ABSTRACT
The patient was a 73-year-old man who was referred to our hospital due to an abnormal thoracic shadow. CT scans revealed Kommerell's diverticulum and saccular aortic arch aneurysm accompanied by abnormal origins of the right aortic arch and the left subclavian artery. Although there were no subjective symptoms, a surgical operation was planned considering the risk of a rupture of the saccular aneurysm. For the surgery, a median sternotomy approach was employed. Under cardiopulmonary bypass, the aortic arch was detached using the open distal method. Further, an open stent graft was inserted, and the aortic arch was replaced with a four-branched artificial blood vessel. After weaning off the cardiopulmonary bypass, coil embolization was performed on the left subclavian artery, and the site was checked to ensure that there was no endoleak. Although hoarseness was noted postoperatively due to paralysis of the right vocal cord, the patient progressed without any other major complications and was discharged 30 days after the operation.
ABSTRACT
A fifty-seven-year-old male farmer with a history of cerebral infarctions twice in the past without any functional disability stopped prescribed antithrombotics and regular medical follow-up. He had sudden left hemiplegia after the work, and was taken to our hospital. A contrast-enhanced computed tomography (CT) scan showed infarction at the right basal ganglia, occlusion of the internal carotid artery and the left vertebral artery, and mural thrombus in the ascending aorta. Mural thrombus in the ascending aorta was suspected to be the causative thrombus of other infarctions. He was started on continuous heparin infusion on the day of presentation, and had ascending aortic replacement surgery on day 24. No perioperative complication was confirmed. He was extubated on postoperative day (POD) 1, and was transferred to another rehabilitation hospital with almost no functional disability. No thrombotic event was confirmed as of POD 180.
ABSTRACT
Non-occlusive mesenteric ischemia (NOMI) is a rare but often fatal event following cardiac surgery. Early diagnosis of NOMI is difficult because the related abdominal symptoms are not very specific. From April 1999 to September 2003, 1,040 patients underwent cardiac surgery, among whom 5 patients who underwent angiography were given a diagnosis of NOMI. A catheter was used for immediate intra-arterial infusion of 500<i>μ</i>g prostaglandin E1 into the superior mesenteric artery over a period of 30min. Prior to angiography, all patients had cutis marmorata and elevated serum lactate levels. Three patients showed peritoneal signs and therefore underwent laparotomy. Of the 5 patients, 4 survived. In conclusion, if mesenteric ischemia is suspected, selective angiography must be performed as soon as possible for diagnosis and treatment. Additionally, the presence of other findings such as cutis marmorata and elevated serum lactate levels proved to be useful in the early diagnosis of NOMI.