| Yoshiko Watanabe | Shin Ishimaru | Satoshi Kawaguchi |
| Taro Shimazaki |
(Department of Surgery II, Tokyo Medical University, Tokyo, Japan)
We studied the appearance of pleural effusion and inflammatory reactions after endovascular grafting in cases of aortic dissection. From December 1995 to January 2000, 16 patients with chronic double-barrel type aortic dissection (DeBakey type Ⅲb) were treated by endovascular grafting. In all cases, enhanced computed tomography (CT) of the chest was examined before operation and at about the 7th postoperative day (POD). Patients were divided into 3 groups. Group P: patients who had pleural effusion before the operation. Group E: patients who had new pleural effusion after the operation. Group N: patients who did not have any pleural effusion. In each group, onset of dissection, patient’s age, maximum diameter of dissecting aorta, period of postoperative fever (above 37.0℃), and WBC counts and CRP value at POD 1, 3, 7 and 14 were compared. Four patients were in group P, 4 patients were in group E, and 8 patients were in group N. Period between onset and operation was 41.6±34.6months in group P, 18.2±27.3months in group E and 7.3±11.6months in group N. There was no relation between the effusion and the period after onset. Postoperative fever continued for 5.0±2.0 days in group P, 13.5±2.6 days in group E and 2.5±0.3 days in group N. The period of fever of group E was significantly longer than in group N and P (p<0.01). WBC showed a peak on the first POD in each group. CRP showed a peak value on POD 3 in group P and N. There was no significance among the 3 groups about WBC and CRP, but group E showed slightly high CRP values on POD 7 and 14. No patient had complications regarding respiratory function. After endovascular grafting for aortic dissection, postoperative pleural effusion appeared in 25% of patients. They had prolonged postoperative fever, but there was no respiratory function complication. Endovascular grafting is a minimally invasive procedure with regard to respiratory function.| Hidenori Gohra | Masahiko Nishida | Ken Hirata |
| Taro Shimazaki | Akihito Mikamo | Yoshitaka Ikeda |
| Haruhiko Okada | Kimikazu Hamano | Nobuya Zempo |
| Kensuke Esato |
(First Department of Surgery, Yamaguchi University School of Medicine, Ube, Japan)
To test the hypothesis that neutrophils play a role in ischemia/reperfusion injury during heart surgery, granulocyte elastase and myeloperoxidase release from coronary circulation were measured before and after aortic cross-clamping. The production of granulocyte elastase and myeloperoxidase across the coronary circulation elevated significantly after release of aortic cross-clamp. Furthermore, the level of granulocyte elastase and myeloperoxidase released from coronary circulation demonstrated positive correlation with the duration of the aortic cross-clamp. These data indicate that neutrophils play a major role in ischemia/reperfusion injury occurring during heart surgery.| Determination of Entry Site for Acute Type A Aortic Dissection by Initial Enhanced CT-Scan | ||||||
（The Second Department of Surgery, School of Medicine, Aichi Medical University, Aichi, Japan) |
||||||
| Acute type A aortic dissection presents
a surgical emergency because conservative therapy is not effective
in the majority of instances. Enhanced CT-scan of the chest is
commonly available and is considered to be an optimal diagnostic
method for this disease. The operative strategy is to resect
the primary tear to close the entry site of the aortic dissection
and replace it with a tubular Dacron graft. Therefore, the existence
of the entry site is important in determining the operative procedure.
Based on the numerical value of the enhanced CT-scan inspection,
the present study seeks to preoperatively identify the location
of the presumed entry site in aortic dissection. From May 1996
to June 1999, 21 consecutive patients (Marfan’s syndrome excluded)
with acute type A aortic dissection underwent surgical treatment.
Nineteen patients were preoperatively examined by enhanced CT-scan:
11 men and 8 women, with a mean age of 61 years. CT-scan slices
used for early diagnosis were of the ascending aorta, aortic
arch, descending aorta, and thoracoabdominal aorta. The largest
diameters of the whole and true lumen were measured from cross-sectional
aortic images with a personal computer, and the areas of the
whole and true lumen were obtained by the manual tracing method.
