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Ventricular septal rupture (VSR) is a rare but fatal complication after acute myocardial infarction (AMI). However, the mortality in patients with recent VSR and appropriate timing of surgical repair have not been clarified. To examine the background characteristics and mortality of VSR patients as well as the usefulness and appropriate timing of surgery in this patient cohort. Among 3,947 consecutive patients with AMI at our hospital, 39 patients diagnosed with VSR from 2002 to 2020 were included in the analysis. All patients underwent transthoracic echocardiography to confirm VSR on admission. Coronary angiography (CAG) and measurement of pulmonary-systemic flow ratio were performed before emergent surgery. The use of mechanical support devices before or after procedures was considered for all patients who underwent CAG. Basically, we performed emergent or urgent operations to patients who were in a shock state or who needed mechanical support. The final decision of the timing of the operation was made by the cardiac team. Patients' mean age was 76.3 years, and 33.3% of them were males. Most culprit lesions were located in the left anterior ascending artery (81.3%). The mean pulmonary-systemic flow ratio after VSR onset was 3.07 ± 1.98. On admission, 48.7% of patients were in a shock state. Surgical repair was possible in 28 patients at a median of 1 day after admission, with a mortality rate of 25%. Among all patients, the mortality rate was 43.6%. Survivors were significantly younger (71.3 ± 11.3 vs. 82.7 ± 6.2 years, p < 0.01), had higher mean arterial blood pressure (75.6 ± 14.4 vs. 62.8 ± 16.2 mmHg, p = 0.0496) and lower ejection fraction (44.3 ± 11.7% vs. 54.8 ± 7.9%, p = 0.04), and underwent surgical repair more frequently (95.5% vs. 41.2%, p < 0.01) than the non-survivors. In multivariate analysis, younger age (odds ratio [OR] 1.18 95% confidence interval [CI] 1.01-1.38, p = 0.04) and surgical repair (OR 0.04, 95% CI 0.00-0.73, p = 0.03) were significant predictors of survival. In surgical repair cases, time from admission to operation did not differ significantly between survivors and non-survivors. Surgical repair and younger age are predictors of survival in patients with recent VSR, but the timing of surgery was not.
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Procedimientos Quirúrgicos Cardíacos , Infarto del Miocardio/mortalidad , Rotura Septal Ventricular/mortalidad , Rotura Septal Ventricular/cirugía , Factores de Edad , Anciano , Anciano de 80 o más Años , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/mortalidad , Femenino , Humanos , Incidencia , Japón/epidemiología , Masculino , Infarto del Miocardio/diagnóstico por imagen , Admisión del Paciente , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Tiempo de Tratamiento , Resultado del Tratamiento , Rotura Septal Ventricular/diagnóstico por imagenRESUMEN
An 80-year-old woman with essential thrombocythemia was diagnosed with severe mitral regurgitation and moderate tricuspid regurgitation. Preoperatively, she had been treated with hydroxycarbamide and low-dose aspirin since her platelet count was high( 96.2×104/µl). After the platelet count was reduced to 46.2×104/µl, she underwent mitral valve repair and tricuspid valve annuloplasty. Atypical heparin resistance was noted intraoperatively. After initial heparin infusion, the activated clotting time(ACT) increased as expected. However, it decreased after initiation of cardiopulmonary bypass, despite additional heparin infusion and heparin concentration maintenance. A correlation between platelet factor 4 and heparin resistance was suggested. On discharge, she had no complications. We should consider the possibility of heparin resistance in essential thrombocythemia even when platelet count is adequately controlled.
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Anuloplastia de la Válvula Mitral , Insuficiencia de la Válvula Mitral , Trombocitemia Esencial , Insuficiencia de la Válvula Tricúspide , Anciano de 80 o más Años , Femenino , Humanos , Válvula Mitral , Insuficiencia de la Válvula Mitral/etiología , Trombocitemia Esencial/complicaciones , Válvula TricúspideRESUMEN
A 48-year-old man underwent aortic root remodeling for a giant aneurysm of sinus of Valsalva, 98 mm in diameter, as well as a bicuspid aortic valve. The aortic valve was defined as type 0(L-R) according to Sievers classification and the aortic annulus was highly dilated up to 35 mm. Geometric height of the left and right cusps were 22 mm and 32 mm in diameter, respectively. Dacron straight graft of 24 mm was chosen and each tongue was then created in a 180°fashion. After completion of root reconstruction, external circular suture annuloplasty using CV-0 expanded polytetrafluoroethylene (ePTFE) was made to adjust the annulus down to 22 mm in diameter. The free margin of both cusps were centrally plicated to raise the effective height to 9 mm. Postoperative echocardiography at 2 year showed trivial aortic regurgitation but no root re-dilatation. Remodeling with external circular suture annuloplasty is a reproducible and reliable method to stabilize the root, even for the patient with a giant aneurysm of sinus of Valsalva.
