ABSTRACT
We report a case of dysphagia caused by compression of the esophagus by the nonaneurysmal tortuous descending aorta (dysphagia aortica). A 69-year-old woman was admitted suffering from dysphagia. Esophagoscopy showed esophageal stenosis caused by pulsatile and extramural compression. Esophagography and aortograms also showed that the nonaneurysmal tortuous descending aorta compressed the esophagus in an anteromedian direction. To avoid the esophageal ulcer and the aortoesophageal fistula, resection of the tortuous aorta and a Dacron graft replacement was performed. After operation compression of the esophagus was released and her complaint improved.
ABSTRACT
Splenic artery aneurysm is considered to be a relatively uncommon disease. It is difficult to diagnose asymptomatic cases of splenic artery aneurysm when the physician does not recognize the presence of this disease. The recent development of diagnostic imaging technology has resulted in an increasing number of reported asymptomatic cases of splenic artery aneurysm using ultrasonography and computed X-ray tomography. An asymptomatic case of a 44-year-old woman who had an abdominal mass around the splenic hilus detected with ultrasonography is reported. Color-coded Doppler ultrasonography led to a preoperatively confirmed diagnosis of splenic artery aneurysm with the detection of intraluminal arterial flow in the mass. The aneurysm was a semispherical mass, 20×16×13mm in size. At operation, only aneurysmectomy was carried out and splenectomy was not performed. The patient was discharged with a complete cure on the 18th postoperative day. Color-coded Doppler ultrasonography is extremely effective in the diagnosis of abdominal splanchnic artery aneurysms.
ABSTRACT
Left ventricular rupture is one of the major lethal complications of mitral valve replacement. A case of successful repair of postoperative left ventricular rupture following mitral valve and aortic valve replacements, tricuspid valve annuloplasty in chronic renal failure is described. The patient was a 58-year-old male and suffered from mitral stenosis and regurgitation with left atrial thrombi, aortic stenosis and regurgitation, and tricuspid regurgitation. It has been 13 years since the patient was operated on for mitral stenosis with open mitral commissurotomy. Mitral valve and aortic valve replacements, tricuspid valve annuloplasty was performed under cardiopulmonary bypass and cardioplegic arrest using the extracorporeal ultrafiltration method (ECUM) and continuous venovenous hemodialysis (CVVH). The patient has been in good condition during weaning from cardiopulmonary bypass. After the operation, left ventricular rupture occurred due to transient high blood pressure in the operating room. The patient was quickly put back on cardiopulmonary bypass. In this case, the rupture occurred although no technical errors were thought to be made. The site of the rupture was type II in the Treasure classification. The left ventricular rupture was repaired with the patch closure method under cardiopulmonary bypass and cardioplegic arrest. The postoperative cardiac function was relatively well preserved. More attention should be paid to cases in this type of condition; mitral stenosis, long history, multiple valve replacements, and chronic renal failure. This patient died from sepsis caused by the infectious route of continuous ambulatory peritoneal dialysis (CAPD) on the 61st postoperative day.