The true ratio was calculated for the largest diameter and area
of the whole lumen. The nineteen patients were divided into two
groups according to the location of the entry site based on the
operating views. Seven patients with the entry site in the ascending
aorta were classified as group A, and twelve patients with the
entry site further in the aortic arch and descending aorta were
classified as group B. Comparisons were performed by non-parametric
analysis. Moreover, a discriminant analysis was applied to evaluate
the classification between the two groups. The ratio of the largest
diameter of the true lumen in group A at the level of the ascending
and descending aorta was significantly greater than that in group
B (75.0±11.3 vs. 59.7±14.0%, 82.7±8.6 vs. 70.1±11.4%). Linear
discriminant analysis resulted in the correct classification
rate of 68.2%, and 77.3%, respectively. The ratio of the area
of the true lumen in group A at the level of the aortic arch
was also significantly greater than in group B (65.4±17.3 vs.
45.7±15.8%) and linear discriminant analysis resulted in the
correct classification rate of 55.1%. When the entry site was
located in the aortic arch, the diameter of the true lumen was
seen to be smaller in the ascending and descending aorta, and
the dissecting lumen appeared enlarged. When the entry site is
located in the ascending aorta, the ratio of the area of the
true lumen in the aortic arch was significantly higher (55.1%).
Detailed examination of enhanced CT-scans is useful to Jpn. J. Cardiovasc. Surg. 31：12-17 (2002) |
||||||
| Cardiac Surgery in Patients with Chronic Dialysis | |||||||||
(Department of Thoracic and Cardiovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan) |
|||||||||
| This study was designed to evaluate
the perioperative outcome of dialysis patients undergoing cardiac
surgery, who were managed with our perioperative dialysis program.
Between April 1994 and August 1999, 11 patients (7 men and 4
women with a mean age of 57.3±10.3 (36-73)) with hemodialysis
(HD, n=8) and peritoneal dialysis (PD, n=3) underwent cardiac
surgery. The duration of dialysis was 5.6±4.3 years. Operation
included mitral valve replacement (n=1) and isolated coronary
artery bypass grafting (n=10). Patients with HD had single hemodialysis
on the day before operation. Patients with PD were maintained
on PD in the usual manner until the day before surgery. Intraoperative
hemofiltration during extra-corporeal circulation and normokalemic
non-depolarizing cardioplegic solution were used in all patients
to avoid post-operative hyperkalemia. All HD patients had dialysis
on the first post-operative day (POD1), and then every other
day. PD patients had PD soon after arriving at the ICU. Levels
of serum creatinine, urea nitrogen, acid-base balance were successfully
controlled within acceptable ranges. No patients required emergency
HD or any post-operative managements for hyperkalemia in the
ICU. Six of 8 HD patients required an increase in vasopressor
because of a tendency toward hypotension and 4 of 8 patients
suffered from atrial fibrillation during the initial HD on POD
1. Eight of 11 patients could be extubated on the first POD.
No hospital death occurred. The use of normokalemic cardioplegic
solution was useful to avoid post-operative hyperkalemia. Our
perioperative dialysis programme successfully managed the perioperative
clinical course of dialysed patients undergoing cardiac surgery. Jpn. J. Cardiovasc. Surg. 31：18-23(2002) |
|||||||||
| Risk Factors Affecting Survival Rates in Patients with Ruptured Abdominal Aortic Aneurysm(New Factor, Shock Time Index) | ||||||
(Department of Cardiovascular, Hachioji Medical Center, Tokyo Medical University, Tokyo, Japan and Second Department of Surgery, Tokyo Medical University*, Tokyo, Japan) |
||||||
| We tried to identify the risk factors
affecting the high mortality rates associated with ruptured abdominal
aortic aneurysm (AAA). The subjects consisted of 18 patients,
operated on for ruptured AAA, who were admitted to our hospital
between 1992 and 1999. The preoperative factors, which were hemoglobin
levels less than 9.0g/dl, creatinine levels higher than 2.1mg/dl,
type 4 on the Fitzgerald classification, shock state lasting
longer than 6h and a shock time index (the time from shock state
onset to the beginning of operation divided by the time from
complaint of abdominal pain to the beginning of operation) higher
than 0.3, were associated with increased intraoperative and overall
mortality rates. The postoperative factors, which were bleeding
and blood transfusion more than 6,000ml and an operating time
of more than 400 min, were associated with increased intraoperative
and overall mortality rates. It is concluded that these risk
