A Patient with an Aberrant Right Subclavian Artery Who Underwent Endovascular Aortic Repair for Stanford Type B Acute Aortic Dissection / 日本心臓血管外科学会雑誌

<p>Case : A 75-year-old man was brought to our hospital by ambulance with dorsal pain. Contrast-enhanced computed tomography (CT) revealed acute communicating aortic dissection (Stanford type B) complicated by an aberrant right subclavian artery (ARSCA). Under a diagnosis of type B dissection, conservative treatment by hypotensive therapy and resting was performed. One month after onset, contrast-enhanced CT showed the expansion of the false lumen, and intermittent abdominal pain persisted. To close the entry of the distal arch and reconstruct the ARSCA route, right common carotid artery-right axillary artery bypass, thoracic endovascular aortic repair (TEVAR), and coil embolization of the ARSCA were performed. Five days after surgery, contrast-enhanced CT revealed the expansion of a false abdominal lumen. Abdominal endovascular aortic repair (EVAR) was additionally conducted, leading to the disappearance of false lumen blood flow. ARSCA is a congenital arch vessel abnormality. It may cause obstruction of the esophagus/trachea, aortic aneurysm/dissection of an adjacent area, or aneurysmal changes/rupture of the ARSCA. Various techniques have been reported ; reconstruction of the ARSCA route and closure of the false lumen by de-branch TEVAR may be effective for acute communicating aortic dissection with an ARSCA.</p>

A Successful Case of Cardiac Operation and Chemotherapy for Primary Cardiac Malignant Lymphoma with Superior Vena Cava Syndrome / 日本心臓血管外科学会雑誌

Primary cardiac lymphomas are rare cardiac neoplasms with poor prognoses. We report a 61-year-old man who presented with superior vena cava (SVC) syndrome. Trans-thoracic echocardiography showed a 77×91-mm mass occupying the right atrium. The tumor obstructed the SVC. The deteriorating hemodynamics of our patient prompted a surgical intervention. We resected as much of the tumor as possible under cardiopulmonary bypass. The postoperative course was uneventful, and the SVC syndrome disappeared. Pathological examination was consistent with malignant lymphoma, diffuse large B-cell type. After cardiac operation, the patient was treated with rituximab, cyclophosphamaide, adriamycin, vincristin, and prednisone (CHOP-R). The patient has been in good health for 30 months without signs of recurrence.