Hidefumi Obo

Ruptured sinus of Valsalva aneurysm associated with aortic regurgitation caused by hemodynamic effect solely

We describe a case of ruptured sinus of Valsalva aneurysm (RSVA) with moderate aortic regurgitation (AR), which developed on the second day after admission. The AR was caused by a hemodynamic effect solely, in which the shunt blood flow through ruptured site pulled the right aortic cusp away from closure. The pathological mechanism of the AR was clearly visualized by intraoperative transesophageal echocardiography (TEE) and the AR was successfully resolved after simple closure of the RSVA without any additional procedure to the aortic valve.

Pulmonary thromboendarterectomy for chronic pulmonary thromboembolism in protein C deficiency.

Pulmonary thromboendarterectomy was performed on a patient with chronic pulmonary thromboembolism showing thrombophilia. The patient was a 56-year-old female with the above condition complicated by congenital protein C deficiency. She was admitted to our hospital with severe dyspnea accompanied by right ventricular failure. A pulmonary arteriogram showed occlusion and stenosis from lobar to segmental arteries. Cardiac catheterization showed marked pulmonary hypertension. A lung perfusion scintigram revealed multiple defects in the right and left lungs. After the insertion of an inferior vena cava filter, she was operated on. Following a median sternotomy, thromboendarterectomy of the bilateral pulmonary arteries was performed using deep hypothermia and intermittent circulatory arrest. Circulatory arrest was employed in three periods totaling up to 36 minutes. After surgery, she had improvements in pulmonary hypertension and pulmonary vascular resistance. She maintained improved lung functions, and remained in the New York Heart Association functional class I for more than two years and eight months after surgery.

Malignant Hyperthermia after Surgical Repair of Acute Type A Aortic Dissection

症例は45歳,男性.A型大動脈解離に対して全弓部置換術を行った.術中の経過は安定していたが,術後7時間目ころから洞性頻脈となり,続いてPaCO2が上昇,PaO2が低下し,代謝性アシドーシスが進行した.その後39.7℃までの急激な体温上昇とともに血圧が低下した.全身冷却にて体温は低下傾向となったが,意識障害,無尿と低酸素血症は持続した.悪性高熱と診断しダントロレンを投与したが,多臓器不全が進行し術後7日目に死亡した.血中CPKは最高12,446IU/lまで上昇,血中ミオグロビンは術後2日目で36,500ng/mlと非常に高値であった.開心術後に悪性高熱を発症することはきわめてまれであるが,原因不明の急激な体温上昇を認めたときには念頭におかなければならない.

Successful emergency aortic valve replacement following percutaneous cardiopulmonary support for the patient with aortic stenosis and cardiac arrest

We present a 57-year-old woman with severe aortic stenosis. She was diagnosed with acute myocardial infarction by electrocardiography and the detection of elevated creatine phosphokinase in another hospital. Soon after transfer to our hospital, this patient developed cardiac arrest. Percutaneous cardiopulmonary support (PCPS) was established, and subsequently performed coronary angiography revealed normal coronary arteries. However echocardiography revealed severe aortic stenosis. Emergency aortic valve replacement (AVR) was performed, and the patient was discharged from hospital 30 days after surgery in good health. Prompt establishment of PCPS maintained her systemic circulation, and allowed us to conduct investigations for diagnosis. In patients with critical aortic stenosis, emergency AVR should be performed as early as possible following diagnosis.

Successful In Situ Repair for Mycotic Aneurysm of the Iliac Artery with Autologous Superficial Femoral Vein

腸腰筋膿瘍を合併した感染性腸骨動脈瘤に対して自家浅大腿静脈グラフトを用いたin situ血行再建術を施行し良好な結果が得られたので報告する.症例は73歳,男性.発熱と左下腹部痛を主訴に他院入院となり,入院後の腹部CT検査にて左腸骨動脈瘤の破裂が疑われたため当科緊急入院となった.入院時の血液検査にて高度の炎症所見が認められたことと造影CT所見より,腸腰筋膿瘍を合併した感染性腸骨動脈瘤と診断された.人工血管による血行再建術はグラフト感染の危険性が高いことから,自家静脈である右浅大腿静脈を採取し,血行再建術を行うこととした.手術は,瘤切除ならびに腸腰筋内の膿瘍腔をdebridementしたのちに,浅大腿静脈グラフトを使用してin situにて左腸骨動脈の血行再建術を行った.現在,術後1年6ヵ月が経過しているが再感染の徴候もなく順調に経過している.