Simplified elephant trunk graft technique for aortic arch replacement.

We refined the elephant trunk graft to facilitate and reinforce the distal anastomosis in aortic replacement operations. A cuff is created in a single four-branch graft, which is used for the distal anastomosis; the trunk below the cuff is inserted into the distal aortic stump. This method is feasible for repairing extensive aortic aneurysm with a fragile wall and for treating acute aortic dissection where thromboocclusion of the remaining false lumen is desired.

A Case of Successful Surgical Treatment for Open Ruptured Abdominal Aortic Aneurysm due to Salmonella Infection / 日本心臓血管外科学会雑誌

A 60-year-old man with impending rupture of abdominal aortic aneurysm was transferred to our hospital. The patient entered a state of shock because of rupture during a CT scan examination. Emergency in site reconstruction with a dacron Y-graft was performed. There was massive intraperitoneal bleeding but no apparent abscess formation around the aneurysm. No drain was placed. A subcutaneous abscess that developed postoperatively was cured by open drainage and local antibiotic administration. Culture from both the aortic wall and the subcutaneous abscess revealed <i>Salmonella</i> infection. After subsequent intravenous antibiotic therapy for 45 days, the patient was discharged without any evidence of remaining infection.

Left Atrial Free-Floating Ball Thrombus Moving from the Left Appendage / 日本心臓血管外科学会雑誌

A free-floating ball thrombus in the left atrium is a rare occurrence. Few patients who developed a ball thrombus after mitral valve replacement have been reported. Our patient was a 58-year-old man who had undergone mitral valve replacement in 1981. Since bleeding gastric cancer had been diagnosed anticoagulant therapy had been 4 days before admission. On admission, echocardiography revealed a large thrombus in the left appendage. First, he underwent total gastrectomy for gastric cancer. After the operation, he developed aspiration pneumonia, and was intubated. We observed that a large thrombus had moved from the left appendage to the left atrium. Emergency operation was successfull.

A Case Report of Emergency Redo Operation for Active Prosthetic Valve Endocarditis after Bentall's Operation / 日本心臓血管外科学会雑誌

A 39-year-old man received Bentall's operation for annuloaortic ectasia in July 1985. He was admitted with a high fever in July 1998. On the 2nd day of his admission, he suddenly suffered from headache and dizziness. Head computed tomography showed multiple low density areas in the right cerebrum and cerebellum. A transesophageal echocardiogram revealed massive vegetation around the prosthetic valve. The patient underwent emergency operation using cardiopulmonary bypass. The left ventricle outflow was almost occluded by thrombi. The prosthetic valve and graft were removed completely and replaced with a 24mm Gelseal^® graft and a 23mm St. Jude Medical^® valve. The right coronary ostium was reimplanted directly on the prosthesis, and the left coronary ostium was reinserted using a 10mm graft. The patient's intraoperative tissues grew <i>S. aureus</i> and parenteral antibiotics were administered for 5 weeks after surgery. The patient was discharged on the 45th postoperative day and is doing well 9 months after the operation.