Combination of Ascending Aortic Replacement and Less Invasive Quick Open Stenting for Distal Aortic Arch Aneurysm with a Penetrating Atherosclerotic Ulcer / 日本心臓血管外科学会雑誌

A 76-year-old man with hypertension had an enlarged distal aortic arch aneurysm with a maximum dimension of 55 mm. Coronary computed tomography angiogram showed none of stenosis in a coronary artery, but penetrating atherosclerotic ulcer at ascending aorta. We performed open surgical repair combination of ascending aortic replacement and less invasive quick open stenting (LIQS) to reduce operative risk, because of his advanced age. The operation was carried out without any complications (Operation time : 242 min, Cardiopulmonary bypass time : 154 min, Aortic cross clamp time : 71 min). The patient's postoperative course was unremarkable, and he was discharged 19 days after surgery. LIQS is effective to reduce operative risk for high-risk patients, and it can be easily combined with other procedures.

A Case of Postinfarction Left Ventricular Free Wall Rupture in an Elderly Patient / 日本心臓血管外科学会雑誌

An 85-year-old man was admitted complaining of chest pain. The ECG showed ST depression in leads II, III, _aV_F, V₃-V₆ and Q wave in leads I, _aV_L with elevation in ST segments. An emergency coronary angiography revealed 75% stenosis in the left main trunk, 75-90% stenosis in the left anterior descending artery, total occlusion in the acute marginal branch, 75% stenosis in the left circumflex artery, and 75% stenosis in the right coronary artery. He was treated medically, because he was old and his hemodynamics were stable. About 39h later, he lost consciousness suddenly and was shown to have cardiogenic shock. Echocardiogram revealed pericardial effusion. Percutaneous drainage was performed, resulting in improved blood pressure and level of consciousness. He was transferred to Okaya Enrei Hospital and received emergency surgery for subacute LVFWR. A sutureless repair and coronary bypass was performed under cardiopulmonary bypass and cardiac arrest. He experienced no major complication and was discharged 40 days after surgery. It is concluded that the sutureless technique allowed for a shorter operation time and concomitant coronary bypass successfully prevented pseudoaneurysm and improved cardiac function. A higher quality operation is possible by using a combination of on-pump, cardiac arrest, coronary bypass and left ventricle repair with the sutureless technique in such cases in which treatment is needed for cardiac arrest as in the above example. This method contributed to an improved prognosis.