Thoracic Endovascular Aortic Repair with the Chimney Technique for Blunt Traumatic Pseudoaneurysm of the Aortic Arch in a No-Option Patient

A 42-year-old man was involved in a motor vehicle collision. Imaging studies revealed the presence of a post-traumatic aortic pseudo-aneurysm (about 34x26 cm) arising from the descending thoracic aorta at the level of the left subclavian artery (LSA), prone to rupture. Thoracic endovascular aneurysm repair (TEVAR) was the only feasible option due to his poor overall medical status. In this case, LSA needed to be covered in order to extend the proximal landing zone. Eventually, modified TEVAR was successfully performed by means of the chimney technique to preserve flow to the LSA and to prevent flow into the pseudoaneurysmal sac.

Hybrid Approach for the Treatment of Thoracic Aortic Arch Aneurysm in a Patient With Chronic Obstructive Lung Disease and Retrosternal Adhesion

A 73-year-old woman with a history of chronic hypertension and severe chronic obstructive pulmonary disease, presented to a district general hospital with thoracic pain in a profound state of shock. She was diagnosed with cardiac tamponade, severe mitral regurgitation, and Stanford type A (Debakey type I) intramural hematoma. Her ascending aorta was of a significant size and therefore emergent repair was done to replace the ascending aorta and mitral valve. After 6 months, an increased aneurysmal size of 6.0 cm was observed in a follow up contrast-enhanced computed tomography angiography. The patient was successfully treated by a staged hybrid procedure involving initial supra-aortic reconstruction.

A Case of Cardiac Tamponade due to Primary Hypothyroidism

Pericardial effusions occur in approximately 30% of patients with untreated hypothyroidism. The effusions are more common in patients with longstanding, severe disease. But, cardiac tamponade is a very rare complication, because of the elasticity of pericardium and slow progression. We experienced a 61 year old female patient with cardiac tamponade due to primary hypothyroidism. She was treated with pericardiocentensis and thyroid hormone replacement, confirmed by echocardiography,thyroid function test and TRH stimulation test.

Persistent Truncus Arteriosus with Survival to the Age of 29 Years

The Truncus arteriosus is a congenital malformation in which only one great artery arises from the base of the heart and gives origin to the systemic, pulmonary and coronary arteries proximal to the aortic arch. Pulmonary blood flow is governed by the size of the pulmonary arteries and the pulmonary vascular resistance. In infancy, pulmonary blood flow is usually excessive because pulmonary vascular resistance is not greatly increased. Thus, despite an obligatory admixture of systemic and pulmonary venous blood in the common trunk, only minimal cyanosis is present. Rarely pulmonary blood blood flow is restricted by hypoplastic or stenotic pulmonary arteries arising from the truncus. The prognosis in persistent truncus arteriosus is very poor. the median age of survival of the 94 patients with the disease reported up to 1962 was only five weeks. The longest survival reported is the case of the man described by Carr et al who lived to the age of 36 years and 2 months. We report the case of a man with persistent truncus arteriosus who lives to the age of 29 years.

Acute Myocardial Infarction in Patient with Spontaneous Coronary

Spontaneous coronary artery dissection is a rere incident occurring usually in young patients, predominautly in females. It is usually fatal and found postmortem. It is also a rare cause of acute myocardial infarction. We present the case of a twenty nine-year-old-man with spontaneous right coronary artery dissection found angiographically which caused an inferior wall myocardial infarction. He was treated with medical therapy only amd after uneventful hospital course, he was discharged with medication. Three months later, coronary angiography was done to follow up the lesion and found that the site was completely healed.