Takafumi Yamada

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.

Myocardial recovery during post-ischemic reperfusion: Optimal concentrations of Na+ and Ca2+ in the reperfusate and protective effects of amiloride added to cardioplegic solution

SummaryThe effects of Na+ and Ca2+ concentrations in the reperfusate on post-ischemic myocardial recovery were examined. Also, the myocardial protective effects of amiloride, an inhibitor of the Na+/Ca2+ and Na+/H+ exchange systems, added to cardioplegic solutions were assessed, using an isolated working rat heart perfusion system. Global myocardial ischemia was induced by 30-min normothermic cardioplegic arrest, using St. Thomas’ solution. The concentration of Na+ in the reperfusate varied, stepwise, from 75 to 145 mM/l, and that of Ca2+, from 0.1 to 2.5 mM/l. In this study post-ischemic functional recovery was best at 110 mM/l Na+ and 1.2–1.8 mM/l Ca2+ in the reperfusate. A significantly greater postischemic functional recovery and a lower creatine kinase release were observed when amiloride was added to the cardioplegic solution. Ca2+ overload via Na+/Ca2+ and Na+/H+ exchange systems would, thus, appear to be due, at least in part, to post-ischemic reperfusion injury.

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.

The role of low-density lipoprotein apheresis as postoperative care of bypass grafting for chronic arterial occlusion

Since November 1989, low-density lipoprotein apheresis has been applied to patients with intractable hyperlipidaemia following bypass grafting for chronic arterial occlusion of the lower extremities. The treatment group comprised six patients (four men, two women) with arteriosclerosis obliterans. In five patients, the ankle pressure index deteriorated and intermittent claudication recurred due to atherosclerotic progression. Results of low-density lipoprotein apheresis were dramatic; the deteriorated ankle pressure index and intermittent claudication improved significantly after several applications of low-density lipoprotein apheresis. Significant angiographic improvement was obtained in two patients. It is concluded that low-density lipoprotein apheresis appears to be an efficient method to preserve graft patency and treat postoperative patients with deteriorated ankle pressure index.

A case of dedifferentiated liposarcoma of the heart and stomach

Highlights • Liposarcoma of the heart and stomach is rare.• Dedifferentiated histology is also rare.• Tumor resection and mitral valve replacement were performed, and biopsy was performed for the gastric tumor.• Both the tumors were diagnosed as dedifferentiated liposarcoma.

Deep Vein Thrombosis Associated with Iliac Lymph Node Metastasis of an Unknown Primary Tumor: Report of a Case

Secondary deep vein thrombosis associated with iliac lymph node metastasis of an unknown primary tumor has not been previously reported. The patient was a 57-year-old male with persistent right leg edema. Computed tomography demonstrated a mass surrounding the right external iliac vessels, and deep vein thrombosis in the right external iliac and femoral veins. Physical, laboratory, and imaging examinations did not reveal any further tumor. The patient was diagnosed with deep vein thrombosis associated with right iliac lymph node metastasis of an unknown primary tumor. Complete resection of the tumor along with the involved vessels and vascular reconstruction was performed.

Co-Existence of Severe Coarctation of the Aorta and Aortic Valve Stenosis in a 65-Year-Old Woman: A Case Report

Coarctation of the aorta is usually diagnosed and corrected early in life. Survival to more than 60 years of age of a patient with unrepaired coarctation of the aorta is extremely unusual, and the optimal management strategies for such patients are controversial. We describe the case of a woman who was first diagnosed as having coarctation of the aorta and aortic valve stenosis at the age of 65 years and underwent successful aortic valve replacement.

Risk factors for disordered cerebral autoregulation during hypothermic cardiopulmonary bypass

Disordered cerebral autoregulation during cardiopulmonary bypass (CPB) is regarded as one of the causes of neurological dysfunction after cardiac surgery. However, little documentation of risk factors associated with cerebral autoregulation during CPB has been reported. Sixty consecutive patients undergoing coronary artery bypass were classified into subgroups according to whether they had preoperative cerebrovascular disease (CVD), hypertension (HT), or diabetes (DM). Cerebral oxygenation was monitored by jugular venous bulb oxygen saturation (SjvO2) and near-infrared spectroscopy parameter (%Oxy-Hb) during the operation, and the relationships between these values and intraoperative parameters were evaluated. The results showed that SjvO2 and %Oxy-Hb in the CVD+group were lower than in the CVD-group. Multiple stepwise regression analysis on SjvO2 and %Oxy-Hb in the CVD+ group revealed that only MAP was a predictive factor and that there was a positive correlation between MAP and both SjvO2 and %Oxy-Hb (r=.651,r=.693, respectively,P<0.0001). The coexistence of HT and DM increased the strength of the correlation between MAP and SjvO2 (r=.863,p<0.0001) PaCO2 was the predictive factor in the CVD- group. A positive correlation was found with SjvO2 (r=.458,P>0.0001), and the correlation was stronger in patients without any risk factors (r=.671,P=0.0001). The results suggested that patients with CVD, HT, and DM may experience failure of cerebral pressureflow autoregulation and cerebrovascular reactivity during CPB.