Was the internal thoracic arterial graft selection for coronary artery bypass grafting appropriate in a patient with neurofibromatosis-1?

Neurofibromatosis type 1, also called von Recklinghausen's disease, is a hereditary congenital disorder that affects tissues of neuroectodermal or mesodermal origin. This disease has various manifestations, including pigmented skin lesions, cutaneous neurofibromas, skeletal abnormalities, and tumors of the central/peripheral nervous and gastrointestinal systems, and vascular abnormalities. Because of vasculopathy, part of the vessel wall may be replaced by neurofibromatosis tissue. Involvement of the internal thoracic artery is, however, extremely rare. Off-pump coronary artery bypass grafting using the left internal thoracic artery was performed for coronary arterial disease in a patient with neurofibromatosis, and the residual left internal thoracic artery vessel pathology was investigated. The left internal thoracic artery vessel showed intimal proliferation, medial thinning, and fragmentation of elastic tissue. However, these findings were not typical for von Recklinghausen's neurofibromatosis. Internal thoracic artery graft selection was feasible for coronary artery bypass grafting in a patient with neurofibromatosis type 1.

[Simultaneous Transapical Transcatheter Aortic Valve Implantation and Coronary Artery Bypass Grafting;Report of a Case].

Coronary artery disease(CAD) is often found concurrently in patients presenting with severe aortic stenosis(AS). Surgical aortic valve replacement(SAVR) and coronary artery bypass grafting(CABG) were usually selected with such patients. Recently, transcatheter aortic valve implantation (TAVI) is considered as a less invasive and more feasible treatment option in high-risk AS patients. A 74-year-old woman admitted due to acute myocardial infarction and treated with percutaneous coronary intervention revealed severe AS. Because of her comorbidities, concomitant transapical TAVI and CABG were performed with an excellent clinical course.

[Native Aortic Valve Endocarditis Caused by Nocardia asteroides;Report of a Case].

Infection by Nocardia sp. is rare and usually affects immuno-depressed patients, such as those receiving chemotherapy and long-term steroid therapy. Cardiac involvement is uncommon and usually occurs as endocarditis. We present a case of native aortic valve endocarditis caused by Nocardia asteroides. Aortic valve translocation method was chosen because of extensive root infection with major disruption of the aortic annulus. Over 2 years after the surgery, there is no recurrence and no enlargement of the aortic annulus.

[Redo Coronary Artery Bypass Grafting Through Left Thoracotomy in Patient with Patent Left Internal Thoracic Artery Graft;Report of a Case].

A 61-year-old man was admitted because of unstable angina. The patient had a history of CABG [LITA-left anterior descending artery(LAD), aorta-saphenous vein graft(SVG)-posterolateral branch (PL)-diagonal branch (D1)]4 years ago. Coronary angiography revealed an occlusion of old SVG at proximal anastomosis site and a stenosis of native high lateral artery (HL). To reduce the risk of cardiac injury and damage to the patent grafts due at sternal reentry, we performed redo CABG through left thoracotomy. The proximal site of SVG was anastomosed to descending aorta using automated proximal anastomosis system. The SVG was anastomosed to the HL and old SVG in a sequential mode. Postoperative course was uneventful and the patient was discharged on postoperative day 14. Redo CABG through left thoracotomy provides safe and effective surgical approach in patient who requires revascularization of left circumflex territory.

[Total arch replacement for spontaneous rupture of the thoracic aorta;report of a case].

A 75-year-old man without history of trauma and aortic aneurysm presented with chest discomfort. A computed tomography (CT) revealed massive mediastinal hematoma without intimal flap in the aorta. Under hypothermic circulatory arrest, total arch replacement was performed. A transmural tear was found just distal to the left subclavian artery. Aortic dissection was not found macroscopically. When we encounter massive hematoma in the anterior mediastinum or the left thoracic cavity, spontaneous rupture of the thoracic aorta should be suspected, and emergency operation should be performed via optimal surgical approach.

Brachiocephalic venous aneurysm with unusual clinical observations.