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Válvula Aórtica/anomalías , Enfermedades de las Válvulas Cardíacas/cirugía , Válvula Aórtica/cirugía , Enfermedad de la Válvula Aórtica Bicúspide , Dilatación Patológica , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Myocardial ischemia due to acute type A dissection is a fatal complication. This study was undertaken to evaluate the surgical results of acute type A aortic dissection with myocardial ischemia. Between 1986 and 2014, 364 patients were treated for acute type A dissection in our hospital. Twenty-four patients were underwent myocardial revascularization. Preoperative coronary artery stent placement was involved in 2, coronary-artery bypass grafting (CABG) 18 (right 12, left 4, both 2), reCABG 2, and Carrel patch with coronary orifice restoration 2. Seven of CABG group had no symptom of myocardial ischemia, but right coronary artery was circumferentially detached from the intimal ostia. Hospital mortality was 20.1% in patients who underwent CABG. Sixteen patients with significant electrocardiogram ischemic change were not undertaken with CABG, because coronary artery was not involved by dissection. In these cases, acute aortic valve regurgitation, loss of backward pressure from distal aorta, or valve formation by intimal tear in ascending aorta might decrease diastolic pressure at aortic root and make myocardial ischemia.
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Aneurisma de la Aorta Torácica/complicaciones , Aneurisma de la Aorta Torácica/cirugía , Disección Aórtica/complicaciones , Disección Aórtica/cirugía , Puente de Arteria Coronaria , Isquemia Miocárdica/etiología , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/cirugía , Revascularización Miocárdica , StentsRESUMEN
Takayasu's arteritis (TA), also known as pulseless disease and young female arteritis, is a chronic inflammatory large-vessel vasculitis (LVV). TA is pathologically characterized by arterial wall thickening, stenotic/occlusive lesions, aneurysm formation, and dissection. TA usually develops between 20 and 30 years of age. However, pregnancy and puerperium can affect the immune system, and several cases of postpartum onset or flare-up of TA have been reported. Herein, we report an extremely rare case of postpartum-onset TA complicated by aortic dissection. This is a case of Postpartum onset Takayasu's arteritis presenting with aortic dissection. A 34-year-old healthy woman was performed cesarean section. After 2 weeks, she presented with chest pain and fever, followed by mild dysphagia and hoarseness. Laboratory findings showed C-reactive protein (CRP) 21.61 mg/dl and computed tomography (CT) demonstrated thickening of the vessel wall of mainly ascending aorta. 18F-fluorodeoxyglucose (FDG)-position emission tomography (PET)/CT revealed high FDG uptake in the same areas. We diagnosed with TA and steroid pulse therapy was started. However, five days after treatment, the patient developed worsening symptoms of hoarseness. A contrast-enhanced CT showed Stanford A type dissection, and emergency artificial vessel replacement was performed. The specimen from surgical resection of the ascending aorta suggested active TA associated with dissection. The prednisolone dosage was gradually tapered with tocilizumab. Then, her symptoms and laboratory findings improved. It is important to recall the onset of TA and/or arterial dissection, when patients develop chest pain and hoarseness in the postpartum period.
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We describe the case of a 68-year-old man who underwent ascending aortic replacement and thoracic endovascular aortic repair. Four years later, the patient developed neck pain on the right side and chest computed tomography showed expansion of fluid in the mediastinum which had extended to the neck. Echocardiography revealed advanced severity of aortic regurgitation and decreased ejection fraction. Given the progression of aortic regurgitation, decreased cardiac function, and rapidly expanding fluid accumulation causing neck pain, reoperation was indicated. All microbiological test including polymerase chain reaction were negative indicating absence of any infection. The patient is being followed-up without antibiotics and CT has not shown peri-graft fluid 2 years postoperatively. Since infection cannot be excluded completely, it is important to assess the condition with selective medium, extended culture periods, genetic testing, and consultations with microbiology laboratories when normal culture tests for general bacteria, and fungi are negative which can help avoid drug-resistant bacteria count, elevated medical costs, and drug side effects due to the improper use of antibiotics through proper diagnosis.
