Successful Endovascular Repair of a Kommerell's Diverticulum and a Right-Sided Aortic Arch.

BACKGROUND: A 57-year-old woman was diagnosed with Kommerell's diverticulum in the setting of a right aortic arch on computed tomography. CASE REPORT: Although asymptomatic, the maximum diameter of the aneurysm was 55 mm; thus, she underwent surgery to prevent rupture of the aneurysm. A bypass was constructed from the left common carotid artery to the left subclavian artery. A stent-graft was deployed from the distal right subclavian artery, and coil embolization of the diverticulum was performed via the left subclavian artery. She was discharged after 12 days of surgery. The postoperative four-month follow up showed a smaller aneurysm. CONCLUSION: Thoracic endovascular aortic repair is feasible and effective for Kommerell's diverticulum.

Retrograde Type A Aortic Dissection after Thoracic Endovascular Aortic Repair for Type B Dissection.

BACKGROUND: A 64-year-old woman presented with dilatation of the distal aortic arch secondary to chronic type B aortic dissection. CASE REPORT: The patient underwent fenestrated thoracic endovascular aortic repair (TEVAR) for closure of the entry site, and reconstruction of the left subclavian artery with a covered stent. On the 40th postoperative day, a retrograde type A aortic dissection (RTAD) was observed on computed tomography and she underwent emergency surgery. The entry tear, related to the proximal bare metal stent, was located in front of the aortic arch. A partial aortic arch replacement was performed. CONCLUSION: Consideration of the risk factors of RTAD is important when performing TEVAR.

[Stanford type B aortic dissection associated with coarctation of the aorta].

We report a rare case of type B aortic dissection associated with coarctation of the aorta. A 35-year-old man had sudden dyspnea and severe back pain. Computed tomography revealed aortic coarctation at the distal aortic arch, and aortic dissection below the coarctation. The diameter of proximal descending aorta was enlarged to 52 mm. We electively performed excision of aortic coarctation and descending aortic graft replacement. Coarctation of the aorta has a poor prognosis, The risk of aortic rupture due to aortic dissection is very high, and the histological abnormality is also pointed out. Therefore we should perform aggressive surgical treatment.

[Reoperation for a giant aortic arch aneurysm using cervical cannulation of the common carotid artery for cerebral perfusion after the ascending aortic replacement; report of a case].

Reoperation for a giant thoracic aneurysm touching the sternum needs to be performed with special precautions. The patient was a 65-year-old man who had undergone ascending aortic replacement due to acute Stanford type A dissection 5 years previously. He visited an outpatient clinic after an interval of 4 years, and was diagnosed with an aortic arch aneurysm which was touching the sternum. Preoperative examinations suggested a high risk of rupture if resternotomy was performed. Therefore, we performed resternotomy under cardiopulmonary bypass. In addition, the left carotid artery was secured for cerebral perfusion through a neck incision, which enabled core cooling in case of uncontrollable hemorrhage. He successfully underwent aortic arch replacement, and he was discharged without any neurological complications.

Benign symmetric lipomatosis in a 73-year-old man: a case report with a brief review of the literature.

Benign symmetric lipomatosis (BSL) is a rare disease which is characterized by symmetric diffuse deposition of mature fat tissue and considered to originate in brown fat. A case of benign symmetric lipomatosis in a 73-year old man is presented. He has been treated for alcoholic abuse in mental hospitals several times and referred to our hospital for evaluation and treatment of the subcutaneous tumor in the neck, bilateral supraclavicular areas, bilateral upper arms, anterior chest wall, back, and the abdomen. Resected tumors had ill-defined margin and smooth surface. Histologically, the tumor was composed of diffuse proliferation of mature fat tissues, focal myxoid change and spindle cell proliferation. A histopathological diagnosis of lipomatosis with focal spindle cell proliferation was made. Although several hypotheses of this disease have been postulated, the present case suggested that the etiology of BSL is closely related with alcoholic abuse-induced metabolic disorder and deteriorated function of adipocytes due to specific location of tumor.