ABSTRACT
A 68-year-old man with unstable angina after old myocardial infarction, and Leriche's syndrome was admitted. Coronary angiography found 90% stenosis of the left anterior descending artery (LAD), 99% stenosis of the diagonal branch, 99% stenosis of the right coronary artery (RCA), and 90% stenosis of the 4-posterior descending branch (4 PD). Left circumflex artery (LCX) was diffusely stenotic and small. Aortography revealed complete occlusion of the infrarenal aorta. Due to the risk of limb-threatening ischemia, we planned simultaneous revascularization of myocardium and the lower extremities. Off-pump coronary artery bypass (OPCAB) was performed first. Subsequently Y graft replacement of abdominal aorta was completed. The postoperative course was uneventful and he was discharged on the 14th day after operation.
ABSTRACT
A 71-year-old man was transferred to our hospital because of impending rupture of an abdominal aortic aneurysm (AAA). Preoperative CT scan demonstrated a huge aneurysm of the aortic arch (TAA) associated with an AAA. Emergency coronary angiography revealed 3-vessel disease. One-stage surgery including TAA repair, coronary bypass surgery, and AAA repair was performed to avoid the possibility of rupture of the remaining aneurysms and the risk of ischemic heart diseases. One-stage surgery is a possible approach for patients with severe multivascular diseases.
ABSTRACT
An 86-year-old woman was transferred to our hospital because of chest pain and left incomplete paralysis. CT-scan revealed a dissecting aortic aneurysm (DeBakey type 2) 6cm in diameter. Coronary angiography and aortography were perfomed to assess the coronary artery disease and ASO, they showed occluded LAD, 90% stenosis of CX and occluded left external iliac artery. We planned a 1-stage operation. Coronary artery bypass grafting with the beating heart was carried out prior to replacement of the ascending aorta. Then we performed femoro-femoro bypass. The postoperative course was uneventful and the patient was discharged 23 days after the operation.
ABSTRACT
A 53-year-old woman underwent mitral valve replacement for congestive heart failure due to mitral stenosis and regurgitation. She had been receiving hemodialysis because of diabetic nephropathy since 1993, and had had congestive heart failure since 1999. Echocardiography demonstrated mitral stenosis (MVA; 1.10cm<sup>2</sup>) and regurgitation with a severely calcified mitral annulus. Annular calcification extended to the posterior wall of the left ventricle and the base of bilateral papillary muscles. After removing all calcium from the mitral annulus to the base of the papillary muscle, the left ventricular posterior wall and mitral annulus were reconstructed by glutaraldehyde-preserved autologous pericardium. Then, a Carbo-Medics mechanical valve was placed at the mitral annulus using everting mattress sutures. Although her hemodynamics were stable, bacteremia and multi-organ failure developed 3 months after surgery and she died. Autopsy showed that the reconstructed left ventricular posterior wall and mitral annulus using glutaraldehyde preserved autologous pericardium were in excellent condition without any thrombus. No dehiscence was found at the suture line of the mechanical valve. Mitral annulus reconstruction with glutaraldehyde preserved autologous pericardium is thought to be effective for patients with calcified mitral annulus who require mitral valve surgery.
ABSTRACT
Extracorporeal shock wave lithotripsy (ESWL) represents the preferred treatment for most upper ureteric and renal calculi. Complication rates associated with ESWL are low, justifying the enthusiasm and acceptance of this treatment modality. We report a case of abdominal aortic pseudoaneurysm due to ESWL. A 47-year-old man had undergone ESWL treatment for ureteric calculi since 1990. He was admitted to our hospital because of lumbar pain. Physical examination revealed a pulsatile mass in his abdomen. Abdominal CT scan showed an abdominal aortic aneurysm (5.3cm in diameter). Angiography showed a fusiform aneurysm of the infrarenal abdominal aorta. Y-graft replacement was performed after aneurysm resection. Histological examination revealed that it was a pseudoaneurysm. The patient had no history of trauma, inflammation or operation except ESWL. This is the first report of abdominal aortic pseudoaneurysm due to ESWL.