A Chronic Aortic Dissection with Aberrant Right Subclavian Artery and Kommerell's Diverticulum / 日本心臓血管外科学会雑誌

A 65-year-old woman suffered from left-side paralysis and dysarthria after sudden chest pain, and we diagnosed cerebral infarction caused by type A acute aortic dissection in the Stanford classification. At that time, the aberrant right subclavian artery with Kommerell's diverticulum was found on enhanced computed tomography. The acute aortic dissection with closed false lumen was treated conservatively. Because the ulcer-like projection (ULP) expanded during the course, we performed surgery. Ascending aorta and arch replacement, patch closure of Kommerell's diverticulum and reconstruction of right subclavian artery were performed simultaneously. The postoperative course was good.

Revascularization of the Superior Mesenteric Artery in an Intestinal Angina / 日本心臓血管外科学会雑誌

A 69-year-old woman suffered from postprandial abdominal pain and hematochezia. Colonoscopy suggested ischemic colitis, and intestinal angina was diagnosed by multirow-detector computed tomography (CT), which showed occlusion of the superior mesenteric artery (SMA). On enhanced CT, there was extensive calcification on the aortic wall and aortic expansion and several mural thrombi in the thoracoabdominal and abdominal aorta, as well as severe stenoses in the bilateral common iliac arteries. A bypass from the right renal artery, which was the only artery without significant stenosis of the major branches of the abdominal artery, to the SMA, was created using a saphenous vein graft. Postoperatively, the postprandial abdominal pain disappeared, and the patient was discharged after a good postoperative course.

Total Posterior Papillary Muscle Rupture Associated with Acute Myocardial Infarction: A Case Report with Successful Emergency Surgery and a Review of Japanese Literatures / 日本心臓血管外科学会雑誌

A 64-year-old man was transferred to our hospital because of acute heart failure associated with myocardial infarction. Echocardiography revealed severe mitral regurgitation due to total rupture of the posterior papillary muscle. Following the diagnosis of papillary muscle rupture, intraaortic balloon pumping support was started, and surgery was performed without coronary angiography because of cardiogenic shock and renal dysfunction. The posterior papillary muscle was completely ruptured, and the anterior leaflet of the mitral valve was severely prolapsed. Without resecting the posterior leaflet, mitral valve replacement was successfully performed using a St. Jude Medical^® prosthetic valve. The postoperative course was uneventful except for ventricular tachyarrhythmia which occurred during the acute phase postoperatively. Postoperative coronary angiography demonstrated no significant coronary arterial stenosis. In a patient with cardiogenic shock due to papillary muscle rupture, immediate surgical intervention is recommended as soon as the diagnosis has been established by echocardiography.