Surgical repair for tracheo-innominate artery fistula with a muscle flap.

A 70-year-old woman was quickly diagnosed as having tracheo-innominate artery fistula by three-dimensional computed tomography. Immediate surgical exploration was performed to control the bleeding using a temporary shunt. After the damaged artery was excised, vascular reconstruction was performed to preserve the connection between the proximal and distal ends of the innominate artery with the interposition of a saphenous vein graft. A pedicled sternocleidomastoid muscle flap was successfully used for the tracheal reconstruction.

Successful surgical management of patients with infective endocarditis associated with acute neurologic deficits.

Subjects were 2 patients with neurologic deficits due to infective endocarditis. The first, a 30-year-old woman with acute ischemic stroke, was found to have vegetation from infective endocarditis as the embolic source. Two weeks after she experienced an acute ischemic stroke, we conducted elective cardiac surgery. The second, a 16-year-old girl with infective endocarditis, suffered a ruptured mycotic aneurysm in the left carotid system complicated by intracranial hemorrhage. We conducted a successful staged mitral valve replacement following craniotomy.