A Case of Aortoesophageal Fistula in Advanced Esophageal Cancer Treated with SB-Tube and TEVAR / 日本心臓血管外科学会雑誌

The patient is a 71-year-old man. After receiving chemoradiotherapy (CRTx) for an unresectable esophageal cancer, he developed sudden hematemesis during a follow-up examination. Subsequent imaging via contrast-enhanced computed tomography (CT) showed leakage of the contrast medium from the descending aorta into the esophagus. Consequently, an aortoesophageal fistula (AEF) was diagnosed and an emergency thoracic endovascular aortic stent graft repair (TEVAR) was scheduled. However, during the preparation for surgery, the patient vomited a large amount of blood and went into cardiopulmonary arrest. Following the administration of cardiopulmonary resuscitation, a Sengstaken-Blakemore tube (SB-tube) was inserted intranasally to control bleeding and TEVAR was performed to save his life. Although a gastrostomy was necessary after the surgery, the patient was transferred from the hospital on the 32nd day without any complications. Nonetheless, his general condition deteriorated as the cancer progressed and he died on the 103rd postoperative day. It is generally reported that the risk for esophageal perforation is 10-20% in CRTx for unresectable esophageal cancer. Although issues regarding the long-term prognosis of patients treated with TEVAR have been highlighted in recent years, there have also been reports of life-saving cases following its use; in this case, the patient was discharged home after SB-tube insertion and TEVAR with prompt treatment, resulting in his life being prolonged for an estimated 3 months.

Effective Management with IMPELLA CP® and Hypothermia Therapy for a Case of Severe Ischemic Coronary Disease after Cardiopulmonary Arrest / 日本心臓血管外科学会雑誌

A 67-year-old man was admitted to our hospital following cardiopulmonary arrest (CPA) during work. After resuscitation, coronary angiography revealed left main coronary artery stenosis and three-vessel disease. We considered that coronary artery revascularization was required, but the neurological prognosis was unknown. Thus, an IMPELLA CP® device was inserted and systemic management, including hypothermic therapy, was initiated. Circulatory conditions were stable during hypothermia therapy. Rewarming was initiated 24 h later, and we confirmed no abnormal neurological findings. Emergency off-pump coronary artery bypass was then performed. During the procedure, hemodynamic status was maintained using the IMPELLA CP® device. After surgery, the patient was discharged without neurological complications. We report the management of a patient with severe three-vessel disease after resuscitation for CPA using an IMPELLA CP® device and hypothermic therapy.