Acute Aortic Dissection Combined with Obstructive Sleep Apnea Syndrome / 日本心臓血管外科学会雑誌

Obstructive sleep apnea syndrome (OSAS) has symptoms such as severe snoring, apneic attack, and daytime hypersomnia due to repeated obstruction of the upper respiratory tract during sleep. The mortality rate due to cardiovascular complications in severe OSAS. We reported 5 cases of OSAS among the acute aortic dissection cases we treated. They were 2 cases of DeBakey I (cases 1, 2) and 3 cases of III b (cases 3, 4, 5). Organ ischemia was recognized in 4 among 5 cases of dissection combined with OSAS. There was 1 case of renal ischemia (case 1), 2 cases of limb ischemia (cases 3, 4), 1 case of visceral and spinal ischemia (case 5). Case 4 was III b type dissection with severely compressed true lumen and limb ischemia. The false lumen occluded by combining antihypertensive therapy and continuous positive airway pressure used to OSAS. Case 5 also had a severely compressed true lumen, and visceral ischemia 4 days after the onset. Angiography showed a severly compressed orifice of the true lumen of the celiac artery and superior mesentric artery due to the occluded false lumen. We placed a stent into the orifice of celiac artery transluminally and then patient recovered. There were many dangerous situations such as organ ischemia, and severely compressed true lumen among the cases of dissection combined with OSAS. Marked changes of intrathoracic pressure in apneic attacks may place stress on the thoracic aorta.

A Case of Acute Type B Dissection with Limb Ischemia and Severely Compressed True Lumen Cured by Conservative Therapy / 日本心臓血管外科学会雑誌

A 73-year-old man suddenly felt severe back pain. Computed tomography showed acute type B dissection. The false lumen existed from the distal arch to the right common femoral artery and was patent. The true lumen was severely compressed by the false lumen and his right leg was cold. In spite of limb ischemia, we started conservative therapy because he had severe airway stenosis due to obesity and obstructive sleep apnea syndrome (OSAS) and we thought surgical intervention very risky. We thought OSAS also involved a risk of high blood pressure and started continuous positive airway pressure. His blood pressure went down along with the improvement of respiratory conditon. After 12 days from the onset he evacuated bloody stool and gastrointestinal fiberscopy revealed giant gastric ulcer bleeding. Platelet counts and prothrombin time began to increase 2 days later. Computed tomography 14 days after onset showed a patent false lumen and severely compressed true lumen. Computed tomography 39 days after onset showed thrombosis of the false lumen and considerable dilatation of the true lumen. Hypercoagulability after bleeding from gastric ulcer and treatment of OSAS were important in this successful conservative therapy.

A Case of Right Atrial Myxoma with Chronic Pulmonary Embolism / 日本心臓血管外科学会雑誌

A 68-year-old man was admitted to our hospital with dyspnea and general fatigue. At first, pulmonary embolism was diagnosed by electrocardiography and pulmonary scintigram. X-ray CT scans and echocardiography revealed a tumor occupying the right atrial cavity. To prevent further pulmonary embolism, he underwent tumor resection. In surgery, two venous drainage cannulas were inserted directly to the superior vena cava and to the inferior vena cava via the right femoral vein, in order to avoid the direct contact with the right atrium prior to institution of extra-corporeal circulation. The tumor was carefully removed together with the atrial wall around the site where the tumor originated. A pathological study showed that the specimens were myxoma in the right atrium. His post-operative course has been uneventful until now, however, long-term observation with respect to the metastasis and/or recurrence of this tumor will be carried out.