Seiichi Tada

Genetic risk factor for abdominal aortic aneurysm: HLA-DR2(15), A Japanese study

PURPOSE Autoimmunity has been proposed to play a role in the pathogenesis of the abdominal aortic aneurysm (AAA). Several autoimmune diseases are associated with specific HLA DR alleles. These experiments were carried out to determine whether the same HLA DR types that have been reported to be associated with AAA in a mixed North American population are similarly associated with AAA in a more homogeneous group of patients in Japan. METHOD HLA DR typing was performed by a serologic method on samples of peripheral blood of patients with nonspecific infrarenal AAA in Nagasaki University Hospital in Japan. The frequencies of HLA DR antigens were compared with those of volunteers approximately matched for age and sex from the same referral area. RESULTS HLA DR haplotypes were determined in 46 Japanese patients with AAA and in 50 patients in a control group. The HLA-DR2(15) antigen was observed in 27 (58.7%) patients (29 alleles 31.5%) with AAA and in 14 (28%) subjects (16 alleles 26.0%) in the control group (p < 0.005). CONCLUSIONS The data suggest that HLA-DR2(15) has an important role as a genetic risk factor for AAA in Japanese patients, as previously reported in a mixed North American population.

Acute occlusion of an abdominal aortic aneurysm--case report and review of the literature.

Acute thrombosis of an abdominal aortic aneurysm (AAA) is a surgical emergency. Only 44 cases have been reported in the literature. The mechanism of the thrombosis has not been delineated. The proposed etiologies include propagation of thrombus from distal artery occlusion, cardiac thromboembolism, and dislodgment of a mural thrombus. Patients often present bilateral lower extremity ischemia, mimicking a saddle embolism. Systemic heparinization immediately after diagnosis and prompt surgical revasculariza tion can reduce the mortality rate. The authors present a patient with sudden throm bosis of an AAA who was successfully treated with an axillobifemoral bypass graft. All published cases of thrombosed AAAs are analyzed.

Coronary atherosclerosis with dual coronary artery fistulas.

Coronary artery fistula (CAF) is an uncommon congenital anomaly. Bilateral CAFs, arising from both right and left coronary arteries are rare. Myocardial infarction is by far a less frequent complication of CAF than angina pectoris. Ligation of CAF and coronary artery bypass graft were performed in the treatment of coronary artery stenosis with CAF.

Successful surgical repair for Emery–Dreifuss muscular dystrophy valvular disease with long-term follow-up

Emery-Dreifuss muscular dystrophy (EDMD) is an X-linked muscular dystrophy in which cardiac involvement can be serious. The disease progresses rapidly and the prognosis is strongly associated with cardiac involvement. We present the case of a 49-year-old man who was admitted with shortness of breath. Echocardiography revealed a huge right atrium and severe tricuspid regurgitation caused by annular dilatation and destruction of leaflets and chordae by pacemaker leads. Tricuspid valve replacement, right atrial plication and implantation of epicardial pacemaker leads were performed. The patient is in a good condition seven years after surgery. Cardiac transplantation is the desired therapy for valvular disease in EDMD cardiomyopathy, but this case indicates that valve replacement is also acceptable if performed with the appropriate timing.

Atrial septal defect as an uncommon cardiovascular malformation with Turner’s syndrome

Cardiovascular malformations are frequently observed in Turners syndrome. Bicuspid aortic valve and coarctation of aorta are commonly associated with Turners syndrome while an atrial septal defect is unusual. Here report a rare case of atrial septal defect with Turners syndrome.

A Case of Perioperative Coronary Artery Spasm in Initial and Redo Open-Heart Surgery.

冠動脈に有意病変を有しない僧帽弁膜症患者で, 初回手術時, 再手術時の2回にわたり高度の術中冠攀縮を発生したまれな1例を経験した. 患者は56歳女性. 7年前 (49歳時) の僧帽弁交連切開術の際にも術中に強い冠攀縮をきたし, IABP駆動下にようやく救命できた. 再手術時には, 麻酔導入時から心電図上STの高度上昇を伴う徐脈と低血圧の発作が頻回に生じ, ニトログリセリン静注も効果が少なく, そのまま体外循環に移行して僧帽弁置換術を施行した. 人工心肺離脱後も冠攀縮発作が頻発したが, ニトログリセリン, ノルエピネフリン, IABPなどの併用により救命できた. 術中術後の全経過を通じて心筋逸脱酵素の上昇を認めなかった.