Myonephropathic Metabolic Syndrome after Cardiac or Aortic Surgery / 日本心臓血管外科学会雑誌

Myonephropathic metabolic syndrome (MNMS) is a fatal complication following open-heart or aortic surgery. We evaluated 7 cases of MNMS following cardiac or aortic surgery. The patient's ages ranged from 43 to 81 years old. Of the 7 patients, four presented with myocardial infarction, which required coronary artery bypass grafting (CABG), and three presented with acute aortic dissection. Two patients with Stanford type A underwent total arch replacement and CABG and 1 patient with Stanford type B underwent a left axillo-femoral bypass. MNMS was caused by acute arterial occlusion due to intra-aortic balloon pumping (IABP) or percutaneous cardio-pulmonary support (PCPS) in patients who experienced myocardial infarction and acute lower limb ischemia in patients who experienced aortic dissection. The ratio of MNMS caused by IABP and PCPS, and acute aortic dissection was 1.4% and 4.2%, respectively. Four patients died; 3 had undergone CABG and 1 had undergone an aortic operation 18.5h after acute dissection. Both IABP and PCPS were removed early in possible cases. Limb wash-out was performed in 1 patient, and 5 were treated with hemodiafiltration. IABP and PCPS should be introduced via a prosthetic graft if limb ischemia is noticed. MNMS should be recognized as a disastrous complication of aortic dissection, and early bypass graft or limb amputation may become the treatment of choice. We emphasize that hemodiafiltration should begin as soon as MNMS is diagnosed.

Management of Inguinal Vascular Graft Infection by Lateral Femoris Axillo-Popliteal Bypass / 日本心臓血管外科学会雑誌

A 81-year-old man was referred to our hospital for treatment of a skin ulcer of the right anterior crus. After 2 months left common femoral artery-right popliteal artery bypass, graft infection was occurred and methicillin-sensitive <i>Staphylococcus aureus</i> was found in the bacterial culture. The wound was extended in order to decide the extent of graft infection, but graft healing was totally insufficient. All of the graft was excised, and right axillo-popliteal bypass using 8mm Bionit graft was performed. The graft was passed through lateral femoral. Thus, in this case the graft excision was necessary, but major amputation could be avoided by successful revascularization.