[A case report of successful reoperation of aneurysm developed subsequently to Bentall operation].
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Biomedical subjects
Publications and source records attributed to H Ohteki.
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A dissecting aortic aneurysm involving a right-sided aortic arch is quite rare. This report describes this unusual entity and emphasizes the requirement for precise anatomical definition by aortography to permit appropriate successful surgical therapy. Bilateral thoracotomy is essential for the surgical approach.
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A 56-year-old man was involved in an automobile accident and had abdominal blunt injury with the steering wheel. He developed slight abdominal distension and pulseless, cold sensation and peripheral cyanosis of the left lower extremity which suggested acute arterial occlusion. DSA revealed complete obstruction of the common iliac artery near its origin and the leakage of contrast medium at peripheral branch of the SMA. Four and a half hours after injury, surgical exploration was carried out. Laparotomy showed the laceration of the mesentery with accumulation of massive fresh and clotted blood in the abdominal cavity. Obstructed portion of the left common iliac artery was resected and arterial reconstruction was performed with prosthetic graft (8mm Gore-Tex for end to end left common-left external iliac bypass, 6mm Gore-Tex for side to end right common-left hypogastric bypass). A resected specimen demonstrated completely disrupted intima, resulting in the obstruction of the lumen associated with distal fresh thrombosis. The postoperative course was uneventful with successful patency of both grafts.
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A new model of the stent-mounted porcine aortic bioprosthesis was prepared with 0.625% glutaraldehyde while the valve was partially open. A radiopaque marker was attached to the center of the free margin of each leaflet so that the leaflet movements could be observed in an in vivo testing unit by fluoroscopic cinematography. This valve was compared with a porcine xenograft that currently is available commercially. While the heart was beating, the specially prepared leaflets showed some characteristics that contrasted with those of the currently used bioprosthesis. These features included (1) uniformity versus asymmetry of leaflet excursions under low flow conditions, (2) slower and more gradual closing (actual closing time averaging 536 msec versus 81 msec), and (3) more prolonged period of valve opening, the duration of opening averaging 60% versus 49% of the cardiac cycle. These features support the validity of open-position fixation as a means of further improving xenograft durability.
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Constricting the tricuspid annulus to an optimal size and ensuring competency of the suture in situ are essential to the performance of a successful de Vega annuloplasty. An approach to this goal is presented. Important maneuvers include placement of the inside suture just on the ring portion, use of a 33 mm of 35 mm valve obturator to obtain an annulus of the desired size, and ligation of the knots at their roots to prevent potential loosening.