Successful Treatment of Aortobronchial Fistula due to Distal Aortic Arch Aneurysm Using Emergency Thoracic Endovascular Repair / 日本心臓血管外科学会雑誌

<p>Aortobronchial fistula is a rare but fatal condition, if not treated surgically. Conventional graft replacement is usually recommended for eradication of the fistula and infection, but mortality and morbidity remain high. Recently the effectiveness of endovascular repair for such cases has been reported. We encountered a case of an 83-year-old man with aortobronchial fistula due to a distal aortic arch aneurysm. The computed tomography (CT) scan showed severe calcification and stenosis in the abdominal aorta and iliac artery, indicating inadequacy for use as access vessels. The patient presented with hemoptysis, and was treated successfully by endovascular repair via the descending aortic conduit. Although the patient had a history of heavy smoking, he fully recovered after surgery and was discharged without any complication. There are potential risks of recurrence of aortobronchial fistula and infection, and we plan to continue close follow-up.</p>

Migration of a Temporary Epicardial Pacing Wire into the Ascending Aorta / 日本心臓血管外科学会雑誌

A 77-year-old woman was referred to our hospital for the treatment of aortic insufficiency and paroxysmal atrial fibrillation. She underwent aortic valve replacement, pulmonary vein isolation and left atrial appendectomy. Temporary epicardial pacing wires (TEPWs) were placed on the right ventricle at the operation, and were cut flush with her skin surface prior to discharge because of difficulty in traction removal. She was discharged in good condition. Sixteen days after her discharge, she was re-admitted for fever. A computed tomography revealed cellulitis of the chest, and migration of one retained TEPW extending from the ascending aorta to the right subclavian artery. Removal of the migrated TEPW and sternal resection with omentopexy for sternal osteomyelitis were performed. Her postoperative course was uneventful. TEPWs should be completely removed when possible. If TEPWs are retained, this should be kept in mind when the patient presents with complications postoperatively.

Off-Pump CABG and Ligation for Coronary Artery Pseudoaneurysm Occurring during the Chronic Post-PTCA Period / 日本心臓血管外科学会雑誌

Pseudoaneurysm after the rupture of a coronary artery is a rare complication of percutaneous transluminal coronary angioplasty (PTCA). We report a pseudoaneurysm of the left anterior descending artery (LAD) occurring 3 months post-PTCA, that was successfully treated by off-pump coronary artery bypass grafting (CABG) and ligation. An 84-year-old man underwent urgent PTCA for unstable angina. The LAD ruptured during this procedure, but bail-out was successfully performed by balloon catheter inflation. The patient left the hospital symptom-free. Three months later, he was rehospitalized complaining of angina. Coronary angiography revealed a 10-mm diameter pseudoaneurysm at the site of the LAD rupture as well as restenosis of the LAD and high lateral branch at the previous PTCA sites. Surgical treatment was indicated because of the difficulty in delivering a covered stent within the diffusely stenosed LAD. CABG to the distal LAD with the left internal mammary artery and ligation of the LAD pseudoaneurysm were performed. To reduce perioperative morbidity, CABG was performed without cardiopulmonary bypass. The postoperative course was uneventful, and follow-up angiography revealed a patent graft and no pseudoaneurysm. The patient has continued comfortably for 18 months postoperatively. Because off-pump CABG is less invasive than conventional surgery techniques, we believe it to be a valid option during coronary pseudoaneurysm ligation.