ABSTRACT
<p>A 79-year-old man, who had a history of intravesical instillations of bacillus Calmette-Guérin (BCG) therapy for urinary bladder cancer, developed bloody sputum 4 years after BCG therapy. BCG was detected from the sputum by detailed examination. Medical therapy for tuberculosis (TB) was started, but bloody sputum continued. Computed tomography (CT) for the chest was performed to evaluate the state of TB, and surprisingly, found impending rupture of tuberculosis mycotic thoracic aneurysm. He was emergently transferred to our hospital. CT revealed that the aneurysm made a lump with surrounding lung and lymph nodes. It seemed to be quite difficult to dissect and to be quite high risk to perform graft replacement with pneumonectomy. On the other hand, TB infection was controlled with antibiotic therapy. Thus we chose debranch TEVAR for this complicated situation. His bloody sputum regressed soon after the procedure and disappeared during his hospitalization. He was discharged home on POD 13 without serious complication and continued to have antibiotic therapy under the instruction of his primary physician.</p>
ABSTRACT
A 74-year-old woman was referred to our unit with a chief complaint of dysphagia. Enhanced CT showed a Kommerell diverticulum with a maximum diameter of 46 mm, associated with a right-sided aortic arch and aberrant left subclavian artery. We performed two-staged operations : left subclavian-common carotid artery bypass followed by total arch, and descending aortic replacement by an antero-lateral thoracotomy with partial sternotomy (ALPS). The postoperative course was uneventful. Total arch and descending aortic replacement for a Kommerell diverticulum by an ALPS approach is rare. ALPS approach for Kommerell diverticulum achieves safe surgery with good exposure.
ABSTRACT
PA-LA communication is a rare congenital heart disease consisting of direct communication between a branch of the PA and LA through an aneurysmal structure. This disease reveals the central cyanosis with clubbed fingers and surgical repair is needed when symptoms are apparent. Computed tomography is highly recommended for definitive diagnosis. Angiographic catheterization is also recommended to support the diagnosis and decide on the treatment. PA-LA communication is categorized into 4 types. Two types do not need cardiopulmonary bypass (CPB) when treated surgically, but the others need CPB. A 16-year-old girl with clubbed fingers was found to have PA-LA communication by 3DCT. She underwent surgery and was discharged in good condition. The surgical procedure was done through median sternotomy without CPB. The anomalous aneurysmal fistula was doubly ligated. No communication was found after ligation by TEE.
ABSTRACT
A 76-year-old woman with abdominal aortic aneurysm coexisting horseshoe kidney and pelvic arteriovenous malformation (AVM) is reported. Operation was performed by a transperitoneal approach via typical median laparotomy. The aneurysm was successfully replaced by a bifurcated prosthetic graft without division of the renal isthmus. Cold lactated Ringer solution was injected into an aberrant renal artery at the time of aortic cross-clamping. This was useful not only to protect the kidney against ischemic injury, but also to know the perfusion area of the vessel. The aberrant renal artery was attached to the prosthetic graft following the aortic proximal anastomosis. Though a part of the asymptomatic AVM, which involved the left ureter, ovary, and uterus, was located anterior to the left iliac arteries, distal anastomoses at the internal and external iliac arteries were done smoothly. No surgical intervention was applied to the AVM in the operation. The post-operative course was uneventful.
ABSTRACT
A 25-year-old woman, at 38 weeks of gestation, suddenly developed a left lumbar pain. Emergency cesarean section was performed to rescue the fetus since there was fetal bradycardia. At operation, a slight amount of retroperitoneal hematoma was observed, but was left without further examination. After the surgery, the patient complained of severe lumbar pain and fell into shock. A ruptured aneurysm of the left renal artery was suspected by computed abdominal tomography. At the second operation, a massive hematoma was observed in the retroperitoneal space, and a ruptured aneurysm of the left renal artery was confirmed after mobilization of the left kidney with the aid of manual hemostasis. Aneurysmectomy with arterial reconstruction was not considered feasible, and complete left nephrectomy was done because the patient was severely ill, in addition to the fact that the aneurysm was located at the trifurcation of the left main renal artery. The postoperative course was uneventful. On the surgical specimen the aneurysm measured 27mm in circular length, the lower half of which was ruptured. Histologically, the internal elastic lamina was torn, and the medial smooth muscle fibers were sporadically replaced with fibroblastic cells. The prognosis of ruptured aneurysm of a renal artery is often lethal. Therefore it is very important to suspect this lesion when we have to manage physical problems with patients in pregnancy so that we can make an early diagnosis with better results.