Occurrence of pseudoaneurysm of the coronary button due to aortic remodeling after Bentall operation.

Here, we present a case report detailing a pseudoaneurysm of the coronary button due to aortic remodeling that occurred 2 years after aortic root replacement. The patient was referred to our hospital with a diagnosis of left coronary artery pseudoaneurysm. Intraoperative findings revealed substantially loosened sutures in both the left and right coronary arteries with bleeding. Specifically, the left coronary artery was detached at the 6-9 o'clock positions. The operation was concluded with ligation of the loose suture and addition of a new suture. Chronic dissection thickened the aortic wall of the coronary artery ostium in the initial Bentall operation, whereas the sutured coronary button in this operation exhibited a normal arterial wall without a thickened dissected intima. This suggests that aortic wall remodelling of the coronary ostium leads to suture loosening and subsequent haemorrhage. Aortic wall remodeling may lead to bleeding or pseudoaneurysms during the remote period.

Mid-term outcomes of hypogastric artery embolization in endovascular aneurysm repair: a case series.

Hypogastric artery embolization is performed during endovascular aneurysm repair (EVAR) involving the common iliac artery. Within this case series, we have observed elevated rates of sac expansion subsequent to this intervention. April 2009 to March 2021, 22 patients underwent EVAR with hypogastric artery embolization. We evaluated the mid-term outcomes for these patients. The mean follow-up period was 57 months. We achieved a 100% technical success rate without open conversion and no hospital deaths. The rates of freedom from aneurysm expansion at 1, 3, and 5 years were 90.5%, 59.1%, and 37.5%, respectively. The percentage of sac expansion exceeding 5 mm was 54.5% (12/22). Combined endovascular aortic aneurysm repair and embolization of the hypogastric artery might be associated with a high rate of remote sac expansion. Larger trials are needed to verify risks and benefits.

Insertion Multi-Parachute Suturing and Knotting (IMS-K) Technique for Aortic Surgery.

Successful surgical interventions for aortic surgery, such as hemiarch repair and total arch replacement, pivot on the foundation of optimal anastomosis. We propose an alternative approach to anastomosis. The "insertion multi-parachute suturing and knotting" (IMS-K) technique entails the deployment of two parachute sutures, which can be effectively employed for both proximal and distal anastomoses. The first suture is applied loosely to the posterior half of the anastomosis and subsequently parachuted down, tightening the suture with a nerve hook. The second suture replicates the procedure in the anterior half of the anastomosis, loosely securing it in a similar manner and tightening it with a nerve hook at the end. As a result, the artificial graft is completely inserted into the aorta with a substantial grip. This technique simplifies the aortic anastomosis by ensuring procedural simplicity while minimizing bleeding risk, thus potentially advancing surgical outcomes.

Severe right ventricular infarction due to iatrogenic aortocoronary dissection successfully treated by surgical repair and extracorporeal membrane oxygenation.

Iatrogenic aortocoronary dissection (IACD) is a rare but potentially fatal complication of percutaneous coronary intervention or coronary angiography (CAG). In particular, if the condition of the patient is complicated by cardiogenic shock and right ventricular (RV) dysfunction, the mortality rate is high. Herein, we report the case of an 85-year-old woman with IACD who underwent elective CAG of the right coronary artery complicated with cardiogenic shock due to RV infarction. After prompt surgical repair and postoperative extracorporeal membrane oxygenation, the postoperative course was uneventful and the patient was discharged to a rehabilitation facility.

Outcomes of isolated CABG from "OPCAB favor institution" for patients with left ventricular dysfunction.

OBJECTIVES: Although off-pump coronary artery bypass (OPCAB) has been reported to have better short-term results than on-pump coronary artery bypass (ONCAB) in terms of bleeding and stroke even in patients with cardiac dysfunction, details are unknown. The purpose of this study was to evaluate the outcomes of CABG (coronary artery bypass graft) in patients with low cardiac function based on our treatment policy. METHODS: Retrospectively, we reviewed patients with low ejection fraction (< 35%), who underwent isolated OPCAB or ONCAB between 2013 and 2020 in our institute. RESULTS: Isolated CABG was performed for 67 patients: 54 OPCABs and 13 ONCABs. In the ONCAB group, six were converted from OPCAB. Patients with AMI, heart failure, liver dysfunction, cardiogenic shock, and ventricular arrhythmia were more common in the ONCAB group. More patients required postoperative mechanical circulatory support in the ONCAB group. Intra-operative blood transfusion, ICU stay, intubation time, and hospital stay were significantly worse in the ONCAB group. Postoperative graft patency was 91.5%. Hospital mortality was 7.5%. Mid-term survival at 30-day, 1-year, and 5-year were 98.5%, 84.6%, and 75.8%, respectively. CONCLUSION: In our institute, ONCAB was selected for the patients who could not complete treatment with OPCAB due to poor preoperative circulatory status. Our treatment policy for the patients with impaired cardiac function was acceptable.

[Transient Left Ventricular Dysfunction after Giant Coronary Aneurysm Resection and Repair of Coronary Arteriovenous Fistula with Coronary Artery Bypass Grafting:Report of a Case].

