From May 1981 through April 1996, 19 patients with ruptured abdominal aortic aneurysm were admitted to our department. There were 18 men and 1 woman with a mean age of 69 years. Fifteen cases were in shock with a systolic blood pressure<80mmHg and 4 cases required chest compression for hypotension. One patient died of cardiac arrest on the operating table, 3 died of multiple organ failure or respiratory failure in hospital. The overall mortality rate was 21%. The mortality rate of patients under the age of 70 years was 10%, whereas that for those over 70 years of age was 33%. We believe that the use of intraoperative ileal tubing and postoperative continuous hemofiltration would improve the mortality rate in cases of ruptured abdominal aortic aneurysms.

CPK-MM, one of the CPK-isozyme, is divided into the three subbands (isoform) MMa, MMb, MMc. It has reported that in acute myocardial infarction serum MMa and MMa/MMc increased earlier than other myocardial intracellular enzyme, such as CPK-MB. In this study, we measured serum CPK, CPK isozyme, and CPK isoforms during and after open heart surgery and examined whether CPK isoforms would serve as a marker for myocardial damage during open heart surgery. CPK-MB peaked at 153.3±85.1IU six hours after cardiopulmonary bypass (CPB) was taken off and subsequently decreased. On the other hand, MMa/MMc peaked at 5.6±2.2 immediately after CPB was taken off. Moreover, we found that there was a statistically significant positive correlation (Y=24.46X+16.68, r=0.63, p<0.05) between MMa/MMc immediately after CPB was taken off and CPK-MB six hours after CPB was taken off. The maximum value of CPK-MB correlates with the degree of myocardial damage. Therfore, it is reasonable to suggest that the maximum value of MMa/MMc immediately after CPB is taken off also correlates with the degree of myocardial damage. We concluded that serum CPK isoform, especially MMa/MMc served as a marker to estimates the degree of myocardial damage in open heart surgery at an early stage.

A 59-year-old man underwent an aorto-bifemoral bypass operation for aorto-iliac arteriosclerotic occlusive disease. The total aortic occlusion time was 38min. Soon after the operation, the patient was found to have motor and sensory loss between right L₂ and S₁, which did not improve. We considered that spinal cord damage was caused by occlusion of the lumbar artery as a result of side clamping of the atherosclerotic abdominal aorta. Therefore, side clamping of the atherosclerotic aorta should be avoided to prevent this serious complication.

A 28-year-old woman with no underlying health issues was injured in a motorcycle accident and taken to our hospital by ambulance when she was 26 years old. Though she was diagnosed with multiple trauma, upon arrival at the hospital neither cardiac murmurs nor cardiac abnormalities on transthoracic echocardiography were detected. She was managed conservatively, and discharged on hospital day 16. She experienced dyspnea upon mild effort, and an early diastolic murmur appeared. She was again referred to our hospital, and diagnosed with severe aortic regurgitation. We scheduled an aortic valve replacement using an bioprosthetic valve because she intended to give birth. We also considered simultaneous aortic root enlargement as her aortic annulus was small. We performed the surgery 2 years after the initial motorcycle accident. Perioperatively, we noticed that her non-coronary cusp was torn. We converted the procedure to an aortic valve repair using an autologous pericardial patch. Her aortic regurgitation disappeared after the operation, and she was discharged on postoperative day 14. We successfully preserved the aortic valve cusps and avoided the need for anticoagulant therapy.

Cardiac rupture remains a severe complication after acute myocardial infarction (AMI) and its prognosis is poor. Between February 1985 and February 1995, six male patients (age range, 59 to 76 years, average 65.2) underwent repair of heart rupture after AMI at our clinic. The time interval between heart rupture and emergency surgery ranged from one hour to 24 hours (average 11 hours). Two patients did not recover from the initial shock, and were treated by emergency operation under IABP or PCPS. These two patients both had the blow-out type of heart rupture, and were treated by the felt-sandwich method. Neither patient was cured, due to uncontrollable bleeding. The other 4 patients recovered from circulatory catastrophe after pericardial drainage, and surgery was then carried out. One blow-out type patient died of bleeding. Two cases of hemorrhagic dissecting type were successfully treated by the felt-sandwich method. One oozing type case was treated with fibrin-glue and good results were obtained. The hemorrhagic dissecting type or oozing type showed good results but the blow-out type showed poor results. Initial pericardial drainage after establishing the diagnosis and gentle handling of the heart is essential to obtain good results. For the blow-out type of repture, other strategy is needed to control bleeding and facilitate recovery from shock.

Anastomotic false aneurysm (AFA) of the aorta or iliac artery is a rare but life-threatening complication of prosthetic grafts. We report a surgical case involving AFA of the right external iliac artery which developed at the site of peripheral anastomosis of the temporary bypass procedure used during prosthetic reconstruction of the descending aorta for dissecting aneurysm (DeBakey IIIb) 15 years previously. A 60-year-old woman was hospitalized with rapidly growing right lower abdominal mass. Computed tomography and angiography revealed that the mass was an anastomotic external iliac artery false aneurysm and surgery was performed. The AFA was exposed transperitoneally and resected with a part of the intact external iliac artery without complication. Anatomical reconstruction was completed with a prosthesis. The postoperative course was uneventful. We conclude that patients with retroperitoneal grafts require lifelong routine periodic follow-up and if an AFA is discovered, it should be resected.

We experienced unusual dilatation of gelatin-impregnated knitted Dacron prostheses after abdominal aortic aneurysm surgery. Therefore, we investigated dilatation of gelatin impregnated knitted Dacron grafts compared with other types of Dacron grafts after abdominal aortic aneurysm surgery. Eighteen grafts inserted after abdominal aortic aneurysm surgery were studied for to evaluate dilatation. Enhance CT was used to determine the external diameter of the most dilated portion of the abdominal aortic grafts and high speed plain CT was used to determine the most dilated internal diameter. The gelatin-impregnated knitted Dacron grafts dilated from 25% to 43.8% (mean 31.8±7.2%), significantly more than collagen impregnated woven Dacron grafts (p=0.0003). Moreover, high fever was frequently noticed after these grafts implantation (66.7%). Therefore, caution must be used concerning these implantation in aortic lesions and careful follow-up study should be performed after implantation.

We encountered an unusual disruption of an expanded polytetrafluoroethylene (EPTFE) axillofemoral bypass graft apart from that anastomoses. We suspected the possible robe of the physical effects of body movement provoking the disruption of the axillofemoral bypass graft and therefore examined the physical effect of body movement on the axillary-to-femoral artery graft in 15 healthy men. At the lower part of the graft, the physical effect was significantly stronger. The disruption of this axillary-to-femoral artery graft was associated with the physical effect of body movement.

The purpose of this study was to determine the effect of intraoperative autologous blood salvage during elective abdominal aortic aneurysm repair with Cell Saver 4 (Heamonetics Inc.). Fifty patients prospectively received intraoperative autologous transfusion (Group CS; n=50, 1991-94) and 25 received no intraoperative autologous transfusion (Group NCS; n=25, 1983-91). Only 7 patients in Group NCS received no homologous blood (28%), while 43 in Group CS received autologous blood transfusion (86%). There was no difference between the groups with respect to postoperative platelets counts or serum concentrations of total protein, albumin, BUN and LDH. We conclude that the use of the Cell Saver 4 reduces perioperative homologous blood during elective aortic aneurysm repair.