ABSTRACT
A 77-year-old man with an abdominal aortic aneurysm, detected by abdominal ultrasonography, was referred to our hospital. Multi-detector computed tomography (MDCT) revealed an intrathoracic left subclavian artery aneurysm 30 mm in diameter and a small distal arch aortic aneurysm as well as an abdominal aortic aneurysm 40 mm in diameter. Surgery was indicated for the subclavian artery aneurysm considering the risks of rupture and distal embolism. Our choice for treatment was endovascular repair ; thoracic endovascular aortic repair (TEVAR) and coil embolism. The operation was performed successfully. Orifices of the left subclavian artery and the distal arch aneurysm were covered with a stent graft and the left subclavian artery was occluded with coils distal to the aneurysm. The operation time was 1 h and 44 min. He was extubated in the operation theater. A follow-up CT scan performed at 1 week showed the correct position of the TEVAR device, patency of the common trunk of the brachiocephalic and right common carotid arteries, and complete exclusion of the aneurysms. He was discharged on the 12th postoperative day without complication. Subclavian artery aneurysms, in particular in the intrathoracic location, are rare. Conventional surgery for this entity tends to require arch replacement to be unreasonably invasive as a therapy for peripheral artery disease. We believe this endovascular therapy can be a useful, less-invasive alternative to conventional open surgery.
ABSTRACT
Reoperations after operations for acute type A aortic dissection were performed in two cases under deep hypothermic circulatory arrest. In case 1, the aortic arch replacement was performed with an inclusion technique seven years ago. The reason for reoperation was the leak from the suture lines of all anastomosis sites. Three sites of leak were closed putting sutures with pledgets. In case 2 the graft replacement of the ascending aorta was performed five years ago. The reason for reoperation was the persistent dissection from the aortic arch to the thoracic descending aorta due to the new entry formation at the site of the aortic clamp. At first the graft replacement of the thoracic descending aorta was performed, followed by arch replacement. As these conditions are preventable, we should perform the open distal anastomosis technique without using a clamp and graft replacement of aortic arch with the branched graft. Moreover, deep hypothermic circulatory arrest may appear to be a valuable adjunct for reoperation after operation on acute type A dissection.
ABSTRACT
Thirty-nine patients underwent emergency coronary bypass surgery for acute myocardial infarction, Patients were divided into two age groups; 10 patients aged 75 years or older and 29 patients under the age of 75 years. In addition, we compared these two groups and another 23 patients aged 75 years and older who recieved reperfusion therapy alone. The rate of mortality was 30% in the patients 75 years or older, 31% in the patients under 75 years and 52% in the patients with reperfusion therapy alone. There were no significant differences between the three groups. The majority of two groups of surgical patients died of low cardiac output after the operation. Fifty percents of the patients who recieved reperfusion therapy alone died of extension of myocardial infarction or reinfarction. However, no surgical patients died of reinfarction. There were no significant differences in Killip's class, preoperative hemodynamics and the number of diseased vessels between two surgical groups. In the patients of 75 years or older, the post-operative cardiac output did not increase in comparison with the patients under the age of 75 years. They required a longer period for oral uptake and a longer recovery period after the surgery. Therefore, emergency coronary bypass surgery for acute myocardial infarction was effective in the elderly population aged 75 years or older, although it still carried a high operative mortality.
ABSTRACT
We experienced a very rare case in a 26-year-old man who underwent surgery for bilateral atrial myxomas. Moreover, his initial symptoms were due to acute myocardial infarction, which strongly suggested coronary artery embolization. Transesophageal echocardiography revealed not only left atrial myxoma at posterior wall, but also right atrial myxoma at the fossa ovalis which had not been detected by transthoracic echocardiography. At surgery, both left and right atriotomy was performed and bilateral atrial myxomas were completely removed. We emphasized that transesophageal echocardiography was very useful in detecting the location of myxomas, and that surgical exploration of the right atrium would have been necessary even if left atrial myxomas had not existed at the atrial septum.