A Case of Coronary-Pulmonary Artery Fistula with a Giant Aneurysm / 日本心臓血管外科学会雑誌

A 67-year-old woman was admitted to our hospital for examination of a chest X-ray abnormality. Chest computed tomography and coronary angiography revealed a giant aneurysm and coronary-pulmonary artery fistula originating from both the proximal left anterior descending and the right coronary artery. The fistula was ligated and the aneurysm was resected by means of extracorporeal circulation. The postoperative course was uneventful. Computed tomography and coronary angiography showed that the aneurysm and coronary-pulmonary artery fistula had completely disappeared.

Reoperation after Corrective Surgery for Right Ventricular Outflow Tract Obstruction / 日本心臓血管外科学会雑誌

In the past 13 years, 17 patients underwent reoperation after intracardiac repair, including reconstruction of the right ventricular outflow tract. Primary diagnoses of the cardic anomalies were tetralogy of Fallot (TOF) (8 patients), extreme type (TOF) (4 patients), TOF with absent pulmonary valve (1 patient), double outlet right ventricle (DORV) (2 patients), truncus arteriosus (1 patient) and transposition of the great arteries (TGA) (1 patient). Patients were divided into 4 groups based on the surgical procedures for reconstruction of the right ventricular outflow tract as follows: Group A, porcine valved conduit; Group B, autologous pericardial valve bearing tube graft; Group C, transannular patch; Group D, outflow patch with pulmomary valvotomy. The main reason for reoperation in groups A and B was pulmonary stenosis due to calcification of the porcine valve or shrinkage of the pericardial tube graft. Average periods between corrective surgery and reoperation were 7 and 13 years in groups A and B, respectively. Reoperation was performed for massive tricuspid regurgitation and residual shunt, 15 and 24 years after previous operations in groups C and D, respectively. Low cardiac output syndrome, proconged right heart and respiratory failure were major postoperative complications in groups A, B and C. Furthermore, one patient in group A and one other in group C died in the long-term period after reoperation. Both patients had had markedly dilated hearts associated with frequent PVCs. In conclusion, earlier reoperation for progressive and/or residual lesions should be performed to obtain better surgical outcome and quality of life of the patients.