ABSTRACT
A 35-year-old man was referred to our hospital for surgical repair of grade IV/IV aortic regurgitation secondary to a congenital unicuspid aortic valve accompanied by aneurysm of the ascending aorta. The aortic valve was the unicuspid unicommissural type and a fully developed commissure was located in the left lateral position (left coronary/right coronary). The anterior (non-coronary/right coronary) and posterior (non-coronary/left coronary) borders were rudimentary with calcified raphe. We performed aortic valve repair in combination with valve sparing root replacement (reimplantation) and partial arch replacement. We converted the unicuspid into a bicuspid aortic valve by preserving his own free margin tissue and creating a neocommissure to the 180 degrees opposite side of the left lateral commissure at the same height by enlarging the cusp with a glutaraldehyde-treated autologous pericardium patch to the cusp belly. The patient was discharged on the 17th postoperative day with trace aortic regurgitation. We successfully repaired the unicuspid aortic valve by augmenting the cusp size using a pericardium patch in order to preserve the free margin of the cusp.
ABSTRACT
The patient was a 15-month-old girl with Down's syndrome. She had a heart murmur on the first day after birth. The echocardiogram revealed that she had the tetralogy of Fallot (TOF) and mitral insufficiency (MI). She was observed because she had no heart failure or cyanosis. However, she developed heart failure with progressive MI. Then, she was admitted to our medical center for surgical treatment. During the operation, it was confirmed that the primary septum was intact and a large ventricular septal defect was located at the inlet to outlet portion with anterior malalignment. Each leaflet of the atrioventricular valve were attached to the same level and the ventricular septum was scooped out. TOF with endocardial cushion defect (ECD) without primary septal defect was diagnosed based on the operative findings. Surgical repair was performed through the right atrium and pulmonary artery. She was discharged 17 days after operation without any complications. This was a very rare combination of TOF with ECD without a primary septal defect. We discussed this rare condition with a review of the literature.
ABSTRACT
Subclavian arterial aneurysms are relatively rare compared to aortic aneurysms. The common causes of subclavian arterial aneurysms are arteriosclerosis, non-specific inflammation, thoracic outlet syndrome, and trauma. A case of a subclavian arterial aneurysm is reported. The patient was a 57-year-old woman. She had no previous history of hypertension, infection and trauma. She underwent complete resection of the aneurysm and reconstruction of right subclavian artery. Exploration of the aneurysmal wall revealed circumferential ridge which caused stenosis of the right subclavian artery at the orifice of the aneurysm. It has been suggested that a subclavian arterial aneurysm developed as a result of abnormal development of the embryologic right fourth and distal sixth aortic arches.