ABSTRACT
The patient was a 58-year-old woman with untreated diabetes. She consulted a local doctor in May 2006 complaining of constipation that had persisted for 2 weeks, under gradually worsening abdominal pain. She was transferred to our hospital with a diagnosis of aortic aneurysm. Blood tests indicated high inflammatory response, and CT showed hematoma around the aorta from directly under the diaphragm to the level of superior mesenteric artery and influx of contrast medium into the hematoma. Control of the infection was first attempted with antibiotics, but eventually surgery was performed because the hematoma increased. The hematoma and aortic wall were completely excised from the local of the diaphragm to the level beneath the renal artery, with partial cardiopulmonary bypass and selective perfusion to abdominal branches, and anatomic reconstruction was performed with a synthetic graft and omental implantation. The hematoma was fetid and Citrobacter koseri was detected in culture. The patient was discharged after 4 weeks of antibiotic treatment, without complications and with satisfactory progress. At present, there has been no recurrence of infection in the 22 months since her discharge.
ABSTRACT
A 33-year-old man presented with respiratory distress and lower leg edema in April 2006. Atrial septal defect (ASD), complicated with moderate mitral regurgitation (MR), advanced tricuspid regurgitation (TR) and pulmonary hypertension (95/32mmHg), was diagnosed. Qp/Qs was 6.3 and L-R shunt ratio was 84.4%. An “edge-to-edge” mitral valve plasty for MR complication as well as closure of the septal defect and tricuspid annuloplasty was performed, and a good result was obtained. It is known that ASD has a tendency to be accompanied by MR, and the strategy for treatment course for MR is debatable. The mitral lesions of MR complicating ASD are often seen in the posteromedial side of the anterior mitral leaflet, and usually many of the tendinous cords and valve leaflets are in the normal range in length. There have been reports on the mid-term results of edge-to-edge repair of mitral regurgitation due to degenerative lesions but the mid- and long-term results for MR complicating ASD, such as this case are unknown. We need to carefully observe the time course of this case.
ABSTRACT
We report a case of mitral regurgitation due to an atypical variant of Fabry disease. A 60-year-old man was admitted to our hospital. He had a history of myocardial infarction and heart failure, and was repeatedly admitted for worsening heart failure (NYHA class II to III). A follow-up echocardiogram revealed deteriorating dilated cardiomyopathy and mitral regurgitation. We performed valvuloplasty for mitral regurgitation. Cardiomyopathy was suspected during the operation and myocardial biopsy was performed. We diagnosed Fabry disease by histopathological findings. After the operation, his heart failure temporarily improved. Heart failure worsened 4 months later. He died of heart failure a year later from the operation. Fabry disease (α-galactosidase-A deficiency) is an inherited metabolic disease. In Fabry disease, angina, myocardial infarction, hypertrophic cardiomyopathy, dilated cardiomyopathy, and mitral regurgitation are common cardiac manifestations. Recently, an atypical variant of Fabry disease, with manifestations limited to the heart, has been increasingly reported. This case suggested that we might encounter Fabry disease with only cardiac manifestations such as cardiomyopathy and valvular disease in routine clinical work.
ABSTRACT
We encountered an instructive case of anterolateral papillary muscle rupture after acute myocardial infarction. A 73-year-old woman with rapidly progressive dyspnea came to our emergency room. Her symptoms associated with acute heart failure rapidly worsened. We diagnosed anterolateral papillary muscle rupture after acute myocardial infarction due to occlusion of the first diagonal branch, based on transesophageal echocardiogram and coronary angiography. We immediately performed mitral valve replacement and coronary artery bypass grafting (CABG) to the diagonal branch. Although she required postoperative intraaortic balloon pumping (IABP) and percutaneous cardiopulmonary support (PCPS), she eventually recovered. Mitral papillary muscle rupture causes rapidly deteriorating hemodynamics and requires surgical treatment. Because of a serious complication of myocardial infarction, this case emphasizes that early diagnosis and aggressive treatment are required for mitral papillary muscle rupture.
ABSTRACT
We reported a successfully operated case of ruptured coronary artery aneurysm which resulted from a coronary artery fistula. A 70-year-old woman who had been treated for hypertension developed syncope and profound shock. Echocardiography and chest CT-scan suggested the presence of cardiac tamponade. An emergency operation was done. An aneurysm was seen at the left side of the right heart outflow and pulmonary artery, on the proximal left anterior descending coronary artery. Closure of the orifice of the inflow and the outflow vessels of the aneurysm, and aneurysmorraphy was performed under cardiopulmonary bypass. Serpentine small arteries were found around the aneurysm and were simply ligated by mattress sutures. The postoperative course was uneventful, and coronary angiographic study demonstrated normal coronary distribution.
ABSTRACT
A gelatin-sealed knitted Dacron graft which has zero-porosity at implantation and does not require preclotting preparation has been developed. Gelatin-sealed aortic grafts were implanted into 39 patients and vascular surgery reconstruction was performed for thoracic aortic aneurysm (TAA) in 10, abdominal aortic aneurysm (AAA) in 19, and arteriosclerosis obliterans (ASO) and other conditions in 10. A total of 39 bifurcated or straight grafts were inserted. The Gelseal Dacron graft had superior handling characteristics and biocompatibility in comparison to conventional graft. There was no measurable blood loss from the body of the sealed graft at the time of implantation. The gelatin-sealed Dacron graft (<i>n</i>=10) was compared with an Intervascular Micron<sup>®</sup> graft (<i>n</i>=10) implanted into the abdominal aorta. No problems were evident with regard to intraoperative bleeding, allogenic and autologous transfusion volume and blood parameters between the two groups. These results suggested that the Gelseal Dacron graft sealed with gelatin was a safe, zero-porosity implantable prosthesis for clinical use.
ABSTRACT
Left heart bypass was performed with Bio Medicus Co.-made Bio-pump, a representative centrifugal pump. A vinyl chloride tube for the usual cardio-pulmonary bypass not treated with antithrombogenic material. was used in the bypass circuit. In the experiment, the mongreal adult dogs were divided into the systemic heparinized group and non-heparinized group and the bypass was performed for 6 hours. As a result, coagulation and fibrinolysis were more activated in the non-heparinized group than the other group. So, when this method is used clinically, a small quantity of heparin should be administered. Clinically, this approach was used as an adjunct in operation for 7 cases of thoracic aortic aneurysm. During left heart bypass, a small quantity of heparin (0.5-1.0mg/kg) was administered. A rise in FPA and FDP considered attributable to autotransfusion during the operation was noted. Distal perfusion could be performed fully and the amount of bleeding during and after operation was small, but 1 case each of acute renal failure and paraplegia as postoperative complication was encountered. Neither was considered due to left heart bypass; and, changes in respiratory system and hepato-renal function were considered within the tolerable range. These results have led us to believe that left heart bypass using Bio-pump is safe and useful as an adjunct in operation for thoracic aortic aneurysm and should be used positively in the future.
