ABSTRACT
We report the rare case of a 68-year-old man, who was admitted to our hospital with a diagnosis of aortic arch anastomotic pseudoaneurysm, with concomintant aortic root enlargement and coronary artery stenosis. Eleven years previously, at age 56, he underwent total arch replacement with island reconstruction for chronic aortic dissection. We performed redo total arch replacement, aortic root replacement and coronary artery bypass, making use of a cardiopulmonary bypass with cannulation through the right subclavian artery, femoral artery and femoral vein before resternotomy. We also used selective cerebral perfusion. Postoperatively, the patient temporarily required reintubation ; however, he was discharged in good condition on the 50th post-operative day. The case suggests that island reconstruction has the potential to cause an aortic arch pseudoaneurysm, particularly after a long postoperative period of time. Therefore, thorough postoperative care strategy is required. We also need to consider surgical reconstructive techniques which eliminate vascular lesions as much as possible at the time of the primary surgery, particularly in cases of chronic aortic dissection.
ABSTRACT
We report a rare case of 16-year-old boy who was given a diagnosis vasculo-Behçet disease after removing a right atrial thrombus. He was admitted to our hospital with abdominal pain and fever. He was underwent appendectomy for suspected appendicitis, but the appendix was normal. Additional image examinations revealed a mobile right atrial mass and inferior vena cava thrombosis, and the patient was sent to reoperation urgently to prevent pulmonary embolism. Surgery revealed the mass to be a thrombus. Vasculo-Behçet disease was diagnosed based on the patient's history and examination data. He was discharged on the 17th postoperative day. Cardiac mass excision should be immediately considered in such cases, and the differential diagnosis of Behçet disease was important for this case.
ABSTRACT
We report a rare case of type A acute aortic dissection with paraplegia which was cured immediately after an emergency operation. A 79-year-old woman was transferred to our institution with sudden back pain and paraplegia. Computed tomographic scans revealed a cardiac tamponade with an acute type A aortic dissection. She went into shock soon after arrival, and about 4 hours from onset we performed an emergency replacement of the ascending aorta. Three hours after the operation, her neurological deficit gradually resolved and could walk by postoperative day 3. This case suggests that early restoration of the blood flow to the spinal cord is mandatory to relieve paraplegia caused by type A aortic dissection.
ABSTRACT
Noncompaction of the left ventricular myocardium (NCLV) is a rare congenital cardiomyopathy resulting from an arrest in normal endomyocardial embryogenesis. The prognosis of NCLV is poor, including progress on to heart failure. However, some cases of NCLV in adults have been recently reported. To the best of our knowledge, there are only 3 cases of cardiac operations reported in patients with NCLV in adults. We describ a 54-year-old man with NCLV and severe coronary artery disease. Echocardiography demonstrated NCLV and low LVEF (25%). Coronary angiography (CAG) showed triple vessel disease with total occlusion of vessels #1 and #6. Tl-cintigraphy and magnetic resonance imaging (MRI) demonstrated viability from the base to the middle of the anterior wall. Coronary artery bypass grafting (CABG) was done after controll of the heart failure. The postoperative course was uneventful and the patient was discharged 7 days after operation. LVEF improved to 52% after surgery. Careful observation of cardiac function is vital because of the possibility of progression to heart failure.