Daisuke Futagami

Aortic valve replacement for a patient with anomalous left coronary artery from the right sinus of Valsalva

Anomalous origin of the left coronary artery (LCA) from the right sinus of Valsalva (RSOV) is an uncommon but clinically important feature. A 75-year-old man with progressive nocturnal dyspnea was diagnosed with severe aortic valve stenosis and moderate regurgitation. Preoperative computed tomographic scan revealed that the LCA originated from the RSOV separate from the right coronary artery and coursed into the ventricular septum. Because he did not experience any episodes of cardiac ischemia, isolated aortic valve replacement was performed using a 23-mm stented bioprosthesis without concomitant coronary revascularization. The postoperative course was free from coronary ischemia.

Adventitial Wrap Technique for Acute Type A Aortic Dissection

We describe a simple and reproducible technique to achieve complete and immediate hemostasis of the distal anastomosis in total arch replacement with the frozen elephant trunk technique. The adventitia was left seamlessly 1.0 cm longer than the level of the suture line. The adventitial remnant covered most of the distal anastomosis line tightly while the distal anastomosis was completed with continuous sutures. The adventitia was thin and tough, making it suitable to cover the suture line. This technique can contribute to eliminating bleeding from the distal anastomosis independent of unreliable blood coagulability during aortic surgery for acute aortic dissection.

Double-line closure of anterior postinfarction ventricular septal perforation

We describe a modified patch closure technique for repairing subacute anterior ventricular septal perforation. Through a left ventriculotomy, a larger double-layered planar patch is secured with double suture lines to close the defect and cover the ventricular septum. This modification is simple and easy, and may help to avoid a residual shunt.

Femoro-Femoral Bypass Anterior to the Pubis and Inside of the Thigh Muscle for Treatment of Suspected Infected Aneurysm in the Ilio-Femoral Area

症例は72歳,男性.閉塞性動脈硬化症に対して人工血管による腹部大動脈-左大腿動脈バイパス術を施行して10年後に感染を疑われる動脈瘤を発症した.左鼠径部の発赤,腫脹と炎症反応の著しい上昇を認めたため,感染を疑い,感染瘤に準じた治療を行った.緊急で人工血管抜去と感染瘤の掻爬を行った.自家静脈を用い感染創部を迂回する恥骨前面-左大腿内側の交叉型大腿動脈-大腿動脈バイパス術を施行した.術後経過は良好であった.感染性大腿動脈瘤では感染瘤を取り除くとともに救肢のための血行再建術が必要となり,その術式にも様々な工夫が必要となる.今回,巨大な感染を疑われる大腿動脈吻合部仮性瘤の1治験例を経験したので報告する.