ABSTRACT
A 49-year-old man complaining of nausea and vomiting was admitted to our hospital for the examinations. Blood tests demonstrated anemia due to iron deficiency and slightly elevated D-dimer. Colonoscopy defected early stage sigmoid colon cancer. Enhanced systemic computed tomography revealed that a 5-cm-long mass was growing along the descending aortic lumen and that multi-embolism had occurred in the peripheral arteries. The limited graft replacement of the descending aorta was carried out under cardiopulmonary bypass to prevent recurrent embolism. Histologically, the mass was a blood clot. In addition, the thickened endothelial lining and slight atheromatous degeneration was detected in the resected aortic wall. The patient was discharged after endoscopic mucosal resection for the sigmoid colon cancer. During the two-year follow-up period, despite no anticoagulation, the patient has developed no thrombus in the aorta and suffered no embolic events.
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.