Coronary artery aneurysm with coronary arteriovenous fistula is a relatively rare clinical setting. We report a surgical case of a 69-year-old male with a giant coronary artery aneurysm, finding coronary arteriovenous fistula on computed tomography (CT). We performed complete aneurysm excision and coronary artery bypass grafting with the left internal thoracic artery to the posterolateral branch. The fistula was located between the giant aneurysm on the circumflex artery and the coronary vein close to the coronary sinus, closed with aneurysm sac. The postoperative CT found no residual aneurysm and fistula. However, the great cardiac vein was thrombosed, and the impeded venous flow by the thrombus seemed to reduce the left ventricular ejection fraction (LVEF). Four months after the operation, the LVEF improved to the preoperative level.

[Cystic Myxoma which Obstructed the Mitral Valve Orifice;Report of a Case].

A 44-year-old male presented to our hospital with exertional dyspnea. Transthoracic echocardiography revealed a large cystic mass in the left atrium obstructing the mitral valve orifice. Transesophageal echocardiography during emergency operation showed a large cystic mass along with a solid part near the stalk. The mass was resected en bloc including the margin of the left atrium around the stalk. His hemodynamics improved immediately after the operation and the patient was discharged shortly with uneventful postoperative course. While intra cardiac cystic mass has some possible pathologies including malignancy, pathological examination of this tumor revealed a myxoma with large hematoma which had probably grown up rapidly. This tumor was successfully eradicated under the guide of both transthoracic and transesophageal echocardiography.

[Ascending Aorta Replacement and Extended Myectomy for Acute Aortic Dissection and Coexistent Hypertrophic Obstructive Cardiomyopathy;Report of a Case].

Emergent ascending aortic replacement and extended myectomy were performed in a woman with acute aortic dissection who was aged 63 years. Preoperative transthoracic echocardiography performed in the intensive care unit showed only slight left ventricular outflow tract (LVOT) obstruction, but intraoperative transesophageal echocardiography after induction of anesthesia revealed pericardial effusion, systolic anterior motion(SAM), and associated mitral regurgitation(MR). Perioperative SAM and MR are sometimes facilitated under various hemodynamic conditions, but in this case, the left ventricular wall was thick and LVOT appeared to be obstructive by a hypertrophied septum. Structural hypertrophic obstructive cardiomyopathy (HOCM) was diagnosed, and septal myectomy and aortic replacement were performed. After ascending aortic replacement and simultaneous extended myectomy with resection of abnormal band, weaning from cardiopulmonary bypass was smooth without SAM and MR. The patient was discharged from hospital 24 days postoperatively with no major complications. Extended myectomy should be considered if structural HOCM is diagnosed, even when aortic replacement for the dissected aorta is the primary procedure.

Successful management using airway pressure release ventilation for severe postoperative pulmonary edema.

INTRODUCTION: Postoperative pulmonary edema is a fatal adverse event after a cardiac surgery. We here report successful management using airway pressure release ventilation (APRV) for severe hypoxia with pulmonary edema after a cardiac surgery. PRESENTATION OF CASE: A 58-year-old man underwent an uneventful mitral valve repair. Immediately afterwards, the patient became agitated and made vigorous inspiratory efforts. His oxygen saturation dropped to 90%. Coarse inspiratory rhonchi were heard on auscultation, and copious, pink, frothy sputum was obtained with suctioning. Initial chest radiograph showed right-sided patchy opacities and interstitial infiltrates. A transthoracic echocardiogram demonstrated normal cardiac function. With worsening respiratory failure on mechanical ventilation, APRV was attempted. His condition and blood gas was subsequently improved. Over the following 3days, the patient experienced an uneventful postoperative course and was discharged to home on postoperative day 14. DISCUSSION: Extracorponeal membrane oxygenation (ECMO) is the most effective for severe hypoxia with pulmonary edema; however, ECMO is associated with hemorrhage and infectious complications. Alteratively, APRV was required for the successful management for severe hypoxia with pulmonary edema. CONCLUSION: APRV could be effective for severe hypoxia with pulmonary edema after a cardiac surgery.

A new hybrid sutureless patch repair utilizing chitosan for left ventricle rupture after myocardial infarction: A case report.

INTRODUCTION: There are many publications reporting the use of TachoSil sheets for sutureless repair. Trauma doctors have recently reported that chitosan-based sheets can efficiently achieve hemostasis for active bleeding. PRESENTATION OF CASE: An 85-year-old man was diagnosed with left ventricle free wall rupture that caused cardiac tamponade and cardiogenic shock. Extracorporeal membrane oxygenator (ECMO) was started immediately and surgical repair was planned. Bleeding occurred from a 1-cm tear in the center of the necrotic area in the territory of the left circumflex artery. The tear was treated with a chitosan-based HemCon Bandage. After hemostasis of the myocardium was achieved, the bandage was peeled off and a patch repair was performed using collagen fleece with fibrinogen-based impregnation. His condition subsequently improved. The tracheal tube was extubated and ECMO was removed 2days after the surgery. One month later, the patient had no complications at his postoperative follow-up visit. DISCUSSION: To our knowledge, this is the first report of a hybrid patch repair utilizing chitosan-based sheets for a left ventricle rupture after myocardial infarction. Further studies are necessary to evaluate the short- and long-term efficacy of this procedure, and these results must be compared with those of classical surgical repairs. CONCLUSION: The new hybrid sutureless patch utilizing chitosan was demonstrated as safe, easy and effective.