1.Axillo-Bifemoral Artery Bypass for Atypical Coarctation in an Elderly Patient with Hypertensive Heart Failure
Kazuto Maruta ; Hiromasa Kawaura ; Hiroyuki Iizuka ; Masaomi Fukuzumi ; Noboru Ishikawa ; Tadashi Omoto ; Takeo Tedoriya
Japanese Journal of Cardiovascular Surgery 2012;41(4):215-218
A 81-year old woman had hypertensive heart failure. She had a history of intermittent claudication for 5 years. Her ankle brachial pressure index (ABI) was 0.53 on the right and 0.58 on the left side. Coarctation of the descending aorta with severe calcification was found by a whole body CT. After medical therapy for heart failure, axillo-bifemoral artery bypass using an 8 mm ringed expanded polytetrafluoroethylene (ePTFE) graft was performed. Postoperatively, ABI improved to 0.83 on the right and 0.87 on the left side. The patient is doing well without any signs of heart failure or intermittent claudication. Although it is a palliative operation, axillo-bifemoral artery bypass is an effective and less-invasive procedure and appropriate for elderly patients.
2.Surgical Treatment of Internal Iliac Artery Aneurysms
Kazuto Maruta ; Masaomi Fukuzumi ; Atsushi Bito ; Yoshiharu Okada ; Yoshiaki Matsuo ; Masahiro Aiba ; Makoto Yamada ; Toshihiro Takaba
Japanese Journal of Cardiovascular Surgery 2004;33(4):231-234
Between 1987 and 2002, 22 internal iliac artery aneurysms in 14 patients were repaired. In 13 we performed aneurysm excision or reconstruction. There were 3 cases in which simple proximal ligation of the internal iliac artery was performed; in 2 of these CT scans confirmed that the reduction of the internal iliac artery aneurysms was not recognized, but blood flow was not shown in the aneurysm. However, 6 years postoperatively 1 patient was confirmed with an expansion of the aneurysm, and blood flow was seen on a CT scan. In the 2 latest patients, the blood pressure of the internal iliac artery was measured before and after proximal clamping of the internal iliac artery, but the blood pressure of aneurysms could not be fully lowered by proximal ligation of the internal iliac artery. Therefore, endoaneurysmorrhaphy seemed to be the operative method of choice for treatment of the internal iliac artery aneurysms.
3.Congenital Coronary Artery Fistula Associated with Infective Endocarditis of the Mitral Valve
Masahiro Ohno ; Tadashi Omoto ; Makoto Mohri ; Masaomi Fukuzumi ; Masaya Ohi ; Takahisa Okayama ; Noboru Ishikawa ; Takeo Tedoriya
Japanese Journal of Cardiovascular Surgery 2008;37(5):264-267
A 54-year-old woman complained of prolonged fever. Echocardiography showed severe mitral regurgitation with vegetation, and computed tomography showed right coronary artery (RCA) fistula to the coronary sinus (CS). Blood culture revealed Strep. viridans, thus a diagnosis of active infective endocarditis was established. The patient underwent urgent surgery. Surgical findings showed that vegetation was located in A3 to P3 of the mitral valve. The patient underwent mitral valve repair using a glutalualdehyde-treated autologous pericardial patch and artificial chordea. Epicardial ligation for fistula was performed. Her postoperative course was uneventful.
4.A Case of Left Main Trunk (LMT) Obstruction after Aortic Valve Replacement (AVR) Using Carpentier-Edwards PERIMOUNT MAGNA
Naritomo Nishioka ; Naoto Morimoto ; Keitaro Nakagiri ; Shunsuke Matsushima ; Yuya Tauchi ; Masaomi Fukuzumi ; Hirohisa Murakami ; Masato Yoshida ; Nobuhiko Mukohara
Japanese Journal of Cardiovascular Surgery 2012;41(1):49-52
We 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.
