fibrosis / 日本心臓血管外科学会雑誌

A 66-year-old man who suffered from intermittent abdominal and back pain underwent medical examinations at our hospital. A high value of leukocyte, inflammatory reaction and IgG4 was detected, and computed tomography demonstrated that there was thickened soft tissue around the abdominal aorta which extended to the superior mesenteric artery and the renal arteries. He was given a diagnosis of retroperitoneal fibrosis, and prednisolone (PSL) was administered. Although the decrease in thickness of the soft tissue around the aorta was seen, the enlargement of the aorta mainly near the orifice of the celiac artery was shown. We were consulted on this thoracoabdominal aortic aneurysm (Crawford type IV) at this time, and considered that this aneurismal change had occurred secondary to chronic periaortitis. In a few weeks, the rapid expansion of this aneurysm was occurred, so we planned early surgical treatment after tapering of PSL. He underwent graft replacement of thoracoabdominal aorta with rifampicin-bonded graft, because the infection could not be denied as a cause of this aneurysmal change. Although <i>Streptococcus pneumoniae </i>was detected in the specimens from the periaortic tissue, false lumen and aortic wall in the culture test, he had a good post operative course with prolonged antibiotic therapy.

Waffle Procedure for a Cool Constrictive Epicarditis / 日本心臓血管外科学会雑誌

We describe the case of a 59-year-old man who developed constrictive epicarditis 2 months after an episode of acute pericarditis. Magnetic resonance imaging demonstrated parietal pericarditis and epicarditis. Through a median sternotomy, a markedly thickened parietal epicardium was noted which was removed where possible. After this procedure, however, no improvement of the hemodynamic parameters was observed. We attempted removal of the epicardium, but the procedure had to be abandoned due to myocardial injuries and bleeding. Multiple longitudinal and transverse incisions were carefully performed on the thickened epicardium, following which relief of constriction along with a remarkable improvement of the hemodynamic status was achived. Although the dip and plateau pattern was persisted, cardiac index increased from 2.2 to 2.9 <i>l</i>/min/m² and the pulmonary capillary wedge pressure decreased from 20 to 13 mmHg. Patient's postoperative course was uneventful and he was discharged on postoperative day 22.

Effectiveness of Assisted Ventilation Supplemented by RTX and NPPV for the Prevention of Postoperative Respiratory Failure in a Patient with Severe COPD Undergoing Total Arch Replacement / 日本心臓血管外科学会雑誌

A 74-year-old man with very severe chronic obstructive pulmonary disease (COPD) was scheduled for elective total arch replacement for a distal arch saccular aneurysm. Postoperative respiratory failure was anticipated because of a marked reduction in forced expiratory volume in one second (FEV_1.0 - less than 0.5<i>l</i>). Through median sternotomy, total arch replacement using selective cerebral perfusion was completed uneventfully. Postoperative respiratory condition was stable. Therefore, the patient was extubated on postoperative day 2 (POD2). However, as the respiratory condition started getting worse, respiratory therapy external (RTX) was introduced to assist ventilation. Additionally, non-invasive positive pressure ventilation (NPPV) with BiPAP was used on POD3 and management with both RTX and NPPV was continued during the remainder of the intensive care unit stay. As a result, we were able to avoid re-intubation. In conclusion, assisted ventilation supplemented by RTX and NPPV was useful for the prevention of postoperative respiratory failure in a patient with very severe COPD undergoing total arch replacement.

Surgical Treatment of Pulmonary Valve Disease Associated with Pulmonary Arterial Dilatation in the Adult: Reports of Two Cases / 日本心臓血管外科学会雑誌

Pulmonary artery (PA) aneurysm is rare, but its true incidence is unclear, because most cases remain asymptomatic. The need for surgical treatment is controversial. We report two cases of surgical treatment of PA aneurysm associated with pulmonary valve (PV) disease in adults. Case1: A 54-year-old woman. She underwent pulmonary valvotomy for pulmonary stenosis (PS) at age 22. She had suffered from palpitations and dyspnea on effort recently. Then progressive changes of pulmonary stenosis-regurgitation (PSR) occurred. After further examinations, she was diagnosed as having PA aneurysm and right ventricular dysfunction with PSR, tricuspid regurgitation and paroxysmal atrial fibrillation. We performed PV replacement, PA aneurysmo-plasty, tricuspid annuloplasty, cryo-MAZE procedure. Case2: A 70-year-old man sufferd recently from dyspnea on effort. The dilatation of the pulmonary artery was pointed out on chest X-ray. PA aneurysm and PS with ventricular arrhythmia were diagnosed. We performed PV commissurotomy and PA aneurysmo-plasty. There were no significant findings of high PA pressure in either case. PA with pulmonary valve disease in the presence of low pulmonary pressure have low risk of rupture and dissection. Surgical treatments are recommended when right ventricular dysfunction or ventricular arrhythmia secondary to pulmonary valve disease is present.