Mitsuaki Matsumoto

Late aortic root redissection following surgical treatment for acute type A aortic dissection using Gelatin-Resorcin-Formalin glue.

OBJECTIVES Although Gelatin-Resorcin-Formalin (GRF) glue is widely used in surgery for acute aortic dissection, late complications possibly due to the glue, such as late aortic root redissection, have also been reported. We have experienced similar complications, some of which required redo surgeries, and these cases are reviewed. METHODS Twenty-six consecutive patients who underwent surgery for acute type A aortic dissection using GRF glue, from December 1996 to February 2001, were retrospectively studied, with a special focus on any late complications and any reoperation. RESULTS Of the 21 patients who survived and were followed as outpatients, false aneurysms were found in 5 patients (21%) at 24-42 (mean 34) months following the initial surgery. Of these, 2 patients required resternotomy because of the increasing aneurysm diameter. In both cases, the aortic root was redissected at the site of the GRF glue use where the anastomosis between the aortic root and the prosthesis had widely opened and had become the aneurysm entry point. Significant aortic regurgitation was noticed in 3 patients (14%, 1 of whom showed a false aneurysm), and 2 of these underwent reoperation for aortic root redissection. CONCLUSIONS A high incidence of aortic root redissection with false aneurysm and/or aortic insufficiency was found following the surgery for acute aortic dissection using GRF glue. These patients should be carefully followed for years after surgery.

Staged repair of a thoracoabdominal aortic aneurysm with mesenteric ischemia using the reversed elephant trunk technique

Improvements in surgical techniques, and adjuncts for spinal cord protection and perioperative care have resulted in decreased morbidity and mortality in repair of thoracoabdominal aortic aneurysm (TAAA). However the surgical treatment of TAAA of extent II is still associated with high mortality, especially in patients with preoperative co-morbidities. We report a successful staged repair of extent II TAAA using the reversed elephant trunk technique for a patient with ischemic colitis.

Chronological Progress of Calcified Lesion in the Iliofemoral Vein in a Patientwith Chronic Renal Failure

We report the case of a 64-year-old man refered to our department for edema and tiredness in legs, who had been followed up for chronic renal failure and secondary hyperparathyroidism. He had no history of medical treatment for deep venous thrombosis, however, computed tomography (CT) revealed extensive calcification in veins of the lower half of the body. Since peripheral venous calcification is a rare disease and advances slowly, imaging the chronological progress of calcification is difficult. This case suggests the usefulness of CT for diagnosing and treating peripheral venous calcification.

Hypogastric and lumbar artery bypasses to restore gluteal perfusion after open aortoiliac aneurysm repair

Gluteal ischemia is a rare but often fatal complication after open abdominal aortic aneurysm repair. A 67-year-old man with an aortoiliac aneurysm presented with a patent right internal iliac artery (IIA) and an occluded left IIA. A bifurcated graft replacement was performed with both limbs of the graft anastomosed to the external iliac arteries. The right IIA was ligated and the inferior mesenteric artery was reimplanted. Postoperatively, the patient developed right gluteal ischemia. Hypogastric and lumbar artery bypasses were immediately performed and the patient recovered without gait disturbance. This treatment prevented potentially fatal necrosis of the buttock.

A Case of Video-Assisted Thoracoscopic Surgery for Clipping the Patent Ductus Arteriosus in a Child.

症例は11歳, 女児. 内径5mmの動脈管開存症 (PDA) に対して, 胸腔鏡下にクリッピング術を行った. この症例は, 経肺動脈コイル塞栓術の困難症例であった. 手術は片肺換気下に左胸腔に4カ所のポートを作製し, 閉鎖長11mmのチタン製クリップにてクリッピングした. 術中は経食道心エコーを使用し, PDAの位置や残存短絡の有無を確認した. 術後は反回神経麻痺や出血も認めず, 経過は良好で術後9日目に退院した. 胸腔鏡下手術, VATS (video-assisted thoracoscopic surgery) によるPDA遮断術は石灰化のない外径7mmまでの症例に適応でき, 低侵襲かつ確実で術後のQOLも高く優れた手技であると考えられた.

Case Report of CABG Undergone in a Patient with Malignant Hyperthermia Risk and AT III Deficiency.

悪性高熱 (MH) の high risk group で, さらに術中にアンチトロンビンIII (AT III) 欠乏症を早期に疑い回避しえた準緊急冠動脈バイパス術 (CABG) の1例を経験した. 症例は67歳, 男性. 既往歴として頻回におきるこむらがえりあり. 紹介医通院時より, 筋痙攣に対してダントロレン50mg/day を経口投与されておりCKも高値を示していた. 不安定狭心症にて当院に紹介され, CABG (4枝) を施行した. 手術にさいし, ダントロレン25mg内服および麻酔導入前に同160mgを静脈内投与した. 術中, 内胸動脈採取のさい, ヘパリン1ml投与後のACT延長が14秒と通常例 (約60秒) より著明に短縮していたため, AT III欠乏症を疑い, AT III製剤を1,500単位投与した. 術中・術後経過ともに良好であった. MH, AT III欠乏症ともに希ではあるが, ひとたび発症すると重篤な合併症となる疾患であるため, 予測・予防および早期発見・早期治療開始が重要である.

Risk Factors and Treatment for Mediastinitis in Internal Mammary Artery Grafting, with Particular Regard to Diabetic Patients.

内胸動脈 (IMA) を使用した冠動脈バイパス術 (CABG) 後の縦隔炎について検討した. 過去5年間における当施設での単独CABGは400例であり, その内IMA使用の386例を対象とした. 両側, 片側IMA使用群はおのおの97例, 289例であった. 縦隔炎を (1) 創傷治癒遷延, (2)-(1)創部表層感染と(2)-(2)創部深層感染 (狭義の縦隔炎) に分類した. 狭義の縦隔炎は認めず, 両側, 片側IMA使用各群における縦隔炎の発生率は, おのおの7.2% (7例), 7.3% (21例) であり, 初回, 再手術症例においても有意差を認めなかった. 縦隔炎の発生率は, 糖尿病患者かつ両側IMA使用群では,12.0% (4/33), 片側IMA使用群では, 12.0% (14/117) であり有意差を認めなかった. 同様に非糖尿病患者かつ両側IMA使用群では, 4.7% (3/64), 片側IMA使用群では, 4.1% (7/172) であり有意差を認めなかった. 各IMA使用群において, 糖尿病の合併は非合併の約3倍の創傷治癒遅延の発生率の増加傾向を認めた.

A case report of intrathoracic aneurysm of left subclavian artery

A case of intrathoracic aneurysm of the left subclavian artery is reported. The case was 68-year-old male. Chest CT and angiography revealed an aneurysm of left subclavian artery (LSA) located the proximal portion of LSA. The chest was opened by fourth intercostal thoracotomy. We evaluated the intima of distal aortic arch and LSA by introperative direct echography using a small probe (finger tip size). Since there was no calcification or mural thrombi at the distal aortic arch, the aneurysm was resected using partial cardiopulmonary bypass and the orifice of LSA was closed direct suture. LSA was reconstructed with knitted Dacron graft (8 mm). Postoperative course was uneventful.