Résumé
A 65-year old man with a diagnosis of aortic regurgitation from childhood referred to our hospital due to palpitations and dyspnea on exertion. Transthoracic echocardiography showed severe aortic regurgitation, but the form of left coronary aortic cusp was not detected clearly. Trans esophageal echocardiography revealed small left coronary aortic sinus covered with a rudimentary left coronary cusp. Right coronary angiography showed retrograde flow to left coronary artery, and pooling of contrast material in the aortic cusp. Cannulation into the left coronary ostium could not be performed, aortography revealed no antegrade left coronary blood flow. The patient underwent aortic valve replacement with mechanical valve after resection of the rudimentary left coronary cusp, and ascending aorta replacement using selective cerebral perfusion. The post operative course was uneventful. We report on a rare case of occlusion of left coronary ostium with a rudimentary aortic cusp.
Résumé
A 80-year-old woman was referred to our hospital for coagulation abnormality and huge abdominal aortic aneurysm (AAA). She had persistent hemorrhage from the surgical wound after the operation for her cubital tunnel syndrome 5 days before. Enhanced computed tomography image revealed AAA with a maximum diameter of 91 mm. Laboratory data were compatible with disseminated intravascular coagulation (DIC). Due to the marked hemorrhagic status, we thought the open repair of AAA was an extremely risky procedure. We initiated the medical treatment with gabexate mesilate. However, the hemorrhage continued after 2 weeks of medical therapy. We performed endovascular aneurysm repair (EVAR). DIC improved after the procedure. Postoperative enhanced computed tomography image showed regression of the aneurysm with no endoleak. EVAR might be an acceptable procedure for AAA with DIC.