ABSTRACT
A 31-year-old woman was admitted to our hospital with a sudden onset of chest pain and dyspnea. Echocardiography, chest CT, and chest MRI revealed a huge mass in the right atrium. She underwent pericardial drainage to alleviate cardiac tamponade. Emergency surgery was performed because of superior vena cava syndrome and the risk of tricuspid valve obstruction by the mass. The tumor was resected en bloc, including the right atrial wall and a large segment of the proximal superior vena cava. The right atrium was then reconstructed with a Xenomedica patch and the superior vena cava was reconstructed using an expanded polytetrafluoroethylene (ePTFE) vascular graft. The pathological diagnosis was haemangiosarcoma. Cardiac angiosarcoma is a rare tumor, and its prognosis is very poor. The patient could survive for about 5 months after surgical resection.
ABSTRACT
A 51-year-old man developed a high fever with congestive heart failure after treatment for his dental caries and was admitted to our hospital. Transesophageal echocardiogram showed severe aortic regurgitation with a bicuspid aortic valve where vegetation and perforation was identified on its leaflets. Infective endocarditis caused by <i>Streptococcus constellatus</i> was diagnosed by blood culture. A computed tomography scan of the chest showed enlargement of his ascending aorta with a maximum diameter of 5.0cm. After treatment with antibiotics and diuretics for 60 days, he underwent surgical treatment for his aortic valve and ascending aorta. After excising the diseased aortic leaflets with vegetation, a mechanical prosthetic valve (Carbomedicus 23mm) was implanted. His ascending aorta was also replaced separately with a woven Dacron tube graft. There was an anomalous origin of the right coronary artery which was detached from the ascending aortic wall as a button and was implanted on the tube graft. Histologically the aortic wall showed disappearance of elastic fibers with myxomatous degeneration in the media. Immunohistochemical staining also revealed that matrix metalloproteinase-2 (MMP-2) was strongly expressed in the aortic media. The postoperative course was uneventful and he was discharged on the 37th postoperative day.
ABSTRACT
We present a rare case of acute type A dissection which developed compression of the true lumen after starting cardiopulmonary bypass (CPB) with femoral arterial return. In this case, the entry was located in the proximal descending thoracic aorta, and the dissection expanded up to the ascending aorta in a retrograde direction. After starting CPB, the false lumen suddenly enlarged and the true lumen was compressed. We observed those changes by intraoperative transesophageal echocardiography, so the perfusion was stopped immediately. A long arterial cannula (Wessex) was inserted from the left ventricular apex with the tip of the cannula remaining in the true lumen of the ascending aorta, and antegrade perfusion was restarted. After that we could maintain adequate extracorporeal perfusion and the replacement of the total aortic arch was completed uneventfully.
ABSTRACT
The case presented is a 76-year-old woman with a ruptured abdominal aortic aneurysm. We tried to pass a Fogarty balloon catheter from the left subclavian artery for proximal occlusion of the ruptured aneurysm but failed to inset the balloon into the descending aorta. Although the aneurysm was safely replaced with a gelatine coated dacron graft, she developed cerebral embolism and never regained consciousness and died two months later. Balloon insertion through the subclavian artery may cause complication through dislodgement of atheromatous plaque and may induce cerebral embolism.