Successful hybrid management of a ruptured abdominal aortic aneurysm induced by type II and IIIB endoleaks after endovascular aortic repair.

Ruptured abdominal aortic aneurysm after endovascular abdominal aortic repair is a relatively rare condition. The management of this type of a rupture is challenging and controversial. We report here a case of ruptured abdominal aortic aneurysm 6 months after endovascular abdominal aortic repair. Although the main cause of this rupture was initially believed to be a type II endoleak, it was also a type IIIB endoleak practically. The patient was successfully treated via the hybrid approach. He recovered well, with no endoleaks for the next 6 months.

A Case of Thoracic Endovascular Aortic Repair Using Carotid Access with Axillary-Carotid Bypass for Descending Aortic Aneurysm in a Patient with Aortoiliac Occlusive Disease.

The authors report a 71-year-old male with descending thoracic aortic aneurysm and multiple risk factors (aortoiliac occlusive disease, obesity, ascending aorta dilatation, and history of left ventriculoperitoneal shunt for hydrocephalus) who was treated with thoracic endovascular aortic repair (TEVAR) via left common carotid artery (LCCA) access and left axillary-carotid artery (Ax-CA) bypass; this approach shortened the LCCA clamp time during the procedure. The patient was discharged without any complications. TEVAR via LCCA access with left Ax-CA bypass is a useful and safe procedure for patients in whom conventional femoral artery access is not feasible.

Surgical treatment for adult congenital heart disease: consideration for indications and procedures.

The number of the adult patients with congenital heart diseases (ACHD) continues to grow owing to improvement of surgical results and medical management. Corrective surgery for complex CHD does not always mean complete cure. It is not rare that the patients will visit the cardiology institutes because of secondary lesions due to residua or sequela in adults. Some patients with CHD remain unrepairable with different degree of heart failure and pulmonary arterial hypertension. Association of arrhythmias is common in ACHD patients and sometimes critical. We experienced 265 surgical procedures for ACHD patients at our center between 1999 and 2015. Of these procedures, palliative surgery was performed in 3%, palliation to corrective surgery in 6%, primary repair in 57%, and redo surgery in 34%. Hospital mortality within 30 days in this period was 1.1%. Surgery for ACHD patients is safe, beneficial and low-risk treatment; however, tailored procedures for the individual patient are essential to obtain the optimal quality. A comprehensive multidisciplinary approach is required to fulfill this goal.

Esophageal necrosis after endovascular repair for ruptured aortic dissection.

A 78-year-old man presented with back pain and shock and was transferred to our hospital. Computed tomography showed a ruptured aortic dissection in which the false lumen was thrombosed with an ulcer-like projection, and the mid-esophagus was shifted to the right due to a mediastinal hematoma. He underwent emergency thoracic endovascular aortic repair of the descending thoracic aorta. One week later, esophageal necrosis occurred, and he died of mediastinitis and sepsis on postoperative day 16. Although esophageal necrosis is a rare and fatal complication after thoracic endovascular aortic repair, a management strategy has not yet been established.

Reoperation for composite graft infection after aortic root replacement.

Composite graft infection after aortic root replacement is a serious complication and requires surgical reintervention with a high mortality rate. We report two cases of composite graft infection 3 months and 44 months after the primary operation. Each successfully underwent redo aortic root replacement with a new composite graft and a Freestyle stentless bioprosthesis, respectively. Both patients are currently well and without recurrence of infection 35 months and 48 months postoperatively.

A case of early failure of the freestyle stentless bioprosthesis due to cuspal tear.

We report an unusual case of early structural failure of the Freestyle stentless bioprosthesis 22 months after initial implantation. A 71-year-old woman, who had undergone stentless valve implantation by the subcoronary method, presented with a new diastolic murmur and progressive congestive heart failure 20 months after the initial implantation. Reoperation was performed using a stented bioprosthesis. The explanted prosthesis showed a tear along the annulus in one cusp. There were no findings of bacterial endocarditis or other macroscopical changes including calcification, thrombus attachment and pannus formation. It is believed that the cause of the cuspal tear was primary tissue failure. Further study is needed to clarify the incidence of this event.