Shoichiro Shiraishi

Fenestrated Stent-Graft for Traumatic Juxtahepatic Inferior Vena Cava Injury

Purpose: To report the use of a fenestrated stent-graft to manage a traumatic rupture of the juxtahepatic inferior vena cava (IVC). Case Report: A 62-year-old man was involved in a traffic accident and hospitalized for severe right leg fractures. Computed tomography also uncovered liver contusion and retroperitoneal hematoma. The next day, he became hemodynamically unstable; a huge retroperitoneal hematoma had developed from a rupture of the juxtahepatic IVC. An emergent procedure to implant a self-expanding fenestrated stent-graft was successful in repairing the IVC injury and maintaining hepatic venous return. The patient recovered and continues in good health with a patent endograft 16 months after treatment. Conclusions: This experience supports the efficacy of fenestrated endograft implantation for emergent repair of IVC injuries, although proper facilities, an experienced interventional team, and an assortment of devices must be available.

Laparoscopic lumbar sympathectomy for lower-limb disease

Background: The standard procedure for sympathectomy is open surgery. The oblique retroperitoneal approach is popular because it provides good visibility, albeit at the expense of requiring a long skin incision. Chemical sympathectomy has been introduced as a less invasive means of achieving sympatholysis; however, this method is also associated with a significant incidence of incomplete block and transient denervation. Laparoscopic surgery is a new approach that simplifies various surgical procedures. The aim of our report was to evaluate the benefits of endoscopic retroperitoneal surgery for lumbar sympathectomies. Methods: Between March 1997 and April 2000, seven patients underwent laparoscopic lumbar sympathectomy in our department (all men, with an average age or 45.1 years). The predominant presenting symptoms were unilateral pain at rest and lower-extremity coldness. Symphaectomy was performed using a retroperitoneal approach on six patients and an anterior transperitoneal approach on one patient. After laparoscopic lumbar sympathectomy, skin thermometry was carried out on all patients. Results: The postoperative skin temperature of the affected leg rose to 36.6 ± 0.5°C, as compared to 33.8 ± 0.8°C preoperatively. After laparoscopic lumbar sympathectomy, none of the patients complained of neuralgia. All patients achieved sustained symptomatic relief, and no major postoperative complications were noted. Conclusions: Lumbar sympathectomy can be performed laparoscopically. Currently, our standard technique is the retroperitoneal approach. More clinical experience and long-term follow-up will ultimately determine if this will become the procedure of choice. However, we believe that a learning period is necessary for this technique to be fully mastered.

Early and follow-up results of butterfly resection of prolapsed posterior leaflet in 76 consecutive patients

OBJECTIVE The present study aims to examine the medium-term results of butterfly resection. METHODS Of 587 consecutive patients who underwent surgery for mitral regurgitation between January 2002 and August 2012, 162 patients underwent valve reconstruction of a prolapsed posterior leaflet. Quadrangular resection (n = 50, Quadrangular group) was primarily used before November 2006 (when we innovated the concept of butterfly resection). After that, we mainly used butterfly resection (n = 76, Butterfly group). RESULTS Although there was no sign of systolic anterior motion in the Butterfly group, it occurred in 2 patients in the Quadrangular group. One patient in the Quadrangular group died of stroke at postoperative day 17. The mean follow-up period was 2.2 ± 1.6 years for the Butterfly group and 6.1 ± 2.5 years for the Quadrangular group. During those periods, 2 patients died of noncardiac causes in the Butterfly group and 1 patient died of an unknown cause in the Quadrangular group. One patient in the Quadrangular group required a reoperation for recurrent mitral regurgitation arising from a new lesion of the anterior leaflet. One patient in the Butterfly group required a reoperation for partial dehiscence of suture at the posterior leaflet. The 3-year estimated survivals free from overall death and reoperation for recurrent mitral regurgitation in the Butterfly group and the Quadrangular group were 97% ± 2% versus 96% ± 3% (P = .89) and 95% ± 3% versus 96% ± 3% (P = .75), respectively. CONCLUSIONS Butterfly resection provides acceptable early and medium-term results.

