Syphilitic aortic aneurysm became rare after the discovery of penicillin. Syphilitic aortitis involves the ascending aorta and dilates the aortic annulus, causing aortic valve regurgitation. We report a case of syphilitic aortic aneurysm with severe aortic valve regurgitation, which was successfully treated with the replacement of the valve-sparing root and the total arch. A 55-year-old man, admitted earlier to another hospital for colon diverticulum, was found to have an aortic arch aneurysm. Enhanced computed tomography revealed the aneurysm of the ascending aorta to the transverse arch aorta with the maximum short diameter of the aneurysm at 68 mm. He also had a saccular aneurysm in the ascending aorta. Although he had never had a history of syphilis, a routine laboratory test for syphilis was positive. That said, we looked upon this case as a syphilitic aortic aneurysm. In preoperative cardiac echography, the aortic regurgitation was severe with mild valve stenosis and mainly due to dilation of the aortic root. We thought the native valve could be spared and replaced both the valve-sparing root and the total arch. He was discharged on the 11th postoperative day without any complications.

Aortopulmonary fistula with an arch aortic aneurysm is a rare disease that is difficult to diagnose and often presents with sudden, life-threatening heart failure. Here we report a case of aortopulmonary fistula for which we performed a thoracic endovascular aortic repair (TEVAR) with favorable results. A 79-year-old man presented with slurring of speech and body malaise at a neighborhood clinic. A distal arch aortic aneurysm was detected on chest computed tomography (CT) scans, and the patient was referred to our hospital for further management. We identified a saccular aneurysm and the dilated pulmonary artery, with maximum vessel diameters of 80 and 38 mm, respectively, on preoperative chest CT scans. He was diagnosed with an impending aortic rupture and a TEVAR was performed after preparing for a cervical ramification bypass. Intraoperatively, the aortopulmonary fistula had invaded the pulmonary artery, and the shunt created by the invasion was responsible for the sudden exacerbation of heart failure symptoms in the patient. The diameter of the saccular lump did not increase in the postoperative CT and follow-up visits were scheduled for subsequent monitoring. In the absence of significant complications and with improvement of heart failure symptoms, the patient was discharged from our hospital on the 37th postoperative day. He was later transferred to a neighborhood clinic for rehabilitation and subsequently discharged for further recuperation at home in the fifth postoperative month.

Background/Aims: In Asia, right-sided diverticular bleeding is more common than that of the left side. It often causes massive bleeding and difficulties in identifying the stigmata of recent hemorrhage (SRH) of colonic diverticular bleeding (CDB). This case series demonstrates the efficacy of the gel immersion method using OS-1 Jelly (Otsuka Pharmaceuticals Factory, Tokushima, Japan) in patients with CDB. Methods: This retrospective case series analyzed data of patients with CDB who underwent the gel immersion method from April 2016 to February 2020 at St. Luke’s International Hospital, Japan. All patients diagnosed with CDB who underwent the gel immersion method were included. We collected data on the site of bleeding, identification of SRH, and efficacy of the method from the electronic medical records. Results: A total of 9 patients (including 7 with right-sided CDB) underwent gel immersion method and were included in this study. SRH were successfully found in 66.7% (6/9) of patients. Moreover, effective hemostasis was achieved in 85.7% (6/7) of patients with right-sided CDB. There were no adverse events. Conclusions The gel immersion method was found to be effective, especially for massive right-sided CDB.

Background/Aims: In Asia, right-sided diverticular bleeding is more common than that of the left side. It often causes massive bleeding and difficulties in identifying the stigmata of recent hemorrhage (SRH) of colonic diverticular bleeding (CDB). This case series demonstrates the efficacy of the gel immersion method using OS-1 Jelly (Otsuka Pharmaceuticals Factory, Tokushima, Japan) in patients with CDB. Methods: This retrospective case series analyzed data of patients with CDB who underwent the gel immersion method from April 2016 to February 2020 at St. Luke’s International Hospital, Japan. All patients diagnosed with CDB who underwent the gel immersion method were included. We collected data on the site of bleeding, identification of SRH, and efficacy of the method from the electronic medical records. Results: A total of 9 patients (including 7 with right-sided CDB) underwent gel immersion method and were included in this study. SRH were successfully found in 66.7% (6/9) of patients. Moreover, effective hemostasis was achieved in 85.7% (6/7) of patients with right-sided CDB. There were no adverse events. Conclusions The gel immersion method was found to be effective, especially for massive right-sided CDB.

Background/Aims: Endoscopic band ligation (EBL) is used to treat colonic diverticular bleeding (CDB). An endoscopic variceal ligation device for esophageal varices is used as a conventional EBL device (C-EBL). A new EBL device (N-EBL) was developed by Sumitomo Bakelite Co. in August 2018. We aimed to evaluate the clinical outcomes of N-EBL compared with those of C-EBL. Methods: Seventy-nine patients who underwent EBL for CDB at St. Luke’s International Hospital, Japan, between 2017 and 2020 were included in this retrospective study. Patients were divided into the C-EBL and N-EBL groups. Their clinical outcomes, including achieving initial hemostasis, early rebleeding, procedure time, and EBL-associated adverse events, were evaluated. Results: Of the 79 patients, 36 (45.6%) were in the C-EBL group and 43 (54.4%) were in the N-EBL group. The rate of achieving initial hemostasis was 100% in the C-EBL group and 93.0% in the N-EBL group. No significant difference was noted in the early rebleeding rate between the groups (p=0.24). The N-EBL group achieved a shorter median EBL procedure time than the C-EBL group (18.2 minutes vs. 14.2 minutes, p=0.02). No adverse events were observed in either group. Conclusions The N-EBL device is safe and useful and may reduce EBL procedure time.

We report a case of ruptured chronic type B aortic dissecting aneurysm that was successfully treated with the Candy plug technique to exclude a false lumen. A 57-year-old man had undergone abdominal fenestration for complicated acute type B aortic dissection previously. He then underwent debranching TEVAR for an impending rupture because of a dilated thoracic aortic dissecting aneurysm in 2014. After one year, the aneurysm was ruptured because of continuous distal flow of the false lumen. We performed TEVAR using the Candy plug technique, and he was discharged on the 11th postoperative day. The false lumen diameter was reduced. TEVAR using the Candy plug technique for chronic type B aortic dissection was thought to be useful in high-risk patients, but we need more careful observation.

The efficacy of minimally invasive cardiac surgery (MICS) has often been reported. However, in Japan most of these procedures are supported with robotic systems, which are expensive. We report the technique of atrial septum defect (ASD) closure by MICS and a three-dimensional endoscope without the aid of a robotic system. From March 2012 to April 2015, we performed ASD closure using this method in 7 patients. The use of a three-dimensional endoscope enables cardiac surgery to be performed through smaller incisions (≤5 cm in width). We have adopted this method of ASD closure with the Maze procedure for patients complicated by atrial fibrillation. The operation time will decrease as we improve our surgical technique. Our current practice is to attempt ASD closure with totally endoscopic support.