Infected abdominal aortic aneurysm (IAAA) are rare, but life-threatening. This time we experienced six cases of infected abdominal aortic aneurysm. We measured the soothing of bacteremia by two weeks of antibiotic treatment before operation, if not in a state of impending rupture or rupture. The in situ prosthetic graft replacement surgery was the first choice. In five cases, we replaced by an in situ dacron graft with Rifampicin. However, one case that was by pondylitis caused by Helicobacter cinaedi was treated by extra-anatomical bypass. There was no post-operative infectious complication. In addition, surgery/hospital death was 0%.

A-54-year-old man with an extensive dissecting thoracic aortic aneurysm underwent staged surgery which consisted of preceding total aortic arch replacement with the frozen elephant trunk technique using J Graft Open Stent Graft, followed by open descending aorta repair. During the second operation, a Dacron graft was anastomosed directly to the stent graft and the true lumen thus, the true lumen could be preserved around the stent graft. We herein discuss our approach in this case, focusing on prevention of bleeding from the elephant trunk.

A 44-year-old man underwent implantation of a DDD pacemaker for third degree heart block at age 20. The cutaneous pocket for the pulse generator was situated in the left pectoral region. He visited our hospital because of skin ulcer over the pacemaker without any other complaint such as fever or pain. The patient received a new DDD pacemaker system in the right pectoral region and old pacing leads were translocated under the pectoral muscle. However, right pectoral skin ulcer appeared 1 month later. Patch tests revealed a positive reaction to silicon. Wrapping of the pacemaker with a polytetrafluoroethylene (PTFE) sheet proved to be effective.

We report 4 cases of delayed hypersensitivity reaction to Vancomycin (VCM) after cardiac surgery. Case 1: A patient developed sepsis and mediastinitis after aortic valve replacement (AVR) for aortic valve insufficiency. Case 2: A patient developed mediastinitis after coronary artery bypass grafting (CABG) for effort angina pectoris. Case 3: A patient developed pneumonia after AVR for aortic valve infective endocarditis. Case 4: A patient developed sepsis after CABG for acute myocardial infarction. All of them received VCM intravenously and their infections improved. However, sudden high fever, skin rush and eosinophilia occurred 12 or 13 days after the initiation of therapy. These symptoms resolved after halting VCM administration. We need to take examine eosinophils when considering further administration of VCM.

A 62-year-old man suddenly felt severe back pain. An enhanced computed tomography (CT) demonstrated an acute Stanford type B dissection and the true lumen was severely compressed by the false lumen. We started conservative therapy because there was no sign of organ ischemia. A 23 days from onset, he developed bilateral limb ischemia and renal failure because the compression of the true lumen increased. After bilateral axillo-femoral bypass the organ ischemia disappeared. Four months later, CT showed the dilatation of the true lumen and occlusion of the bilateral grafts. In spite of graft occlusion, there was no sign of organ ischemia.

Fatal intestinal necrosis developed following off-pump CABG and implantation of a bifurcated vascular prosthesis in a 70-year-old man with unstable angina pectoris and abdominal aortic aneurysm. A CT scan with three-dimensional reconstruction (3D-CT), showed no narrowing or obstruction of the SMA. The patient was scheduled to undergo an extensive resection of the intestine on the 23rd postoperative day. The pathological diagnosis was nonocclusive mesenteric ischemia (NOMI). He died of multiple organ failure on the 38th postoperative day. Early diagnosis of NOMI is essential to lower mortality and postoperative morbidity. Invasive angiography is the gold standard in diagnosis. 3D-CT, a non-invasive method, is an increasingly useful technique, which may allow identification of vascular anatomy and pathology with sufficient detail for diagnosis. Several other causes of acute abdomen, other than mesenteric ischemia, can be ruled out. Therefore, 3D-CT might be useful in screening for NOMI.

A 56-year-old man was admitted with fever of unknown origin and congestive heart failure. Blood cultures grew Streptococcus gordonii. An echocardiographic examination showed vegetation attached to the bicuspid aortic valve and severe aortic regurgitation. Despite the aggressive therapy, an emergency operation had to be performed because it was otherwise impossible to control heart failure. Vegetation was attached to the aortic valve leaflets. There was no noticeable lesion on the aortic annulus, but a myocardial abscess was noted in the left atrial wall. Aortic valve replacement was performed after the myocardial abscess was drained. It was assumed that the myocardial abscess was due to the septic state from Infective endocarditis because it was recognized at a distant zone from the active valvular infection.