[Delayed Type â ¢b Endoleak After Thoracic Endovascular Aortic Repair for Thoracic Aortic Aneurysm: Report of a Case].

An 85-year-old woman underwent aortic arch replacement and thoracic endovascular aortic repair (TEVAR) 5 years ago. She suffered from chest and back pain. Computed tomography (CT) demonstrated enlargement of the aortic aneurysm by a type Ⅲb endoleak. TEVAR was performed to close a type Ⅲb endoleak with a relining technique uneventfully. Intraoperative completion aortography and postoperative CT confirmed the disappearance of a type Ⅲb endoleak. She was discharged 27 days after the treatment.

[Acute Type A Aortic Dissection Complicated by Cerebral Malperfusion and Leg Ischemia:Report of a Case].

An 82-year-old woman suddenly developed chest pain and apoplexy. Computed tomography (CT) showed acute type A aortic dissection, the true lumen in the brachicephalic artery was severely compressed by the faulse lumen. Pulsation in the either leg was not detected during induction of anesthesia. We evaluated the cerebral blood flow and lower extremity blood flow using near infrared spectroscopy (NIRS) during the operation, tissue oxygenation index (TOI) was continuously monitored during the operation. Cardiopulmonary bypass( CPB) was established by puncturing the true lumen in the ascending aorta and bicaval venous drainage. TOI was returned to normal range by CPB. Although the central repair (ascending aorta replacement) was performed, leg ischemia persisted. We performed ascending aorta-bifemoral bypass. After the operation, leg ischemia disappeared and CT revealed patency of the bypass graft. Postoperative course was uneventful without deterioration of neurological function. She was discharged 49 days after the operation.

[Compartment Syndrome After Stanford Type A Acute Aortic Dissection Surgery:Report of a Case].

A 53-year-old man presented to the emergency department with chest and back pain. Contrast-enhanced computed tomography( CT) revealed a Stanford type A acute aortic dissection with a pseudo-lumen occlusion. On the same day, the patient underwent emergent aortic arch replacement with frozen elephant trunk. When introducing cardiopulmonary bypass, arterial cannula was inserted into the right femoral artery. The day after surgery, swelling of the right lower leg appeared with CK and intramuscular compartment pressure elevation. Thus, the patient was diagnosed with compartment syndrome and decompressive fasciotomy was performed. Although there was no preoperative blood flow disturbance in the lower extremities on preoperative CT, lower limbs ischemia happened. Necrotic muscles in his right leg required debridement, but amputation was not needed. The patient was discharged unaided utilising orthotics on the day 120. In muscular, young male patients, care should be taken in the method of blood delivery.

[Amyloidosis Diagnosed Following Aortic Valve Replacement:Report of a Case].

A 76-year-old man had been under observation for nephrotic syndrome. He suffered from hypotension and transient loss of consciousness. He was diagnosed with thoracic aortic aneurysm and severe aortic valve stenosis. Ascending aorta replacement concomitant with aortic valve replacement was performed uneventfully. He was diagnosed with light chain amyloidosis by pathological examination of the resected ascending aorta. He was received referral treatment for amyloidosis.

[Stanford Type A Acute Aortic Dissection Complicated by Right Lung Hemorrhage:Report of a Case].

A 59-year-old woman was transferred to our hospital because of a sudden onset of chest and back pain. Computed tomography (CT) demonstrated Stanford type A acute aortic dissection with cardiac tamponade and right airway bleeding. Hemorrhage from ruptured false lumen extended along the pulmonary artery (PA), compression of the right PA were recognized due to hematoma surrounding the PA. An emergency operation was performed. The primary tear was located at the distal aortic arch, and total arch replacement with frozen elephant trunk was performed. During the operation, she had airway bleeding. The bleeding was thought to be due to the hematoma extending along the pulmonary artery. She was extubated 7th postopratively. She was discharged 44 days after the operation.

[Very Late Stent Thrombosis during Perioperative Period of Aortic Valve Replacement:Report of a Case].