factors were predictors of mortality and it is necessary to operate
early because of the risk factors. Jpn. J. Cardiovasc. Surg. 31：24-28 (2002) |
||||||
| Retrograde Cerebral Perfusion Using a New Double-Lumen Balloon Catheter via Internal Jugular Vein Cannulation | |||||||||
(Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan) |
|||||||||
| 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. Jpn. J. Cardiovasc. Surg. 31：29-32 (2002) |
|||||||||
| Hiromi Yano | Naoki Konagai | Mitsunori Maeda |
| Mikihiko Itou | Taisuke Matsumaru | Tatsuhiko Kudou |
| Masaharu Misaka* | Shin Ishimaru* |
(Department of Cardiothoracic Surgery, Hachioji Medical Center of Tokyo Medical University, Tokyo, Japan and Second Department of Surgery, Tokyo Medical University*, Tokyo, Japan)
During a 9-year period from January 1991 through December 2000, 30 patients underwent surgical interventions for peripheral vascular injuries associated with catheterizations. Pseudoaneurysm, the most frequent complication, was seen in 19 patients (63.3%). This was followed by arteriovenous fistula in 6 patients (20%), uncontrolled hemorrhage in three (10%), arterial thrombosis in one (3.3%), and pseudoaneurysm complicated with arteriovenous fistula in one patient (3.3%). We performed repair of the puncture site in 26 patients (86.6%), followed by arterial ligation in two (6.6%), thrombectomy combined with percutaneous transluminal angioplasty and aneurysmectomy in one patient (3.3%) respectively. There was a tendency for patients to have diabetes mellitus or hypertension. Though secondary suture had to be performed in two patients with wound infection postoperatively, there was no other complication. In pseudoaneurysmal patients proximal arterial control followed by direct incision into the aneurysm cavity and tangential finger pressure over the hole in the artery was a safe method to control bleeding. In arteriovenous fistula patients aggressive repair resulted in good outcome. In uncontrolled hemorrhage and arterial thrombosis patients prompt intervention is essential. By using accurate techniques in arterial puncture and adequate arterial compression following removal of the catheter, the incidence of vascular injuries can be reduced.| Hiroshi Sunami | Hiroyuki Irie |
| Yu Oshima | Kozo Ishino |
| Masaaki Kawada | Koichi Kino |
| Toshihiko Nagao* | Hidetaka Iida** |
| Takeo Tedoriya*** | Shunji Sano |
（Department of Cardiovascular Surgery, Okayama University School of Medicine, Okayama, Japan, Department of Cardiovascular Surgery, Ako Chuo Hospital*, Hyogo, Japan and Department of Cardiology** and Department of Cardiovascular Surgery, Tsukazaki Kinen Hospital***, Hyogo, Japan)
Between February 1999 and November 1999,33 patients（age 67.0±7.6years old）underwent off-pump CABG using coronary shunt tubes. The number of graft anastomoses per patient was 2.8±0.8. The operative mortality was 0%. There was no incidence of on-pump conversion, low cardiac output syndrome, IABP insertion, mediastinitis or stroke. The maximum CPK-MB during the perioperative period was 25.9±18.8IU/l. One patient had perioperative myocardial infarction probably due to native coronary artery spasm. In patients with off-pump CABG, the intubation time, the ICU stay and the hospital stay were shorter. The number of patients who were extubated in the operating room was higher and the cost was lower than those with on-pump CABG. An early phase study revealed patency ratios of 85%（the previous term）and 97%（the latter term). Off-pump CABG is a safe and effective means of revascularization with no mortality, minimal morbidity and good short-term patency.| Is Minimally Invasive Cardiac Surgery for Congenital Heart Defects Reasonable as a Standard Operation? | ||||||
(Department of Pediatric Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan) |
||||||
| Minimally invasive cardiac surgery（MICS）has
been developed to offer patients the benefits of open heart operations
with limited skin incision, but this procedure tends to be more
difficult than conventional methods. We tried to evaluate whether
MICS would be reasonable as a standard operation for congenital
heart defects. From August 1997 to March 2000, 42 patients with
atrial septal defects (ASD) and 47 patients with ventricular
septal defects (VSD) underwent total repair by the minimal skin
incision and lower partial median sternotomy. Fifteen ASD patients
and 6 VSD patients were enrolled by residents（resident group).
Twenty-seven ASD patients and 41 VSD patients were treated by
leading surgeons（staff group). We compared the clinical course
of the patients between resident and staff groups. Operative
time, bypass time and cardiac arrest time (VSD) of the staff
group were clearly shorter than those of the resident group (p<0.05).