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Insuficiencia de la Válvula Aórtica , Masculino , Humanos , Anciano , Dolor de Cuello , Complicaciones Posoperatorias , Antibacterianos , InflamaciónRESUMEN
BACKGROUND: Anomalous aortic origin of the coronary artery (AAOCA) is a rare congenital heart disease. Therefore, optimal indications for surgery in patients with severe aortic valve stenosis (AS) complicated by AAOCA remain uncertain. CASE PRESENTATION: We report the case of a 57-year-old male patient who underwent aortic valve replacement (AVR) and aortic root enlargement using a Y-incision procedure for severe AS with an anomalous aortic origin of the right coronary artery (AAORCA). Since preoperative single-photon emission computed tomography revealed no ischaemic lesions, an aortic root enlargement with a Y-incision was performed to prevent the potential compression of the prosthetic valve on the AAOCA and prosthesis-patient mismatch. CONCLUSIONS: Preoperative evaluation of the coronary anatomy and myocardial ischaemia using advanced imaging modalities and aortic root enlargement with the Y-incision procedure is an effective strategy for preventing ischaemic complications in cases of severe AS with AAORCA.
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Estenosis de la Válvula Aórtica , Anomalías de los Vasos Coronarios , Implantación de Prótesis de Válvulas Cardíacas , Masculino , Humanos , Persona de Mediana Edad , Aorta Torácica/cirugía , Anomalías de los Vasos Coronarios/complicaciones , Anomalías de los Vasos Coronarios/cirugía , Estenosis de la Válvula Aórtica/complicaciones , Estenosis de la Válvula Aórtica/cirugía , Válvula Aórtica/cirugía , Válvula Aórtica/anomalías , Implantación de Prótesis de Válvulas Cardíacas/métodosRESUMEN
BACKGROUND: Acute coronary artery obstruction is a rare but lethal complication of surgical aortic valve replacement (SAVR), which may be caused by embolization of resected native tissue such as calcium plaque, thrombus, or perivalvular aortic tissue like fat embolus. Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are the main treatment modalities. PCI is less invasive, but it is difficult to determine its feasibility intraoperatively. CASE PRESENTATION: We report an 86-year-old woman who had asymptomatic severe aortic stenosis. She had scleroderma with an intractable left leg ulcer and bilateral leg varices. Considering the possibility of the spread of infection from the leg wound, SAVR was performed via right anterior thoracotomy to avoid complications such as mediastinitis. Coronary artery occlusion was suspected after weaning of cardiopulmonary bypass in the operation room due to asynergy with ST elevation and new severe mitral regurgitation. Transoesophageal echocardiography (TEE) helped diagnose coronary obstruction by embolus based on the degree of stenosis and the movement of the stenosis site. Percutaneous catheter intervention was performed successfully to restore coronary perfusion. CONCLUSION: TEE facilitated the diagnosis of coronary artery stenosis caused by an embolus and helped in determining the feasibility of percutaneous catheter intervention, thus allowing us to choose PCI over CABG as a less invasive surgery. This is especially invaluable in cases where obtaining a saphenous graft for CABG is difficult or where CABG would have required conversion from minimally invasive surgery (anterolateral approach) to median sternotomy.