Thoracic venous aneurysm is an extremely rare condition. This report describes the case of a 70-year-old woman with a left brachiocephalic venous aneurysm that caused recurrent nerve paralysis. Contrast-enhanced computed tomography and venography revealed a venous aneurysm, 4 cm in size, located adjacent to the venous angle. Anticoagulation therapy was started, and 1-1/2 months later, the aneurysm greatly decreased in size and showed marked calcification along its periphery. Venous aneurysms that shrink after anticoagulation therapy are exceptionally rare. The clinical features of this condition have been briefly reviewed.

Outcome after concomitant unilateral embolization of the internal iliac artery and contralateral external-to-internal iliac artery bypass grafting during endovascular aneurysm repair.

OBJECTIVE: Despite improvement of devices, endovascular aneurysm repair (EVAR) is still challenging in cases with associated aneurysmal involvement of the iliac arteries. This study examined the safety and efficacy of EVAR with concomitant unilateral embolization of the internal iliac artery (IIA) and contralateral external-to-internal iliac artery bypass grafting, with bilateral endograft limbs extended into the external iliac arteries (EIAs). METHODS: The study included 22 consecutive patients (mean age, 74 years) who underwent elective endovascular repair of aortoiliac or iliac aneurysms, with concomitant coil embolization of the unilateral IIA and contralateral EIA-to-IIA bypass in the same operative setting. Five patients had a unilateral IIA aneurysm, and eight had bilateral IIA aneurysms. EIA-to-IIA bypass grafting was performed through the retroperitoneal approach. The perioperative and midterm outcome of the procedure was assessed. RESULTS: The procedure was successfully performed in all cases. Eleven patients underwent IIA embolization at the main trunk, and the other 11 cases required IIA occlusion at distal branches. There was no perioperative death or severe complication. The mean follow-up period was 15.7 ± 7.8 months, ranging from 2 to 32 months. The bypass remained patent in all cases, and there was no occurrence of graft-related complication. Enlargement of aneurysms or development of type I endoleak was not observed. Persistent mild buttock claudication occurred in two patients (9%) ipsilaterally to the occluded IIA; one patient after IIA occlusion at the main trunk and the other at distal branches. No other pelvic ischemic manifestation was observed. CONCLUSIONS: EVAR with simultaneous unilateral IIA embolization and contralateral EIA-to-IIA bypass grafting is feasible, with a relatively low risk of complications. It can be a useful treatment option in cases with complex aortoiliac aneurysms, including those with bilateral IIA aneurysms.

[Our methods and techniques of thoracic endovascular aneurysm repair].

Thoracic endovascular aneurysm repair (TEVAR) is acquiring an established role as treatment for thoracic aortic aneurysm. It may be no exaggeration that TEVAR is a standard procedure, especially for decending aortic aneurysm. Furthermore we consider that aortic debranching with TEVAR for aortic arch or thoracoabdominal aortic aneurysm is very useful, and we aggressively perform TEVAR for them. We describe our methods and techniques of TEVAR.

[Preferable surgical approaches to the aortic root-arch in patients with functioning tracheostomy].

Preferable surgical approaches to aortic diseases occurring between the aortic root and the arch in patients with functioning tracheotomy or permanent tracheostomy are described for securing adequate exposure and avoiding postoperative mediastinitis. Case 1: A 41-year-old man with Marfan syndrome presented with chronic type A thrombosed aortic dissection and severe aortic valve regurgitation. He had had a functional tracheostomy for managing respiratory function due to traumatic spinal cord damage. The heart and the ascending aorta were shifted to the right side of the chest and showed a significant counterclockwise rotation. Therefore, the reverse L-figure approach of a right-sided 3rd intercostal anterior thoracostomy and lower midline sternotomy was performed for Bentall operation. Case 2: A 76-year-old woman presented with thoracic aortic aneurysm of 11 cm in diameter. She had had a permanent tracheostomy with total laryngectomy. Therefore, cram shell approach was performed for total arch replacement. The 2 cases had no postoperative mediastinitis. These approaches are recommended for aortic diseases occurring in the ascending aorta or the aortic arch in patients with functioning tracheotomy.