ABSTRACT
<p>ImmunoglobulinG4 (IgG4)-related sclerosing disease can occur in various organs, rarely in cardiovascular lesions. We report a case of IgG4-related cardiac tumor which was concomitant with aortic dissection. A 72-year-old woman visited our hospital with chief complaints of difficulty swallowing and weight loss. A tumor was found in the pericardium adjacent to the left ventricle on echocardiography, and a dissecting aneurysm of the ascending aorta with a maximum of 60 mm in the short diameter was noted on contrast CT. There had been no episodes related to the onset of aortic dissection such as chest pain, and chronic dissection was also identified on diagnostic imaging. A tumor biopsy was performed via a left lateral thoracotomy for tumor tissue diagnosis. Histopathologically, the tumor showed no malignant findings and we identified infiltration of IgG4-positive plasmacytes. The IgG4 level in blood exceeded the reference level, but no findings of IgG4-related disease were observed in other organs. Coronary artery CT showed the left circumflex branch of the coronary artery to run over the tumor. It was thus judged to be difficult to surgically resect the tumor. Oral steroid administration was started to reduce the size of the tumor. However, due to an enlarging trend of the aortic aneurysm involving the ascending aorta on CT at 1 month, the patient underwent ascending aorta replacement. Although infiltration of IgG4-positive plasmacytes was found in the outer lining of the resected arterial wall, the association between IgG4 and the onset of aortic dissection was unclear.</p>
ABSTRACT
<p>We report a case of a 72-year-old woman, who had an anastomotic pseudoaneurysm in the ascending aorta, successfully treated by endovascular aortic repair with vascular embolic devise and stent-graft. It seemed to be high risk to achieve conventional surgery with extracorporeal circulation, therefore we selected endovascular treatment because she had a bleeding tendency which derived from disseminated intravascular coagulation. Then, we adopted stent-grafting with a vascular embolic device, because the distal side of pseudoaneurysm had too short a landing zone to cover the stent-graft only. The patient well tolerated this procedure and her postoperative course was uneventful. The pseudoaneurysm shrank at 6th months after operation.</p>
ABSTRACT
A 63-year-old man suffered from multisystem trauma including pelvic bone fracture and lung contusion caused by a traffic accident. Chest CT revealed mediastinum and periaortic hematoma. Because of hemorrhagic complications, a emergency operation was avoided, and conservative therapy was decided on. Though his blood pressure was controlled strictly, re-bleeding appeared. An urgent operation was performed 4 days after the injury. Under partial cardiopulmonary bypass, the aortic isthmus disruption was resected and replaced with an artificial graft. The postoperative course was uneventful. In cases of traumatic aortic disruption with multisystem trauma, the delayed operation is more common than urgent operation. However, there is always the possibility of rupture. It is extremely important to appropriately judge the timing of the operation.