Other clinical course parameters of the two groups showed no
significant difference. The results of this study indicate that
MICS for ASD and VSD is reasonable as a standard operation because
there was no significant difference of postoperative clinical
course except the time required for the operation. Jpn. J. Cardiovasc. Surg. 31：40-44(2002) |
||||||
| A Case of Left Ventricular Pseudoaneurysm Formation in the Antero-lateral Wall Following Repair of Left Ventricular Rupture Subsequent to Mitral Valve Replacement | |||
(Department of Cardiovascular Surgery, Okamura Memorial Hospital, Mishima, Japan) |
|||
| A case of left ventricular pseudoaneurysm
formation at an atypical site in the left ventricle is described.
A 32-year-old man underwent mitral valve replacement and he was
taken to the intensive care unit (ICU) in good condition. Two
hours later, he sustained massive bleeding from the chest drainage
tubes, hypotension, and shock. We reopened the sternotomy in
the ICU and found massive bleeding from the lateral wall of the
left ventricle. Under cardiopulmonary bypass and cardiac arrest,
the myocardial laceration was closed with Teflon felt-buttressed
interrupted sutures and then the involved area was covered with
a Xeno-medicaTM patch. Postoperative echocardiography, computed
tomography, and left ventriculography revealed pseudoaneurysm
formation at antero-lateral wall of left ventricle. Because the
patient was asymptomatic, he was discharged from our hospital
without reoperation. However we are closely following him in
the outpatient clinic. Jpn. J. Cardiovasc. Surg. 31：45-47(2002) |
|||
| A Case of Endovascular Stent-Graft Treatment for Traumatic Thoracic Aortic Dissecting Aneurysm Complicated with Multiple Injuries | |||
(Department of Cardiovascular Surgery, San-in Rosai Hospital, Yonago, Japan and Department of Cardiovascular Surgery, Okayama University Medical School*, Okayama, Japan) |
|||
| We report the use of endovascular
stent-graft treatment for a case of traumatic thoracic aortic
dissecting aneurysm complicated with multiple injuries. A 65-year-old
man who had fallen from a 6 m high roof was admitted to our hospital
with severe circulatory failure and deep coma. Examination showed
right hemopneumothorax, hematoma around the thoracic descending
aorta and abdominal cavity, and bone fractures of all right ribs,
skull, right clavicle, pelvis and lumbar vertebra. The patient
recovered without major neurological deficit, but a dissecting
aortic aneurysm approximately 6.5cm in diameter occurred at the
proximal portion of the descending aorta. Since we considered
that conventional aortic repair would be difficult with high
operative risks based on the complicated thoracic and head injuries,
we performed an endovascular stent-graft treatment. The postoperative
course was uneventful and the aneurysmal diameter has been decreasing
to date. Jpn. J. Cardiovasc. Surg. 31：48-51(2002) |
|||
| A Case of Acute Occlusion of the Brachial Artery due to Strangulation and Traction | ||||||
(First Department of Surgery, Gifu University School of Medicine, Gifu, Japan) |
||||||
| A 61-year-old woman with paresthesia
and coldness of the right forearm came to our institute. Her
right arm was strangulated and tracted by a vinyl string tied
at her right brachium. No pulsation of her right radial artery
was detected, and her forearm had swollen with subcutaneous hematoma.
Her arteriography showed occlusion of the distal site of the
right brachial artery, and just proximal to the brachial arterial
bifurcation was enhanced by collaterals. She underwent emergency
revascularization 6h after injury. There was a thrombus in the
artery at the strangulated site, and the arterial intima was
circumferentially dissected. The injured site of the artery was
completely resected and interposed with basilic vein. Although
8h had passed from injury to reperfusion, myonephropathic metabolic
syndrome did not occur after the operation. Her brachial arterial
pulsation is now well palpable. The arterial occlusion was probably
caused by the circumferential tear of the intima due to not only
direct strangulation but also strong traction of the arm. It
is necessary to resect a sufficient length of injured artery. Jpn. J. Cardiovasc. Surg. 31：52-54(2002) |
||||||
| Tuberculous Abdominal Aortic Aneurysm―A Case Report― | ||||||||
(Department of SurgeryII, Miyazaki Medical College, Miyazaki, Japan and Department of Pathology, Miyazaki Medical College Hospital*, Miyazaki, Japan) |
||||||||
| A 52-year-old woman who had been
treated for miliary pulmonary tuber culosis complained of left
flank pain. Abdominal aortic angiography revealed a saccular
type aneurysm in the supra-renal abdominal aorta. We resected
the aneurysm and reconstructed the aorta by arificial graft patch
under partial extracorporeal circulation. The left renal artery
was reconstructed by an artificial graft. During the operation,
the superior mesenteric artery and the bilateral renal arteries
were perfused by blood from the extracorporeal circuit. On pathological
examination, it was shown that the aneurysm was caused by tuberculosis. Jpn. J. Cardiovasc. Surg. 31：55-57(2002) |
||||||||
| A Case of Successful Emergency Dor’s Operation for Left Ventricular Aneurysm with Acute Heart Failure | |||
(Cardiovascular Surgery Department, Nagoya Tokushukai General Hospital, Kasugai, Japan) |
|||
| An 84-year-old woman was admitted
on an emergency basis for dyspnea and cyanosis. Large left ventricular
aneurysm with uncontrollable ventricular tachycardia was diagnosed.