A 73-year-old man underwent drug eluting stent (DES) implantation in the left anterior descending artery (LAD) 11 years ago and in the right coronary artery (RCA) 8 years ago. He suffered from chest tightness and was diagnosed with severe aortic valve stenosis. Perioperative coronary angiography revealed no significant stenosis and thrombotic occlusion of the DES. Five days before operation, antiplatelet therapy was discontinued. Aortic valve replacement was performed uneventfully. But he developed chest pain and transient loss of consciousness, electrocardiographic changes were observed on the 8th postoperative day. Emergency coronary angiography revealed thrombotic occlusion of the drug eluting stent in the RCA, despite the postoperative oral adoministration of warfarin and aspirin. Percutaneous catheter intervention (PCI) restored the stent patency. Dual antiplatelet therapy (DAPT) was initiated immediately after the PCI, and anticoagulation therapy with warfarin was continued. Clinical symptons of stent thrombosis disappeared immediately after the PCI. He was discharged 7 days after the PCI.

[Gallbladder Necrosis after Surgery for Stanford Type A Aortic Dissection in an Elderly Patient:Report of a Case].

An 86-year-old woman who suffered from cardiac tamponade due to acute Stanford type A aortic dissection was admitted to our hospital. An emergency operation was performed uneventfully. She suffered from abdominal pain 13 days after the operation. Computed tomography( CT) scan revealed pericholecystic fluid and unclear gallbladder wall, revealing acalculous necrotizing cholecystitis. We performed open cholecystectomy and abdominal cavity drainage. No gallstones were observed. She underwent intensive treatment. She was discharged without complications 44 days after the cholecystectomy.

[Hybrid Treatment of the Intrathoracic Right Subclavian Artery Aneurysm:Report of a Case].

A 78-years-old woman was referred to our institution for the treatment of right subclavian artery (SCA) aneurysm. She previously underwent total arch replacement via median sternotomy approach. Preoperative computed tomography revealed a 55 mm sized SCA aneurysm. Stent graft was inserted from brachiocephalic artery to right common carotid artery via the graft anastomosed. The orifice of the right SCA was covered with stent graft inserted into the right common carotid artery-brachiocephalic artery and the right SCA was occluded with coils distal to the aneurysm, carotid-SCA bypass was performed with 8 mm ePTFE graft. Postoperative examination confirmed complete exclusion of the aneurysm and patency of the bypass graft. We thought that hybrid treatment for this patient was a less invasive alternative to conventional surgical procedure.

[Internal Hernia Accompanying Intestinal Necrosis after Aortic Arch Replacement:Report of a Case].

A 76-year-old man with thoracic aortic aneurysm was admitted to our hospital. Aortic arch replacement was performed uneventfully. He suffered from abdominal pain 17 days after the operation. Computed tomography (CT) scan revealed a strangulated bowel obstruction, and we performed emergent open abdominal surgery. During the operation, we found an adhesion between the greater omentum and the retroperitoneum. The small intestine was intussuscepted into this site, and strangulated with necrosis of a 35-cm length. We performed a partial resection of the small intestine. We encountered rare strangulated bowel obstruction after open heart surgery due to adhesion of the great omentum in a patient without a history of abdominal surgery.

[Surgical Treatment of Ventricular Perforation and Left Lung Injury by a Permanent Pacing Lead:Report of a Case].

A 84-year-old man was diagnosed with complete atrioventricular block and underwent pacemaker implantation( PMI). Two days after the PMI, chest X-ray revealed left pneumothorax, and a chest tube was inserted. The pneumothorax did not improve, and computed tomography revealed left lung injury by the right ventricular lead. Surgical procedure through median sternotomy was performed, and the penetrated lead was removed. The injured right ventricle and left lung were repaired. Ten days after the surgical procedure, intravenous implantation of new right ventricular lead was performed. He was discharged 38 days after the surgical procedure.

[Aortic Valve Replacement Combined with Ablation for Outflow Tract Premature Ventricular Contraction:Report of a Case].

