[Successful Repair of a Blow-out Type Left Ventricular Free Wall Rupture after Acute Myocardial Infarction Using a Viscous Diisocyanate Prepolymer].

We report our experience with blow-out type left ventricular free wall rupture after acute myocardial infarction, treated by a sutureless technique using Hydrofit (a viscous diisocyanate prepolymer). A 70-year-old woman suddenly experienced cardiopulmonary arrest during gastrointestinal endoscopic examination. Computed tomography revealed cardiac tamponade, loss of contrast in the posterolateral wall of the left ventricle and contrast medium leakage into the pericardial cavity from the lateral wall of the left ventricle. Under cardiopulmonary resuscitation, the patient was transferred to our hospital. Percutaneous cardiopulmonary support was initiated in the operating room, and median sternotomy was immediately performed. The myocardial tear and necrotic area were sealed with Hydrofit and further covered with BioGlue and TachoSil under cardioplegic heart arrest. Hemostasis was completely achieved, and cardiopulmonary bypass (CPB) was discontinued under intraaortic balloon pumping (IABP) support. At 5 years after surgery, echocardiography showed no pseudoaneurysm formation. This sutureless repair technique using Hydrofit may be useful for a selected case of blow-out type left ventricular free wall rupture.

[In situ Replacement with Bovine Pericardial Roll Graft for Infected Aneurysm of the Thoracoabdominal Aorta].

A 63-year-old man presented to a nearby doctor with fever and lumbago. Enhanced computed tomography showed a thoracoabdominal aortic aneurysm and enhancement of soft tissue around the aneurysm. He was diagnosed with an infected thoracoabdominal aortic aneurysm and given antibiotics. After 2 weeks, the infection was controlled and he underwent in situ replacement with a bovine pericardial roll graft. A week after the operation, the inflammatory reaction was increased, but the bovine pericardial roll graft was not infected. This suggests that a bovine pericardial roll graft is a suitable material for use in patients with bacterial infections.

Long-term outcomes of open surgical repair for ruptured iliac artery aneurysms.

BACKGROUND: Rupture of an iliac artery aneurysm is rare but could be catastrophic unless it is treated with an appropriate strategy. We reviewed our 10-year institutional experience in treating iliac artery aneurysms to elucidate the effectiveness of open surgical repair strategies for ruptured iliac artery aneurysms in terms of short- and long-term postoperative results. METHODS: A total of 26 patients (men/women = 22/4), with a mean age of 72 years, underwent open repair of iliac artery aneurysm with or without rupture (unruptured/ruptured = 15/11) between January 2001 and April 2010. There was no difference in the distribution of aneurysm morphology between the unruptured and ruptured groups, and 20 (76.9%) of the 26 patients had aneurysms involving unilateral or bilateral internal iliac arteries. Long-term event-free survival rates and freedom from secondary intervention were analyzed using the Kaplan-Meier method (follow-up: 55 ± 39 and 40 ± 25 months in the unruptured and ruptured groups, respectively). RESULTS: There was no difference in the time of surgery between the two groups (351 ± 118 and 348 ± 152 minutes in the unruptured and ruptured groups, respectively), but the ruptured group showed greater blood loss/min (time of surgery) and transfusion volume than the unruptured group. The early postoperative mortality was 6.7% in the unruptured group and 0% in the ruptured group (p = 0.557). There was no difference in the number of postoperative morbidities between the two groups, but the ruptured group showed significantly greater C-reactive protein, lactate dehydrogenase, and total bilirubin levels than the unruptured group. The cardiovascular event-free survival rate at 5 years was 93.3% and 100.0% in the unruptured and ruptured groups, respectively. The secondary intervention-free rate at 5 years was 100.0% and 90.0% in the unruptured and ruptured groups, respectively. CONCLUSIONS: The short- and long-term postoperative mortality rates after open repair for iliac artery aneurysms were satisfactorily low and similar in unruptured and ruptured groups. This suggests that open repair strategies remain as a reliable treatment option to obtain successful postoperative results in patients with rupture of an iliac artery aneurysm.

In situ replacement of the thoracic aorta using an equine pericardial roll graft for an aortobronchial fistula due to aortic rupture.

A 74-year-old woman with massive hemoptysis and shock who had been diagnosed with thoracic aortic rupture underwent in situ replacement of the thoracic aorta using an equine pericardial roll graft. The lower lobe of the left lung was resected because of a massive hematoma and adhesion to the wall of the thoracic aorta. Intraoperative microscopic examination of the resected aortic wall revealed Gram-positive bacteria (alpha-streptococcus in bacterial cultivation). Histology of the resected aorta revealed abscess formation in the media and adventitia of the aortic wall associated with disruption of the media (dissection). Postoperative computed tomography revealed no fluid collection around the graft 1 month after surgery, and magnetic resonance imaging showed no significant graft dilation 20 months after operation. The equine pericardium can be an option of alternative graft materials for in situ replacement of the thoracic aorta in patients with an aortobronchial fistula due to aortic rupture.