Abdominal aortic aneurysms (AAA) are frequently associated with clinically significant coexistent ischemic heart disease (IHD). Cardiac events are the most common cause of death after AAA repair. Preoperative coronary evaluation and revascularization have been recommended to reduce postoperative cardiac complications following AAA repair. In this study, we retrospectively reviewed all patients who underwent AAA repair and compared operative results in patients with and without IHD. Of 388 patients who underwent elective AAA repair, 382 (98.5%) had aortography and coronary angiography for preoperative evaluation. Significant coronary artery disease was seen in 124 patients (32.5%). As a result of the evaluation, 46 patients (12.0%) were considered candidates for medical therapy, 18 for percutaneous coronary intervention (PCI), and 60 for coronary artery bypass grafting (CABG). In 24 patients (6.3%) who needed CABG and had large sized AAAs (>60mm), simultaneous CABG and AAA repair were performed. In the remaining 36 patients (9.4%) who needed CABG and had medium sized AAAs (40mm<, <60mm), staged operation was performed. We performed retrospective review comparing postoperative cardiac events and operative mortality among these treatment groups. There were 5 operative deaths (5/388, 1.3%) in patients following AAA repair. There were 2 operative deaths (2/124, 1.6%) in patients with significant IHD and 3 deaths (3/258, 1.2%) without IHD. In patients with IHD, 1 patient who received medical therapy died of acute renal failure and another one who received PCI died of acute myocardial infarction. There were no operative deaths or cardiac-related events in patients who received CABG before or concomitant AAA repair. There was only 1 cardiac-related event in all patient groups following AAA repair. Coronary arteries were preoperatively evaluated in almost all patients with AAA. If IHD was significant, the treatment for the IHD preceded AAA repair. Our strategy succeeded in reducing operative mortality and cardiac-related events in patients with both AAA and IHD. If a patient with a large sized AAA (>60mm) needs CABG, one-stage operation is recommended.

We report the successful repair of left main coronary artery obstruction with aortitis syndrome. She was a 39-year-old woman and was admitted to Saiseikai Kumamoto Hospital because of angina pectoris. Her bilateral radial artery pulsation was not palpable. Total occlusion of the left main coronary artery (LMT) and bilateral subclavian artery was detected by angiography. Patch enlargement of the LMT was performed using a Distaflo (Impra Carbon PTFE) graft. Postoperative coronary angiography showed an adequate LMT diameter and sufficient blood flow.

A 68-year-old woman was referred to our hospital with arrhythmia and cardiomegaly. She lost consciousness in the waiting room. After urgent hospitalization, cardiac ultrasonography showed cardiac tamponade, and urgent pericardial drainage was performed. A ruptured coronary aneurysm with a fistulous communication was diagnosed by CT scan and coronary angiography. Under extracorporeal circulation, ligation of the unusual coronary vessels and resection of the aneurysm were performed. The postoperative course was uneventful and she was discharged on the 25th postoperative day. No ischemic signs were observed on treadmill test at one year after surgery. Most congenital coronary aneurysms are asymptomatic; however, once rupture occurs, it is important to diagnose this condition rapidly and treat surgically.

[Objective]There are few reports of inpatients who received acupuncture treatment in departments of internal medicine in Japan. The aim of this analysis is to clarify such information by reviewing patients who received acupuncture treatment during admission to our department of internal medicine at Gifu University Hospital. Our department is organized into three subdepartments of cardiology, respirology, and nephrology.
[Methods]We surveyed the chief complaint for acupuncture treatment, basic disease for admission and the number and period of acupuncture treatment of inpatients who received acupuncture treatment in our department from July 2004 through March 2007.
[Results]Two hundred and sixty-six patients received acupuncture treatment and they had 429 symptoms.
The chief complaint was the side effects of chemotherapy for cancer treatment (n = 84), that is, nausea, anorexia, dysethesia and so on. Other symptoms were dyspnea or shortness of breath (n = 49), pain originating from cancer (n = 38), pain originating from skeletal muscle (n = 38), anorexia (n = 25), and general fatigue (n = 18). Several symptoms were cough, edema, constipation or diarrhea, conscious disturbance, insomnia, paralysis, etc.
Of the chief complaints, 86.4%were closely connected with diseases or treatments for admission.
The mean number of patients who received acupuncture was 10.0/day. This was equal to about 20%of all patients (53beds) per day in our department.
[Conclusion]There were many patients whose chief complaints for acupuncture were closely connected with disease for admission. It is suggested that acupuncture treatment is accepted as one of treatments of internal medicine for inpatients in our department.

A 68-year-old man was taken to our hospital by ambulance due to syncope. He was in shock with cardiac tamponade. Pericardial drainage was performed. Aortic valve regurgitation gradually increased and surgery was performed at 25 days after onset. Surgical finding showed that there was a detachment of the commissure between the right and non coronary cusps of the aortic valve. An intimal tear was detected in the same place and aortic root replacement was required. The patient had a good recovery and he was discharged 14 days after surgery.

A 78-year-old woman was referred to our hospital because of progressive exertional dyspnea due to nonrheumatic severe aortic valve stenosis and moderate mitral valve stenosis with mitral annular calcification. We subsequently performed aortic valve replacement and mitral anterior leaflet decalcification. During surgery, we found that the cause of mitral valve stenosis was calcification of A2 aortic curtain-medial trigon through aortic valve annulus and resected calcification with SONOPET. The postoperative echocardiography revealed good mitral valve motion with mild mitral valve stenosis.