Kiyohiro Ohshima

Abdominal Aortic Dilatation in Japanese Residents.

The correlation between abdominal aortic dilatation and arteriosclerotic risk factors was studied in 2514 Japanese residents (947 men, 1567 women, mean age 70 years old). The aortic diameter was measured by ultrasound and an aortic dilatation was defined as above 30 mm in diameter, including abdominal aortic aneurysm (AAA). Forty-three (1.7%) patients with a dilated aorta and 2471 with a normal-sized aorta were compared. Abdominal aortic dilatation was significantly (p<0.01) more frequent in men than in women (3% vs 0.7%). Obesity and hyperlipidemia were slightly (p<0.1) more frequent in patients with a dilated aorta than in those with a normal-sized aorta. There were no significant differences between the two groups in mean age, frequency of smoking, diabetes mellitus, and coronary artery disease. In conclusion, male obesity and hyperlipidemia may be risk factors for aortic dilatation in Japan. Women may not be screened because of cost-effectiveness. The prevalence of aortic dilatation in Japan was lower than in European countries. However, screening for AAA using ultrasound would be advantageous when considering the grave prognoses of ruptured AAA.

Surgical treatment with deep hypothermia for thoracic aortic aneurysm in a patient with renal transplantation

An increasing number of patients have undergone aortic reconstruction, exposing the transplanted kidney to ischemic injury. A 58-year-old male underwent renal transplantation previously. A thoracic aortic aneurysm (TAA) of the distal aortic arch was identified. His renal function was poor due to chronic rejection. The TAA was exposed by a left anterolateral thoracotomy through the 4th intercostal space, and cardiopulmonary bypass established with canulation of the left femoral artery and vein. Deep hypothermic circulatory arrest with retrograde cerebral perfusion was adopted at a rectal temperature of 20 degrees C, and distal arch replacement was successfully performed. Prednisolone was administered intravenously for perioperative immunosuppression. Poor renal function recovered to the preoperative level. No other complications occurred. Perioperative renal graft protection, immunosuppression and infection control are mandatory for surgical treatment in patients with TAA after renal transplantation.

Successful graft replacement of the descending aorta after an extended reconstruction of the ascending and transverse aorta in a patient with Marfan's syndrome.

A 27-year-old man with Marfan’s syndrome underwent a total aortic graft replacement in three separate stages. Initially the abdominal aorta was replaced, followed by the ascending aorta and aortic arch, and finally the residual portion. The extensive reconstruction of both the ascending and transverse aorta at the second operation, even though no dissection was present in the aortic arch, reduced the risk of the subsequent operation since the same surgical approach did not have to be used.