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Article in Japanese | WPRIM | ID: wpr-367188


A 74-year-old man who had received graft replacement of ruptured abdominal aortic aneurysm 6 years previously was admitted to our hospital because of hematemesis. Gastroduodenoscopy revealed no bleeding site in the stomach or the first and second portions of the duodenum. Preoperative CT scan demonstrated an adhesion of the aorta-duodenum at the proximal anastomosis of the prosthetic graft. Preoperative angiography demonstrated no leak of contrast material at the proximal anastomosis of the prosthetic graft. Therefore, we performed an emergency operation under a diagnosis of an aortoduodenal fistula. Operative reconstruction was performed with <i>in situ</i> grafting using a new prosthetic graft, and the greater omentum was used to fill defects surrounding the anastomotic site. We report a case of surgical treatment for an anastomotic aneurysm associated with a graft-duodenal fistula after abdominal aortic aneurysm repair.

Article in Japanese | WPRIM | ID: wpr-367130


We report a case of surgical treatment of iatrogenic cardiac trauma. A patient with cardiac tamponade was treated by pericardiocentesis. During pericardiocentesis both right and left ventricles were perforated. These perforations were repaired in the beating heart state using 20 monofilament mattress sutures reinforced by felt pledgets. Iatrogenic cardiac trauma is rare. Fatal complications might arise when proper procedures are not followed during the placement of a catheter for pericardiocentesis. Here we present successfull surgical treatment of cardiac penetrations induced by pericardiocentesis.

Article in Japanese | WPRIM | ID: wpr-366546


We report a very rare case of a coronary artery fistula with communication between the right coronary artery and the left atrium. The patient was a 45 year-old woman admitted for evaluation of heart murmur. Selective coronary angiography demonstrated right coronary artery-left atrial fistula. The operation was indicated due to volume overload of the left ventricle. At operation, the proximal portion of the coronary fistula was successfully ligated from the epicardial side and the entrance of the fistula into the left atrium was directly closed from the inside of the left atrium under the cardiopulmonary bypass. The post-operative course was uneventful. Post-operative coronary angiography showed disappearance of the fistula. Angiography 6 months later, demonstrated that the orifice of the right coronary artery remained dilated, while the diameter of the distal site was normalized.