RESUMO
A 69-year-old man had been treated with total arch replacement for acute Stanford type A aortic dissection. He had cardiac failure at 9 years after his previous operation. Computed tomography and transesophageal echocardiography showed re-dissection of the aortic root and aortic regurgitation. He was referred to our hospital for surgical treatment. In the second operation, aortic root replacement was performed. Re-dissection of the aortic root at the site of the non-coronary sinus was noted intraoperatively, and intraoperative findings suggested necrosis of the aortic wall related to the use of GRF glue. Care should be taken to ensure proper use of GRF glue. The aortic root replacement using a Freestyle valve provided good hemodynamic function and low thrombogenicity. The use of this valve in this case which had residual dissection of the descending aorta seemed useful because of the excellent hemodynamic function without anticoagulant therapy.
RESUMO
Surgical treatment of abdominal aortic aneurysms in elderly patients aged over 90 is rare, and the surgical indications in such patients is controversial. Two cases of abdominal aortic aneurysm successfully treated surgically are reported. The first case was a 92-year-old woman, who manifested a severe abdominal pain without hypotension. An impending rupture of an abdominal aortic aneurysm was suggested on enhanced CT scan, and emergency surgery was indicated. The aneurysm was replaced with a woven Dacron Y-graft. Postoperatively, the patient's social activity returned to the preoperative level. The second case was a 91-year-old man, in whom an increasing abdominal aortic aneurysm had been pointed out on UCG and enhanced CT scan. Because he was socially very active for his age, elective surgery was indicated. The aneurysm was resected and replaced with a woven Dacron I-graft. Postoperatively, the patient overcame a respiratory complication and was eventually discharged without any physical complication. Although he was able to climb mountains before the surgery, he lost some physical activity after the surgery. Because of the potential decrease in physical strength especially in very elderly patients, the general risk evaluation did not always correspond to a precise evaluation and prediction of postoperative activity. It is therefore necessary to be flexible in deciding on the surgical indications in each case.
RESUMO
A 72-year-old man was admitted with an abnormal shadow on chest X-ray. Chest CT and aortography showed double saccular aneurysms at the aortic arch and the descending thoracic aorta. Three-dimensional CT was useful to detect the association between the arch aneurysm and neck vessels. Graft replacement, from the distal arch to the descending thoracic aorta, was performed by the lateral approach with hypothermic arrest and open proximal method. The aorta had severe atherosclerotic changes and the intima was absent at the orifices of the aneurysms. Pathological examination showed the aneurysmal wall to be composed of fibrous tissue without medial components. These macroscopic and pathological findings of aneurysms corresponded with double pseudo-aneurysms originating from the penetrating atherosclerotic ulcer.
RESUMO
A case of successful surgical treatment for a ruptured infected aneurysm of the abdominal aorta is presented. A 63-year-old man was admitted with a history of persistent fever of unknown cause and lumbago. During medical treatment, a new abdominal pulsatile mass was revealed on physical examination. Leucocytosis and elevation of C-reactive protein were demonstrated. Abdominal echogram and CT scan showed a ruptured aneurysm of the abdominal aorta. Ruptured infected aneurysm of abdominal aorta was diagnosed, and an emergency operation was performed. We found a tight inflammatory adhesion around the aneurysm, but there was no abcess formation. The aneurysm had the mural thrombi and necrotic tissue. As usual infected tissue was removed as possible with aneurysmectomy, and an artificial graft was replaced. The culture of the aneurysmal wall tissue was negative, but the infiltration of the inflammatory cells, mainly neutrophilic segmented leukocytes, were found on pathological examination. He is doing well without recurrent infection at 8 months after operation. Twenty five cases of infected abdominal aortic aneurysm (AAA) were reported in Japan, and 21 cases of them received surgical treatment. Management of infected AAA is discussed.