After intubation and intraaortic balloon pumping insertion, ventricular
aneurysmal exclusion with patch plication (Dor’s method) was
successfully performed. The postoperative course was uneventful
and the patient was discharged 2 months after the operation.
Left ventricular function improved and ventricular tachycardia
disappeared. The patient is now doing well with (NYHA functional
class 2) eight months after the operation. Jpn. J. Cardiovasc. Surg. 31：58-60 (2002) |
|||
| Takanori Ayabe | Yasunori Fukushima | Eiichi Chosa |
| Makoto Yoshioka | Toshio Onitsuka* |
（Department of Surgery, Miyazaki Shigun-Ishikai Hospital, Miyazaki, Japan and Department of SurgeryII, Miyazaki Medical College*, Miyazaki, Japan)
A 30-year-old man with a fever, cough, and dyspnea, was admitted to our hospital. A ruptured aneurysm of the Valsalva sinus（Konno classification, type I）was diagnosed associated with infective endocarditis of the aortic valve accompanied by aortic regurgitation（AR, grade II)，and a ventricular septal defect（VSD, subarterial type). The operation was performed as follows: the removal of the aortic and pulmonary valves involved with endocarditis, the resection of the right aneurysm of the Valsalva sinus, and the myectomy of the fragile tissue of the right ventricle around the VSD. As a result, the large deficit region with the VSD and the resected right Valsalva sinus was patched with double sheets of equine pericardium. Aortic valve replacement（a prosthetic valve, ATS18AP）was anastomozed to the closed patch with the aid of the sheet as a part of the aortic valvular ring, and pulmonary valve replacement（a prosthetic valve, ATS23A）was done to the native pulmonary valvular site. During the 13 months after the surgery, under strict control of warfarin administration, the patient’s clinical outcome has been favorable without infection and congestive heart failure. This case had AR accompanied with the subarterial type VSD, and aneurysmal formation of the Valsalva sinus and its rupture, and also revealed progressive infective endocarditis of the aortic and pulmonary valves, which resulted in severe cardiac failure. Early and appropriate surgical treatment for the ruptured aneurysm of the Valsalva sinus is required for a better prognosis prior to prevent exacerbation leading to infective endocarditis and critical heart failure.| Ryo Hasegawa | Hideo Tsunemoto | Hidemasa Nobara |
(Department of Cardiovascular Surgery, Matsumoto Kyoritsu Hospital, Matsumoto, Japan)
We report two operated cases of papillary fibroelastoma of the aortic valve. Case 1: A 56-year-old man was referred to our hospital with hyperlipidemia. On echocardiogram, he was found to have a mobile mass attached to the NCC of the aortic valve. At operation, a sea anemone-like tumor was found attached to the free edge of the RCC and resection of the tumor was performed without valve replacement. Case 2: A 75-year-old woman was referred with heart murmur, and echocardiogram showed a tumor of the NCC of the aortic valve. At operation, the tumor was attached to the NCC and resection of the tumor was performed. On each case, microscopic examinations showed typical findings of PFE. The patients´ postoperative courses were unremarkable.| Masanobu Yamauchi | Tomoki Hanada | Seishi Nosaka |
(First Department of Surgery, Shimane Medical University, Izumo, Japan)
We report here a case of pseudo-false aneurysm of the left ventricle with ventricular septal perforation following myocardial infarction. An 85-year-old man was treated for acute inferior myocardial infarction three months previously. He was admitted due to an acute posterior myocardial infarction. Since a cardiac catheter study showed three diseased coronary arteries, a left ventricular aneurysm and a ventricular septal perforation, he underwent emergency surgery. The ventricular aneurysm was located on the right side along the posterior descending branch, and was 4×1.5cm in size. We ruled out a false aneurysm because there was no adhesion between the epicardium and the pericardium. The communication between the aneurysm and the left ventricle was then closed with a Gore-Tex patch, and the perforation of the right ventricle was closed directly. CABG was performed for the left anterior descending artery using a vein graft. The postoperative course was uneventful, and he was discharged on the 27th post-operative day. The pathological findings showed a pseudo-false aneurysm of the ventricle.| Naoki Konagai | Hiromi Yano |
