ABSTRACT
A 57-year-old man complained of dyspnea, and his echocardiography showed diffuse severe left ventricular dysfunction. Five days after admission and starting the treatment for congestive heart failure, a computed tomography pointed out DeBakey type 1 aortic dissection with a patent false lumen incidentally. The ostium of the left coronary artery was compressed with the false lumen, and this finding was thought to be a cause of development of left ventricular dysfunction. A modified Bentall procedure with bioprosthesis and total arch replacement were performed. The patient was discharged on the 28th postoperative day without any complications.
ABSTRACT
Retrograde type A aortic dissection (RTAD) following thoracic endovascular aortic repair (TEVAR) is a lethal complication. A 54-year-old woman with bovine aortic arch presented with dilatation of the descending aorta due to chronic type B aortic dissection. She underwent TEVAR in zone 2 for closure of the entry site just below the origin of the left subclavian artery. On the day after TEAVR, she showed right hemiparesis, and was diagnosed with cerebral infarction on MRI and RTAD on CT. She underwent an emergent operation. The entry was at the proximal end of the bovine trunk, where the edge of the bare stent stuck out. We performed partial arch replacement with entry resection. Her postoperative course was uneventful. She was transferred to another hospital for rehabilitation 37 days after the surgery.
ABSTRACT
<p>A 42 year-old woman with Marfan syndrome, who had replacement of the ascending aorta for acute aortic dissection several years ago, was found to have distal aortic arch aneurysm. The aneurysm had small entries at cervical arterial branches and large re-entry at the left external iliac artery. It was necessary to perform two-staged operation Bentall procedure with total arch replacement and abdominal aortic replacement with re-entry closure. It was usually performed with a primary entry closure for chronic aortic dissection, but massive invasion was expected. We performed catheter angiography for entry and re-entry, and decided to perform preceding re-entry closure. First, we underwent replacement of the abdominal aorta, and then successfully performed the Bentall procedure with total aortic arch replacement. The catheter angiography was useful for decision-making for medical treatment.</p>
ABSTRACT
A 65-year-old man was admitted with subacute myocardial infarction. During medical treatment, the patient lost consciousness as a result of an atrioventricular block and underwent an operation for an emergency percutaneous coronary intervention in the right coronary artery. In a follow-up examination, transthoracic echocardiography and computed tomography showed a left ventricular pseudo-false aneurysm, and therefore another operation was carried out. The operative findings showed that the heart markedly adhered to the pericardium and the aneurysm at the apex. The patient then underwent a double-patch closure of the ruptured point using an equine pericardial patch and a Dacron patch. No perioperative complication was observed. Left ventricular pseudo-false aneurysm is a rare complication following myocardial infarction. Here, we report a successful case of a double-patch closure of a pseudo-false aneurysm.
ABSTRACT
A 34-year-old woman had received a diagnosis of X-linked hypophosphatemic osteomalacia when she was born. As an adult she complained of general fatigue, palpitations dyspnea exertional and leg edema. Transthoracic echocardiography showed aortic stenosis and regurgitation with severe aortic valve calcification. Chest computed tomography revealed her ascending aorta to be circumferentially calcified. Surgery was performed through a median sternotomy via cardiopulmonary bypass, with perfusion from the right subclavian artery and the right femoral artery and drainage from the superior and the inferior venae cavae. A left ventricular venting cannula was inserted from the right superior pulmonary vein. When her bladder temperature had dropped to 28°C by central cooling, we stopped the perfusion from the right femoral artery and performed aortotomy. We examined the lumen and clamped the aorta at the usual site, while flushing with blood by femoral perfusion. Aortic valve calcification was observed to extend from the sinus of valsalva to the outflow tract of the left ventricle on the non-coronary cusp side. He was necessary to repair the aortic annulus due to a defect resulting from careful removal of the calcified valve. We then performed aortic valve replacement using a 19-mm Carpentier-Edwards perimount Magna. Her postoperative course was uneventful without any sign of neurological complications, and she was discharged 13 days after surgery. On pathological examination, localized ossification with calcification was observed in her aortic valve which seemed to be characteristic of X-linked hypophosphatemic osteomalacia.