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Estenosis de la Válvula Aórtica , Enfermedad de la Arteria Coronaria , Embolia , Intervención Coronaria Percutánea , Anciano de 80 o más Años , Femenino , Humanos , Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/complicaciones , Constricción Patológica/complicaciones , Enfermedad de la Arteria Coronaria/cirugía , Toma de Decisiones , Embolia/complicaciones , Enfermedad Iatrogénica , Resultado del TratamientoRESUMEN
OBJECTIVE: Median sternotomy is a standard approach in cardiovascular surgery, and wire fixation is commonly used for sternal closure. However, postoperative intermittent stress on the sternum can lead to sternal breakdown, potentially resulting in deep sternal wound infection (DSWI). Sternal closure with rigid plate fixation was recently reported to be effective for preventing DSWI and promoting sternal healing. We investigated the effectiveness of a rigid plate fixation system in patients at a high risk of developing DSWI. METHODS: This retrospective observational study evaluated the incidence of DSWI and the progression of postoperative sternal fusion observed on computed tomography. Forty-eight patients at a high risk of DSWI who underwent sternal closure with a rigid plate fixation system between 2020 and 2023 were assessed. RESULTS: Among the 48 patients, 1 (2.1%) developed DSWI requiring surgical treatment. Sternal fusion improved over time, with significant progression observed during the follow-up period compared with the early postoperative period. Additionally, patients who did not show sternal fusion in the early postoperative period showed progressive fusion during follow-up. CONCLUSIONS: The rigid plate fixation system prevents sternal displacement and may be beneficial in preventing DSWI by maintaining and promoting sternal fusion in high-risk patients.
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Placas Óseas , Esternotomía , Esternón , Infección de la Herida Quirúrgica , Humanos , Masculino , Femenino , Infección de la Herida Quirúrgica/prevención & control , Infección de la Herida Quirúrgica/etiología , Anciano , Estudios Retrospectivos , Esternotomía/efectos adversos , Esternón/cirugía , Esternón/diagnóstico por imagen , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Factores de Riesgo , Anciano de 80 o más Años , Resultado del TratamientoRESUMEN
Cardiac hemangioma is a rare benign disease, and extracardiac tumors consisting of 3 lobes are exceptionally rare. Preoperative diagnosis is extremely difficult, and it is important to evaluate the disease through a multifaceted examination.
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A 78-year-old woman with liver cirrhosis due to chronic hepatitis C visited our department for treatment of a thoracic aortic aneurysm. Her Child-Pugh classification was class A, and her model for end-stage liver (MELD) disease score was 8. As she also had thrombocytopenia associated with splenomegaly and esophageal varices, endoscopic injection sclerotherapy and partial splenic embolization were performed before total arch replacement surgery for treating esophageal varices to reduce the bleeding risk during transesophageal echocardiography and for thrombocytopenia, respectively. After endoscopic injection sclerotherapy and partial splenic embolization, the platelet count increased; hence, total arch replacement surgery was performed. By combining partial splenic embolization and endoscopic injection sclerotherapy, we were able to safely perform transesophageal echocardiography and total arch replacement surgery in the perioperative period.
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A 54-year-old woman with a mycotic superior mesenteric artery (SMA) aneurysm underwent emergent aneurysm resection with a great saphenous vein bypass. Follow-up computed tomography revealed a rapidly growing recurrent SMA aneurysm at the stump. Under the diagnosis of recurrent pseudoaneurysm of SMA with a fragile stump, we performed an open dual arterial bypass using indocyanine green fluorescence angiography and endovascular coil embolization. Subsequently, the patient's recurrent mycotic SMA aneurysm was successfully managed without mesenteric ischemic complications. This method may help prevent fatal mesenteric ischemia during SMA aneurysm surgery.
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Surgical reconstruction is one of the standard treatments for renal artery aneurysm. However, its intraoperative evaluation is sometimes difficult depending on the operative field, aneurysm morphology, and peripheral blood vessel distribution. This case demonstrated that after renal artery reconstruction, indocyanine green fluorescence angiography is used to evaluate the results of repairing. This method is useful in visceral aneurysm evaluation not only for assessing reconstructed blood flow but also for confirming tissue perfusion of the renal parenchyma.
