Placement of an Open Stent Graft for Treatment of a Distal Aortic Arch Aneurysm and Migrated Stent Graft Nine Years after TEVAR for Stanford Type B Dissection / 日本心臓血管外科学会雑誌

A 76-year-old man who underwent thoracic endovascular aortic repair (TEVAR) of an early chronic phase of Stanford type B dissection developed a 71 mm distal aortic arch aneurysm in conjunction with the migration of its proximal end over 9 years of follow-up. The proximal end of the graft had migrated 7 cm distal to the takeoff of the left subclavian artery. The patient underwent total arch replacement with an open stent graft which was connected with the TEVAR graft. He was discharged home 15 days after surgery without complications.

Concomitant Transapical Transcatheter Aortic Valve Replacement and Off-Pump Coronary Artery Revascularization / 日本心臓血管外科学会雑誌

<p>An 84-year-old woman with severe aortic stenosis (AS) and coronary artery disease (CAD) was admitted repeatedly with syncope and heart failure. Due to her comorbidities, concomitant transapical transcatheter aortic valve replacement (TAVR) and off-pump coronary artery bypass grafting (OPCAB) were performed. She did well postoperatively. CAD is often found concurrently in patients presenting with severe symptomatic AS. Concomitant TAVR and OPCAB is considered as a less invasive and more feasible treatment option in high-risk patients.</p>

A Case of Aortic Regurgitation Accompanied by Multiple Metal Allergy Treated with Aortic Valve Replacement under Median Sternotomy / 日本心臓血管外科学会雑誌

A 58-year-old man who complained of dyspnea on effort was given a diagnosis of decompensated congestive heart failure. Echocardiography revealed severe aortic regurgitation and cardiomegaly. We decided to perform aortic valve replacement with a mechanical valve, however his past history made us suspicious of allergy to metal. From his previous patient records, we determined he was allergic to many metals : gold, iron, platinum, cobalt, chrome, bronze, and zinc. Newly performed skin patch tests showed positive reactions to aluminum, tin, palladium, indium, iridium and stainless steel. We selected a CarboMedics mechanical valve made of nickel-titanium alloy. Aortic valve replacement with a 27-mm CarboMedics mechanical valve was performed by median sternotomy. At sternum closure, we used polyester non-absorbable suture thread, instead of surgical steel wire, because it contains stainless steel. His postoperative progress was good and he was discharged on the 10th postoperative day. One year after surgery he is doing well without any allergic symptoms.

A Rare Case of Intracardiac Angiomyolipoma / 日本心臓血管外科学会雑誌

A 34-year-old woman was admitted with a history of syncope and a mass was detected in the right atrium (RA) by transthoracic echocardiography (TTE). Preoperative chest computed tomography (CT) also demonstrated an RA tumor measuring 4×3 cm. We performed resection of the RA tumor under cardiopulmonary bypass. Histopathological findings showed that the tumor was an angiomyolipoma. It is well known that angiomyolipomas are most frequently found in the kidney and are associated with tuberous scleroses. There was no evidence of tuberous sclerosis in this case. Primary tumors of the heart are rare. However, there have been a few intracardiac angiomyolipomas reported previously.