Surgical repair of a giant pulmonary artery aneurysm that caused severe left bronchial obstruction.

A 63-year-old woman on oral steroids for systemic lupus erythematosus presented with a giant pulmonary artery aneurysm severely compressing the left main bronchus and lung. Her presenting symptom was severe respiratory distress. Surgical graft replacement of the main and branch pulmonary arteries was performed, and her respiratory function improved dramatically. Bronchial obstruction was resolved immediately after the procedure.

Complete repair with unifocalization of the only unilateral lung.

A boy with 22q11.2 deletion was diagnosed with pulmonary atresia with ventricular septal defect (PAVSD) and major aortopulmonary collateral arteries (MAPCAs). At 8 months, unifocalization of left MAPCAs and BT shunt was performed at another hospital. However, they occluded directly after surgery. An angiography revealed 2 MAPCAs supplying all segments of the right lung. Qp:Qs was 2.24. At 1 year 6 months, we performed VSD closure with unifocalization of the only right lung vascularity, using intraoperative PA flow study. We report a successful case of complete repair with unilateral lung in PAVSD and MAPCAs.

Pediatric Case of Staphylococcus lugdunensis-Induced Infective Endocarditis at Bovine Jugular Vein.

A 2-year-old boy underwent repeat right ventricular outflow tract reconstruction (re-RVOTR) with a bovine jugular vein (BJV) graft. He presented with high fever on postoperative day 6. Blood and drainage effusion cultures were all positive for Staphylococcus lugdunensis and vancomycin was prescribed. Echocardiography showed vegetation at the BJV. Re-re-RVOTR was performed 51 days after re-RVOTR. In the operation, vegetation was adhered to the right-sided leaflet and three leaflets were degenerated. After complete BJV graft resection, an expanded polytetrafluoroethylene conduit with trileaflets was implanted. There was no sign of recurrent infection 8 months after the surgery.

Novel Left Atrioventricular Valvuloplasty for Atrioventricular Septal Defect.

An infant boy with 21 trisomy was diagnosed with complete atrioventricular septal defect-Rastelli type A with parachute left atrioventricular valve and absent left mural leaflet. Biventricular repair was difficult in infancy because the left ventricular volume and left atrioventricular valve annulus were too small. After 2 pulmonary artery bandings, the left atrioventricular valve annulus increased to 85% of normal mitral valve, and the left ventricular end-diastolic volume increased to 98% of normal. We report a successful instance of complete atrioventricular septal defect that achieved biventricular repair via novel left atrioventricular valvuloplasty for parachute left atrioventricular valve and absent left mural leaflet.

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.

Dilated right internal thoracic artery as a systemic pulmonary shunt.

We report the use of a dilated right internal thoracic artery as a systemic-pulmonary shunt in a patient with a single ventricle who developed a systemic-pulmonary shunt stenosis following a modified Norwood's procedure. The systemic-to-pulmonary artery shunt was performed at 13 months of age, and the patient has stable oxygen saturations five years after the surgery.

Novel three-sinus enlargement technique for supravalvular aortic stenosis without aortic transection.

BACKGROUND: Although repair of a supravalvular aortic stenosis (SVAS) can be performed with low mortality rates, surgery for the complex form of SVAS continues to be associated with a high incidence of residual stenosis. CASE PRESENTATION: The patient was referred to our hospital at 1 month of age and was diagnosed with aortic valve stenosis (AS) by using echocardiography. Cardiac catheterization revealed moderate AS, and subsequent left ventriculography revealed discrete stenosis of the sino-tubular junction and a narrowed proximal ascending aorta. We performed a reconstructive operation for such heart defects involving novel three-sinus and ascending aorta enlargement without aortic root transection in a 6-month-old boy. CONCLUSION: Our novel three-sinus enlargement technique is suitable for treating each type of SVAS and is a useful method for a baby particularly less than 10 kg without disturbing the growth of the ascending aorta.

[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.