| Mitsunori Maeda | Masanori Misaka |
| Masataka Matsumoto | Tatsuhiko Kudo |
| Shin Ishimaru* |
(Department of Cardiovascular Surgery, Hachioji Medical Center of Tokyo Medical University, Tokyo, Japan and Second Department of Surgery, Tokyo Medical University*, Tokyo, Japan)
A 31-year-old man underwent mitral valve replacement because of mitral regurgitation due to continued active infective endocarditis despite antibiotic therapy. Because cerebral mycotic aneurysm was suggested by preoperative IVDSA (Intravenous Digital Subtraction Angiography), cerebral angiography was performed on the first postoperative day. Cerebral mycotic aneurysm was detected in the middle cerebral artery and emergency aneurysm trapping was successfully performed. Although the patient had no neurologic deficit and postoperative cardiac function was stable, impending rupture of the mycotic aneurysm of the superior mesenteric artery occurred suddenly on the twelfth postoperative day. Endovascular treatment using the coil-embolization technique was immediately performed, and the postoperative course was uneventful.| Kenji Mogi | Mitsunori Okimoto |
（Department of Cardiovascular Surgery, Chiba Emergency Medical Center, Chiba, Japan）
A case of mycotic aneurysm in the gastroduodenal artery associated with infectious endocarditis (IE) penetrating into the residual stomach is reported. A 50-year-old woman was transferred to our hospital because of sudden onset of hematemesis and bloody stool. She had had partial gastrectomy due to duodenal ulcer 6 years previously and aortic prosthetic valve replacement due to infectious endocarditis eight months previously. Emergency laparotomy was performed. Aneurysm of the gastroduodenal artery penetraing into the lumen of the residual stomach was found. The aneurysm had not been detected in the CT scan 8 months earlier. It was surmised that it was related to IE and had developed over the last 8 months. Aneurysmectomy was performed. The postoperative course was uneventful and she was discharged on the 22nd postoperative day. Mycotic aneurysm associated with IE developing into the gastroduodenal artery and penetrating into the stomach is rare. It is possible that a mycotic aneurysm could develop in any artery of a patient with IE. We should thus carefully examine patients with IE in order to detect mycotic aneurysms using angiography and the contrast-enhanced CT scan.| Yasumi Maze | Hidehito Kawai |
| Yoshihiko Katayama | Makoto Kimura |
| Sekira Shoumura |
(Department of Thoracic Surgery, Yamada Red Cross Hospital, Mie, Japan)
Three surgical cases of postinfarction left ventricular free wall rupture (LVFWR) are described. Patient 1, a 76-year-old woman, developed LVFWR of the posterior wall after acute myocardial infarction (AMI). Coronary arteriography (CAG) revealed total occlusion of left circumflex artery (Cx) (＃11). Direct closure of the myocardial tear was performed using cardiopulmonary bypass (CPB) and cardiac arrest. Patient 2, a 67-year-old man, developed LVFWR of the anterior wall after AMI. CAG revealed total occlusion of left anterior descending artery (LAD) (＃7). He was placed on a percutaneous cardiopulmonary support system (PCPS) prior to the operation and direct closure of the myocardial tear was performed with the heart beating. Patient 3, a 57-year-old man, developed LVFWR of the posterior wall after AMI. CAG revealed total occlusion of Cx (＃13). He was placed on PCPS prior to the operation and direct closure of the myocardial tear was performed using CPB and cardiac arrest. Patients 2 and 3 who were placed on PCPS prior to the operation successfully underwent emergency operations. In all cases, 2-0 Prolene horizontal mattress sutures with Teflon felt strips were used through the infarcted area in order to close the myocardial tear.