Tamiyuki Obayashi

Aortoiliac Artery Reconstruction Using Bilateral Reversed Superficial Femoral Veins for an Infected Abdominal Aortic Aneurysm.

Surgical treatment of an infected abdominal aortic aneurysm (IAAA) is difficult and the ideal graft material is a subject of debate. A 60-year-old man with untreated diabetes mellitus was referred to our hospital presenting with fever and left lower abdominal pain. The patient was diagnosed with an IAAA by blood culture and computed tomography. We treated the patient surgically for the IAAA using bilateral reversed superficial femoral veins which were shaped into a bifurcated graft. No signs of recurrent infection or aneurysmal dilation were observed for 3 years after the procedure.

Spontaneous innominate and left common carotid artery dissection with bovine aortic arch

We describe a case of a 63-year-old woman who presented with spontaneous dissection of the innominate and left common carotid arteries arising from a common trunk, so-called “bovine aortic arch.” The entry tear was seen in the common trunk at the origin of the innominate artery with no dissection extending into the aortic arch or the ascending aorta. The dissection was resected and total arch replacement was performed considering the aortic wall fragility complicated by the dissection.

Long-Survival Case of Thymic Carcinoma With Superior Vena Cava Tumor Thrombus

Sarcomatoid carcinoma of the thymus is rare and responds poorly to treatment. Invasion of great vessels and metastasis are significant predictors for poor prognosis. Thymic tumors commonly cause superior vena cava (SVC) obstruction by extrinsic compression or invasion, but intraluminal permeation is the most uncommon cause. We report a rare, long-surviving case of sarcomatoid carcinoma with SVC syndrome developed by tumor thrombus. She underwent SVC replacement and extended thymectomy. The resection indicated intracaval extension without direct invasion of thymic tumor, histologically diagnosed as sarcomatoid carcinoma. After adjuvant chemotherapy, she continues to show no apparent recurrence for five years.

Surgical case of isolated pulmonary valve endocarditis in a patient without predisposing factors

We report a case of isolated pulmonary valve endocarditis in a 47-year-old woman without predisposing factors. She had episodes of low-grade fever and non-productive cough and was initially diagnosed with bacterial pneumonia. With antibiotic treatment, her condition improved transiently, but she had repeated respiratory events. Forty days after her first visit, she complained of severe dyspnea. Echocardiography revealed a large vegetation adhering to the pulmonary valve and she was diagnosed with isolated pulmonary valve endocarditis. Surgical treatment was selected because antibiotic treatment was not effective. The main pulmonary artery was transected above the annulus and the infected valve was excised. To avoid contact of the prosthetic valve with the infected pulmonary annulus, a stentless bioprosthesis was interposed between the transected parts of the pulmonary trunk. Two years after the surgery, the patient is stable with no sign of infection.

Infected abdominal aortic aneurysm caused by Streptococcus pneumoniae diagnosed using polymerase chain reaction

We report the case of a 55-year-old man who initially visited the emergency department of our hospital owing to fever, headache, and neck stiffness. He was diagnosed with meningitis because cerebrospinal fluid culture was positive for Streptococcus pneumoniae. After intravenous antibiotic treatment, the patient’s condition returned to normal. On hospital day 20, he complained of lumbar pain with abdominal distension. Because an abdominal computed tomography (CT) scan showed a small sacciform infrarenal abdominal aortic aneurysm, an infected aneurysm was suspected. However, cerebrospinal fluid and blood cultures were negative for S. pneumoniae. Seven days later, a second abdominal CT was performed that showed rapid expansion of the sacciform infrarenal abdominal aortic aneurysm. The patient was diagnosed with an infected abdominal aortic aneurysm and underwent surgery for resection of the aneurysm and in situ reconstruction with a rifampicin-soaked vascular prosthesis. Although blood and aneurysmal tissue cultures were negative for S. pneumoniae, the autolysin (lytA) gene, which is the target gene of S. pneumoniae, was detected in the abdominal aortic wall by using polymerase chain reaction (PCR). Therefore, appropriate molecular diagnostic techniques can be used for the rapid detection of pathogens. An accurate diagnosis can be used to direct postoperative antibiotic therapy.

Apicoaortic conduit for severe hemolytic anemia after aortic valve replacement

We describe the case of an 82-year-old woman who had undergone aortic mechanical valve replacement for aortic stenosis with a small annulus, and coronary artery bypass grafting. Four years after the operation, she began to experience hemolysis. Prosthetic valve obstruction was observed but there was no paravalvular leakage or aortic regurgitation through the mechanical valve. We elected to perform apicoaortic bypass in this patient with severe hemolytic anemia secondary to a mechanical valve malfunction.

Ruptured Aneurysm of the Sinus of Valsalva with a Double Chambered Right Ventricle in a Jehovah's Witness Patient.

症例はエホバの証人信者の45歳の女性で, 動悸および息切れを主訴とした. 右室流出路狭窄を伴うバルサルバ洞動脈瘤破裂の診断のもとに, 手術を施行した. 術中所見からは, 右室二腔症と心室中隔欠損症を合併したバルサルバ洞動脈瘤破裂であった. 無輸血下にバルサルバ洞動脈瘤切除およびパッチ閉鎖, 異常筋束切除および右室流出路パッチ拡大, 心室中隔欠損直接閉鎖を行った. 先天性心疾患の中でバルサルバ洞動脈瘤破裂と成人の右室二腔症はおのおの頻度が少なく, 両者の合併はさらに稀である. 両者を合併したエホバの証人信者の手術症例を経験したので, 若干の文献的考察を加えて報告した.

A Case of Graft Replacement of Abdominal Aortic Aneurysm in Congenital Deficiency of Coagulation Factor X III

先天性X III因子欠乏症を伴った腹部大動脈瘤に対して人工血管置換術を施行した. 症例は66歳男性で既往歴としてX III因子欠乏症によると思われる大量出血と創傷治癒遅延があった. 経過観察中に腹部大動脈瘤の拡大を認め手術を施行した. 迅速なXIII因子測定のため, 院内で定量を行い, 必要に応じてヒト胎盤由来濃縮X III因子製剤 (フィブロガミン®) を補充投与した. 術中・術後に異常な出血はなく, 安全に手術を施行でき, また創傷治癒遅延もみられず退院した.

Excellent Hemostatic Effects of Aprotinin in Coronary Artery Bypass Surgery and Some Problems.

冠状動脈バイパス術を対象として, アプロチニンによる体外循環時の出血量節減効果について検討を行った. アプロチニン群 (A群) は34例にアプロチニン200万単位を人工心肺回路内に投与し, コントロール群 (C群) として31例を比較した. 術中, ACTはA群で体外循環開始後60分まで延長がみられたが, 血小板数では全経過を通じて両群に差はなかった. 術中出血量は, A群366±112mlに対してC群514±190ml, 術後ドレーン出血量は, A群354±138mlに対しC群570±226mlと有意 (p<0.05) にA群で少なかった. この結果, 総出血量でもA群で720±199ml, C群1,084±346mlと, アプロチニン使用により冠状動脈バイパス術時の出血は非使用に比べ34%減少させることができた. 周術期の心筋障害についての比較を行うと, 発生率に差はみられなかったが, 良好な止血効果に起因するグラフト開存性への影響など, 今後は合併症に関する検討を要すと思われた.