ABSTRACT
We report a rare case of vasculo-Behçet's disease complicated by an intracardiac thrombus. A 48-year-old woman with a history of Behçet's disease and deep vein thrombosis in a lower limb, and who had been treated with colchicine and warfarin, was given a diagnosis of an appendectal tumor by colonoscopy. Preoperative examinations, including chest computed tomography, showed a pedunculated mobile tumor from her inferior <i>vena cava</i> (IVC) to the right atrium (RA). Urgent surgery was performed to prevent pulmonary embolism. We exposed the RA through a median sternotomy under cardiopulmonary bypass and extirpated the tumor that appeared macroscopically to be an organized thrombus attached to the IVC wall. The pathological diagnosis was organized thrombus. A month later, she underwent ileocecal resection and was given a pathological diagnosis of mucinous cystadenoma. Her postoperative course was uneventful. Intracardiac thrombus complicated by vasculo-Behçet's disease is rare, and it is important in the differential diagnosis of intracardiac tumor.
ABSTRACT
A 67-year-old man was given a diagnosis of lung cancer and thoracic aortic aneurysm (TAA). We first performed thoracic endovascular repair (TEVAR), and then right lower lobectomy for lung cancer. TEVAR shortened the operation time and yielded less operative damage. Therefore, TEVAR can be an effective choice for simultaneous surgery of TAA and lung cancer.
ABSTRACT
We report two cases of coronary artery fistulas (CAF) in children with successful surgical repair. The first case was a 14-year-old boy with a continuous heart murmur. A fistula was diagnosed between the right coronary artery (RCA) and the right atrium by echocardiography. He was asymptomatic, but the pulmonary to systemic flow ratio was shown to be high by cardiac catheterization. He underwent surgical closure of the fistula and coronary artery bypass grafting to the RCA with the right interthoracic artery. The second case was a 5-year-old boy with a continuous heart murmur and cardiomegaly on the chest X-ray film. The CAF from the left coronary artery to the right atrium was revealed by echocardiography. The pulmonary to systemic flow ratio was shown to be high by cardiac catheterization. He was asymptomatic, but he also underwent surgical closure of CAF. Surgical repair was effective and safe in these cases. Echocardiography was very useful in the diagonosis of CAF. Surgical repair in the young is recommended because CAF is much more likely to cause congestive heart failure, angina, and infective endocarditis when growing.
ABSTRACT
A 46-year-old man was given a diagnosis of hypertension about 20 years previously. At age 41, aortitis syndrome was diagnosed, with descending thoracic aortic aneurysm and the coarctation of abdominal aorta by CT scan. He then underwent surgery to replace the descending thoracic aortic aneurysm and right axillo-bifemoral bypass. Recently, a thoraco-abdominal aortic aneurysm was pointed out at the distal site of the graft and, he was referred to our institute. We occluded the distal end of the aneurysm using an endoluminal occlusion stent graft. Today, in most cases of aortopathy associated with aortitis syndrome, surgical replacement of the aneurysms and extra-anatomical bypass is performed. An endovascular stent graft treatment combined with extra-anatomical bypass could be useful for various aortic disorders.
ABSTRACT
A 38-year-old man underwent surgery for impending rupture of an inflammatory celiac artery aneurysm with a maximum diameter of about 50 mm. First, an extra-anatomical bypass was performed from the iliac arteries to the celiac artery, superior mesenteric artery and bilateral renal artery using ringed ePTFE grafts. Second, the celiac artery aneurysm at the distal site was directly closed and then a stent graft was placed in the abdominal aorta to cover the orifice of the celiac artery. An endovascular stent graft treatment combined with extra-anatomical bypass is useful for the treatment of inflammatory aneurysm to avoid the various surgical complications in Behçet syndrome.
