ABSTRACT
<p>Aortobronchial fistula is a rare but fatal condition, if not treated surgically. Conventional graft replacement is usually recommended for eradication of the fistula and infection, but mortality and morbidity remain high. Recently the effectiveness of endovascular repair for such cases has been reported. We encountered a case of an 83-year-old man with aortobronchial fistula due to a distal aortic arch aneurysm. The computed tomography (CT) scan showed severe calcification and stenosis in the abdominal aorta and iliac artery, indicating inadequacy for use as access vessels. The patient presented with hemoptysis, and was treated successfully by endovascular repair via the descending aortic conduit. Although the patient had a history of heavy smoking, he fully recovered after surgery and was discharged without any complication. There are potential risks of recurrence of aortobronchial fistula and infection, and we plan to continue close follow-up.</p>
ABSTRACT
A 77-year-old woman was referred to our hospital for the treatment of aortic insufficiency and paroxysmal atrial fibrillation. She underwent aortic valve replacement, pulmonary vein isolation and left atrial appendectomy. Temporary epicardial pacing wires (TEPWs) were placed on the right ventricle at the operation, and were cut flush with her skin surface prior to discharge because of difficulty in traction removal. She was discharged in good condition. Sixteen days after her discharge, she was re-admitted for fever. A computed tomography revealed cellulitis of the chest, and migration of one retained TEPW extending from the ascending aorta to the right subclavian artery. Removal of the migrated TEPW and sternal resection with omentopexy for sternal osteomyelitis were performed. Her postoperative course was uneventful. TEPWs should be completely removed when possible. If TEPWs are retained, this should be kept in mind when the patient presents with complications postoperatively.
ABSTRACT
A 68-year-old woman with a chief complaint of dyspnea was admitted in March, 2007. She had undergone percutaneous angioplasty of the right coronary artery in 2002. Elective surgery was advised because echocardiography, left ventricular cineangiography and 64-multidetector-row CT (64MDCT) had revealed a left ventricular aneurysm (LVA), a ventricular septal perforation (VSP) through the aneurysm, and three diseased coronary arteries. The aneurysm wall was located on the inferior wall, and this was incised longitudinally. The VSP was directly sutured using 4-0 polypropylene, and the aneurysm was closed with large patches, and pledgetted mattress and running sutures. The postoperative course was uneventful, and the patient was discharged on the 13th postoperative day. It is rare for LVA and VSP to be diagnosed simultaneously, but the risk of pseudo-false aneurysm of the left ventricle is high because of free wall rupture and septal wall perforation, and therefore surgical repair is recommended.