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Volume 41, Issue 1
Displaying 1-13 of 13 articles from this issue
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Preface
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[in Japanese]2012 Volume 41 Issue 1 Pages m1-m1_2
Published: January 15, 2012
Released on J-STAGE: March 14, 2012
JOURNAL FREE ACCESSDownload PDF (210K)
Originals
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Ai Tomotaki, Hiroaki Miyata, Suguru Okubo, Noboru Motomura2012 Volume 41 Issue 1 Pages 1-7
Published: January 15, 2012
Released on J-STAGE: March 14, 2012
JOURNAL FREE ACCESSRecently, the use of databases for clinical trials is being promoted. We used the Japan Adult Cardiovascular Surgery Database (JACVSD) data was used as a historical control in a clinical trial, and we analyzed following : the processes of using data and the efficiency of data collection, available variables for statistical analysis, and query functions for missing and invalid data. We chose available variables of JACVSD data and created rules for merging JACVSD data with interventional group data, in addition to analyzing the data collection processes for clinical trials. Subjects were selected from cases registered in the JACVSD. On statistical analysis, 63% of 76 variables were used ; variables related to the patients' symptoms had to be collected separately. Missing and invalid data were effectively excluded. We could conduct data collection efficiently by using the JACVSD as a historical control for clinical trials. Selecting subjects from the JACVSD could reduce the burden of selecting subjects from hospitals and prevent selection bias.View full abstractDownload PDF (451K)
Case Reports
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Akira Furutachi, Hitoshi Ohteki, Kozo Naito, Junichi Murayama, Masanor ...2012 Volume 41 Issue 1 Pages 8-11
Published: January 15, 2012
Released on J-STAGE: March 14, 2012
JOURNAL FREE ACCESSA 68-year-old woman with multiple gastric ulcers was admitted to our hospital due to post-prandial abdominal pain. Multirow detector computed tomography (MDCT) showed severe stenoses of both the celiac trunk and superior mesenteric artery (SMA) ; therefore, we decided to operate based on the presumed diagnosis of abdominal angina. We bypassed the stenoses using a saphenous vein graft from the right external iliac artery to the SMA, distal to the stenosis. The patient was symptom-free postoperatively. In summary, this case of abdominal angina was accurately evaluated preoperatively with MDCT and the flow meter®. Thereafter, a focal stenosis in the superior mesenteric artery was successfully treated with an external iliac-SMA bypass using a saphenous vein graft.View full abstractDownload PDF (665K) -
Tetsuro Uchida, Hideaki Uchino, Yoshinori Kuroda, Kazue Nakashima, Tak ...2012 Volume 41 Issue 1 Pages 12-15
Published: January 15, 2012
Released on J-STAGE: March 14, 2012
JOURNAL FREE ACCESSOsteochondromas, or exostoses, are the most frequent benign bone tumors. Although many osteochondromas are asymptomatic, they are sometimes responsible for vascular complications, most often associated with the popliteal artery. Here, we present a rare case of pseudo-aneurysm of the popliteal artery secondary to an osteochondroma of the femur in a 48-year-old woman. During surgery, a pseudo-aneurysm developed from a 1-mm hole in the anterior aspect of the popliteal artery, which was closely related to the protrusion of the femoral osteochondroma. The surface of the osteochondroma was quite sharp, rigid and firm. It was removed completely through the lumen of the aneurysm. A short segment of the popliteal artery, including the hole, was resected with an end-to-end anastomosis. The postoperative course was uneventful, and the patient recovered completely. The precise pathogenesis of pseudo-aneurysmal formation is still unknown. We speculate that local compression of the popliteal artery by a spiky osteochondroma can stretch the vessel and lead to rupture of the artery by continuous friction. Considering the potential risk of this vascular complication, shonld be closely monitered patients with osteochondroma of the femur.View full abstractDownload PDF (569K) -
Tomoyuki Matsuba, Goichi Yotsumoto, Kousuke Mukaihara, Takayuki Ueno, ...2012 Volume 41 Issue 1 Pages 16-20
Published: January 15, 2012
Released on J-STAGE: March 14, 2012
