The author encountered two cases of iliac arteriosclerotic occlusive disease with the clinical symptoms due to plaque rupture. Lower leg pain was noted at the subacute onset. Stenosis and niche-like opacification of a common iliac artery were indicated by angiography. The stenotic portions were resected and replaced by prosthesis. Leg pain subsequently disappeared. Macroscopic findings showed plaque rupture at the inflow surface of the iliac artery and blood entered the plaque. Acute arterial thrombosis may possibly occur by the same mechanism.

A 53-year-old male patient was admitted with back pain. A diagnosis of DeBakey IIIb type dissecting aortic aneurysm was made based on the results of examinations such as CT-scan and MRI. The right renal artery bifurcated from the pseudolumen. The right iliac artery and left renal artery showed severe stenosis due to aortic dissection. Y-graft replacement of the abdominal aorta was carried out to save the right iliac artery and left renal artery. At the same time, a fenestration operation was carried out to maintain the blood flow of the right renal artery which bifurcated from the pseudolumen. Secondarily, replacement of the descending aorta was carried out with successful thrombotic obstruction of the pseudolumen.

For aortic root replacement in annuloaortic ectasia (AAE), an artificial prosthesis is commonly sutured to the aortic annuls (hemodynamic ventriculoaortic junction). In this case report, suturing was conducted using the anatomic ventriculoaortic junction along with full-thickness-suturing. The first case was a 28-year-old man and the second, his 31-year-old brother. The former showed AAE (maximum diameter, 120mm) with 4°AR and the latter, AAE (maximum diameter, 54mm) without AR. The present method is simple due to the flat suture line and is quite reliable owing to full-thickness-suturing.

Methylprednisolone (MP) has anti-inflammatory properties. We evaluated the influence of MP on systemic inflammatory response syndrome (SIRS) in a conventional coronary artery bypass grafting (CABG) operation. We compared three groups: (1) the HD-MP group (high-dose MP group): injecting 30mg/kg MP before extracorporeal circulation, (2) the LD-MP group (low-dose MP group): injecting 5mg/kg MP, (3) the N-MP group (non-MP group): no MP injected. Postoperative SIRS duration was shorter in the HD-MP and LD-MP groups than in the N-MP group, although low-dose MP had a shortening effect on the duration of SIRS. Interleukin 6 (IL-6) and interleukin 8 (IL-8) showed lower values in the HD-MP and LD-MP groups than in the N-MP group, although low-dose MP had an inhibitory effect on the production of interleukin. However, there were no differences between the three groups in the organ protective action of MP, such as total dose of catecholamine (as an index of cardiac dysfunction), intubation period (pulmonary dysfunction), GPT/D-Bil abnormality (liver dysfunction), or BUN/Cr abnormality (renal dysfunction). The maximum value of the postoperative white blood cell count showed a higher value in the HD-MP group than in the N-MP group. In conclusion, the usage of low dose (5mg/kg) MP in a conventional CABG operation is able to shorten SIRS duration and inhibit the production of IL-6 and IL-8 without increasing the risk of infection.

A 65-year-old woman presented with coughing and dyspnea. Giant left atrial myxoma was found by echocardiography. The tumor size was 7×5×4cm and its weight was 70g. The biatrial approach was chosen over left atriotomy or the transseptal approach. However, it may not be possible to decide on the correct incision line in cases of giant tumor. Intraoperative trans-esophageal echocardiogaphy was useful for evaluation of the mitral valve.

The patient was an 83-year-old man. He had pyloric stenosis due to Borrmann type III gastric cancer. He also had an abdominal aortic aneurysm 7cm in length. We performed gastrectomy and Y graft replacement simultaneously. His postoperative course was good. We discussed the operative indications and operative method, especially with regard to simultaneous operation.

Preoperative and postoperative evaluation was conducted on 25 patients (33 lesions) with arteriosclerosis obliterans (ASO) by three-dimensional CT angiography (3D-CTA) and intraarterial digital subtraction angiography (IA-DSA). The usefulness and problems of 3D-CTA for diagnosis of ASO were studied. Both methods had equal ability to detect lesions in the area of the iliac artery and the femoral artery. Totally occlusive lesions were accurately diagnosed by 3D-CTA, but diagnosis of stenotic lesions was much less accurate. To confirm blood flow following vascular reconstruction 3D-CTA was useful and IA-DSA was not required. 3D-CTA images can be obtained from desired directions and clearly detect calcification and blood clots with little health risk involved. They are useful for the diagnosis of ASO.

Conventional CT and three-dimensional CT angiography (3D-CTA) were conducted after peripheral arterial bypass surgery on 17 patients (26 grafts) from October, 1994 to April, 1996. Seventeen grafts were patent. The following objectives were satisfied in these cases: 1. Prosthetic graft or saphenous vein was depicted by 3D-CTA, 2. The distal portion of the native artery was depicted by 3D-CTA, and 3. Opacification of the graft interior was recognized by transverse section of CT. Nine grafts were occluded but prosthetic grafts were depicted in 5 cases, and prosthetic grafts and the distal portions of native arteries in 3 cases. Opacification of the graft interior was not seen in any case. Achievement of the above three objectives was considered necessary to determine graft patency.

A comparison was made of the three-dimensional CT angiography (3D-CTA) images of four grafts (IMPRA, Bionit, GELSOFT, and saphenous vein). All patent grafts were visualized by 3D-CTA, and opacification of the graft interior was noted in all cases on transverse sections of CT. Occluded GELSOFT and saphenous vein grafts could not be visualized by 3D-CTA. In spite of occlusion, IMPRA and Bionit were visualized by 3D-CTA. However, opacification of the graft interior could not be noted on transverse sections of CT. Confirmation should be made of the following: 1. distal portion of native artery shown on 3D-CTA, 2. recognition of opacification (high density) of graft interior on transverse sections of CT. When the CT threshold changed, occluded IMPRA and Bionit showed spotty images. This phenomenon should facilitate accurate diagnosis.

A 62-year-old man was diagnosed as having atrial septal defect (ASD) and atrial fibrillation (Af) upon admission to our hospital with acute myocardial infarction. He was placed on medication for 3 years but surgery was considered necessary because of the further complication of angina pectoris. Coronary arterial bypass grafting, ASD closure and right atrial separation procedure which was a modification of the right-sided maze operation, were performed simultaneously. Although chronic Af disappeared immediately after surgery, it reappeared on the 8th postoperative day, and medicinal and electrical defibrillation had no effect. We considered that the main cause of Af accompanied by ASD had existed in the right atrium before surgery. Also, as the right atrial separation procedure was less invasive than the Cox/maze procedure for such complications in patients with ischemic heart disease, we chose this method. In our patient, postoperative left ventricular loading was considered to have been the cause of Af recurrence. Therefore the indications for this procedure should be decided carefully in patients with preoperative left ventricular hypofunction or left atrial dilatation.