Stent-Graft Infection with Severe Pulmonary Adhesion Cured by Extra-Anatomical Bypass through the Anterior Position of the Pulmonary Hilum: a Case Report / 日本心臓血管外科学会雑誌

This is a case of an 81-year-old male who underwent stent-graft (SG) placement for type B aortic dissection at the age of 79. Two and a half years after the surgery, he was diagnosed with SG infection. Although he was scheduled for SG removal and the in-situ replacement of the descending aorta, he had difficulty maintaining oxygenation under single lung ventilation and detaching the severe adhesion of the aneurysm to the lung; therefore, only the aneurysm sac was opened, and abscess drainage was performed. The continuous irrigation and drainage of the aneurysm sac were performed, but the infection did not improve. On the 6th day after the surgery, the aortic aneurysm in the lung adhesion area was left untreated, and an extra-anatomical bypass was performed from the distal aortic arch to the anterior position of the pulmonary hilum, anastomosing with the abdominal aorta. All SGs were removed, the abscess and intima of the aortic aneurysm were extensively excised, and the remaining cavity was filled with omentum. The infection rapidly improved after the surgery, and he was discharged on the 52nd day after admission. Fortunately, the infection did not recur for 2 years since the surgery. This procedure is useful as an option for surgical reconstruction for stent graft infection for which in-situ descending aorta replacement is difficult.

Surgical Strategy for Protecting Major Branch Arteries during Thoracic Endovascular Aortic Repair for Shaggy Descending Aortic Aneurysms / 日本心臓血管外科学会雑誌

Surgery for a shaggy aortic aneurysm requires a meticulous strategy to prevent embolic complications since the complications are associated with longer length of hospital stay and higher mortality. However, until now, there are no established treatment options to prevent embolic complications. We report a case of a 75-year-old man with a descending aortic aneurysm and a shaggy aorta who underwent thoracic endovascular aortic repair (TEVAR) with major branch artery protection. During the procedure, we placed balloon catheters in the left subclavian and left common iliac arteries, a filter device in the superior mesenteric artery, and a sheath at the ostium of the right common iliac artery. The patient did not develop embolic or other complications and was discharged on the eighth postoperative day. Our strategy of using the balloon occlusion technique and filter placement at the major vessels effectively prevented embolic complications during TEVAR for a shaggy aorta.

A Rare Case of Intracardiac Angiomyolipoma / 日本心臓血管外科学会雑誌

A 34-year-old woman was admitted with a history of syncope and a mass was detected in the right atrium (RA) by transthoracic echocardiography (TTE). Preoperative chest computed tomography (CT) also demonstrated an RA tumor measuring 4×3 cm. We performed resection of the RA tumor under cardiopulmonary bypass. Histopathological findings showed that the tumor was an angiomyolipoma. It is well known that angiomyolipomas are most frequently found in the kidney and are associated with tuberous scleroses. There was no evidence of tuberous sclerosis in this case. Primary tumors of the heart are rare. However, there have been a few intracardiac angiomyolipomas reported previously.