We report a case of an infected aortic pseudoaneurysm caused by delayed sternal osteomyelitis. A 79-year-old man underwent combined surgery comprising aortic valve replacement (AVR), coronary artery bypass grafting (CABG) and permanent pacemaker implantation at our department due to aortic insufficiency (third degree), coronary sclerosis, and sick sinus syndrome (type 1). The subject was discharged home on postoperative day (POD) 27. Sternal osteomyelitis developed on POD 50, and the subject was re-hospitalized. However, on day 6 of readmission, auscultation revealed a new systolic murmur (Levin IV/VI) in the second right intercostal space sternal border and transthoracic echocardiography showed abnormal blood flow from the base of the aorta to the left front. Contrast-enhanced computed tomography (CT) revealed an infected pseudoaneurysm of the ascending aorta that was not detected by CT at readmission. An infected aortic pseudoaneurysm caused by delayed sternal osteomyelitis was diagnosed. On day 8 of readmission, the pseudoaneurysm was excised and the ascending aorta was replaced. Intraoperative findings revealed that the aortic pseudoaneurysm had formed from the site of the ascending aorta anastomosis at the time of performing AVR and that part of the aneurysm had perforated into the right ventricular outflow tract. In the present case, the new cardiac murmur identified on auscultation and consequently performing echocardiography at the bedside led to the definitive diagnosis.

A 65-year-old man was referred to our hospital for surgical treatment of left ventricular aneurysm (LVA) with mural thrombus. Systemic lupus erythematosus had been diagnosed when he was 57 and antiphospholipid syndrome (APS) had been diagnosed at age 61. Steroid and anticoagulant therapy with warfarin has been continuously performed. He suffered acute myocardial infarction at the age of 64, and percutaneous coronary intervention was performed to the diagonal branch. Seven months later, coronary angiography showed occlusion of the diagonal branch and left ventriculography showed a large LVA. Left ventricular reconstruction was performed and his postoperative course was uneventful. Cardiac surgery for the patients with APS was reported to have high morbidity and mortality. Perioperative anticoagulant management was very important for such patients.

In this report, we present our initial experience of endoscopic saphenous vein harvesting (ESVH) using the Vasoview System. ESVH was performed in 72 patients between May 2006 and October 2007. The mean patient age was 73±6.7 years, and 54 (75%) were men. The success rate of ESVH was 98.6% (71/72). The mean harvest time was 36±11 min. The mean number of side branches requiring repair was 1.19±1.21. Comparing the first 5 cases with the last 5 cases, the time for harvesting time and the number of repaired branches improved significantly. Wound complications occurred in 2 patients (2.7%) postoperatively. The intraoperative mean graft flow was 25±13 ml/min. The early patency was 87% (47/54) as evaluated by postoperative angiography or CT. The intraoperative graft flow and early patency were satisfactory. ESVH is easy to adopt and has excellent cosmetic advantages.

The objective of this study was to evaluate the inflammatory responses in patients who received 1 of 2 different types of woven Dacron grafts. Abdominal aortic surgery was performed in 154 patients between 2002 and 2006, and 102 patients were enrolled in this study. Sealed woven Dacron grafts (INTERGARD^TM woven graft, Group I) were implanted in 77 patients and non-sealed woven Dacron grafts (UBE woven graft, Group N) were implanted in 25 patients. All patients received either a bifurcated graft or straight graft replacement. Body temperature (BT), white blood cell counts (WBC), and C-reactive protein (CRP) levels were measured preoperatively and on postoperative days 1, 3, 5, 7 and 14, and were compared between the 2 groups. There were no differences in the patient's mean ages, 73±9 and 71±7 years, or operation time, 213±57 and 210±63 min, between Groups I and N, respectively. Postoperative changes in BT and WBC were similar in both groups. CRP levels were higher in Group N than Group I on postoperative days 5 and 7, but these differences were clinically insignificant. Prolonged inflammatory response which lasted longer than 2 weeks occurred in 2 patients in Group I and in 1 patient in Group N. All patients eventually returned to baseline conditions without special treatments. Thus the postoperative inflammatory responses to coated and non-coated woven Dacron grafts were similar in abdominal aortic surgery.

The survival rate of patients with cardiac rupture due to a blunt trauma is low, therefore it is necessary to have a well-defined diagnostic and treatment plan in order to improve the survival rate. In 8 such patients transthoracic echocardiograms at the time of arrival at our hospital showed pericardial effusion with cardiac tamponade in all patients. The mean time between suffering the injury and arriving at the hospital was 186±185min, and the mean time between arrival and being brought to the operating room was 82±49min. Preoperative pericardial drainage was performed in 2 patients, and percutaneous cardiopulmonary support system was used in 2 patients. The rupture site was in the right atrium in 3 patients, the right atrium-inferior vena cava in 1 patient, the right ventricle in 2 patients, the left atrium in 1 patient, and the left ventricle in 1 patient. Extracorporeal circulation was used in 4 patients, and the injured site was repaired. We were thus able to save the lives of 6 of the 8 patients (survival rate 75%). Transthoracic echocardiography was easy to perform and effective for making an accurate diagnosis. Many such patients tend to have multiple traumas, but, if the patient is in a state of shock due to cardiac tamponade, the patient should be moved immediately to the operating room. It is important to provide circulatory maintenance until surgery, and pericardial drainage and PCPS are also effective additional treatment modalities.

We report a case of a 53-year-old woman, who was transported as an emergency case to our institution because of type A acute aortic dissection. Total arch replacement and coronary artery bypass grafting (CABG) with open stent graft was performed. After the operation, during rehabilitation for discharge (33 and 38 days after the surgery), she developed acute arterial occlusion of the right lower limb, and we performed thrombectomy. Both thrombi extracted from the right common femoral artery were organized clots. No perioperative arrhythmia was observed, and no obvious left atrial appendage thrombus was observed on CT. We performed angiography to diagnose the cause of the spread of organized clots, and an entry was detected at the distal tip of the open stent graft, and antegrade blood flow in a false lumen was observed. We considered that the thrombus was caused by the antegrade blood flow in a false lumen, TEVAR (c-TAG) was performed to seal the entry 48 days after the surgery. Embolism did not occur afterward, and the patient was discharged for rehabilitation.

The patient was an 81-year-old woman who had undergone TAVI (Evolut PRO® 26 mm) for severe aortic stenosis at our hospital approximately 6 months previously. She was discharged from the hospital without any postoperative complications, but at 6 months after the surgery, fever, back pain, and high inflammatory findings were observed. Based on lumbar spine MRI findings, the patient was diagnosed with pyogenic spondylitis and epidural abscess, and drainage surgery was performed. Enterococcus faecalis was identified from a blood culture. MRI of the head showed scattered subacute infarcts in the right frontal lobe, and transthoracic echocardiography revealed hyperintense deposits at the aortic valve leaflet, suggesting vegetation. The diagnosis of PVE was made and medical therapy was initiated. However, the vegetation gradually increased in size and mobility, and a surgical approach was indicated. A surgical procedure was performed through a median sternotomy to remove the prosthetic valve and replace the aortic valve. The postoperative course was good, with no recurrence of infection, and the patient was transferred to another hospital for rehabilitation on the 26th postoperative day. In general, TAVI patients are older and have more comorbidities, and surgery is associated with a higher degree of risk. However, radical surgery should be considered if medical therapy is not effective in PVE after TAVI. We reported a case of surgical aortic valve replacement for PVE after TAVI.