JOURNAL FREE ACCESSA 69-year-old woman, who had undergone a right nephrectomy for renal tuberculosis in her teens, was admitted with a low grade fever, anorexia and progressive dyspnea. Transthoracic echocardiography showed cardiac tamponade and chest CT revealed an enlarged ascending aorta. She was treated with pericardiocentesis. Specimens of pericardial effusion failed to demonstrate any acid-fast bacilli, but they did reveal a high level of adnosine deaminase (72 IU/l). A diagnosis of tuberculous pericarditis was considered, and antituberculous chemotherapy was started. However, he presented with severe back pain 32 days later and CT revealed type A acute aortic dissection. We therefore replaced the ascending aorta and aortic root. A histopathological examination of the ascending aorta revealed evidence of a granulomatous inflammatory reaction with Langhans giant cells. She thereafter received antituberculous chemotherapy with 4 drugs for 2 months, with continued rifampicin and isoniazid treatment. There was no evidence of any graft infection after 70 days.View full abstractDownload PDF (674K) -
Chikara Ueki, Takeshi Shimamoto, Genichi Sakaguchi, Tatsuhiko Komiya2012 Volume 41 Issue 1 Pages 21-24
Published: January 15, 2012
Released on J-STAGE: March 14, 2012
JOURNAL FREE ACCESSA 68-year-old man visited our hospital with a high fever with chills 4 years after aortic valve replacement. Streptococcal species were cultured with a venous blood culture. An echocardiogram and a cardiac computed tomography (CT) scan revealed a perivalvular abscess (11 mm×15 mm). Because his prosthetic valve functioned well, he was treated with intravenous ampicillin and gentamicin. Cardiac CT scan performed at 6 weeks showed the perivalvular abscess to have disappeared and he was discharged from the hospital. He is free from recurrence of the abscess 20 months after the initiation of therapy.View full abstractDownload PDF (556K) -
Kazuhiro Hisamoto, Masaaki Toyama, Masanori Katoh, Mitsuhisa Kotani, Y ...2012 Volume 41 Issue 1 Pages 25-28
Published: January 15, 2012
Released on J-STAGE: March 14, 2012
JOURNAL FREE ACCESSA 72-year-old woman underwent a double aortic valve replacement with the Freestyle aortic bioprosthesis and subcoronary implantation with the Mosaic mitral bioprosthesis because of rheumatic multivalvular heart disease in 2000. During her annual follow-up, her Sinotubular junction was observed to have gradually increased in diameter on echocardiography and computed tomography. Therefore, 9 years after surgery we performed a reoperation for severe aortic regurgitation. Intraoperatively, the stentless bioprosthesis was found to be structurally intact. We believe that the dilation of the Sinotubular junction associated with a stentless bioprosthesis in the subcoronary position have caused her severe aortic regurgitation.View full abstractDownload PDF (512K) -
Satoshi Kimura, Yasutaka Ueno2012 Volume 41 Issue 1 Pages 29-32
Published: January 15, 2012
Released on J-STAGE: March 14, 2012
JOURNAL FREE ACCESSAortic pseudoaneurysm is a rare but life-threatening complication after graft replacement. One of the main challenges of surgery is the appropriate and safe method of re-entering the chest cavity. Therefore, it is necessary to consider a strategy which includes cardiopulmonary bypass. The patient was a 64-year-old man who had undergone hemi-arch replacement for pseudoaneurysm of the native thoracic aorta 17 years previously. The exact surgical details of the previous operation were unknown. He experienced progressive chest pain for 1 month, and noticed a parasternal pulsatile mass. An enhanced computed tomographic scan revealed a pseudoaneurysm originating from the thoracic aortic artificial graft itself, which had eroded the left parasternum and which would possibly rupture out of the skin. Preoperative examinations suggested a high risk of bleeding if redo sternotomy was performed. Therefore, we decided to perform open surgical repair with a cardiopulmonary bypass with cannulation through the femoral artery and vein before resternotomy. In addition, we performed a transthoracic left ventricular venting and selective cerebral perfusion using bilateral axillary arteries, which enabled core cooling in case of uncontrollable hemorrhage. He successfully underwent redo graft replacement of the thoracic aorta, and his postoperative course was uneventful.View full abstractDownload PDF (433K) -
Koji Sato, Tatsuya Murakami, Yutaka Makino, Takashi Sugiki2012 Volume 41 Issue 1 Pages 33-37
Published: January 15, 2012
Released on J-STAGE: March 14, 2012
