Surgical Repair of Coronary Artery Fistulas with a Giant Coronary Artery Aneurysm Dilated from Valsalva Sinus / 日本心臓血管外科学会雑誌

We report a case of a 64-year-old man who had a fistula from the right coronary artery to the right ventricle, with an asymptomatic giant coronary aneurysm. Multi-detector computer tomography showed an aneurysm from the sinus of Valsalva to the mid-right coronary artery (RCA). Its diameter was over 50 mm. We performed aneurysmectomy direct closure of the fistula, and coronary artery bypass graft with saphenous vein graft cardiopulmonary bypass. The enlarged RCA orifice was closed with a vascular prosthesis, and the postoperative course was uneventful.

An Operated Case of Cardiac Compression by Chronic Expanding Hematoma in the Pericardial Cavity after Cardiac Surgery / 日本心臓血管外科学会雑誌

A rare surgical case of chronic expanding hematoma in the pericardial cavity is reported. A 78-year-old man had undergone coronary artery bypass grafting 2 years previously. He had suffered from general malaise, increasing shortness of breath and systemic edema from 18 months after the operation. Echocardiography revealed an intrapericardial mass compressing the cardiac chambers resulting in insufficiency of the ventricular expansion. Under extracardiopulmonary bypass and cardiac beating, resection of the mass and additional coronary artery surgery were implemented. The mass was encapsulated with thick fibrous membrane containing old degenerated coagula the bacterial culture of which was negative and was histopathologically diagnosed as chronic expanding hematoma. The patient's postoperative course was uneventful and symptoms with cardiac failure were relieved. There has been no recurrence for more than 18 months.