A 71-year-old man was referred to the University Hospital because of left lumbago and a pulsating mass in his umbilical region. An inflammatory abdominal aortic aneurysm 5cm in diameter and left hydronephrosis were identified by enhanced computed tomography (CT). One month after admission, rapid expansion of the aneurysm with sealed rupture were detected by follow-up enhanced CT. The patient immediately underwent an emergency operation. We confirmed fissure on the posterior aneurysmal wall with a localized hematoma. We replaced the aneurysm with a straight prosthetic graft and the postoperative course was uneventful.

A 77-year-old man was hospitalized for a proximal anastomotic aneurysm 9 years after surgery for an abdominal aortic aneurysm. The aneurysm was located 3cm distal to the renal artery. The maximum diameter was 55mm. His medical history included a reoperation for the proximal anastomotic aneurysm and cerebral infarction. Endovascular stent grafting was performed because it was possible anatomically. Postoperatively, no endoleak nor migration were found. At present, the patient is being followed up regularly in the outpatient department. Endovascular stent graft placement can be an effective method for reoperation cases of an abdominal aortic aneurysm, and if it is possible anatomically, it should be attempted.

A 67-year-old man was referred to our department for surgical treatment of ischemic cardiomyopathy. Chest X-ray showed cardiomegaly with a cardiothoracic ratio of 62% and pulmonary congestion. CAG revealed multiple obstructive lesions in the left coronary artery system. LVG and UCG showed ventricular dilatation and dysfunction. ECG showed complete left bundle branch block with a QRS duration of 180ms. He underwent autologous bone marrow cell implantation and biventricular pacing concomitant with coronary artery bypass grafting. He is doing well after 15 months without any complications. Combination with therapeutic angiogenesis and cardiac resynchronization therapy may contribute to the development of new regenerative strategy for patients with severe ischemic cardiomyopathy.

We evaluated the efficacy of sternal coaptation pins used to improve the fixation of the transected sternum after coronary artery bypass grafting (CABG) with the internal thoracic artery (ITA). The subjects were 37 patients who underwent scheduled single CABG with ITA in our department and they were classified into two groups, i. e., Group A, without sternal pins (18 patients), and Group B, with sternal pins (19 patients). The efficacy was assessed by the following measurements : drain bleeding volume up to 12 and 24 h after ICU admission, the time until the removal of drain, surgical site infection (SSI) and the maximum split level between the sternal body and manubrium after surgery. Drain bleeding volume up to 12 and 24 h after ICU tended to be less in Group B. The time until the removal of drain was significantly shorter in Group B. SSI was 17% in Group A but 0% in Group B. The use of sternal coaptation pins reduced misalignment of the coapted sternum, and we belive that the use of sternal coaptation pins contributed to the early removal of drain, and SSI reduction.

The purpose of this study was to examine the responses of cerebral blood flow and metabolism to changes in arterial carbon dioxide tension during moderate hypothermic cardiopulmonary bypass in patients with cerebrovascular disease undergoing open heart surgery. Computed tomography scan (CT) and single photon emission computed tomography (SPECT) were performed preoperatively for 17 patients. The patients were categorized according to their CT and SPECT findings. Ten patients were included in the normal group, 7 patients were included in the CVD group. Blood flow velocity in the middle cerebral artery (MCAv) was measured by means of transcranial Doppler ultrasonography at two different arterial carbon dioxide tensions (at a high PaCO₂ of 45-50mmHg, at a low PaCO₂ of 30-35mmHg, uncorrected for body temperature) during moderate steady-state hypothermic cardiopulmonary bypass. Simultaneously cerebral oxygen consumption was estimated by relating the arteriovenous oxygen content difference to flow velocity (D-CMRO₂). MCAv and D-CMRO₂ were expressed as percentages of the values determined at 30 minutes before cardiopulmonary bypass. In the normal group, a PaCO₂ of 47.4±2.5mmHg (mean±SD) was associated with an MCAv of 99.4±17.8% and a D-CMRO₂ of 53.4±25.5%, while a PaCO₂ of 33.7±1.3mmHg was associated with an MCAv of 64.3±18.1% and a D-CMRO₂ of 53.5±26.2%. In the CVD group, a PaCO₂ of 49.1±4.2mmHg was associated with an MCAv of 81.4±22.3% and a D-CMRO₂ of 34.0±19.4%, while a PaCO₂ of 33.6±1.3mmHg was associated with an MCAv of 54.7±23.8% and a D-CMRO₂ of 49.0±19.4%. We conclude that in patients with cerebrovascular disease cerebral blood flow is changed in response to changes in arterial dioxide tension during moderate hypothermic cardiopulmonary bypass, however a high PaCO₂ depresses cerebral oxygen consumption because hypercarbia may cause potentially harmful redistribution of regional cerebral blood flow away from marginally-perfused to otherwise well-perfused areas.

We evaluated long-term survival and morbidity of 191 patients (161 non-ruptured and 30 ruptured) undergoing abdominal aortic aneurysm repair between 1980 and 1997. Thirty-day mortality rates of non-ruptured and ruptured aneurysms were 1.2% and 36.6%, respectively. Hospital death occurred in 3.1% of patients with non-ruptured aneurysms and 53.3% of those with ruptured aneurysms. Cumulative survival rates after successful AAA repair at 5 and 10 years were 76.3% and 42.3%, respectively. These were lower than survival rates in the age- and gender-matched general population. The most frequent cause of late death was cardiac problems (28.8%) including myocardial infarction. Other causes included stroke (19.2%), malignant neoplasm (17.3%), and ruptured recurrent aneurysms at or above the proximal anastomosis (9.6%) including aorto-enteric fistulas. Regarding late vascular complications, recurrent aneurysms at or above the proximal anastomosis were found in 10% of patients, including 3.5% of true aneurysms, 4.7% of anastomotic aneurysms, and 1.8% of aorto-enteric fistulas. Thoracic aortic aneurysms were found in 3.7% and aortic dissection in 4.2%. Cumulative graft patency rates at 10 and 15 years were 97.4% and 90.9%, respectively. Suppressive treatment for arteriosclerosis and continuous careful follow-up with an aggressive diagnostic approach may reduce morbidity and mortality from recurrent aneurysms or coronary artery disease, thereby improving late survival after AAA surgery.