[An Anastomotic Aneurysm Thirty Years After Open Surgery of the Descending Thoracic Aorta:Report of a Case].

An 86-year-old man was hospitalized urgently to our department because of his worsening hemoptysis. He had undergone open thoracic aortic grafting for the Stanford type B chronic aortic dissecting aneurysm 30 years earlier. Contrast enhanced computed tomography (CT) revealed the distal anastomotic aneurysm, leakage of the contrast medium around the distal anastomotic site. We urgently performed thoracic endovascular aneurysm repair( TEVAR) for the distal anastomotic aneurysm. TEVAR was done under local anesthesia because of his poor respiratory condition due to hemoptysis. He recovered well without hemoptysis. Patients after open aortic surgery are expected to survive longer. Thus, special attention should be paid to the occurrence of anastomotic aneurysms.

[Infected Thoracic Aortic Aneurysm Secondary to the Purulent Pericarditis;Report of a Case].

A 69-year-old man was hospitalized urgently to the department of cardiology, with the progressive general malaise. On admission, his blood pressure was 80/42 mmHg, his white cell count 13,700/µl, and C-reactive protein 25.55 mg/dl suggesting existence of aggressive infection with impaired circulation. Massive pericardial effusion was detected in echocardiography. Pericardial drainage was undergone promptly. There was drainage of 700 ml and the property was purulent. Pneumococcus was detected by the culture test of the pericardial fluid. Antibiotic administration was started by a diagnosis of the purulent pericarditis. His general condition was improved. However, a rapidly expanding saccular aneurysm was found in a descending thoracic aorta by computed tomography( CT). As an infected thoracic aortic aneurysm secondary to the purulent pericarditis, we performed thoracic endovascular aneurysm repair (TEVAR). The intravenous administration of antibiotics was continued for 2 weeks after TEVAR, which was followed by oral antibiotic administration for 1 year. The aneurysm completely disappeared by CT, 10 months after TEVAR. In case with an infected thoracic aortic aneurysm, TEVAR can be a 1st choice of treatment, depending on a causative organism and the morphology of the aneurysm.

Deep vein thrombosis in orthopedic surgery of the lower extremities.

To prevent pulmonary embolism due to deep venous thrombosis (DVT), we have treated 611 patients undergoing orthopedic surgery of the lower extremities with our protocol including pre- and postoperative ultrasonic venous screening and anticoagulant therapy if necessary. A total of 118 patients (19.3%) developed DVT. Among demographic and clinical factors, the site of operation (knee joint surgery: odds ratio 5.17), age (>60: odds ratio 3.91), and operation time (>120 minutes: odds ratio 4.52) were identified as significant risk factors of development of DVT. One patient received an infusion of urokinase for DVT of femoral vein, but no patients developed serious postoperative bleeding or pulmonary thromboembolisms. (*English Translation of J Jpn Coll Angiol, 2010, 50: 95-100.).

[Preservation of arch branch patency during the placement of Gore-TAG; protection sheath insertion method].

PURPOSE: We report a technique to place Gore-TAG (TAG) precisely just below the origin of the neck vessel without overstenting. TECHNIQUE: Before deploying TAG, retrograde insertion of the protection sheath through the left subclavian artery (LSCA), or the left common carotid artery (LCCA), into the aortic arch was accomplished. The proximal flare portion of TAG catheter was positioned to touch or partially cross the protection sheath. Deployment was done in the routine fashion. When the proximal portion of TAG was to protrude in the direction of the ascending aorta the protection sheath could hold the advancement of the device. PATIENTS: Five patients underwent thoracic endovascular aortic repair (TEVAR) using TAG with protection sheath insersion. Open direct puncture of LCCA was done in 3, while percutaneous puncture of the left brachial artery to protect LSCA was done in the remaining 2. RESULT: All the patients underwent TEVAR successfully without endoleak. One patient needed additional stent placement of LCCA, which caused no proximal endoleak. CONCLUSION: Protection sheath insertion into the neck vessel was useful to place TAG precisely just below its origin.

Late rupture of knitted Dacron graft.

An 87-year-old man underwent aorto-bifemoral bypass using a bifurcated Bionit II knitted Dacron graft for high aortic occlusion in 1987 at another hospital. In November, 2004, he was admitted to our institution because of difficulty in walking due to swelling and tenderness in the right groin. Computed tomography (CT) scan indicated bilateral aneurysms of the grafts in the groins. The size of the right and left aneurysms were 73 mm and 52 mm, respectively. Angiography showed some extravasation in the right thigh. We performed surgical replacement of all the dilated parts with new ringed-Dacron grafts. We report a rare case of late rupture of bifurcated Sauvage Bionit II Dacron graft.

A surgical case for severe hemolytic anemia after mitral valve repair.

We report a rare case of severe hemolytic anemia accompanied by moderate renal insufficiency after mitral valve repair. Although the degree of the residual mitral regurgitation was less than 1+ during the first three weeks after the operation, the maximum lactate dehydrogenase (LDH) was up to 7,430 U/l and the minimum hemoglobin was 4.9 g/dl. The mitral valve replacement successfully resolved the hemolysis, but the renal function did not completely recover.

[Surgical treatment of ventricular and pericardial perforation by a permanent pacing lead: a case report].

An 83-year-old woman was transferred to our hospital because of pacing failure and suspected ventricular perforation by a permanent pacing lead. She had undergone permanent pacemaker implantation 5 months previously. Chest radiography showed the pacing lead running out of the cardiac shadow. Computed tomography and echocardiography confirmed the diagnosis of ventricular perforation by the pacing lead. No evidence of cardiac tamponade was found. The lead was surgically removed through a median sternotomy. Intraoperatively, the lead was found perforating the ventricle and the pericardium, and reaching into the left pleural cavity but not injuring the left lung. A pacing lead may potentially injure the heart or the lung. Regular check-up of lead position and pacing status is recommended.

A surgical case for hemolytic anemia after ascending and total arch replacement.

A 61-year-old man presented with consistent hemolytic anemia 15 months after ascending and total arch replacement for DeBakey I type acute aortic dissection. The cause of hemolysis turned out to be mechanical damage of red blood cells at the inverted felt of the proximal anastomosis. Reoperation of resection of the felt and repair of the proximal anastomosis successfully resolved this problem. We report a rare case of hemolytic anemia at the site of inverted felt strip after total arch replacement.