Kiyohito Yamamoto

Molecular diagnosis of nonaneurysmal infectious aortitis

We report a 79-year-old patient who presented with a fever and abdominal pain. The patient was initially thought to have a retroperitoneal fibrosis or inflammatory abdominal aortitis in a normal-sized caliber aorta. Broad-range polymerase chain reaction (PCR) and DNA sequencing revealed the presence of Enterobacter. We finally diagnosed nonaneurysmal infectious aortitis, and we performed a successful surgical resection. Establishing a diagnosis of aortic infection before formation of an aneurysm is difficult. The molecular diagnostic technique was particularly useful in specifying the microbial species and diagnosis.

Effects of Nafamostat Mesilate on Coagulopathy With Chronic Aortic Dissection

A 65-year-old man with chronic aortic dissection experienced two massive subcutaneous hemorrhages. Laboratory data indicated disseminated intravascular coagulation, whereas a contrast computed tomographic scan revealed a dilatated aortic arch with a partial thrombosis at the false lumen. Because disseminated intravascular coagulation can be caused by chronic aortic dissection, and the aortic arch was 6 cm in diameter, we performed graft replacement from the ascending to the descending aorta in a single stage. Before graft replacement, nafamostat mesilate, a protease inhibitor, was administered and the disseminated intravascular coagulation improved. Nafamostat mesilate may be useful for managing disseminated intravascular coagulation associated with chronic aortic dissection.

Perforation of a Tricuspid Pouch Caused by Infective Endocarditis

A 61-year-old man was admitted because of infective endocarditis. Echocardiography revealed the bicuspid aortic valve and a tricuspid pouch bulging into the right ventricle. Color Doppler demonstrated mild aortic regurgitation and left-to-right ventricular shunt through the lower part of the pouch. We successfully performed an aortic valve replacement and closed the interventricular communication. Infective endocarditis of the bicuspid aortic valve appeared to have caused left-to-right ventricular communication at the lower part of the tricuspid pouch.

Discrete subaortic stenosis 37 years after repair of a ventricular septal defect

Discrete subaortic stenosis (DSS) is uncommon in adults after surgical correction of congenital heart defects. There are only a few published reports on the occurrence of DSS in adults. We present an adult case with DSS after repair of a ventricular septal defect (VSD). The case was a 44-year old female patient who underwent VSD closure at 7 years of age. Thirty-seven years later, she presented with congestive heart failure associated with severe subaortic membranous stenosis and atrial fibrillation (AF) that required surgical repair. We report successful surgical treatment of this adult patient with DSS and AF 37 years after repair of a VSD.

A Case of External Compression of Femoral Vein by the Enlarged Iliopsoas Bursa with Long Term Edema

The iliopsoas bursa is the largest bursa in the region of hip joint. It is unusual that these bursa become symptomatic. However the bursa can compress femoral vein, leading to lower extremity edema. A 58-year-old man was referred to our department for his unilateral leg edema which had been treated as deep vein thrombosis without any favorable response. Magnetic resonance angiography was performed, which demonstrated enlarged iliopsoas bursa compressing his femoral vein. Surgical removal of the bursa was performed. The postoperative course was uneventful, and the patient is free from symptoms with no evidence of recurrence.

Successful Surgical Exclusion of Rapidly Expanding Kommerell Diverticulum Following a Total Arch Replacement for an Acute Type A Aortic Dissection

A 50-year-old man presented with an acute type A aortic dissection with an aberrant right subclavian artery. Emergent total arch replacement with an elephant trunk was performed. Intraoperatively, the origin of the aberrant right subclavian artery could not be resected because it was located too far from the distal arch. After two weeks, the patient became aware of dysphagia. Postoperative computed tomography showed the esophagus was compressed anteriorly by the aneurismal origin of this aberrant vessel (Kommerell diverticulum) with a patent false lumen. Additional replacement of the descending aorta via left thoracotomy was performed immediately to exclude a Kommerell diverticulum.

Combined coronary and femoral revascularization for the treatment of hypoplastic aortoiliac syndrome: Report of a case

The coronary artery and aortoiliac occlusive disease frequently coexist and in relatively rare instances, a complication of hypoplastic aortoiliac syndrome (HAIS) may occur. We herein present our experience with a 51-year-old female patient with HAIS and concomitant coronary artery disease. She underwent a successful simultaneous coronary and femoral revascularization. The left anterior descending artery was bypassed with the in situ gastroepiploic artery and a biaorto-external iliac artery bypass was performed with expanded polytetrafluoroethylene precuffed grafts. She had a good postoperative course, with no angina or intermittent claudication. The importance of the technical aspects of reconstructive surgery in patients with HAIS has been emphasized in many reports in the literature, and the surgical options for combined coronary and femoral revascularization are also discussed herein.