A 53-year-old woman complained of symptoms of congestive heart failure and was admitted to a local hospital. Transthoracic echocardiography showed pericardial effusion and left ventricular aneurysm. The patient was transferred to our hospital for examination for treatment. Coronary angiography demonstrated triple vessels disease. The patient underwent left ventricular reconstruction and coronary bypass grafting. The operative findings showed no adhesion between the aneurysm and the pericardium. The pathological examination after operation indicated a ventricular pseudo-false aneurysm. The differentiation of left ventricular pseudo-false aneurysm from pseudo-aneurysm can be difficult.

We reviewed 24 cases of patchplasty for true thoracic aortic aneurysm performed in our hospital up to July 2001. The size of the aneurysm in the ascending aorta was 6.0cm (1 case), and the mean size in the aortic arch was 2.5±0.5cm (4 cases), that in the distal arch was 4.7±1.7cm (11 cases), and that in the descending aorta was 3.7±0.5cm (8 cases). The hospital mortality rate was 12.5% (3 patients out of 24). The causes of death were multiple organ failure, cerebral bleeding and sepsis. In the long-term results, 2 patients had recurrence, but there were no late deaths in relation to the aneurysmal recurrence. We performed open stent operations for severe adhesion and pulmonary dysfunction in the aneurysmal recurrence cases. The postoperative course of these cases was uneventful. The open stent was useful for the treatment of the aneurysmal recurrence in the distal arch.

We treated 261 arteriosclerosis obliterans cases with critical leg ischemia since 1976. Those patients aged 75 years and older were designated as the elderly group and were compared with those under 75 years of age. Among the elderly patients with critical leg ischemia, the percentages of women and Fontaine scale IV cases were higher. The condition of those who had to undergo an initial major amputation was often complicated by cerebrovascular diseases, resulting in a higher early death rate after operation. Therefore, the necessity of early diagnosis and immediate treatment must be emphasized. There were no differences in patency and limb salvage rates between the two groups. In cases of arterial reconstruction however, graft occlusion in the elderly group immediately after operation was frequently observed. It is important to include drug therapy in follow-up to prevent occlusion of the graft following surgery in elderly patients.

A 27-year-old man had received Bentall's operation for annuloaortic ectasia with Marfan's syndrome 4 years previously. He was admitted to our hospital because of sudden abdominal pain and lumbago. The abdominal pulsatile mass with tenderness was palpated and dilatation of abdominal aorta was revealed by abdominal ultrasonography. An emergency operation was performed under a diagnosis of ruptured abdominal aortic aneurysm. At operation, the infrarenal abdominal aorta formed a fusiform aneurysm of which maximum diameter was 6cm. The aneurysm had a thin wall, and ruptured opening about 2cm in diameter at the posterior wall, but no thrombus inside. Graft replacement was done from the infrarenal abdominal aorta to the bilateral common iliac artery using knitted Dacron vascular prosthesis, and reconstruction of inferior mesenteric artery with wrapping of the proximal anastomosis were performed. Histopathological examination of the aneurysmal wall revealed medial necrosis and degeneration, by which Marfan's syndrome was diagnosed. Although abdominal aortic aneurysm is rarely associated with Marfan's syndrome, it often shows rapid development and has a high risk of rupture. Therefore, we suggest that strict observation and early operation are important for abdominal aortic aneurysm associated with Marfan's syndrome.

Twenty-two patients who underwent vascular reconstruction for carotid occlusive disease by April 1998 were examined in terms of long-term results. The cause of disease was atherosclerosis in 16, and aortitis in 6. The operation method included CEA in 11 and bypass in 5 cases in the atherosclerosis cases, and CEA in 2 and bypass in 6 cases in aortitis. Cases of occlusive disease included 1 early occlusion (atherosclerosis) and 4 late occlusion (atherosclerosis 2, aortitis 2). The cause of early occlusion was considered to be due to technical factors, but late occlusion was thought to be related to progression of disease, anastomotic intimal thickening, and recurrence of inflammation. It is important to enforce strict operative indications, accurate intraoperative monitoring, and perioperative drug control.