ABSTRACT
We report 2 cases of successful proximal reoperations after acute type A dissection. Case 1 : A 53-year-old man underwent ascending aorta and aortic arch replacement and aortic valve re-suspension for acute type A dissection with aortic valve regurgitation in 1992. Thirteen years after the first operation, computed tomography demonstrated a Valsalva aneurysm (74 mm) and Doppler echocardiography showed moderate aortic valve regurgitation. Therefore, we performed an operation. We could not locate the dissection in the Valsalva sinus, and the aortic valve cusps had organic change. A David procedure was performed. The postoperative course was uneventful and he was discharged on the 19th postoperative day. Case 2 : A 65-year-old woman underwent ascending aorta replacement and aortic valve resuspension for acute type A dissection with aortic valve regurgitation in 1997, but 11 years after the first operation, computed tomography demonstrated a Valsalva aneurysm (55 mm) and arch aneurysm (65 mm) with stenosis of the innominate vein and she had facial and left arm edema. Doppler echocardiography showed moderate aortic valve regurgitation. We could not find the location of dissection in the Valsalva sinus or aortic arch, and aortic valve cusps had no organic change. A Bentall procedure and total arch replacement were performed and her postoperative course was uneventful.
ABSTRACT
We present a rare case of a 59-year-old-man with a diagnosis of hypertrophic cardiomyopathy (HCM) complicated with left ventricular thrombus. He was admitted to our hospital because of acute re-occlusion of the right brachial artery. Thrombectomy was performed and reperfusion was obtained. Anti-coagulation therapy was started from that day. Four days after surgery, echocardiography revealed mobile thrombus in left ventricular apical aneurysm that was not detected on admission. An emergency thrombectomy and left ventriculoplasty was performed. The patient was discharged 22 days after surgery in good condition.
ABSTRACT
A 65-year-old woman presented to a local hospital with chest, back and right leg pain. She was transferred to our hospital because her abdominal pain gradually increased. CT scan demonstrated an acute type A aortic dissection from the proximal ascending aorta to the right common iliac artery, with a 48 mm diameter in the ascending aorta. The proximal superior mesenteric artery (SMA) was completely occluded by the thrombosed false lumen. Echocardiography showed minor aortic regurgitation, and no pericardial effusion. Her hemodynamics were stable, but abdominal pain persisted. Emergency laparotomy, performed because of mesenteric infarction with intestinal necrosis, provided no evidence of any intestinal necrosis. She underwent left external iliac artery to distal SMA bypass with a saphenous vein graft, because the intestine looked pale. Then the total arch replacement was performed two days later. The patient's postoperative course was uneventful, and her abdominal symptom completely disappeared.
ABSTRACT
An 80-year-old man complained of bilateral leg edema. Doppler echocardiography showed a mobile tumor (33mm) in the right atrium and severe tricuspid regurgitation with an atrial fibrillation. An operation was performed urgently. Excision of the tumor including the right atrial wall and tricuspid annuloplasty were done. Histologic study demonstrated lipoma and no malignancy. Bilateral leg edema disappeared, and the sinus rhythm was restored after the operation.