A 53-year-old man with Behçet's disease was admitted to our hospital for investigation of back and lower abdominal pain. Computed tomography (CT) showed a projecting saccular aneurysm below the right renal artery. We placed a stent-graft just below the right renal artery, successfully excluding the abdominal aortic aneurysm (AAA). His C-reactive protein level and white blood cell count remained elevated after stent-grafting. About 5 months later, he was readmitted with recurrent back and lower abdominal pain and CT showed progression of the AAA. Thus, we performed straight grafting using a woven Dacron graft just below the right renal artery. The patient had an uneventful postoperative course. We discuss the controversial issue of treating AAA in patients with Behçet's disease, focusing on the indications and timing of surgery.

No abstract

hronic ischemic mitral regurgitation (MR) is a cause of congestive heart failure in patients with ischemic cardiomyopathy. Various mitral valve plasty (MVP) techniques have been reported, but the best surgical intervention is still controversial and the development of new techniques is necessary to give better outcome for patients with ischemic MR. We initiated our original procedure called "papillary muscle sandwich plasty" 1 in 2004 and in this study, we evaluated its early and late surgical results. Methods PatientsOf 602 ischemic heart disease patients, 46 underwent MVP for ischemic MR between 1999 and 2007 and of them, 23 patients since 2004 underwent papillary muscle sandwich plasty. The mean age of the patients was 67 (47-82) years and there were 16 men and 7 women. The patients' preoperative characteristics, examination results and operative procedures are summarized in Table 1.According to preoperative echocardiography, the mean left ventricle diastolic and systolic diameters were 54±6 mm and 43±7 mm, respectively. The mean mitral annulus diameter and tenting height was 29.5±2.4 mm and 12.0±2.8 mm, respectively. The grade of preoperative MR was severe in 10 patients and moderate in 13. Mitral ring-annuloplasty was performed in 9 (39%) patients and left ventricular volume reduction in 5 (22%). Postoperative early and late results were evaluated. The mean follow-up period was 24±10 months (range 7-39 months). TechniqueOur technique of "sandwich plasty" is usually performed (Received June 16, 2008; revised manuscript received January 12, 2009; accepted February 19, 2009; released online May 18, 2009 Methods and Results:The present study was a review of 23 patients who underwent an original technique known as "papillary muscle sandwich plasty" in which the mitral valve is approached via either the left atrium or left ventricle. The heads of the papillary muscles of the anterior leaflet and leaflets are plicated using Teflon-pledgeted 3-0 Ticron sutures in both the anterolateral and posteromedial commissural portions. Postoperative residual mild MR occurred in 1 patient (4%), but moderate or severe MR was not observed. In the follow-up study, prominent MR occurred in 1 patients and the MR-free rate at 2 years after surgery was 93%. Late cardiac death was significantly (P<0.05) fewer in patients without prominent MR than that in patients with MR. Conclusions: "Sandwich plasty" is an effective technique for patients requiring left ventricular plasty and may improve the prognosis of ischemic heart failure. (Circ J 2009; 73: 1240 -1242

）for the treatment of arrhythmia was studied in 10 adult patients who underwent cardiovascular surgery. Onoact was continuously infused at a mean rate of 0.018 mg/kg/min initially and followed by 0.01 mg/kg/min. After the initiation of Onoact infusion, supra-ventricular tachycardia was eliminated in 5 out of 6 patients, and ventricular tachycardia disappeared in all 4 patients. The decrease in systemic blood pressure was not significant. Low-dose continuous infusion of Onoact was safe and effective even in patients just after cardiovascular surgery.

SUMMARYThe impact of drug-eluting stents (DES) on the characteristics and operative results of patients referred for coronary artery bypass grafting (CABG) was studied. We reviewed data from isolated CABG patients 24 months before (group A, n = 134) and 24 months after (group B, n = 98) the introduction of DES for clinical use at Teikyo University Hospital in Tokyo. Group B patients were significantly older than those of group A (66 ± 9 versus 69 ± 9 years old). The number of diseased vessels was significantly larger in group B (2.5 ± 0.6 versus 2.7 ± 0.5) and left main trunk disease decreased in group B (27% versus 17%). Preoperative IABP support was more frequent in group B (9% versus 17%) and beating heart surgery was significantly more frequent in group B (26% versus 59%). The number of grafts was similar in the 2 groups (3.2 ± 1.4 versus 3.0 ± 1.1). The operative mortality rates were 0.7% and 4.1% in group A and B, respectively. Incomplete revascularization followed by postoperative percutaneous coronary intervention (PCI) was performed in 11% and 12%, respectively, and all the patients survived surgery. The operative mortality rates for arrested heart and beating heart surgery were 2% and 2%, respectively. In conclusion, after the introduction of DES, more clinically ill patients were referred to CABG. Combination therapy consisting of CABG and PCI (Hybrid) may be a treatment of choice in critical patients. (Int Heart J 2007; 48: 455-461)