5.Infective Endocarditis Followed by Fungal Prosthetic Valve Endocarditis and Mycotic Aneurysm of the Common Iliac Artery
Kazuto Maruta ; Tadashi Omoto ; Noboru Ishikawa ; Masanori Hirota ; Masaya Ohi ; Masaomi Fukuzumi ; Masahiro Ohno ; Tadanori Kawada ; Takeo Tedoriya
Japanese Journal of Cardiovascular Surgery 2007;36(4):188-192
A 44-year-old man with a history of remittent fever for 6 months was given a diagnosis of inf ective endocarditis of the aortic valve related to a congenital ventricular septal defect (VSD), although no bacterial growth was obtained by blood culture. After one week of antibiotic treatment, aortic valve replacement (AVR) and patch closure of the VSD were performed after debridement of infected tissue and vegetations involving the aortic root, pulmonary and tricuspid valves, and myocardium surrounding the VSD. Antibiotic treatment was continued postoper-atively, but elevation of C-reactive protein (CRP) persisted. Blood culture disclosed Candida albicans in the blood 3 months after AVR. Fungal prosthetic valve endocarditis (PVE) was suspected, therefore, aortic root replacement with a Free Style bioprosthesis and VSD re-closure were performed followed by continued systemic antifungal treatment. Five months after reoperation, the patient was readmitted with a high fever. A pseudoaneurysm of the left common iliac artery and complete obstruction of the external iliac artery were shown by contrast-enhanced computed tomography (CT). The aneurysm was resected without revascular-ization. This case presentation concludes that long-term whole body study with contrast-enhanced CT might be necessary even though complete eradication of the infected foci of the heart has been established.
6.Successful Stentless Aortic Valve Replacement Navigated by VR Images in a Case of Bicuspid Aortic Stenosis with Valsalva Sinus Asymmetry
Kenichi KAMIYA ; Yuko GATATE ; Tadamasa MIYAUCHI ; Masaomi FUKUZUMI ; Takeo TEDORIYA
Japanese Journal of Cardiovascular Surgery 2018;47(6):267-271
SOLO SMART is a stentless bioprosthesis that comprises a larger effective orifice area and reduced pressure gradient, exhibiting a better hemodynamic profile than a stented bioprostheses. Currently, SOLO SMART finds application in patients with aortic valve diseases. However, patients with bicuspid aortic valve disease may present Valsalva sinus asymmetry. Recently, some studies have considered SOLO bioprosthesis as contraindicated in patients with a bicuspid aortic valve. Here, we report the case of a 79-year-old female with bicuspid aortic stenosis and Valsalva sinus asymmetry. We preoperatively assessed the aortic root of the patient using a novel 3D workstation that creates virtual reality (VR) images from cardiac CT data. After creating three symmetric commissures at the wall of the Valsalva sinus, we evaluated the distance from the coronary orifices. We determined the appropriate suture line of bioprosthesis avoid coronary orifice occlusion. Aortic valve replacement with SOLO SMART was successful, and the postoperative clinical course was uneventful. Hence, preoperative evaluation of the aortic root using VR images could be a precise and useful method for the assessment of the operative indication for SOLO SMART.
7.Improved Clinical Status Following Aortic Valve Replacement in Two Cases with Refractory Ascites Secondary to Aortic Stenosis and Insufficiency
Masaomi FUKUZUMI ; Yuki TADOKORO ; Yuta TSUCHIDA ; Yuko GATATE ; Tadamasa MIYAUCHI ; Hiroshi OTAKE ; Takeo TEDORIYA
Japanese Journal of Cardiovascular Surgery 2021;50(3):188-192
Ascites is a rare sign of aortic valve disease. Here, we report two cases of refractory ascites that had resulted from aortic stenosis and insufficiency and consequently improved after aortic valve replacement. The first case was a 44-year-old female who had undergone aortic valve repair for aortic stenosis 15 years earlier. She complained of dyspnea and severe abdominal distension due to unimproved massive ascites despite medical therapy. She was diagnosed with aortic stenosis and insufficiency and functional tricuspid insufficiency as well as complete atrioventricular block. She underwent mechanical aortic valve replacement, tricuspid annuloplasty and DDD pacemaker implantation. The second case was a 61-year-old man with a history of alcoholic liver disease who had been hospitalized for massive ascites, progressing rapidly in spite of aggressive medical therapy. Echocardiography revealed severe aortic stenosis and insufficiency; thus, he underwent bioprosthetic aortic valve replacement. Both patients were completely free from ascites about 6 months after surgery.