A new staged operation for extensive aortic aneurysm by means of the modified “Elephant trunk” technique

R E F E R E N C E S 1. Mtiller-Berghaus G, Riess FC, P6tzsch B, Nowak G. Hirudin update. In: Neri Serneri GG, Gensini GF, Abbate R, Prisco P, eds. Thrombosis: an update. Florence: Scientific Press, 1992:i133-47. 2. Walenga JM, Bakhos M, Messmore HL, Fareed J, Pifarr6 R. Potential use of recombinant hirudin as an anticoagulant in a cardiopulmonary bypass model. Ann Thorac Surg 1991;51:271-7. 3. Riess FC, Behr I, Pttzsch B, et al. Recombinant r-hirudin as a potential anticoagulant in open-heart surgery: studies in a pig model. Thromb Haemost 1993;69:A2728. 4. Pttzsch B, Iversen S, Riess FC, et al. Recombinant hirudin as an anticoagulant in open-heart surgery: a case report. Ann Hematol 1994;68:A53. 5. Nowak G, Bucha E. A new method for the therapeutical monitoring of hirudin. Thromb Haemost 1993;69: A2736.

Unruptured Aneurysm of the Sinus of Valsalva Into the Pulmonary Artery

Congenital aneurysms of the sinus of Valsalva are rare lesions. Because the aortic root is central, the aneurysm can rupture into any cardiac chamber, and virtually all combinations of sinus and chamber fistulas have been described. Rupture into the pulmonary artery, however, is very rare. We encountered a 14-year-old boy with conal ventricular septal defect and right coronary cusp prolapse with an unruptured aneurysm of the sinus of Valsalva into the pulmonary artery.

Pericardial-Peritoneal Window for Chronic Exudative Pericarditis Using a Subxiphoidal Approach: Report of Three Cases

From August 1986 to February 2000, three patients were given a pericardial-peritoneal window using a subxiphoidal approach, for pericardial effusion associated with chronic exudative pericarditis. Complete drainage without recurrence was achieved in two patients with a large pericardial-peritoneal window (4 cm diameter) and effusion recurred in another with a small pericardial-peritoneal window (3 cm diameter). No complications were encountered. The pericardial-peritoneal window, approached subxiphoidally, is a simple, safe, and effective procedure and applicable in most patients with noninfectious benign pericardial effusion. We herein describe our techniques, clinical characteristics, and the results for three patients undergoing this treatment.

Supravalvular Stenotic Mitral Ring with Ventricular Septal Defect

Abstract Background: Supravalvular mitral ring is exceedingly uncommon. Methods: We report a 4‐year‐old girl with supravalvular stenotic mitral ring and ventricular septal defect (VSD). The VSD was closed by a Dacron patch and the supravalvular ring was excised. For treatment of supravalvular mitral ring with obstruction, surgical resection is commonly performed. Results: There are no reports of long‐term follow‐up after resecting the supravalvular mitral ring. Conclusion: In our case, no mitral stenosis was evident on postoperative echocardiogram performed 3 years after surgery.

A giant main pulmonary artery aneurysm associated with infundibular pulmonary stenosis

We report a case of a giant pulmonary artery aneurysm associated with infundibular pulmonary stenosis. Echocardiography disclosed markedly enlarged main pulmonary artery, but no left to right shunt flow at levels of the atrial septum, ventricular septum and the pulmonary artery. Continuous wave Doppler revealed a maximum velocity of 1.5 m/s which corresponded to the pressure gradient between the right ventricle and the pulmonary artery of 9.5 mmHg. Contrast-enhanced multidetector-row computed tomography with a 16-slice scanner revealed pulmonary artery aneurysm with the maximum diameter of 67 mm on axial image.

Combined catheter embolization and femorofemoral bypass for pseudoaneurysm of the right external iliac artery: Report of a case

Performing direct surgery for postoperative hemorrhage caused by intraperitoneal arterial injury is very difficult. We report herein the case of a 52-year-old woman who developed sudden right lower abdominal pain after numerous laparotomies and radiotherapy for advanced uterine cancer. A diagnosis of pseudoaneurysm of the right external iliac artery was made, and an emergency catheter embolization and femorofemoral bypass was successfully performed under local anesthesia. The patient was able to walk the next day. To the best of our knowledge, this is the first report of such a combined procedure in the literature.

Bilateral main bronchial compression caused by the ductal ligament

Several authors have reported cases of respiratory distress resulting from bronchial compression due to a hypertensive pulmonary artery in the setting of a large left-to-right shunt. However, respiratory distress due to bilateral main bronchial compression due to an enlarged pulmonary artery suspended posteriorly by the ductal ligament following repair of a ventricular septal defect is extremely rare. In this report, we advocate the necessity of dividing the ductal ligament in some patients with large left-to-right shunts when there are episodes of idiopathic respiratory distress before operation.