Several investigators have reported that aortic dissections with thrombosed false lumens has a better prognosis than those with open false lumens. However, the method of treating dissecting aorta with a thrombosed false lumen has not yet been clearly determined. The purpose of the present study is to determine the factors that would indicate surgical treatment for dissecting aorta with thrombosed lumen. Sixteen consecutive cases of type A dissecting aorta with a thrombosed lumen were classified into two groups: event-free group (group R, n=10), recanalization or ulcer-like projection group (group P, n=6). The maximum aortic diameter and thrombosed lumen diameter in group P were significantly greater than in group R (45.00±1.78 vs. 36.00±2.16mm: p=0.0182, 8.00±0.00 vs. 4.00±0.40mm: p=0.0004). In group P, the thrombosed lumen diameter significantly decreased after 1 month. In conclusion, the maximum aortic diameter (>45mm), the maximum lumen diameter (>8mm), and no decrease of the thrombosed lumen diameter are useful predictors for the risk of recanalization or ulcer-like projection. These cases would require surgical treatment.

The aim of this study was to evaluate the Enclose II anastomosis device (Novare Surgical System, Inc., Cupertino, CA). A retrospective record review was conducted of all cases which underwent off-pump coronary artery bypass surgery (OPCAB) at our general hospital between January 2002 and December 2006. We identified 91 patients (a mean age of 71.0 years, the average number of distal anastomoses 2.5/patient) underwent OPCAB. The proximal anastomoses were constructed with the Enclose II (group E, 40 patients), aorta side-clamp technique (group S, 17 patients), and aorta no touch (group N, 34 patients). Group E had more grafts than group N (E:N=2.7:1.7/patient, p<0.0001), while Group E (3.1/patient) had more distal anastomoses than group S (2.6/patient, p=0.0486) and N (1.8/patient, p<0.0001). There was no difference of graft patency in each group (early; E:S:N=99.1%:97.8%:98.0%, 1-year; E:S:N=95.8%:91.3%:95.2%). There was no patient with sustained permanent neurologic deficits after OPCAB. The Novare Enclose II proximal anastomotic device appears to be a safe and effective tool during OPCAB.

Acute respiratory failure after cardiopulmonary bypass is a severe postoperative complication. We evaluated the effects of a specific neutrophil elastase inhibitor, sivelestat sodium hydrate (Ono Pharma Co. Ltd., Osaka, Japan), on postoperative respiratory failure due to acute aortic dissection (type A, AAD). A retrospective review of clinical records was conducted for all cases of emergency surgery for AAD at Ome Municipal General Hospital between June 2001 and August 2006. We identified 16 patients (median age, 64.9 years old; male: female ratio, 4:12) who had an initial postoperative PaO₂/FIO₂ of less than 300mmHg. Among these patients, 11 treated with sivelestat were compared with 5 (the control group) who did not receive sivelestat. There were no significant differences in age, body weight, sex, operating time, cardiopulmonary time, blood transfusion, initial WBC and CRP between the two groups. At arrival in the ICU, the patients in the sivelestat group had a worse respiratory condition based on parameters such as PaO₂/FiO₂ (sivelestat vs. control, 74.1 vs. 181.1mmHg, p=0.0007), A-aDO₂ (sivelestat vs. control, 620.3 vs. 556.7mmHg, p=0.0003), and respiratory index (sivelestat vs. control, 9.29 vs. 4.92, p=0.0002). However, the patients in the sivelestat group showed a greater improvement in these parameters and CRP over a 3-day observation period, compared to those in the control group. We conclude that sivelestat may attenuate postoperative respiratory complications in patients with AAD.

Vertebral osteomyelitis (VO) is a relatively rare, but lethal, complication of infective endocarditis (IE). We report two cases who had been given a diagnosis of IE during conservative therapy for VO. A 60-year-old and a 52-year-old men each suffered onset of severe back pain. Magnetic resonance imaging demonstrated osteomyelitis in the lumbar spine. IE was revealed from congestive heart failure and persistent fever, as an unusual complication of VO. A series of echocardiograms demonstrated the progression of valvular lesions and vegetation, despite treatment with antibiotics. We therefore performed surgery. One underwent aortic and mitral valve replacement, and the other underwent aortic valve replacement. VO was treated with long-term antibiotics and good responses were achieved in both patients. The possibility of VO in the lumbar spine should be considered in patients with IE complaining of severe back pain. Appropriate antibiotic therapy over a prolonged period is recommended.