ABSTRACT
A 20-year-old man suddenly complained of back pain and bilateral lower limb weakness. Computed tomography showed acute type B aortic dissection. The patent false lumen extended from distal arch to the left common iliac artery. The true lumen was severely compressed by the false lumen and both legs were ischemic. He underwent emergency fenestration of the abdominal aorta and stenting of the left iliac artery. Although the lower limbs ischemia was improved, he developed myonephropathic metabolic syndrome and received plasma exchange, continuous hemodialysis and endotoxin absorption therapy. Thirteen days after the operation, intestinal ischemia occurred and he underwent emergency bowel resection with creation of a stoma. Development of dissection to the superior mesenteric artery (SMA) and the malperfusion of SMA by severe compression of the true lumen were thought to cause intestinal ischemia.
ABSTRACT
Spinal cord ischemia is a very rare and unpredictable complication in surgery of infrarenal abdominal aortic aneurysms. A 65-year-old man who had a history of CABG (LITA-LAD, LITA-Y composite RA-OM) underwent resection of an abdominal aortic aneurysm. Postoperatively, he developed paraplegia and hypoesthesia with associated fecal incontinence. Reduction of collateral flows of patent lumbar arteries probably caused serious ischemia of the spinal cord. A standard infra-renal abdominal aorta surgery still has the risk of postoperative paraplegia, which should be incorporated in the preoperative informed consent.
ABSTRACT
We report a rare case of acute type A aortic dissection with paraplegia which was reversed using cerebrospinal fluid drainage (CFD). The patient was a 80-year-old man who was admitted with acute back pain and paraplegia. Computed tomographic scans showed an acute type A aortic dissection. Four hours after onset of paraplegia, CFD was initiated by inserting an intrathecal catheter at L3-L4. Cerebrospinal fluid was drained freely by gravity whenever the pressure exceeded 10cmH<sub>2</sub>O. After 32h, the neurological deficit was completely resolved. CFD can be considered a useful treatment in patients with paraplegia after acute aortic dissection.
ABSTRACT
We report a 5-year-old girl with a diagnosis of an anomalous origin of the left coronary artery from the pulmonary artery with an intramural aortic route. The left coronary artery entered the aortic wall running parallel to the aorta. With the aid of cardiopulmonary bypass, she underwent establishment of two coronary artery systems by intraaortic reconstruction (unroofing and anastomosis). Her postoperative course was uneventful. Postoperative cineangiogram demonstrated patency and prograde flow in the new coronary systems.
ABSTRACT
The activated clotting time (ACT) is used to assess adequacy of anticoagulation during cardiopulmonary bypass (CPB). However, ACT values during CPB do not correlate with heparin concentration and are affected by variations of such factors as hypothermia and hemodilution. ACT is also used to estimate protamine doses, because excess protamine may result in hypotension and an increase in bleeding after CPB. This study was designed to evaluate the effect of heparin and protamine administration that were administered based on whole blood heparin concentration using Hepcon/HMS (HC group) on the incidence of bleeding and blood transfusion after CPB. We treated 32 of adult cases and 36 pediatric cases. For the control group (NC group), an initial fixed dose of 300U/kg heparin was administered and if the ACT was less than 400s an additional fixed dose of 100U/kg heparin was administered. Heparin was neutralized with an initial fixed dose of protamine. For the HC group, the initial dose of heparin and the additional dose of heparin were based on an automated heparin dose response assay. The initial dose of protamine was based on the residual heparin concentration. The patients in the HC group received greater doses of heparin and lower doses of protamine than the patients in the NC group. In the pediatric HC group, the amount of TAT, FTC and D-dimer post CPB were smaller than those in the NC group. Operative time and closure time were similar the two groups. Operative bleeding, mediastinal chest tube drainage in the postoperative period were similar in the two groups. The volume of total blood transfusion was also comparable in the two groups. In conclusion, the monitoring of heparin concentration during CPB in children was effective for the maintenance of coagulation factors.
