Acute Aortic Dissection with Rhabdomyolysis / 日本心臓血管外科学会雑誌

Acute aortic dissection causes various complications, but rarely causes rhabdomyolysis before the operation. A 69-year-old woman was found to have fallen unconscious and was transported to our hospital. Chest contrast computed tomography revealed thrombosed type A acute aortic dissection. On admission, hypoxia with paradoxical breathing was recognized and she complained of chest and back pain, and severe leg pain. In blood examination, elevation of myogenic enzymes and acute renal dysfunction were recognized. However computed tomography showed no signs of the ischemia of the intraperitoneal organs and legs. Myogenic enzymes decreased gradually and acute renal dysfunction improved by conservative therapy. In spite of strict antihypertensive therapy, enlargement of the false lumen and re-dissection were occurred, for this reason we scheduled ascending aorta replacement. During the operation we did muscle biopsy, and myogenic changes, such as cytolysis and lymphocyte infiltration, were recognized in muscles pathologically. However all various autologous antibody examinations were negative. We concluded that rhabdomyolysis was due to transient shock and caused preoperative marked elevation of myogenic enzymes.

Ruptured Abdominal Aortic Aneurysm with Left-Sided Inferior Vena Cava: A Case Report / 日本心臓血管外科学会雑誌

We present a successful case of ruptured abdominal aortic aneurysm with left-sided inferior vena cava (IVC). A 74-year-old man, with complaints of abdominal pain and loss of consciousness, was referred to our hospital. Computed tomography revealed a ruptured aneurysm of the abdominal aorta, and the operation was performed immediately. At the operation, left-sided IVC was recognized to cross anteriorly over the abdominal aorta at the usual level of the left renal vein. Proximal anastomosis was safely performed with careful mobilization of the IVC in the appropriate direction. The patient was in acute renal failure after this procedure, with 9 days of continuous hemodiafiltration, but he recovered to discharge on the 46th postoperative day with normal renal function. The cardiovascular surgeon should be familiar with anomalies of the IVC in performing procedures of the abdominal aorta, especially in emergency operations, even if they are rare.