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BACKGROUND: There is insufficient information regarding the bleeding sites and surgical strategies of cardiac tamponade during catheter ablation for atrial fibrillation (AF). CASE PRESENTATION: Of the five patients with cardiac tamponade, three required surgical intervention and two required pericardiocentesis. In the first case of three cardiac tamponades requiring surgical intervention, considering that the peripheral route was used, the catecholamines did not reach the heart, and due to unstable vital signs, venoarterial extracorporeal membrane oxygenation (VA-ECMO) was inserted. No bleeding point was identified, but a thrombus had spread around the left atrium (LA) with diverticulum. Hemostasis was achieved with adhesives placed around the LA under on-pump beating. In the second case, pericardiocentesis was performed, but the patient showed heavy bleeding and unstable vital signs. Thus, VA-ECMO was inserted. Heavy bleeding was expected, and safety was enhanced by attaching a reservoir to the VA-ECMO. The bleeding point was found between the left upper pulmonary artery and LA under cardiac arrest to obtain a good surgical view for suturing repair. In the third case, the LA diverticulum was damaged. Pericardiocentesis resulted in stable vitals, but sustained bleeding was present. A bleeding point was found at the LA diverticulum, and suture repair under on-pump beating was performed. CONCLUSIONS: When cardiac tamponade occured in any patient with LA diverticulum, treatment could not be completed with pericardiocentesis alone, and thoracotomy was likely to be necessary. If the bleeding point could be confirmed, suturing technique is a more reliable surgical strategy than adhesive alone that leads to pseudoaneurysm. If the bleeding point is unclear, it is important to confirm the occurrence of LA diverticulum using a preoperative CT, and if confirmed, cover it with adhesive due to a high possibility of diverticulum bleeding. The necessity of CPB should be determined based on whether these operations can be completed while maintaining vital stability.
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Fibrilación Atrial , Taponamiento Cardíaco , Ablación por Catéter , Divertículo , Humanos , Fibrilación Atrial/cirugía , Taponamiento Cardíaco/cirugía , Ablación por Catéter/métodos , Divertículo/cirugía , Atrios Cardíacos/cirugía , Hemorragia/etiología , Toracotomía , Resultado del TratamientoRESUMEN
BACKGROUND: Morphologically, the risk of aortic aneurysm rupture is mainly evaluated based on its type (e.g., fusiform or saccular) and diameter. Based on the finite element analysis, peak wall stress has been identified as a more sensitive and specific predictor of rupture in recent years. Moreover, in finite analysis, the neck of aneurysm is the highest peak wall stress and is associated with the rupture point. CASE PRESENTATION: A saccular aortic aneurysm (84 mm) was incidentally detected during preoperative examination for chronic empyema in a 74-year-old male patient with a history of polycythemia. Aortic arch graft replacement using an open stent was performed. CONCLUSIONS: Morphologically, this case was associated with a very high risk of rupture; nevertheless, it did not rupture. In this case, a mural thrombus (likely formed due to polycythemia) covered the neck of aneurysm that is experiencing the highest peak wall stress and is associated with the rupture point. The mural thrombus decreased peak wall stress and could reduce the risk of rupture even for huge saccular aneurysms. Furthermore, the mural thrombus was fully occupied in aneurysms, such as during coil embolization. Thus, polycythemia could decrease the risk of rupture of huge saccular aneurysms.
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Aneurisma de la Aorta Abdominal , Aneurisma de la Aorta , Rotura de la Aorta , Policitemia , Tromboembolia , Trombosis , Masculino , Humanos , Anciano , Policitemia/complicaciones , Aneurisma de la Aorta/complicaciones , Rotura de la Aorta/complicaciones , Trombosis/complicaciones , Trombosis/cirugía , Tromboembolia/complicaciones , Aneurisma de la Aorta Abdominal/complicacionesRESUMEN
We report 3 patients with recurrences after stent-graft placement for arterio-visceral/arterio-luminal fistulas in long-term follow-up. Two patients had ureteroarterial fistulas and the other had a tracheo-innominate artery fistula. All 3 patients had hemorrhage on initial presentation and underwent a stent-graft placement for an arterio-visceral/arterio-luminal fistula. Recurrences occurred over a period of 8-26 months and were diagnosed by contrast-enhanced computed tomography; pseudoaneurysms were found in contrast-enhanced computed tomography images in all cases. Pseudoaneurysms may be noted on contrast-enhanced computed tomography as the only finding of recurrences during long-term follow-up after stent-graft placement for arterio-visceral/arterio-luminal fistulas.
