A Giant Aortic Arch Aneurysm with Aortopulmonary Fistula / 日本心臓血管外科学会雑誌

A 69-year-old woman complained of general malaise. Chest X-ray film revealed massive left-sided pleural effusion and CT detected a giant aneurysm of the aortic arch. A diagnosis of ruptured aortic arch aneurysm was made and she underwent total arch replacement as emergency surgery. The intraoperative diagnosis was not a ruptured arch aneurysm but an arch aneurysm penetrating into the left pulmonary artery. The postoperative course was uneventful and the patient was discharged home on the 16th postoperative day.

Mitral Valve Replacement in a Patient with Severe Atrial Calcification / 日本心臓血管外科学会雑誌

<p>A 70-year-old woman, who had a history of a percutaneous transvenous mitral commissurotomy for rheumatic heart disease 34 years previously, was admitted with progressive right heart failure. Massive calcification of the left wall was observed on multidetector CT. She underwent a mitral valve replacement, tricuspid annuloplasty and permanent pacemaker implantation. Massive calcification of the left atrial wall is a rare condition, and constitutes a major complication and risk to mitral valve surgery because of the difficulty in entering the left atrium, potential embolization, and impaired hemostasis.</p>

Above-Knee Femoropopliteal Arterial Bypass for Lower Limb Ischemia Associated with Bilateral Persistent Sciatic Arteries / 日本心臓血管外科学会雑誌

<p>Persistent sciatic artery (PSA) is a rare congenital vascular anomaly with an incidence ranging from 0.025 to 0.06% of the general population. We report a 65-year-old male patient with bilateral PSA suffering from intermittent right-calf claudication. Peripheral pulsations could be palpated well at the right common femoral artery but not at the right popliteal artery. His ankle brachial index (ABI) was 0.79 on the right and 0.99 on the left. Computed tomographic (CT) angiography demonstrated that the bilateral PSAs were branched from the internal iliac arteries and the right PSA was completely occluded, whereas aneurysmal change was not evident. Both superficial femoral arteries were incompletely developed. Blood flow to the peroneal artery, anterior and posterior tibial arteries were maintained in both lower legs via a network of collateral arteries. Arterial bypass from right common femoral artery to the above-knee popliteal artery using knitted Dacron graft was performed and postoperative ABI of the right lower limb improved to 1.06. Ten months after the intervention, the patient was then suffered from intermittent left-calf claudication caused by complete occlusion of left PSA, therefore, above-knee femoropopliteal arterial bypass using knitted Dacron graft was performed. PSA is often asymptomatic until a complication develops and the careful monitoring to prevent the risk of thromboembolic and aneurysmal events are recommended.</p>