Tomofumi Umeda

Primary infected abdominal aortic aneurysm: Surgical procedures, early mortality rates, and a survey of the prevalence of infectious organisms over a 30-year period

PurposeThe purpose of this study was to analyze the surgical procedures, culture results, and outcomes, and to survey the prevalence of the infectious organisms over a 30-year period in patients with a primary infected abdominal aortic aneurysm (PIAAA).MethodsA total of 11 patients (1.8%) with PIAAA were surgically treated between 1982 and June 2009. All patients had back pain, leukocytosis, and elevated C-reactive protein level. All of the patients underwent either urgent or emergency operations.ResultsCultures of aortic wall specimens and blood were positive in 10 patients and included Salmonella in 2, Streptococcus in 2, Campylobacter fetus in 2, and Listeria, Haemophilus influenzae, Serratia marcescens, Bacteroides thetaiotaomicron, and an unknown organism in 1 patient each. The 10 patients underwent in situ prosthetic grafting with excision of the infected tissue and lavage using 10 l saline solution; omentum plasty was required in four patients. An axillofemoral bypass was performed in one patient with pus surrounding the AAA. All 10 patients with in situ replacement survived and were administered intravenous antibiotic therapy for 1 month postoperatively. All of these patients left the hospital without any further complications. However, one patient who underwent an axillofemoral bypass died of overwhelming sepsis.ConclusionIn situ replacement with excision of infected tissue, lavage using 10 l saline solution, and omentum plasty for PIAAA successfully resolved the condition. High local concentrations of rifampin-soaked grafts or superficial femoral vein may also be an alternative for an in situ replacement conduit.

A transesophageal echocardiographic and cine-fluoroscopic evaluation of an ATS prosthetic valve opening

PurposeThe effectiveness of the ATS valves includes their durability and the quietness of the valve sound. However, a cine-fluoroscopic study revealed an incomplete opening of the valve leaflet. An overall evaluation of the ATS valve was conducted by transesophageal echocardiography.MethodsThe patients were divided into two groups based on the opening angle (OA): Group A, with a maximum OA of 80° or greater and Group B, with a maximum OA of under 80°.ResultsIn Group A, the peak pressure gradient (PPG) sites of the anterior, central and posterior mitral commissure were 8.17, 8.05, and 8.09 mmHg, respectively, with no significant differences among the three sites. Similar results were obtained for Group B; the PPG at the three respective measurement sites were 8.59, 8.43, and 8.51 mmHg, and the differences were not statistically significant. No statistically significant differences were observed in the mean pressure gradient or pressure half time among the three measurement sites or between the two patient groups.ConclusionAlthough, in many cases, the ATS valves did not open completely, the incomplete valve opening did not pose any problems in the valve function itself or in the cardiac functions of the patients.

Emergency Coronary Artery Bypass Grafting after Substernal Gastric Tube Interposition for Esophageal Cancer

A 67-year-old man who had undergone substernal gastric tube interposition due to esophageal cancer showed ST changes on electrocardiography. Diagnosis was severe stenosis of the left anterior descending branch that required emergency coronary artery bypass grafting. Preoperative computed tomography (CT) showed the feeding arteries of the gastric tube were in contact with the left internal mammary artery. Therefore, we felt harvesting this artery could be dangerous and decided to perform a median sternotomy, approaching from the right side of the gastric tube. The pericardium was easily and safely reached. We undertook on-pump cardiac arrest single coronary artery bypass grafting of the left anterior descending artery with a saphenous vein graft. The postoperative course was uneventful without mediastinitis. Cardiac surgery after esophageal cancer is often performed from a left thoracotomy. But, we recommend a median sternotomy be performed as an option. Preoperative contrast-enhanced CT should be considered as it may indicate the need for a significant revision such as a median sternotomy.