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Background: Prosthetic heart valves, rings, and clips commonly used in heart surgery may contain metals, such as nickel and cobalt, that can cause severe hypersensitivity reactions in allergic patients. These reactions can cause paravalvular leakage and valve dysfunction. Similarly, stainless steel sternal wires can cause contact dermatitis. We should select rings, valves, and wires that do not contain any metals known to cause allergies in patients undergoing cardiac surgery. Case summary: We report the case of a 79-year-old man with severe functional mitral regurgitation (Type IIIb) and a history of nickel and cobalt allergies. We safely performed mitral valve repair with papillary muscle repositioning with nickel- and cobalt-free rings in this patient. He was discharged from the hospital on the 26th postoperative day without dialysis intervention. Two years after surgery, mitral and tricuspid regurgitation had not worsened. Discussion: According to the 2020 American Heart Association guidelines, surgery for severe functional mitral valve insufficiency (Type IIIb) is considered class IIb. Meanwhile, transcatheter edge-to-edge repair is class IIa. Long-term regurgitation is difficult to control with valve replacement and annuloplasty alone; recurrence has been observed. Therefore, additional techniques were considered. Papillary muscle repositioning has been reported and shown good results. The method used in the present case made intervening in the subvalvular tissue easy and demonstrated technical feasibility, safety, and effectiveness.
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BACKGROUND: Cold agglutinin disease can lead to significant complications, especially for patients undergoing arch repair requiring hypothermic circulatory arrest. Rituximab and plasmapheresis are treatments for cold agglutinin disease. However, its use in patients with Stanford type A dissection has not been reported. Therefore, after consultation with hematologists, we used rituximab and plasmapheresis before mild hypothermic aortic arch surgery to maintain the body temperature above the thermal altitude. CASE PRESENTATION: This report describes an 86-year-old male patient with acute type A aortic dissection who received outpatient treatment for rheumatoid arthritis and a 55-mm thoracic aortic aneurysm. The patient was scheduled to undergo urgent surgery for a type A intramural hematoma and progressive aortic aneurysm; however, laboratory test results indicated blood clotting and cold agglutinin. Consequently, urgent surgery was rescheduled. After consulting with hematologists, rituximab was initiated 3 months before surgery, and plasmapheresis was performed 2 days before surgery for cold agglutinin disease. Under mild hypothermia conditions, total arch replacement using the frozen elephant trunk technique was performed while maintaining cerebral and lower body perfusion. The postoperative course was uneventful. On postoperative day 42, the patient was discharged without any neurological deficits. CONCLUSIONS: This case involving total arch replacement with mild hypothermia for an aortic arch aneurysm with cold agglutinin disease after rituximab treatment and plasmapheresis resulted in a successful outcome.
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Anemia Hemolítica Autoinmune , Aneurisma del Arco Aórtico , Aneurisma de la Aorta Torácica , Aneurisma de la Aorta , Implantación de Prótesis Vascular , Masculino , Humanos , Anciano de 80 o más Años , Rituximab/uso terapéutico , Anemia Hemolítica Autoinmune/complicaciones , Anemia Hemolítica Autoinmune/terapia , Implantación de Prótesis Vascular/métodos , Aneurisma de la Aorta/complicaciones , Aneurisma de la Aorta/cirugía , Aneurisma de la Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/etiología , Aorta Torácica/cirugía , Plasmaféresis , Resultado del TratamientoRESUMEN
Background: Closure of the left atrial appendage (LAA) using a clip in at-risk patients reduces stroke risk. The rate of LAA closure procedures is increasing worldwide; however, complications have been reported, with coronary compression being one possible lethal complication associated with the anatomical structures around the LAA. Case summary: A 75-year-old man presented with a diagnosis of a φ50â mm saccular thoracic aortic aneurysm. He had a history of chronic atrial fibrillation and functional tricuspid regurgitation. We performed total arch replacement with an open stent graft, tricuspid ring annuloplasty, left atrium Maze procedure, left atrial plication, and LAA closure using a LAA clip. The blood pressure of the patient dropped after closing the pericardium post-operatively. Coronary artery angiography (CAG) confirmed 90% stenosis at the left coronary main trunk (LMT) origin. Percutaneous coronary intervention (PCI) was performed, and the haemodynamics settled. Discussion: The distance from the anterior wall of the LAA ostium to the LMT can be a risk for AtriClip-induced LMT compression. A different surgical strategy, such as internal sutures or surgical stapler for LAA closure, should be considered under such a condition. Selecting an appropriately sized AtriClip is essential while using the clip, placing it close to the orifice, and visually checking for compression after insertion to prevent LMT stenosis. When LMT compression by the clip was confirmed, levelling the endocardial adipose tissue with the LAA landing zone, cutting and removing the clip or coronary artery bypass grafting during operation, and PCI during CAG should be considered.