Posterior Tibial Artery Aneurysm Caused by Trauma: A Case Report.

In this study, we present a case of 59-year-old man with a posterior tibial artery (PTA) aneurysm. Mostly, PTA aneurysm is caused by trauma, infection, and iatrogenic injury. The patient had a history of ankle trauma that occurred 2 years ago. Computed tomography and ultrasonography showed a 7×14 mm PTA aneurysm. The aneurysm was resected and primary end-to-end anastomosis was performed. So far, there are only few reported cases of PTA aneurysm. Herein, we describe the surgical strategy and provide detailed intraoperative images.

Is central repair with coronary artery bypass grafting enough for multi-organ malperfusion in acute type A aortic dissection with coronary malperfusion?

OBJECTIVES: Acute type A aortic dissection with coronary malperfusion syndrome is rare but associated with high mortality. Multi-organ malperfusion is an independent predictor of acute type A aortic dissection. Coronary malperfusion requires treatment, but it is not feasible to treat all malperfusions. The adequacy of "central repair and coronary artery bypass grafting" for patients with coronary and other organ malperfusion is unknown. METHODS: Of the 299 patients who underwent surgery between 2008 and 2018, 21 patients with coronary malperfusion, who received cental repair with coronary artery graft bypass, were analyzed retrospectively. They were divided; into Group M (n = 13, coronary and other organ malperfusion) and Group O (n = 8, coronary malperfusion only). The patient background, surgical content, details of malperfusion, surgical mortality and morbidity, and long-term outcome were compared. RESULTS: There was no difference in operation time (205 ± 30 vs. 266 ± 88, p = 0.49), but the time from arrival to circulatory arrest tended to be shorter in Group M (81 vs. 134, p = 0.05). Among Group M, cerebral malperfusion was the most common at 92%. Two of the three cases with mesenteric malperfusion died. The mortality of Group M and Group O was 13% and 15% (P = 0.85), respectively. There was no difference in long-term mortality (p = 0.62). CONCLUSIONS: Central repair and coronary artery bypass grafting is a sufficiently acceptable treatment for patients with acute type A aortic dissection and multi-organ malperfusion, including coronary malperfusion.

Rare case of ruptured muscular ventricular septal aneurysm due to silent myocardial ischemia in adult.

Interventricular septal aneurysm of muscular type is uncommon in adult, to say nothing of membranous type. Acute or subacute left-to-right shunt (LR shunt) in a ventricular septum is mostly critical and usually shows severe symptoms. Therefore, ruptured muscular ventricular septal aneurysm (VSA) with LR shunt of unknown onset in adult is highly rare. A 70-year-old man was suffered from mild dyspnea and chest oppression. A muscular VSA was detected at the center of the ventricular septum and LR shunt of unknown onset in it had induced congestive heart failure. The sandwich patch technique through a right ventricular approach was simultaneously performed with coronary artery bypass grafting and the postoperative course was uneventful. In addition, concomitant myocardial biopsy of VSA wall during the surgery could reveal histopathologic evidence of acute or subacute myocardial infarction with old myocardial infarction as silent myocardial ischemia.

Late onset of coronary ostial stenosis following surgical aortic valve replacement in a patient with anomalous origin of the right coronary artery.

Surgical aortic valve replacement (SAVR) in patients with anomalous origination of a coronary artery from the opposite sinus is associated with risk for myocardial ischemia during the perioperative period. [1] However, iatrogenic coronary ostial stenosis (ICOS) generally occurs within the first 6 months after SAVR. We present an unusual case of a 74-year-old man with anomalous origination of the right coronary artery from the left coronary sinus, who developed effort angina due to ICOS 19 months following SAVR and ascending aorta replacement. Angiography and computed tomography were utilized to perform a comparison before and after the procedure. From the results, it was evident that the flattened mild stenosis preoperatively was caused by anomalous origination of a coronary artery from the opposite sinus and progressed to severe stenosis by ICOS after the procedure. The patient was successfully treated with percutaneous coronary intervention. .

Respiratory Failure after Open Descending Aortic Aneurysm Repair: Risk Factors and Outcomes.

