RESUMO
The patient was a 60-year-old woman who underwent thoracoabdominal aorta replacement for type B aortic dissection three years ago and aortic root replacement and total aortic arch replacement due to asymptomatic type A aortic dissection two years previously. Her clinical course was uneventful until follow-up computed tomography (CT) disclosed anastomotic insufficiency in the innominate artery and left main coronary artery stenosis owing to hematoma. Emergent percutaneous coronary intervention and stent graft insertion into the innominate artery were performed successfully. Seven months later, however, CT scan revealed a perforation in the posterior wall of the artificial graft damaged by the edge of the implanted stent graft. The patient underwent open surgery and perforation of artificial graft was sutured and redundant stent graft edge was resected. Artificial graft damage by stent graft placement is rare to date, but may increase in the future in accordance with broader application of endovascular treatment.
Assuntos
Aneurisma da Aorta Torácica , Dissecção Aórtica , Implante de Prótese Vascular , Procedimentos Endovasculares , Humanos , Feminino , Pessoa de Meia-Idade , Prótese Vascular , Tronco Braquiocefálico/diagnóstico por imagem , Tronco Braquiocefálico/cirurgia , Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/métodos , Resultado do Tratamento , Stents , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgiaRESUMO
A state in which thrombus is found in both right and left atria with thrombus penetrating the foramen ovale is called as impending paradoxical embolism (IPE). A 42-year-old man was found to have poor oxygenation and shock when his body was turned prone after induction of anesthesia. We inserted percutaneous cardiopulmonary support (PCPS), and his blood pressure was maintained. Transesophageal echocardiography revealed right heart pressure overload and left atrial thrombus. Computed tomography (CT) showed thrombosis in both main pulmonary arteries. The patient was judged to require emergency surgery. Bilateral pulmonary artery thrombus and thrombus between the right and left atria was removed under hypothermia using a heart-lung machine. Postoperatively, thrombus was detected in the bilateral posterior tibial vein and peroneal vein. He had a good postoperative course. There were few reports of IPE with pulmonary embolism that developed during operation.