ABSTRACT
A 63-year-old woman, in whom a continuous heart murmur had been pointed out previously, complained of congestive heart failure. The patient had undergone surgical treatment for skin cancer on the anterior chest wall, and an autologous skin graft, which partly covered the lower sternum, had been implanted. Patent ductus arteriosus (PDA) was diagnosed by an enhanced chest computed tomography (CT), ultrasonic cardiography and catheterization study. The duct was 4mm in diameter and 5mm long. The Qp/Qs was 1.65 and the L-R shunt rate was 39%. The auto-skin graft was untouched and the heart was approached with a reverse T-shaped partial sternotomy. Normothermic circulatory support with cardiopulmonary bypass was established. The PDA was closed through a left pulmonary arteriotomy with a 0.4-mm-thick PTFE patch. Without clamping the calcified aorta, a balloon catheter was advanced into the aorta through the duct to block the arterial back flow. The follow-up has been conducted with enhanced CT every 6 months and the closed duct has been confirmed.
ABSTRACT
We encountered 4 nonagenarian cases of ruptured abdominal aortic aneurysm (RAAA). They were 2 men and 2 women aged between 90 and 94. Two cases were saved but two were lost. The percentage of success in this age group was low but there was no statistical inferiority. The serum hemoglobin levels on admission were low and they had a tendency towards acidosis in spite of fairly good blood pressure. The causes of death were hemorrhagic shock and intestinal necrosis. We have to treat more carefully and vigorously to secure elderly surgical cases of RAAA. One patient died of cerebral infarction after discharge. We recommend that the patients of RAAA in nonagenarians should undergo surgical operations except in cases of severe shock or cardiopulmonary arrest.