Spontaneous dissection of the superior mesenteric artery as a rare cause of acute abdomen:report of two cases

Spontaneous dissection of the superior mesenteric artery (SMA) is a rare condition. Here we report 2 cases of spontaneous SMA dissection causing acute abdomen. Bowel infarction did not occur in either case despite total occlusion or severe stenosis of the SMA;we successfully managed isolated SMA dissection without surgical intervention. Our nonoperative management regimen for spontaneous SMA dissection consisted of intestinal rest with fasting, administration of a vasodilator, and blood pressure control. Surgical intervention should be unnecessary unless complications, such as intestinal infarction and abdominal angina, occur.</p

Minimally invasive cardiac surgery via a right mini-thoracotomy

　Minimally invasive surgery, which has become very active outside the cardiovascular field, has recently come to the fore in this area. Then, procedures such as offpump coronary artery bypass grafts without extracorporeal circulation and stent grafts for treating aortic aneurysms have been frequently performed.　In cardiac surgery, as in other surgical fields, more and more surgeries that are less and less invasive have been introduced in recent years. Off-pump coronary artery bypass grafting has contributed to the development of these less invasive surgeries. For example, cardiac surgery utilizing a partial sternotomy was introduced as a way to better access the surgical location. However, minimally invasive cardiac surgery (MICS) through a right mini-thoracotomy, a portaccess cardiac surgery, is said to be trending recently because it avoids a sternotomy and has less bleeding and wound infection. All of these factors not only promote early recovery, but are also expected to have a positive impact on early discharge and the health care economy.　With surgeons and hospitals accumulating experience, MICS is being applied to more complex lesions and has begun to be used to treat the aortic valve in addition to the mitral valve. Off-the-job training and team building are also key factors for implementing a successful program. This type of port-access cardiac surgery is already beginning to be developed into a robotically assisted heart surgery by various facilities around the world