Growing Renal Vein Aneurysm Treated by Endovascular Repair: A Case Report and Literature Review.

Renal vein aneurysm (RVA) is extremely rare and often asymptomatic, disclosed only incidentally on diagnostic imaging modalities such as computed tomography and ultrasonography. Management is often just watchful follow-up, but some patients require intervention. We present the case of a 74-year-old man complaining of lower back pain in whom a 53-mm RVA was identified. He underwent successful endovascular repair using Amplatzer vascular plugs. The aneurysm had completely resolved by 12 months. Endovascular treatment of a primary RVA does not seem to have been reported previously. This is a milestone case in the management of RVA.

Mitral valve nonbacterial thrombotic endocarditis: a rare multi-surgery-tolerant survivor of Trousseau's syndrome.

BACKGROUND: Few previous reports have documented cases of nonbacterial thrombotic endocarditis associated with Trousseau's syndrome for which surgery proved possible for both the primary tumor and the cardiac lesion. The effectiveness of direct oral anticoagulants in patients with Trousseau's syndrome has also received scant attention. CASE PRESENTATION: A 69-year-old man with repeated episodes of cerebral infarction was diagnosed as having nonbacterial thrombotic endocarditis after mitral valve replacement surgery. Stroke recurred preoperatively under apixaban administration. A stomach biopsy also identified gastric adenocarcinoma, and gastric surgery was performed on the 40th postoperative day. The patient was discharged from the hospital and has been free of thromboembolism under a regime of subcutaneous heparin self-injection thereafter. CONCLUSIONS: We have reported a rare multi-surgery-tolerant survivor of Trousseau's syndrome in whom subcutaneous heparin injection was useful for preventing thromboembolic events over a long period.

Platypnea-orthodeoxia syndrome associated with aortic insufficiency and aortic elongation.

An 81-year-old female developed dyspnea only upon assuming a sitting position. Trans-esophageal echocardiography demonstrated left-to-right shunt flow across the atrial septum when the patient was sitting, and right-to-left shunt flow when she was supine, along with severe aortic insufficiency. She was diagnosed as having platypnea-orthodeoxia syndrome and her symptoms were completely resolved following aortic valve replacement, closure of a patent foramen ovale, and shortening of an elongated ascending aorta.

Coronary artery bypass grafting in a patient with polyarteritis nodosa presenting with acute myocardial infarction and multiple coronary aneurysms.

Polyarteritis nodosa (PAN) is a necrotizing form of vasculitis that affects small- and medium- sized vessels. Cases of ischemic heart disease involving coronary aneurysms in patients with PAN have been reported previously, but there have only been a few reports of coronary artery surgery for PAN-related coronary disease. A 46-year-old female with a history of PAN arrived at our emergency room due to cardiopulmonary arrest. After cardiopulmonary resuscitation, emergent coronary angiography was performed, because an electrocardiogram demonstrated ST segment elevation in leads V1 to V5. Coronary angiography revealed occlusion of the proximal right coronary artery and left anterior descending coronary artery as well as multiple coronary aneurysms. We performed emergent two-vessel coronary artery bypass grafting (the left anterior descending coronary artery and posterolateral branch of the circumflex system were treated with grafts from the left internal mammary artery and saphenous vein graft, respectively) under percutaneous cardiopulmonary support without cardiac arrest. The patient's postoperative course was uneventful, and postoperative coronary angiography revealed that the bypass grafts were patent. A review of the literature and a discussion of this case are also presented.