ABSTRACT
An 81-year-old man who had a saccular abdominal aortic aneurysm (AAA) with a narrow terminal aorta underwent endovascular aortic aneurysm repair (EVAR) with the Medtronic Endurant<sup>®</sup> stent graft system. After 4 days, computed tomography (CT) showed stenosis of the stent graft left limb, which was pressed flat against the right limb at the narrow terminal aorta. We performed re-intervention to dilate the narrow terminal aorta and bilateral limbs with kissing stenting using Express Vascular LD<sup>®</sup> (Boston Scientific). After operation his ankle brachial pressure index rose from 0.88 to 0.99 and there was no evidence of stenotic limbs at CT image. We need to be careful about the stenotic limb after EVAR with Medtronic Endurant stentgraft system for AAA with a narrow terminal aorta.
ABSTRACT
We report a case of a 64-year-old man who had a fistula from the right coronary artery to the right ventricle, with an asymptomatic giant coronary aneurysm. Multi-detector computer tomography showed an aneurysm from the sinus of Valsalva to the mid-right coronary artery (RCA). Its diameter was over 50 mm. We performed aneurysmectomy direct closure of the fistula, and coronary artery bypass graft with saphenous vein graft cardiopulmonary bypass. The enlarged RCA orifice was closed with a vascular prosthesis, and the postoperative course was uneventful.
ABSTRACT
A rare surgical case of chronic expanding hematoma in the pericardial cavity is reported. A 78-year-old man had undergone coronary artery bypass grafting 2 years previously. He had suffered from general malaise, increasing shortness of breath and systemic edema from 18 months after the operation. Echocardiography revealed an intrapericardial mass compressing the cardiac chambers resulting in insufficiency of the ventricular expansion. Under extracardiopulmonary bypass and cardiac beating, resection of the mass and additional coronary artery surgery were implemented. The mass was encapsulated with thick fibrous membrane containing old degenerated coagula the bacterial culture of which was negative and was histopathologically diagnosed as chronic expanding hematoma. The patient's postoperative course was uneventful and symptoms with cardiac failure were relieved. There has been no recurrence for more than 18 months.
ABSTRACT
We report a case of dysphagia caused by compression of the esophagus by the nonaneurysmal tortuous descending aorta (dysphagia aortica). A 69-year-old woman was admitted suffering from dysphagia. Esophagoscopy showed esophageal stenosis caused by pulsatile and extramural compression. Esophagography and aortograms also showed that the nonaneurysmal tortuous descending aorta compressed the esophagus in an anteromedian direction. To avoid the esophageal ulcer and the aortoesophageal fistula, resection of the tortuous aorta and a Dacron graft replacement was performed. After operation compression of the esophagus was released and her complaint improved.
ABSTRACT
The postgraduate medical training system will officially start the initial clinical training this year, but the subsequenttraining of medical specialists is left, as a matter of fact, to the independence of medical scientific societies which certifiesmedical specialists. The Ministry of Health, Labour and Welfare has approved in spring 2002 the advertisement ofmedical specialists certified by societies under certain conditions as an alleviating measure of the medical advertisementregulations. The Japanese Board of Medical Specialties comprising from medical scientific societies that participate inthe Japanese Association of Medical Sciences and own a medical specialist certification system, is asking cooperationfrom medical societies in order to foster the respectable medical specialists and establish a medical specialist system.However, many problem awaiting solution have been pointed out in the current medical specialist certification system.For fostering high quality medical specialists, the Japanese Board of Medical Specialties needs to be functioning as athird party.
ABSTRACT
We developed a new double-lumen balloon catheter for retrograde cerebral perfusion (RCP) via jugular vein cannulation. Between November 1996 and September 2000, 34 of 73 patients treated with surgical procedures for thoracic aortic aneurysms underwent RCP using the new catheter during circulatory arrest under deep hypothermia. Nine patients underwent a median sternotomy, and 25 underwent a left thoracotomy. In all cases, the new catheter installation under fluoroscopy was easy, and it took about 15min. The mean RCP time, pressure, and flow rate were 26.8min, 20.0mmHg, and 202.6ml/min, respectively. Our procedure using the new catheter was safe and easy in RCP during circulatory arrest in aortic arch replacement regardless of surgical approaches such as a left thoracotomy or median sternotomy.
