Surgical Treatment for Giant Multiple Coronary Artery Aneurysms Caused by an IgG4-Related Disease.

Coronary artery aneurysms (CAAs) due to an immunoglobulin G4 (IgG4)-related disease (IgG4-RD) are relatively rare, and there is no consensus on the choice of treatment method. In the present study, we report the results of the surgical treatment for multiple giant CAAs caused by IgG4-RD. A 71-year-old man was diagnosed with severe aortic regurgitation and CAAs. A blood test showed high IgG4 levels, and computed tomography revealed four giant coronary artery aneurysms: two in the right coronary artery (RCA) (proximal RCA and posterior descending artery (PDA)), one in the left anterior descending (LAD), and one in the diagonal branch (Dx). We planned aortic valve replacement, coronary aneurysm resection, and coronary artery bypass grafting (CABG). After finishing aortic valve replacement, the CAAs in proximal RCA, LAD, and Dx were resected. The proximal and distal tracts of the aneurysm were closed with a pericardial bovine patch and ligation. However, since the distal PDA was too calcified to be anastomosed, and the PDA aneurysm was smaller than the others, it was decided to leave the PDA aneurysm. The anastomoses of SVG-RCA and Dx, as well as the left internal thoracic artery to LAD, were performed. Histopathological examination of the aneurysm wall showed a high IgG4-positive cell/IgG-positive cell ratio, and a diagnosis of IgG4-RD was made. In the treatment of CAAs due to IgG4-RD, it is essential to select a procedure that takes into account the size, location, and nature of the aneurysm, and comorbidities. To ensure resection of the aneurysm and blockade of blood flow, closure of the inflow and outflow tracts with a pericardial bovine patch and CABG are effective.

An operative case of pseudocoarctation with chronic dissection.

A 47-year-old man with a history of hypertension was found to have a prominent aortic knob on routine chest X-ray and was referred to our hospital. Enhanced computed tomography angiography showed severe flexion at the proximal descending aorta with chronic type B dissection localized to the flexion region. Graft replacement of the distal aortic arch was performed. Surgical management of chronic pseudocoarctation dissection is sparsely reported in the literature because of its rare occurrence. We present an operative case of a patient with chronic dissection of distal aortic arch pseudocoarctation.

Extended sandwich technique via the right atrial approach for post-infarction posterior ventricular septal rupture.

An 84-year-old man who underwent percutaneous coronary intervention for acute inferior myocardial infarction due to occlusion of the mid portion of the right coronary artery was transferred to our hospital because of post-infarction posterior ventricular septal rupture. We performed the extended sandwich technique via the right atrial approach as well as tricuspid and mitral valve replacement and permanent pacemaker implantation. Mild residual shunt was detected post-operatively, but the patient's condition was controlled well with diuretics.

Left Subclavian Artery Revascularization for Delayed Paralysis after Thoracic Endovascular Aortic Repair.

Spinal cord ischemia (SCI) is a devastating complication following thoracic endovascular aortic repair (TEVAR). A man with a ruptured thoracic aortic aneurysm (TAA) was transferred to our hospital. Emergency TEVAR, with left subclavian artery (LSA) coverage, was performed for the ruptured TAA. On postoperative day two, the patient had incomplete paralysis in his legs, presumably caused by SCI. We performed LSA revascularization (LSAR) to provide blood supply to the spinal cord; his paralysis improved and almost resolved after surgery. To our knowledge, this is the first report on LSAR's efficacy for delayed paraplegia due to SCI.

Aortic Pseudoaneurysm due to Simple Vertebral Compression Fracture Treated with Conservative Management.

Blunt aortic injures are rarely associated with minimal trauma. We present a 78-year-old man with an aortic pseudoaneurysm resulting from a simple vertebral compression fracture, which was conservatively managed. He was diagnosed with a compression fracture from a minor fall 10 days previously, and fortuitously he visited the hospital after which follow-up computed tomography (CT) for previous multiple aortic surgeries was performed. The enhanced CT revealed a pseudoaneurysm on the abdominal aorta, which was bleeding from a pinhole perforation. He was conservatively treated and follow-up CT 9 months later revealed that the pseudoaneurysm had disappeared.