ABSTRACT
<p>A 66-year-old man presented to a local doctor with a chief complaints of episodes of dizziness lasting several seconds. Electrocardiographic findings were suggestive of arrhythmia and old myocardial infarction, and the patient was therefore referred to our hospital. Left ventriculography showed an aneurysm at the posteroinferior wall of the left ventricle, while coronary angiography showed chronic total occlusion of the left circumflex branch (segment 13) and a coronary-pulmonary artery fistula with a coronary aneurysm. On computed tomography, the orifice of the ventricular aneurysm was small, measuring approximately 10 mm. Magnetic resonance imaging showed wall thinning and mural thrombus in the ventricular aneurysm, with aneurysmal dilatation during systole. Suspecting a ventricular false aneurysm resulting from old myocardial infarction, left ventricular reconstructive surgery and resection of the coronary artery aneurysm were performed. Intraoperatively, myocardial necrosis of the posteroinferior wall accompanied by the ventricular aneurysm was seen. There was no pericardial adhesion to the ventricular aneurysm, and the diameter of the orifice of the aneurysm was approximately 10 mm. The ventricular aneurysm was cut open and then closed using a direct suture combined with patch repair. As for the coronary artery aneurysm, the inflow and outflow arteries were each clipped before the wound was closed. The patient had a favorable postoperative course and was discharged from the hospital on the 15th day after surgery. The pathological examination showed residual cardiomyocytes within the aneurysmal wall, thereby establishing the diagnosis of a pseudo-false aneurysm. Our experience with this rare case is reported.</p>
ABSTRACT
A 78-year-old man presented at the emergency department with anterior chest pain. Coronary angiography (CAG) revealed three-vessel disease and percutaneous transluminal coronary angioplasty (PTCA) was performed on the right coronary artery. A preoperative plain chest computed tomography (CT) scan revealed hyperostosis of the sternum and clavicle. The patient underwent elective coronary artery bypass surgery 49 days later. During surgery, the thickness of the sternum caused difficulties with implementing median sternotomy. The pleura was also thicker than usual and even pulsation of the left internal thoracic artery (LITA) could not be determined due to severe adhesion. We harvested the right internal thoracic artery (RITA) instead of the LITA. The RITA was in a similar condition, but a 5 cm proximal portion could be prepared. The saphenous vein graft was anastomosed to the left anterior descending coronary artery after proximal anastomosis to the ascending aorta with the heartstring device because of the calcified aorta. The RITA-saphenous vein composite graft was anastomosed sequentially to the distal right coronary and circumflex artery. The patient's postoperative course was uneventful but he complained of numbness and lassitude of both upper extremities for one month. A postoperative contrast-enhanced CT scan revealed a patent LITA surrounded by thick tissue, indicating inflammatory disorders. The CT findings indicated a diagnosis of sternocostoclavicular hyperostosis. The postoperative CAG findings indicated that all bypass grafts were patent and the patient was discharged 32 days after surgery. Sternocostoclavicular hyperostosis is an inflammatory disease that might require surgeons to carefully reconsider graft selection.
ABSTRACT
A 51-year-old woman, who had been undergoing regular treatment and follow-up for hypertension since the age of 17, was diagnosed to have a patent ductus arteriosus (PDA) 6 months previously. On experiencing dyspnea, she visited the emergency room, where she was found to have a complete Atrioventricular (AV) Block and therefore was immediately admitted. The next day, she experienced acute heart failure requiring intubation. A DDD pacemaker was then implanted and the patient recovered thereafter. After recovery, a screening contrast-enhanced CT scan revealed coarctation of the thoracic aorta. The arterial pressure gradient between the arms and legs was about 70mmHg. The division of the PDA and the replacement of the coarcted aortic segment were performed under femoro-femoral cardiopulmonary bypass through a left posterolateral thoracotomy. The patient's postoperative course was good, however, she complained of abdominal pain on the 6th postoperative day. An abdominal CT scan showed hemorrhage in the left rectus abdominus and right iliopsoas muscles. This improved after rest. No arterial pressure gradient was observed between the arms and the legs postoperatively. She was discharged on postoperative day 20.Because the average life expectancy of patients with untreated coarctation of the aorta has been reported to be about 34 years, it is recommended that surgical repair be performed as soon as possible. Patients with childhood-onset hypertension should therefore be evaluated to determine the primary disease whenever possible, such as coarctation of the aorta as in this case.