[Surgical Repair of Stanford Type A Acute Aortic Dissection Associated with Anomalous Retroaortic Left Brachiocephalic Vein;Report of a Case].

Anomalous retroaortic left brachiocephalic vein( ARLBV) is a rare vascular abnormaly, usually asossiated with congenital heart diseases. We present a very rare case of Stanford type A acute aortic dissection associated with ARLBV. A 70-year-old man was referred to our hospital complaining of worsening back pain and chest pain. Computed tomographic angiogram showed Stanford type A acute aortic dissection from the ascending aorta to the distal abdominal aorta. Furthermore, systemic venous anomalies were revealed. The left brachiocephalic vein coursed the left side of the aortic arch, anterior to the central pulmonary artery, and posterior to the ascending aorta, and joined the right brachiocephalic vein. Replacement of the ascending aorta was performed in an emergency, and the postoperative course was uneventful.

[Video-assisted Thoracoscopic Pericardial Fenestration for Pericardial Effusion in a Patient with Crow-Fukase Syndrome].

A 65-year-old woman was referred to our department with recurrent pericardial effusion. Her serum vascular endothelial growth factor was high, serum M-protein was positive, and nerve conduction velocity of extremities was decreased. Therefore, she was diagnosed with Crow-Fukase (polyneuropathy, organomegaly, endocrinopathy, M protein, skin changes:POEMS) syndrome, which is characterized by the presence of plasma cell dyscrasia with them. We performed video-thoracoscopic pericardial fenestration with 4×4 cm window. The postoperative course was uneventful, and the pericardial effusion completely disappeared. Video-assisted thoracoscopic pericardial fenestration was a safe and effective treatment for recurrent pericardial effusion.

[Triple-stage Endovascular Treatment for Chronic Type B Aortic Dissection Including Hybrid Procedure;Report of a Case].

A 66-year-old man developed an extended chronic type B dissection involving the thoraco-abdominal aorta with a large entry at the aortic arch and a patent false lumen. We performed triple-stage endovascular repair which included the vascular plug, endovascular aortic repair and hybrid thoracic endovascular aortic repair. His postoperative course was uneventful and the false lumen was finally thrombosed.

[Delayed Hemolytic Anemia Associated with Anti-Jk3 Antibody Following Cardiovascular Surgery;Report of a Case].

We report a 73-year-old man who underwent total aortic arch replacement with an open stent graft for aortic arch aneurysm. The patient received blood transfusion intraoperatively without any signs of hemolysis. However, on post-operative day 16, he developed hemoglobinuria, and was found to have anemia, elevated serum lactate dehydrogenase, elevated total bilirubin, and decreased serum haptoglobin. Initially, the cause for these findings was unknown. Upon further testing, however, antibodies against the high frequency antigen, anti-Jk3 was identified. The patient was conservatively treated and was discharged in stable condition on post-operative day 24. Jka and/or Jkb are red blood cell antigens observed in over 99.9% of the population worldwide. Jk (a-b-) represents the null phenotype and is very rare. This specific phenotype can be extremely dangerous, as homologous transfusion might cause severe delayed hemolysis. The actual patient carried Jk (a-b-) phenotype and, due to intraoperative transfusion of red blood cells, anti-Jk3 antibody was produced. Although very rare, patients who carry the red blood cell phenotype Jk( a-b-) may experience dangerous, or even fatal outcome due to such a common medical treatment as blood transfusion, if this condition is not recognized beforehand.

[Thoracic Endovascular Aortic Repair Following Axillo-femoral Bypass in a Patient with Stanford B Acute Aortic Dissection Accompanied by Abdominal Visceral Ischemia;Report of a Case].

A 60-year-old woman was transfer-red to the emergency department of our medical center with worsening chest and back pain. Computed tomography revealed Stanford type B aortic dissection. There was a false lumen from the distal arch to the abdominal aorta just above the celiac artery. Although she was at 1st treated conservatively, she abruptly developed acute renal failure and lower limb ischemia because of an enlarged false lumen, and emergency axillo-femoral bypass surgery was performed with an 8 mm tube graft. However, renal failure gradually worsened, which necessitated continuous hemodiafiltration was performed. Thoracic endovascular aortic repair was then performed, and her renal function recovered.

Utility of multislice computed tomography as a strategic tool for complex percutaneous coronary intervention.

OBJECTIVES: Multislice computed tomography (MSCT) has been currently utilized as a non-invasive diagnostic modality to detect coronary artery disease. We sought to investigate whether preprocedural lesion assessment by MSCT could offer strategic guidance in the setting of elective complex percutaneous coronary intervention (PCI). METHODS AND RESULTS: Twenty-six complex coronary artery lesions in 23 patients were evaluated using 16-row MSCT scanner and an off-line image analysis workstation prior to the PCI. Procedural strategies of PCI were planned based on the morphologic and geometric analysis of the target lesion and vessel. MSCT provided valuable strategic information, which was useful for subsequent PCI procedure. The three-dimensional computed tomography (CT) images allowed us to determine optimal working view angle that best demonstrated the target lesion with least foreshortening. Furthermore, the thin-slab maximum intensity projected CT images of the target lesion served as a preprocedural road map depicting the bends of complex luminal path, vessel geometry and occluded segment of the vessel. As results, procedural success was achieved in all cases with complex lesions including chronic total occlusion. CONCLUSIONS: Our preliminary results showed that preprocedural lesion and vessel assessment by MSCT provided important additive strategic information that led to successful complex PCI procedures.

Optimal fluoroscopic view selection for percutaneous coronary intervention by multislice computed tomography.

We present 2 cases of patients with stenotic and occlusive coronary lesions, which were detected by multislice computed tomography (MSCT) coronary angiography and treated with percutaneous coronary intervention (PCI) using CT-oriented optimal fluoroscopic views. Preprocedural MSCT allowed us to select the optimal fluoroscopic angle to visualize the target lesions, which provided least amount of foreshortening and minimal overlap of side branches during the PCI procedures. Given its three-dimensional nature, MSCT provides additional anatomical information in the evaluation of complex coronary lesions prior to PCI.

Aortic root replacement using composite valve graft in patients with aortic valve disease and aneurysm of the ascending aorta: twenty years' experience of late results.

The purpose of this study was to evaluate the clinical outcome of composite valve graft replacement in 193 patients with aortic valve disease and aneurysm of the ascending aorta from January 1980 to June 1999. The clinical outcome was compared between the patients diagnosed with Marfan syndrome (M group) and those without Marfan syndrome (non-M group), between those with aortic dissection (AD group) and without dissection (non-AD group), between 2 different techniques for coronary artery reattachment (modified Bentall [mB] and modified Piehler [mP]), and between the time of operation (1980-1989 and 1990-1999). Long-term outcome of this procedure was almost satisfactory with actuarial survival of 71.5 +/- 4.4% at 10 years and freedom from reoperation of 76.5 +/- 4.4% at 10 years. Freedom from cardiovascular events and freedom from reoperation were significantly lower in the M group and AD group than in the non-M and non-AD groups. Also, actuarial survival was significantly higher in the latter 10 years compared with the former 10 years. It was concluded that the improvement of perioperative management and proper selection of the technique for coronary artery reattachment could have improved the clinical outcome. In patients with Marfan syndrome or aortic dissection, there still remains a higher risk of cardiovascular event and future reoperation. Extensive aortic reconstruction or staged operation should be performed in such patients.