ABSTRACT
Preoperative hemodynamics in the lower limbs in 174 limbs of 103 patients were measured and investigated and the surgical results were evaluated. The subjects were divided into the C<sub>4-6</sub>-group, which included 51 limbs with skin changes, and the C<sub>2, 3</sub>-group, which consisted of 123 limbs without skin changes. Plethysmography showed that the maximum venous outflow was significantly higher, and the refilling time was shorter in the C<sub>4-6</sub>-group compared to the C<sub>2, 3</sub>-group. All C<sub>4-6</sub>-group patients had reflux of the long saphenous vein, and the reflux velocity and volume was significantly greater than in the C<sub>2, 3</sub>-group. Limbs with deep vein reflux accounted for 45% of the C<sub>4-6</sub>-group. We performed angioscopic deep vein external valvuloplasty in 23 of those limbs. There was no case of reccurence of skin changes at a mean follow-up of 22 months. However chronic venous insufficiency often was associated with multisegmental reflux lesions and in such cases it might be necessary to perform multiple surgical procedures to eliminate the reflux.
ABSTRACT
This is a case report of a rare combination of a single coronary artery and a coronary artery fistula. An 8-year-old girl was asymptomatic with a grade II continuous murmur in the third left intercostal space. Selective coronary angio-graphy revealed that a single coronary artery arising from the left aortic sinus was dilated and ended as a fistula to the outflow tract of the right ventricle. At operation, the fistula could not be exposed on the surface of the heart. On cardiopulmonary bypass, the aorta was clamped, and the fistula was closed by direct suture in the right ventricle. The postoperative course was uneventful with no complications.
ABSTRACT
To investigate the effect of nafamostat mesilate (FUT) for disseminated intravascular coagulation (DIC) after surgery using cardiopulmonary bypass, we studied DIC scores and parameters of coagulation and fibrinolysis in the DIC cases. Although 12 patients developed DIC, the platelet counts improved by administration of FUT apart from one complicated by sepsis. The DIC scores decreased as a result of the increase of platelets and fibrinogen and improvement of FDP. Thrombin-antithrombin III complex, D-dimer and plasmin-α<sub>2</sub> plasmin inhibitor complex showed an even higher value at the endpoint of FUT administration. These results indicate that patients with DIC after cardiopulmonary bypass may have severe fibrinolytic acceleration and that administration of FUT can be useful in those cases.
ABSTRACT
A 44-year-old woman with over 20 years history of rheumatic heart disease developed progressive heart failure from aortic stenosis and mitral restenosis after open mitral commissurotomy. In December, 1986, she underwent aortic and mitral valve replacements with Medtronic Hall prosthesis (aortic: 21mm, mitral: 27mm). Following an eventful recovery, she was discharged from the hospital and continued on a regimen of Coumadin. In February, 1991, the patient developed chest and back pain, which necessitated her emergency admission to our clinic. During the coronary examination, the aortic prosthetic occluder was not moving, fixed in the opening position, lasting from one to several minutes. She underwent emergency operation for replacement of the defective valve. At operation, we noted the pannus formation into the valve orifice on the inflow side of aortic prosthesis. She made a satisfactory recovery and has enjoyed good health since that time.
ABSTRACT
In a consecutive series of 160 surgically treated abdominal aortic aneurysm, four patients with acute aortic thrombotic occlusion of an abdominal aortic or iliac aneurysm were encountered. Three of four aneurysms were 7cm in diameter or smaller. Also, 3 of 4 patients had chronic occlusive disease of legs. Our mortality rate was 75%. The recommendation is made that all abdominal aortic aneurysms be resected if there is substantial associated distal occlusive disease.