Open Stent Grafting for Stanford Type A Acute Aortic Dissection Originating from an Aberrant Right Subclavian Artery / 日本心臓血管外科学会雑誌

<p>An aberrant right subclavian artery (ARSA) is a relatively rare congenital anomaly of arch branches, occurring in 0.5-2.0% of the population. Stanford type A acute aortic dissection involving an ARSA is rare, and is associated with difficult surgical planning in an emergency situation. We report a case of Stanford type A acute aortic dissection originating from an ARSA in a 50-year-old man. He was referred to our hospital with a chief complaint of chest and back pain. Contrast enhanced CT scan revealed type A aortic dissection involving an ARSA, with the entry located near the ARSA. Given the possible difficulty of performing distal anastomosis over the ARSA and ARSA reconstruction, total arch replacement was performed using the open stent-grafting technique. The postoperative course was uneventful, and a CT scan revealed a thrombosed false lumen and ARSA. The false lumen of the aorta next to the stent graft eventually disappeared at 1 year postoperatively. The open stent-grafting technique might be an effective alternative in the management of Stanford type A acute aortic dissection with ARSA.</p>

Surgical Treatment for Papillary Muscle Rupture after Myocardial Infarction with Sustained Ventricular Tachycardia / 日本心臓血管外科学会雑誌

We report an operative case of papillary muscle rupture after myocardial infarction with sustained ventricular tachycardia. A 56-year-old man referred to our emergency room in shock. Emergency CAG showed total occlusion of the left circumflex artery, in which we placed a metallic stent. Even after re-canalization of the coronary artery was achieved, circulation was unstable. IABP and PCPS were used to maintain the systemic circulation. Trans-esophageal echocardiography showed papillary muscle rupture and massive mitral regurgitation. Under total cardiopulmonary bypass and cardiac arrest, we performed mitral valve replacement with a 27mm SJM mechanical valve. PCPS was continued after surgical treatment because of pulmonary congestion. Since the patient's circulation and respiratory function improved, PCPS and IABP were removed on postoperative days 3 and 5. However, after removal of IABP, ventricular tachycardia appeared and IABP, PCPS were re-inserted. After adequate medication with Amiodarone and Carbedirol, ventricular tachycardia was controlled. PCPS and IABP were then removed uneventfully on postoperative days 14 and 19.