ABSTRACT
Urgent surgical repairs were successfully performed in four patients with blunt traumatic ruptures of the thoracic aorta. All 4 patients were involved in traffic accidents and had ruptures immediately distal to the aortic isthmus. The diagnoses were achieved by IV-DSA in case 1, by IV-DSA and enhanced CT in case 2 and by enhanced helical CT in cases 3 and 4. Intraoperative transesophageal echocardiography was performed in case 4. Operations were accomplished with the aid of temporary shunt in case 1, pulmonary-femoral artery bypass in case 2 and partial left heart bypass in cases 3 and 4. Prosthetic graft interposition was performed in cases 1, 3 and 4 and end-to-end aortic anastomosis was performed in case 2. There was no postoperative paraplegia in any patient. Early diagnosis and urgent surgical repair are important in treating blunt traumatic rupture of the thoracic aorta. Enhanced helical CT and transesophageal echocardiography are useful for the diagnosis of this type of injury.
ABSTRACT
Left ventricular myxoma is very rare and only 13 cases have been reported in Japan. A 14-year-old girl was admitted to a local hospital in November, 1983, with a sudden onset of right hemiparalysis. Two-dimensional echocardiograms and left ventricular angiograms revealed two left ventricular tumors. The patient was transferred to our hospital for the operation which was performed one month later. Two tumors originating from the apical interventricular septum were removed with resection of the septum through a left ventriculotomy. The tumors were 2.0×1.7cm in size and 1.9g in weight, 1.9×1.5cm in size and 1.1g in weight, respectively. The pathological diagnosis was myxoma. Her postoperative course was uneventful, and there has been no recurrence for 15 years after surgery. Japanese literature on the subject was reviewed.
ABSTRACT
Cardiac fibromas are rare tumors. A 12-year-old girl who had no cardiac symptoms was evaluated because of her abnormal ECG. Physical examination revealed a grade 1/6 systolic murmur. Routine laboratory examination results and the chest X-ray films were normal. The ECG showed a negative T wave at leads II, III, aVF and V<sub>3-4</sub>. Two-dimensional echocardiography demonstrated a tumor in the lower right ventricular free wall. Operation was performed on July 12, 1990. Sharp dissection was used to remove the tumor through right ventriculotomy. She had an uneventful postoperative course and is well 7 years later with no evidence of recurrence. Pathological findings including immunohistochemical studies revealed cardiac fibroma. The 22 reported cases of cardiac fibroma in Japan were reviewed.
ABSTRACT
A 58-year-old man was admitted for pneumonia after several business trips to Thailand, Vietnam, and Malaysia. Despite resolution of pneumonia on chest X-ray, high fever persisted. CT scan revealed a juxtarenal, atypical-shaped abdominal aortic aneurysm of 4.5cm in size, and this was thought to be the cause of persisting fever. After prolonged antibiotic treatment, surgical resection and prosthetic tube replacement of the aneurysm was performed. The aneurysm was a pseudoaneurysm, and histological examination showed chronic inflammation with no atherosclerotic change. It was thought to be of mycotic origin. On the 12th day after operation, he became febrile, and an arterial blood culture yielded <i>Burkholderia pseudomallei</i>. Antibiotics chosen according to sensitivity tests, were given. He was finally discharged with no exidence of persisting infection, on the 55th day after operation.