Surgical Treatment for a Coronary Artery Saccular Aneurysm Located in the Left Main Trunk / 日本心臓血管外科学会雑誌

A 67-year-old man was admitted to our hospital with a complaint of heart failure. He had a 12-year history of chronic renal failure and hemodialysis. Coronary angiography confirmed the presence of a saccular aneurysm originating from the calcificated left main trunk with coronary artery stenosis. The aneurysm was successfully treated by saphenous vein patch repair of the orifice and coronary revascularization of the left anterior descending and circumflex arteries. A histological examination of the aneurysm wall demonstrated coronary artery dissection. Postoperative coronary angiography 2 weeks after surgery revealed no evidence of residual aneurysm and showed patent bypass grafts.

The Case of a Patient with Femoral Artery Stenosis Caused by Angio-Seal^® Use Treated with Endoarterectomy / 日本心臓血管外科学会雑誌

In cases of hemostasis of the femoral artery where the sheath is removed after percutaneous catheterization, there is greater improvement in patient condition and shorter duration of hospital stay when arterial puncture closing devices are used rather than standard manual compression because the use of these devices results in shorter hemostasis and rest times. However, some complications due to these devices have also been reported. Here, we report a case of femoral artery stenosis due to Angio-Seal^® use in a 67-year-old woman. Embolization of the basilar artery aneurysm by endovascular treatment was performed at another institution ; the percutaneous puncture site was the right femoral artery. When this treatment was provided, hemostasis of the artery was performed with the Angio-Seal^®. About one month after the embolization, right intermittent claudication occurred after a 300-m walk. Echography and computed tomography (CT) angiogram showed 75% stenosis of the right common femoral artery, and therefore endoarterectomy of the artery was performed. The postoperative course was favorable and the ankle brachial index score improved from 0.82 to 1.15. In addition, CT angiogram showed resolution of the stenosis of the right common femoral artery and right intermittent claudication ameliorated. Based on the intraoperative views, it was suggested that the arteriosclerotic lesion had existed at the common femoral artery before the endovascular treatment and it might be the cause of the complication mentioned above. In order to prevent complications due to Angio-Seal^® use, it is important to examine the indications of the use of this device by evaluating the puncture site of the artery with echography and other diagnostic techniques before the insertion of a sheath.

A Case of Heparin-Induced Thrombocytopenia following Surgery for DeBakey Type I Acute Aortic Dissection / 日本心臓血管外科学会雑誌

A 73-year-old man underwent ascending aortic replacement and F-F crossover bypass for acute aortic dissection with right leg ischemia. He was treated postoperatively for acute renal failure due to myonephropathic metabolic syndrome (MNMS) with continuous hemodiafiltration. He suffered from acute graft occlusion and brain infarction on postoperative day (POD) 3. Although recovery of organ functions was observed, an unexpected decrease in platelet count occurred rapidly below 1.1×10⁴/μl on POD 6. We suspected heparin-induced thrombocytopenia (HIT) and all heparin administration was halted and argatroban was initiated at a dose of 0.2 μg/kg/min, with titration to achieve an activated partial thromboplastin time (APTT) of 1.5-3.0 times the initial value not to exceed 100 sec. The platelet factor 4-reactive HIT antibody was positive and definite diagnosed of HIT was made. Administration of warfarin started after the platelet count recovered to 10.0× 10⁴/μl on POD 36. Awareness of the clinical features and different presentations of HIT are essential for preventing severe complications associated with this disease.