A 73-year-old woman suffered from premature ventricular contraction( PVC) which could not be controlled by medications. Holter 24-hour continuous recording electrocardiogram (Holter ECG) revealed 22,706 PVC beats/day. Upon further examination, she was found to have severe aortic stenosis and mild insufficiency. Preoperative electro-physiological study and standard 12-lead electrocardiogram revealed that the PVC originated from myocardium under the left coronary cusp. Aortic valve replacement and intraoperative cryoablation were performed. Her postoperative course was uneventful, Holter ECG revealed 638 PVC beats/day. Clinical symptons of PVC disappeared immediately after surgery. She was discharged 19 days after the operation.

[Aortic Valve Replacement for Libman-Sacks Endocarditis:Report of a Case].

A 36-year-old woman with severe aortic valve stenosis was admitted to our hospital. She had been diagnosed with antiphospholipid syndrome complicated with systemic lupus erythematosus (SLE) and had been taking prednisolone( 10 mg/day) for 22 years. As SLE patients with prolonged steroid use are known to be at risk of an aortic dissection and aneurysm, femoral artery was chosen for arterial perfusion to reduce a risk of aortic dissection. Aortic valve replacement was performed uneventfully, because the aorta was treated carefully during the operation. Negative microbial culture and pathological examination of the resected aortic valve demonstrated an atypical vegetation, the findings of which were typically characteristic of Libman-Sacks endocarditis in SLE. She was discharged without complications 23 days after the operation.

[Localized Stenosis in a Non-anastomotic Site of the Ascending Aorta to Bifemoral Bypass Graft:Report of a Case].

An 85-year-old man received simultaneous coronary artery bypass grafting (CABG) and the ascending aorta to bifemoral bypass with a Dacron graft 11 years ago. He suffered from intermittent claudication. Angiography demonstrated a localized stenosis in a non-anastomotic site, straight portion of the graft. He received percutaneous transluminal angioplasty. The right ankle-brachial pressure index (ABI) improved from 0.58 to 0.74 and left ABI improved from 0.52 to 0.71. One year later, intermittent claudication appeared again, right ABI decreased to 0.53 and left ABI decreased to 0.52. Computed tomography( CT) demonstrated restenosis at the same portion of the graft. A re-do operation was performed, stenotic portion was removed and replaced by a new ePTFE graft. No restenosis was seen three years after the second operation. We thought that repeated temporary compression of the graft might have led to a clot formation in the non-anastomotic site.

[Infected Epicardial Pacemaker System Treated by Complete Removal of Pacemaker Leads and Omentopexy via Re-sternotomy:Report of a Case].

A 66-year-old man was diagnosed with pacemaker pocket infection in the upper abdominal area. His generator was removed with partial resection of the epicardial leads, and a new device was reimplanted in his left prepectoral area. The abdominal wound was left open, and debridement was performed for several times. After the wound was cured, he complicated a chest pain and was diagnosed with residural epicardial pacemaker lead infection. He underwent complete removal of infected epicardial pacemaker leads and omentopexy under extracorporeal circulation via resternotomy. Postoperative course was uneventful. There was no sign of reinfection during the two-year follow-up.

[Carotid-subclavian Bypass for Radiation-induced Subclavian Artery Occlusion;Report of a Case].

A male patient underwent radiation therapy for hypopharyngeal cancer and esophageal cancer at the age of 58 years without recurrence. At the age of 63 years, he started to experience fatigue, numbness of the left upper limb and dizziness. The symptom gradually worsened and he was admitted to our hospital for further investigation. By computed tomography scan and angiography, the subclavian artery (SCA) occlusion and a patent left vertebral artery with retrograde flow were revealed( subclavian steal syndrome). Subclavian artery occlusion could not be recanalized by percutaneous transluminal angioplasty. He underwent carotid-subclavian bypass. His symptoms clearly improved. Postopertive course was uneventful and no further symptoms developed after surgery.