Résumé
A 72-year-old man was referred to our hospital because of lumbago and an abdominal aortic aneurysm (AAA). Computed tomography revealed the AAA to be 5cm in diameter with a retroperitoneal hematoma. A diagnosis of chronic contained rupture of an AAA was made, and an operation was performed. At laparotomy, a punched-out defect (10×20mm) that was thought to connect the thrombosed aneurysm to an organized retroperitoneal hematoma was discovered on the right side of the aorta. The aneurysm was replaced with a Y-shaped prosthetic graft. The patient's postoperative course was uneventful. This case of chronic contained rupture of an AAA was distinctly different from cases of acute rupture. Although patients with chronic contained rupture of an AAA are hemodynamically stable, such cases should be assessed and treated as quickly as possible because of the risk of re-rupture.
Résumé
A 34-year-old man had been in a motor vehicle accident at age 21. Thirteen years later, he complained of fatigue and palpitations, and was evaluated at an outside hospital. Echocardiography revealed severe tricuspid regurgitation and the patient was referred to our institution for treatment. The anterior leaflet of the tricuspid valve was torn and the attached chorda was also torn. The torn anterior leaflet was sutured directly, and an artificial chorda was created using an e-PTFE suture. An annuloplasty was performed with a 34mm Carpentier-Edwards ring. The patient's recovery was uneventful, and postoperative echocardiography revealed no regurgitation.
Résumé
The possibility of anastomotic pseudoaneurysms as a life-threatening complication following prosthetic graft replacement for an aneurysmal disease or an arterial occlusive disease is well known. However the pseudoaneurysm at an anastomosis between two prostheses is rarely reported. We present a successful surgical treatment for an anstomotic pseudoaneurysm between two prostheses. A 75-year-old man underwent total arch replacement for a true aortic arch aneurysm with the aid of selective cerebral perfusion five years previously. The graft used was a composite prosthesis consisting of 26mm woven Dacron graft for the aortic arch to which a hand-made three-tributary graft was sutured for major three arch vessels. An anastomotic pseudoaneurysm at an anastomotic site between the 26mm graft and a tributary graft was suspected on a chest CT and then differentially diagnosed by aortography. The anastomotic pseudoaneurysm was surgically resected and the anastomosis was repaired with 3-0 polypropylene continuous sutures with the aid of hypothermic circulatory arrest. Anastomotic aneurysm can occur only between a native vessel and a prosthesis but also between two prostheses. Therefore we should make periodical examinations such as CT after prosthetic graft replacement.