Staged Operation for a Patient with Ischemic Heart Disease and Abdominal Aortic Aneurysm Complicating Idiopathic Thrombocytopenic Purpura / 日本心臓血管外科学会雑誌

A 62-year-old man, who had been given a diagnosis of chronic idiopathic thrombocytopenic purpura (ITP), was admitted to our hospital for an operation for abdominal aortic aneurysm (AAA). Preoperative coronary angiography revealed severe triple vessel disease, and we chose to treat this first. The platelet count on his first admission was 2.1×10⁴/μl and preoperative immunoglobulin infusion was introduced for 5 days. Off-pump coronary artery bypass grafting (OPCAB) was performed safely with platelet transfusion, and he was discharged on the 14th postoperative day. Thirty-eight days later, graft replacement of AAA was performed with preoperative immunoglobulin infusion and no platelet transfusion, and he was discharged at the 11th postoperative day. Preoperative immunoglobulin infusion therapy and selection of OPCAB were useful to prevent perioperative bleeding complications. This is the first report of staged cardiac and aortic surgery in a patient with ITP.

A Case of Pulmonary Valve Papillary Fibroelastoma / 日本心臓血管外科学会雑誌

Papillary fibroelastoma (PFE) is a benign tumor accounting for approximately 8% of cardiac tumors. We report a 64-year-old woman with pulmonary valve PFE associated with atrial septal defect. It was detected by a transesophageal echocardiography as a fluttering mass clinging to the pulmonary valve, and was simply removed concomitantly with a patch closure of atrial septal defect. In a review of the past literature, 43 surgical cases of PFE have been reported in Japan, and aortic valve, mitral valve and left ventricle PFE was commonly encountered in 81%. Pulmonary PFE is very rare, and only one case has been reported apart from the present one.

A Case of Successful Transaortic Endovascular Stent Grafting for Distal Aortic Arch Aneurysm with Severely Calcified Chronic Aortic Dissection / 日本心臓血管外科学会雑誌

A 74-year-old man was admitted to our hospital to undergo an operation for distal aortic arch aneurysm with chronic aortic dissection. The first operation was attempted through left lateral thoracotomy. Since the aorta had a severely calcified false lumen, conventional aortic replacement was considered to entail greater risk and graft replacement was given up. As an another option, endovascular stent grafting via the aortic arch through median sternotomy was selected as a second operation. Deep hypothermic circulatory arrest with selective cerebral perfusion was used during delivery and deployment of the stented graft through the aortotomy site. The distal stented graft was deployed into the true lumen at the ninth thoracic vertebral level. Neither endoleaks nor complications were observed. Postoperative computed tomography showed complete thrombosis of the distal aortic arch aneurysm and the false lumen. The postoperative course was uneventful. Transaortic endovascular stent grafting is an effective and less invasive treatment for aortic arch aneurysms with severely calcified aorta.