Axillary Artery Perfusion in Arteriosclerotic Thoracic Aortic Aneurysm / 日本心臓血管外科学会雑誌

Between 1996 to 2000, 12 patients with arteriosclerotic thoracic aortic aneurysm underwent surgery with cardiopulmonary bypass using the right axillary artery as an arterial inflow. All patients received total arch replacement with selective cerebral perfusion and deep hypothermic circulatory arrest. One patient with occlusion of the left carotid artery died of postoperative stroke. There were no postoperative complications or deaths related to axillary artery perfusion except for cerebrovascular accidents. Perfusion through the axillary artery, providing antegrade aortic flow, is a safe and effective procedure to avoid stroke owing to retrograde arterial perfusion. We believe that the axillary artery could be an alternative to conventional femoral artery cannulation in the setting of aortic arch operations.

Endovascular Stent-Grafting in a Patient with Concomitant Descending Thoracic Aortic Aneurysm and Cancer of the Right Lung / 日本心臓血管外科学会雑誌

A 75-year-old woman underwent endovascular stent-grafting for a descending thoracic aortic aneurysm, followed by video-assisted thoracoscopic right upper lobectomy for concomitant lung cancer in a later procedure. Two custom-made endovascular spiral Z stents covered with woven Dacron (DuPont Co., Wilmington, DE, USA) were delivered via the femoral artery under local anesthesia using pull-through technique. Intraoperative angiograms showed successful exclusion of the aneurysm without any endoleakage. Conventional surgical treatments for both diseases in this patient would have required bilateral thoracotomy either in a simultaneous or staged fashion and entail risks of postoperative pulmonary dysfunction and progression of the cancer. Endovascular stent-grafting offered potential superior operative results and quality of postoperative life in this patient with concomitant descending thoracic aortic aneurysm and cancer of the right lung.

A Case of Pulmonary Valve Dysplasia / 日本心臓血管外科学会雑誌

A 2-year-old girl who had been followed because of pulmonary valve stenosis since birth, underwent unsuccessful balloon valvuloplasty twice. The angiographic study showed thin cusps and remarkably thick and immobile filling defects in the main pulmonary artery, which indicated supravalvular PS or pulmonary valve dysplasia. Operation was done under conditions of a beating heart and total cardiopulmonary bypass. Pulmonary valve dysplasia was localized on the edge of all three cusps. After resection of the dysplastic lesion, the stenosis was released and slight regurgitation was observed by ultrasonography study.