[Surgical Removal of a Transvenous Pacemaker Lead with the Right Atrial Perforation:Report of a Case].

Cardiac perforation by a transvenous pacemaker lead is an uncommon, but serious complication. Management strategies in pacemaker lead cardiac perforation depend on the symptoms, the presence of pericardial effusion, hemodynamic status, and injured neighboring organs. A 70-year-old man was admitted due to suspicious right atrial perforation with pneumothorax secondary to a transvenous pacemaker lead. Right atrial perforation was confirmed on computed tomography (CT). A large laryngopharyngeal hemangioma compressing the trachea was also observed. Although he was hemodynamically stable, we chose a surgical removal of a transvenous pacemaker lead considering his large laryngopharyngeal hemangioma. A tracheotomy followed by lower hemisternotomy were performed. A perforated pacemaker lead was observed on the right atrium. The lead was pulled out, and a hole in the right atrium was fixed. His postoperative course was uneventful.

[Incidental diagnosis of giant cell arteritis during a hybrid surgical approach in a patient with annuloaortic ectasia and an extensive thoracic aortic aneurysm].

We report a case of giant cell arteritis that was incidentally diagnosed during a hybrid( open surgical and endovascular) approach to an extensive thoracic aortic disease. A 78-year-old man was admitted for the evaluation and treatment of annuloaortic ectasia and an extensive thoracic aortic aneurysm. We performed aortic root replacement (Bentall procedure) and total aortic arch replacement using the elephant trunk technique under hypothermic circulatory arrest. Pathological examination of the aneurysmal wall revealed giant cell arteritis. He had no specific symptoms such as headache, jaw claudication, or vision loss. Because no findings except for a slightly elevated erythrocyte sediment rate were suggestive of active vasculitis, he was discharged from hospital without steroid therapy 6 weeks after open surgery. However, 4 weeks later he returned in hemorrhagic shock due to rupture of a residual descending thoracic aortic aneurysm. He underwent emergency endovascular repair but died intraoperatively. In conclusion, early second-stage procedure and postoperative steroid therapy may be useful in a patient with aortic aneurysm in giant cell arteritis undergoing a hybrid procedure.

The conversion to Rastelli's type operation from Patrick-McGoon's procedure of an adult with Taussig-Bing heart: a case report.

A 23-year-old female of Taussig-Bing heart with antero-posterior relation of the great arteries was underwent Patrick-McGoon's intraventricular rerouting at 6 years old of age. The left ventricular outflow obstruction (peak pressure gradient of 100 mmHg) developed, and severe aortic valve regurgitation following bacterial endocarditis was noted. The conversion to Rastelli's type operation and aortic valve replacement were performed successfully at 23 years old of age. She is doing well without any significant left or right ventricular outflow obstruction at 7 years postoperatively.

A Simple Reproducible Method to Treat Acute or Subacute Arterial Obstruction When the Thrombus Is Adherent to the Arterial Wall.

We report three consecutive patients with limb ischemia, where symptoms appeared several days to weeks prior to presentation. In all cases, initial over-the-wire thrombectomy failed due to adherence of the thrombus to the arterial wall. We adopted a new approach of stretching the whole obstructed segment by a series of ballooning using a percutaneous transluminal angioplasty (PTA) catheter. A subsequent thrombectomy was successful in all three cases. No further intervention, such as stenting or bypass surgery, was required. The adhering thrombus was dissected by stretching the arterial wall at the site of obstruction.

Early Stent Graft Perforation after Endovascular Repair for Pseudoaneurysm That Was Associated with Clavicle Nonunion.

We report the case of a 62-year-old man who experienced a left axillary artery pseudoaneurysm that was secondary to nonunion of a 30-year-old left midshaft clavicle fracture. He initially underwent endovascular repair using a self-expanding nitinol stent graft, which was perforated at postoperative day 5. Therefore, we performed open repair with concomitant clavicle resection, and no complications were observed during an approximately 6-year follow-up. We recommend performing clavicle resection with vascular repair to prevent recurrence in similar cases.

Severe aortic valve regurgitation due to Takayasu's aortoarteritis in a child.

An 8-year-old Japanese boy with severe aortic valve regurgitation was treated by the Ross procedure with use of the full root technique. Takayasu's aortoarteritis was diagnosed 2 months after the operation. At 8 months after the operation, follow-up echocardiography revealed an aortic root pseudoaneurysm, which was surgically repaired. At 24 months after operation, the patient continues to receive prednisolone, azathioprine, and cyclophosphamide and is in good health, with good pulmonary autograft function.