Background: In abdominal aortic aneurysm (AAA) repair, European and the United States' guidelines recommend performing proximal anastomosis as close to the renal arteries as possible. A long infrarenal residual aorta (IRA) raises concern about the risk of enlargement and aneurysmal formation in the future. There are no descriptions of proximal anastomosis in Japanese guidelines. Objective: To investigate the relationship between the length of the IRA and its long-term enlargement. Subjects: 100 patients who underwent open repair for AAA at our hospital between June 2002 and November 2016 were included. The mean age was 70.2±8.2 (SD) years, and the mean observation period was 8.5±3.3 years. Group S (n=24) consisted of patients whose IRAs were less than 2 cm in length, and Group L (n=76) consisted of patients whose IRAs were more than 2 cm in length. The preoperative diameter of the infrarenal aorta and the length and diameter of IRA in the immediately after surgery, in the early postoperative period (within 1 year), in the mid-term (2 to 9 years), and in the remote period (after 10 years) were measured. Results: There was no significant change in IRA diameter between preoperative and immediate postoperative periods. The preoperative diameter of the infrarenal aorta were 23.0 [21.0-26.0] mm in group S and 22.0 [20.0-24.5] mm in group L. There was no significant difference of the preoperative IRA diameter between the two groups. The IRA diameters in the postoperative period and thereafter were 22.0 [20.0-26.0] mm, 23.0 [21.0-27.0] mm, 24.0 [22.0-28.0] mm, 26.0 [23.3-32.8] mm in group L, showing a significant dilatation immediately after operation (p<0.01). In addition, although there was no statistically significant difference, the group with a preoperative infrarenal aorta diameter of 26 mm or greater showed a larger dilatation after the midterm postoperative period. Conclusions: An association was found between IRA length (≥2 cm) and postoperative IRA dilatation.

A 36-year-old man underwent direct closure of an atrial septal defect through median sternotomy at the age of 14. He also underwent a mitral valve replacement with tricuspid annuloplasty using the same approach at the age of 18. The patient also presented with pretibial edema and congestive liver disease at the age of 27 and the pretibial edema progressed at the age of 35. Hypoalbuminemia (TP ; 3.6 g/dl, Alb ; 1.6 g/dl) was also observed. Further examinations were performed, which revealed that the right ventricular pressure curve presented a dip and plateau pattern by cardiac catheterization. Computed tomography of the chest additionally revealed thickened and calcified pericardium in the left ventricle. Abdominal scintigraphy showed tracer accumulation in the transverse colon hepatic flexure 4 h after intravenous administration of technetium-99m-labelled human serum albumin. The patient was diagnosed with a protein-losing gastroenteropathy caused by constrictive pericarditis. He underwent pericardiectomy via left anterior thoracotomy without cardiopulmonary bypass. No complications were present after the surgery, and he was discharged after 46 postoperative days. Following his discharge from the hospital, the pretibial edema disappeared, and serum albumin levels gradually increased and normalized within 3 months after the surgery (TP 7.1 g/dl, Alb 4.2 g/dl).