PURPOSE: This study was conducted to identify predictors of respiratory failure after open repair of descending thoracic aortic aneurysm (DTAA), and to identify any relationship between respiratory failure and long-term survival. METHODS: A total of 75 patients undergoing elective open DTAA repair at the Shiga University of Medical Science Hospital were included in the study. Univariate and multivariate logistic regression analyses were performed to assess the odds ratios for incident postoperative respiratory failure after open DTAA repair. Survival over time was estimated by the Kaplan-Meier method. RESULTS: Respiratory failure, defined as ventilation dependence for longer than 48 hours, occurred in 11 patients (14.7%). Independent predictors of respiratory failure after DTAA included prolonged operation time and reduced preoperative forced expiratory volume in 1 second/forced vital capacity × 100 (FEV1%). In-hospital mortality was higher (p = 0.020) among patients with respiratory failure (18.2% of those who suffered respiratory failure) than among those without (0%). The survival rates at 8 years were significantly lower (p = 0.010) in the respiratory failure group (at 44.2%) than in the group without respiratory failure (at 89.0%). CONCLUSION: Lower FEV1% and longer operation time were risk factors of postoperative respiratory failure after open repair of DTAA, which in turn is associated with significantly reduced long-term survival.

Surgical treatment for secondary aortoesophageal fistula after prosthetic aortic replacement: A report of four cases.

INTRODUCTION: With the increase of thoracic aortic aneurysm surgery and thoracic endovascular aortic repair, secondary aortoesophageal fistula (AEF) has been reported. However, the treatment strategy for AEF remains controversial. PRESENTATION OF CASES: Four patients who had undergone prosthetic aortic replacement for thoracic aortic aneurysm 4-36 months previously, were hospitalized with sepsis-like symptoms. They were diagnosed with aortic prosthetic graft infection after computed tomography revealed ectopic gas around the prosthesis. After that, esophagogastroduodenoscopy revealed an esophageal perforation, so we diagnosed AEF. They received medication and stepwise surgery; 1 patient was discharged, 2 remain hospitalized, and 1 died. DISCUSSION: Some reports have suggested that combined surgery provides better outcomes for AEF. Infection may be controlled by esophagectomy and antibiotic treatment, so prosthesis replacement is not always necessary. However, we should note that infection between a prosthetic graft and the native aorta brings a danger of pseudoaneurysm of the anastomosis. CONCLUSION: Based on our experience we conclude that surgery performed stepwise along with infection control and general health improvement is a valid treatment strategy for secondary AEF after prosthetic aortic replacement.

[Pulmonary Artery Catheter-induced Massive Tracheal Hemorrhage during Aortic Valve Surgery;Report of a Case].

We report a case of pulmonary artery catheter (PAC)-induced massive intratracheal hemorrhage during aortic valve surgery. An 81-year-old woman underwent aortic valve replacement and pulmonary vein isolation. Operative procedures were uneventful, but active and massive intratracheal hemorrhage started just after cardiopulmonary bypass was discontinued. We immediately resumed cardiopulmonary bypass and replaced the endotracheal tube with a double-lumen one, keeping the airway pressure high (20 cmH2O). Those maneuvers reduced intratracheal hemorrhage and maintained oxygenation, and then cardiopulmonary bypass was disconnected without lung lobectomy. Mechanical ventilation with high positive end expiratory pressure for 6 days in the intensive care unit let her good recovery. A postoperative enhanced computed tomography revealed a thrombosed right pulmonary artery pseudoaneurysm possibly induced by PAC. After close observation the patient left the hospital on foot.

[Stent Graft-induced New Entry after Total Arch Replacement with Open Stent Graft Technique for Aneurysmal Chronic Stanford Type B Aortic Dissection].

A 68-year-old woman after total arch replacement with open stent graft(OSG) technique for aneurysmal chronic Stanford type B aortic dissection was found to have expanding proximal descending aortic aneurysm. Contrast-enhanced computed tomography(CT) showed distal stent graft-induced new entry (distal SINE). We successfully performed additional thoracic endovascular aortic repair (TEVAR). There were no complications and the postoperative course was uneventful. We should take utmost care in selecting surgical procedures with OSG technique for aneurysmal chronic Stanford type B aortic dissection.

Tricuspid valve relocation with endomyocardial fibrosis removal for Löeffler's endocarditis.

Löffler endocarditis with hypereosinophilic syndrome is rare but can cause critical ventricular obliteration by endomyocardial fibrosis. A 52-year-old woman experienced severe right heart failure with extreme shrinkage of her right ventricle, severe tricuspid regurgitation and marked right atrial enlargement. Preoperative tests showed identical pressures in the right atrium and pulmonary artery. Endocardial stripping was done, and to enlarge the right ventricle, we relocated the anterior and posterior tricuspid leaflets cephalad, up the right atrium wall, to 'ventricularize' a portion of the right atrium, with autologous pericardial augmentation of the tricuspid leaflets. An annuloplasty ring was added to reinforce the relocated tricuspid attachment. Right heart pressures normalized postoperatively. The patient recovered uneventfully. She has received corticosteroid therapy continuously and has shown no recurrence of heart failure in the 5 years since surgery.