ABSTRACT
A 42-year-old woman with dysphagia was referred to our hospital. Computed tomography (CT) revealed Kommerell diverticulum( KD) associated with right aortic arch( RAA) and aberrant left subclavian artery (ALSCA). We performed total arch replacement (TAR) using a frozen elephant trunk (FET) technique. We ligated ALSCA at the distal portion of the KD after perfusing from a 8 mm tubular graft from left axillar artery. We inserted a FET from the ascending aorta to avoid locating the nonstented portion at the steep-angled site of RAA. Postoperatively dysphagia disappeared and CT scan showed complete exclusion of KD without leakage of the stent graft and successful reconstruction of the arch. The TAR and FET technique is an effective procedure for KD with RAA and ALSCA.
Subject(s)
Aortic Aneurysm, Thoracic , Blood Vessel Prosthesis Implantation , Deglutition Disorders , Diverticulum , Heart Defects, Congenital , Female , Humans , Adult , Aorta, Thoracic/diagnostic imaging , Aorta, Thoracic/surgery , Deglutition Disorders/surgery , Subclavian Artery/diagnostic imaging , Subclavian Artery/surgery , Heart Defects, Congenital/surgery , Blood Vessel Prosthesis Implantation/methods , Diverticulum/diagnostic imaging , Diverticulum/surgery , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/surgeryABSTRACT
A 58-year-old man was admitted to our institution with sudden onset of hypotension and acute ischemia of left lower extremity. Electrocardiography showed ST segment elevation in leads V1~V6 and a transthoracic echocardiogram revealed antero-septal wall hypokinesis. He was given a diagnosis of acute myocardial infarction caused by left main coronary artery compression due to acute aortic dissection by enhanced computed tomography. We implanted a stent in the left main coronary artery and performed right external iliac-left femoral arterial bypass under general anesthesia. We performed a conventional total arch replacement and frozen elephant trunk and mitral valve repair at day 16. His postoperative course was good. Implantation of a left main trunk stent is an effective strategy for Stanford type A acute aortic dissection with left main coronary arterial occlusion before surgical repair.
Subject(s)
Aortic Aneurysm , Aortic Dissection , Myocardial Infarction , Aortic Dissection/complications , Aortic Dissection/diagnostic imaging , Aortic Dissection/surgery , Aortic Aneurysm/surgery , Coronary Vessels/diagnostic imaging , Coronary Vessels/surgery , Humans , Male , Middle Aged , Myocardial Infarction/diagnostic imaging , Myocardial Infarction/etiology , Myocardial Infarction/surgery , Stents/adverse effectsABSTRACT
722 patients who returned to the intensive care unit( ICU) after completing the cardiac surgery and closing the median sternotomy from Jan 2010 to Feb 2021 at our hospital were divided into 3 groups according to the different sternal closures. Sternum was fixed with 6 wires alone in group A (n=333), with 2 absorbable plates and 6 wires in group B( n=259) or with 3 titanium plates with 20 screws and 4 wires in group C (n=130). Background characteristics were not different between the 3 groups. Total number of 3 complications (postsurgical bleeding, mediastinitis and delayed cardiac tamponade) was significantly less in group B and C than group A. Among them postsurgical bleeding needed hemostasis surgery was significantly less in group C than in group A. Surgical nor hospital mortality were not significantly different in 3 groups. Postsurgical complications were significantly less when the sternum closure was fixed with plates( absorbable, not absorbable).
Subject(s)
Cardiac Surgical Procedures , Mediastinitis , Bone Wires , Cardiac Surgical Procedures/methods , Humans , Sternotomy , Sternum/surgeryABSTRACT
A 79-year-old man was diagnosed with rupture of infective thoracic aortic aneurysm following septicemia caused by infective cholangitis. He underwent emergent endovascular aortic repair and discontinued antibiotics. Graft infection occurred and was treated 29 days after the first operation. He underwent emergent resection of the abscess with graft coverage using pedicled intercostal muscle flaps. Aortic re-rupture was found and treated 183 days after the second operation. He underwent emergency additional thoracic endovascular aortic repair and continued to take antibiotics again. We should continue a careful follow up.
Subject(s)
Aortic Aneurysm, Thoracic , Aortic Rupture , Blood Vessel Prosthesis Implantation , Aged , Aortic Aneurysm, Thoracic/complications , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/surgery , Aortic Rupture/complications , Aortic Rupture/diagnostic imaging , Aortic Rupture/surgery , Humans , Male , StentsABSTRACT
Cardiac papillary fibroelastoma is a rare primary cardiac tumor arising from any part of the endocardium. In particular, papillary fibroelastoma originating from the mitral valve chordae is very rare. A 66-year-old man was hospitalized for a left ventricular tumor. Echocardiography revealed a high echoic mass of the mitral valve chordae with grade I mitral regurgitation. Under cardiopulmonary bypass, we performed excision of the mass and the marginal chordae of the mitral valve, and decided there was no need of valvuloplasty. Pathological diagnosis indicated the tumor was papillary fibroelastoma. The postoperative course was uneventful and echocardiography showed no progression of mitral valve regurgitation.
