The Rarity of Penetrating Ulcer with Intramural Hematoma of the Ascending Aorta

ABSTRACT We report a case of a 58-year-old man with multiple symptomatic penetrating atherosclerotic ulcers and concomitant intramural hematoma of the ascending aorta. The patient was successfully treated using a 24-mm Gelweave graft in the ascending aorta. He was discharged four days post operation and remains asymptomatic 14 months postoperatively. This case uniquely illustrates the rare entity of penetrating atherosclerotic ulcer with intramural hematoma, which presents in only 0.28% of all acute aortic syndrome cases.

The Rarity of Penetrating Ulcer with Intramural Hematoma of the Ascending Aorta.

We report a case of a 58-year-old man with multiple symptomatic penetrating atherosclerotic ulcers and concomitant intramural hematoma of the ascending aorta. The patient was successfully treated using a 24-mm Gelweave graft in the ascending aorta. He was discharged four days post operation and remains asymptomatic 14 months postoperatively. This case uniquely illustrates the rare entity of penetrating atherosclerotic ulcer with intramural hematoma, which presents in only 0.28% of all acute aortic syndrome cases.

The Longest Documented Postoperative Survivor of a Brock Procedure 63 Years Later.

An infant with critical pulmonary valve stenosis underwent a Brock procedure in 1957 with subsequent repair of pulmonary stenosis and an atrial septal defect at age 6. At age 17 she underwent repair for paradoxical embolization secondary to a residual atrial septal defect. She presented 54 years later with recurrent pulmonary stenosis and a symptomatic 6.2-cm pulmonary artery aneurysm repaired with a 23-mm aortic homograft. This patient is the longest reported postoperative survivor after a Brock procedure. She continues to do well 63 years after her initial surgery.

Primary Nonbacterial Thrombotic Endocarditis Presenting with Bowel Infarction Secondary to Superior Mesenteric Artery Embolism.

Nonbacterial thrombotic endocarditis (NBTE) is a rare antemortem diagnosis that is commonly associated with hypercoagulable states such as advanced malignancies, disseminated intravascular coagulation, and autoimmune diseases such as antiphospholipid syndrome and systemic lupus erythematosus. We present a case of a previously healthy 42-year-old man who presented with small bowel infarction caused by embolic occlusion of the superior mesenteric artery and was subsequently diagnosed with NBTE. Despite thorough investigation, efforts to find an underlying cause failed to reveal any associated systemic illnesses. This case report emphasizes the importance of further investigation into the possible underlying causes of NBTE, as it can manifest without any apparent systemic factors.

Management of ventricular perforation during revascularization of an intramyocardial left anterior descending artery.

Ventricular perforation during exposure of an intramyocardial left anterior descending artery (LAD) in preparation for coronary artery bypass grafting is a known surgical complication. In this report, we discuss the management of this complication which avoids closure of the LAD and a myocardial infarction.

Occult Internal Mammary Artery Neurofibromatosis: A Case for Caution in Coronary Revascularization.

Intrathoracic neurofibromas are relatively uncommon in patients with neurofibromatosis. They are usually asymptomatic and may be discovered incidentally. We present the case of a 51-year-old, African American man with neurofibromatosis type 1 who underwent coronary revascularization. Intraoperatively, numerous neurofibromas were discovered, one of which was attached to the left internal mammary artery. The procedure was uncomplicated despite the challenging intraoperative findings. Special considerations in the management of patients with neurofibromatosis undergoing cardiac surgery are discussed, including risks, preoperative imaging and the importance of excision of suspicious tumors.

The Anomalous Coronary Artery in Aortic Valve Replacement: A Case For Caution.

We report obstruction of an anomalous right coronary artery traversing between the pulmonary artery and aorta after placement of a 21-mm bovine bioprosthesis for critical aortic stenosis requiring emergency revascularization. Although this anomaly has been associated with sudden death syndrome, acute coronary ischemia resulting from aortic valve replacement in patients with anomalous coronary artery has not been sufficiently highlighted in the literature. Awareness of this issue may decrease the risk of this complication in patients with anomalous coronary anatomy undergoing aortic or pulmonary valve replacement. Furthermore, the need for careful preoperative imaging in patients undergoing semilunar valve replacement is essential.

Tricuspid Septal Leaflet Detachment for Ventricular Septal Defect Repair in Adults.

We report a 21-year-old patient with a ventricular septal defect (VSD) with an embolic vegetation on the tricuspid valve using a technique of septal leaflet detachment to facilitate the repair of the VSD. Although described in the pediatric patients, this technique has not been reported in adults. The technique of septal leaflet mobilization is described, along with other techniques of tricuspid leaflet mobilization that aid in VSD visualization and repair. Tricuspid leaflet detachment has application for adult surgeons repairing perimembranous, postinfarction, and iatrogenic VSD encountered in resection of subaortic stenosis.