JOURNAL FREE ACCESSA 70-year-old man with dextrocardia with situs inversus, presented to our hospital complaining of chest pain. ECG showed ST elevations in leads II, III and aVf , and ST depressions in leads V3 through V6. Blood tests showed creatinine kinase elevation. He underwent coronary angiography, which revealed obstruction of the anatomical right coronary artery and we diagnosed acute inferior myocardial infarction. However, the anatomical left coronary artery was not clearly identifiable because of its anomalous origin. He was transferred to our intensive care unit and intra-aortic balloon pumping was initiated. Coronary 3D-CT was then performed to obtain an anatomical overview of the coronary artery system. This enabled a second coronary angiography which showed obstruction of the left anterior descending artery and stenosis of the left main trunk in the first diagonal branch and the ramus intermedius branch. Coronary artery bypass grafting surgery (CABG) was indicated. He underwent conventional quintuple CABG using the right internal thoracic artery and saphenous vein grafts. Preoperatively we made digital mirror images of the original coronary angiographic images to clarify his coronary artery anatomy. During surgery, the main surgeon continuously stood on the patient's left side except when opening and closing the chest, which enabled us to perform CABG. The postoperative course was uneventful. CABG in a patient with situs inversus totalis is very rare. We present this case with a review of the relevant literature.View full abstractDownload PDF (592K) -
Hiroshi Yamada, Takuya Miura, Takuji Kawamura, Satoru Kuki, Shigeaki O ...2012 Volume 41 Issue 1 Pages 38-42
Published: January 15, 2012
Released on J-STAGE: March 14, 2012
JOURNAL FREE ACCESSA 61-year-old woman underwent a regular echocardiography in October 2008 in which a mass of 1 cm in diameter was pointed out in the left ventricle apex. It did not dcrease, in spite of anticoagulation therapy, and therefore we performed surgery. The tumor was confirmed on the septal side of the cardiac apex by intraoperative cholangioscopy, and it was excised through the mitral valve. It was diagnosed as myxoma on immediate intraoperative pathological examination, and we confirmed that there was no tumor remnants on the resected stump histologically. The patient was discharged on the 13th day after the operation and 2 years later she was alive without recurrence of the tumor. This is the 25th case of left ventricular myxoma in Japan. In these reports, an initial resection of the tumor in the left ventricle was performed in 23 cases and the approach methods were described in 20 cases. The evaluation of the resected stump, regardless of remaining tumor, was described in only 3 cases. There were no reports of relapse after the operation. There are many reports which emphasize the usefulness of echocardiography, which is very helpful not only in the diagnosis, but also in periodic evaluations after the operation.View full abstractDownload PDF (523K) -
Tsuyoshi Fujimiya, Kouki Takahashi, Masahiro Tanji2012 Volume 41 Issue 1 Pages 43-45
Published: January 15, 2012
Released on J-STAGE: March 14, 2012
JOURNAL FREE ACCESSWe report a case of metastasis to the right ventricle from uterine stromal sarcoma. A 61-year-old woman was admitted to our hospital because of abdominal pain due to gallbladder stones. Preoperative transthoracic echocardiography showed a tumor in the right ventricle and tricuspid regurgitation. The tumor was multilocular and had grown in the right atrium over the tricuspid valve. We performed tumor resection and tricuspid valve plasty. Postoperative transthoracic echocardiography showed the tricuspid regurgitation had resolved.View full abstractDownload PDF (670K) -
Toshiho Tengan, Junya Yokoyama, Akio Nakasu, Hiroshi Yasumoto, Hidemit ...2012 Volume 41 Issue 1 Pages 46-48
Published: January 15, 2012
Released on J-STAGE: March 14, 2012
JOURNAL FREE ACCESSThere is Bartonella henselae (B. henselae) leads to cat-scratch disease and causes infective endocarditis, but shows as negative in blood cultures. We performed aortic valve replacement in a patient with aortic valve infective endocarditis which was regative on blood cultures. The patient had a contact history with a cat prior to admission. Thus, we suspected B. henselae and made a definitive diagnosis by PCR method and Warthin-Starry (WS) stain. A correct diagnosis was possible by detailed history taking and the use of appropriate antibiotics.View full abstractDownload PDF (480K) -
Naritomo Nishioka, Naoto Morimoto, Keitaro Nakagiri, Shunsuke Matsushi ...2012 Volume 41 Issue 1 Pages 49-52
Published: January 15, 2012
Released on J-STAGE: March 14, 2012
JOURNAL FREE ACCESSWe reported a 74-year-old female complicated by ostial obstruction of the left main trunk after aortic valve replacement for severe aortic stenosis. At surgery, the length from the orifice of the left main trunk to the aortic annulus was 3 mm. After a 19 mm Carpentier-Edwards PERIMOUNT MAGNA was implanted in supra-annular position, the orifice of left main trunk was concealed by a sewing cuff of the bioprosthesis. Before aortic declamping, saphenous vein graft was bypassed to the left anterior descending artery. The postoperative course was uneventful. Computed tomography demonstrated the ostial obstruction of the left main trunk by the bioprosthesis.View full abstractDownload PDF (668K)
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