ABSTRACT
A 70-year-old woman diagnosed with angina pectoris was scheduled to undergo off-pump coronary artery bypass grafting (OPCAB) using the left internal thoracic artery and the saphenous vein (SVG). We performed a proximal anastomosis of the SVG to the ascending aorta using a clampless proximal anastomotic device. When this device was removed from the ascending aorta after completion of the SVG proximal anastomosis, we noticed the extensive appearance of an ascending aortic adventitial hematoma. Transesophageal echocardiography revealed a flap in the ascending aorta, which was diagnosed as an iatrogenic aortic dissection. The decision was made to immediately perform an additional aortic replacement. There was an intimal tear consistent with the device insertion site, which was identified as the site for the development of aortic dissection. After performing an ascending aortic replacement, coronary artery bypass grafting was performed. Her postoperative course was uneventful, and enhanced CT on postoperative day 12 showed aortic dissection up to the level of the abdominal aorta, but the false lumen was completely thrombosed. Iatrogenic aortic dissection caused by proximal anastomotic device during OPCAB is a very rare but serious complication, and early intraoperative diagnosis and prompt additional surgical treatment were considered necessary to save the patient's life.
ABSTRACT
A 66-year-old woman attended our hospital for ascending aortic aneurysm. She was admitted with sudden back pain and acute aortic dissection of Stanford type B was revealed by computed tomography. We performed replacement of the ascending aorta and aortic arch with the frozen elephant trunk technique. The left pleural drainage fluid turned cloudy white after diet initiation on postoperative day 2. We diagnosed chylothorax with biochemical analysis and stopped oral intake completely, but the drainage increased to 3,700 ml/day. On postoperative day 8, completely thoracoscopic ligation of thoracic duct was performed. The drainage decreased immediately after the procedure. She could start meals on postoperative day 12 and was discharged on postoperative day 22. We conclude that a completely thoracoscopic ligation of thoracic duct for persistent chylothorax after aortic surgery can lead to early resolution.
ABSTRACT
<p>A 74-year-old male who had a medical history of thoracic endovascular aortic repair (TEVAR) was referred to us for endoleakage. A total of 21 years ago, he underwent emergent descending aortic grafting for aortic aneurysm rupture at his age of 53. After that, 19 years ago, he underwent TEVAR with Matsui-Kitamura stent graft (MKSG) due to pseudoaneurysm formation at the proximal anastomotic site at the age of 55. CT revealed type III endoleakage due to fracture of MKSG and graft. We proceeded to perform TEVAR with Relay Plus successfully, and his endoleakage disappeared. His postoperative course was uneventful. He was discharged from our hospital on the 9th day after the operation, and is now doing well.</p>
ABSTRACT
A 39-year-old woman was found to have a heart murmur by a medical examination at age 37. During a checkup at our hospital, echocardiography revealed mild aortic valve regurgitation (AR) and mild mitral valve regurgitation (MR). When she was 39 years old, echocardiography revealed severe MR and moderate AR. Based on preoperative examinations, antiphospholipid syndrome (APS) was diagnosed. Therefore, she received high-dose prednisolone therapy and underwent plasma exchange before the surgery. We performed double valve replacement using a bioprosthetic valve. On the first postoperative day (POD 1), the number of platelets suddenly decreased. We diagnosed catastrophic APS, and treated her with high-dose prednisolone, high-dose immunoglobulin and plasma exchange. Her blood platelet gradually increased on POD 3. Although she needed time for rehabilitation, she was discharged from our hospital on POD 88. APS can cause a catastrophic event triggered by an operation. Therefore, stringent pre- and postoperative management is necessary in patients with APS.
ABSTRACT
A 50-year-old man was referred to our hospital with a tumor in the left ventricle. He had suffered from rheumatic fever when 14 years old. He had shown signs of chronic heart failure due to atrial fibrillation and rheumatic valves (ASr, MSr) for 10 years. There was a history of unaccountable fever and rash, so infective endocarditis was suspected and echocardiography was performed. It showed a homogeneous mass with a diameter of approximately 10mm, fixed directly to the left ventricular septum 20mm below the aortic valvular ring. At operation, the tumor was excised together with endocardium and a part of the muscular coat. The rheumatic aortic and mitral valves were replaced with a 21mm SJM AHP and a 27mm SJM MTK mitral valve, respectively. Tricuspid annuloplasty (TAP) (De Vega 29mm) was also performed. Histopathological examination of the tumor revealed benign papillary fibroelastoma. It suggested that the tumors were secondary to mechanical wear and tear, and represent a degenerative process due to rheumatic valve disease.