[Right Atrial Blood Cyst with Patent Foramen Ovale:Report of a Case].

A woman in 70s was diagnosed with lung cancer, and a right atrial mass was discovered incidentally during preoperative examination by contrast-enhanced computed tomography (CT). Transesophageal echocardiography revealed a 20-mm, stemmed, spherical mass with low internal echogenicity and partially high echogenicity extending from the junction of the inferior vena cava to the posterior wall of the right atrium. Patent foramen ovale( PFO) was also confirmed. To avoid embolization and obtain diagnosis, the patient was referred for right atrial tumor resection. Cardiopulmonary bypass was established; the right atrial tumor was removed while the patient was in cardiac arrest. The tumor membrane was thin and easily ruptured, revealing jelly-like blood content and calcified mass. The patient recovered well after surgery and was discharged on day 15. According to the pathological examination, the tumor was a blood cyst. This is an extremely rare case of a blood cyst with PFO.

[Endovascular Therapy for Kinking of an Open Stent Graft after Stanford Type A Acute Aortic Dissection Repair:Report of a Case].

This is the case of 50s female with Stanford type A acute aortic dissection who underwent emergent total arch replacement. The aortic arch was transected just distal to the left subclavian artery, followed by the insertion of J Graft Frozenix into the descending aorta. No blood pressure gradient was observed between the radial and femoral arteries immediately after the operation. Nevertheless, intermittent claudication was observed after a week. Ankle-brachial index( ABI) measurement was calculated at 0.7 in both legs. Computed tomography (CT) revealed a kinking of the non-stented part of the endograft. Subsequently, thoracic endovascular aortic repair( TEVAR) was performed. As a result, ABI measurement normalized and lower limb pain disappeared. Three years after, CT showed that the endograft expanded satisfactorily. In deployment of J Graft Frozenix, the non-stented part should be kept as short as possible. For kinking, TEVAR should be considered the initial treatment option.

[Floating Thrombus in Descending Aorta;Report of a Case].

We report a very rare case of floating thrombus in the thoracic descending aorta (TDA). A 54-yearold man complaining of severe lower abdominal pain was admitted to our facility. Enhanced computed tomography demonstrated a filling defect in the TDA, embolism of the superior mesenteric artery (SMA), and bilateral renal infarction. Transesophageal echocardiography revealed that the mass in the TDA was pedunculated, floating, and multiple with maximal diameter of 30 mm. To avoid bowel necrosis, we proceeded with emergent thrombectomy of the SMA. The TDA, including the mass, was removed en bloc for diagnostic confirmation and replaced with prosthesis under cardiopulmonary bypass for prevention of recurrent embolism. The postoperative course was uneventful. On histological examination, the mass proved to be a blood clot on the atherosclerotic wall. No recurrent thrombosis was observed during the 1-year follow-up period.

[Surgical Treatment of Systemic and Left Circumflex Coronary-pulmonary Artery Fistulas with Aneurysm;Report of a Case].

Congenital coronary-pulmonary artery fistulas complicated by continuity to a systemic artery and aneurysm are extremely rare. A 78-year-old woman was admitted to our hospital with a complaint of chest discomfort. Coronary angiography showed a coronary aneurysm and coronary-pulmonary artery fistula arising from the left circumflex artery and entering into the right lower pulmonary artery. Computed tomography angiography revealed a left subclavian artery-pulmonary artery fistula communicating with the coronary-pulmonary artery fistula. Myocardial scintigraphy showed ischemia in the inferolateral wall, indicating a coronary blood steal phenomenon because of the fistula. Endovascular therapy involves a potential risk of life-threatening complications, such as myocardial infarction, and is not recommended for aneurysms with anatomical features, such as the extreme tortuosity of the fistulous tract. Therefore, fistula ligation and aneurysmal resection were performed under cardiopulmonary bypass with cardiac arrest. The postoperative course was uneventful. The coronary steal phenomenon disappeared on postoperative scintigraphy.