A Case of Pseudo-False Aneurysm of the Left Ventricle with Ventricular Septal Perforation / 日本心臓血管外科学会雑誌

We report here a case of pseudo-false aneurysm of the left ventricle with ventricular septal perforation following myocardial infarction. An 85-year-old man was treated for acute inferior myocardial infarction three months previously. He was admitted due to an acute posterior myocardial infarction. Since a cardiac catheter study showed three diseased coronary arteries, a left ventricular aneurysm and a ventricular septal perforation, he underwent emergency surgery. The ventricular aneurysm was located on the right side along the posterior descending branch, and was 4×1.5cm in size. We ruled out a false aneurysm because there was no adhesion between the epicardium and the pericardium. The communication between the aneurysm and the left ventricle was then closed with a Gore-Tex patch, and the perforation of the right ventricle was closed directly. CABG was performed for the left anterior descending artery using a vein graft. The postoperative course was uneventful, and he was discharged on the 27th postoperative day. The pathological findings showed a pseudo-false aneurysm of the ventricle.

Acute High Aortic Occlusion with Aplastic Anemia / 日本心臓血管外科学会雑誌

A 67-year-old man had been diagnosed as having aplastic anemia three years ago. He had taken anabolic steroids continuously. He suddenly complained of the ischemic signs of the lower extremities. Aortography showed the total occlusion of the abdominal aorta with encroachment upon the left renal artery. The right renal artery and superior mesenteric artery were intact. Laboratory data showed acute renal failure. We selected an axillo-femoral bypass because of aplastic anemia and acute renal failure. Throughout the intraoperative and post-operative periods the patient showed a bleeding tendency, then disseminated intravascular coagulation (DIC) has occurred. He required much blood transfusion, anti-coagulant drugs and hemodialysis post-operatively and finally recovered from acute renal failure and DIC.

Three Operations Following Conservative Therapy in Patients with Stanford A Type Acute Thrombosed Aortic Dissection / 日本心臓血管外科学会雑誌

We performed 3 operations for Stanford A type aortic dissections which were confirmed as acute thrombosed type by contrast chest CT. Initially conservative therapy was chosen in all patients. In case 1, a 64-year-old woman received ascending aortic replacement with a Hemashield^® vascular prosthesis 3 days after admission, because of increasing diameter of the ascending aorta and sustained back pain. In case 2, a 54-year-old woman, we replaced the total aortic arch with Hemashield^® graft, on an emergency basis since recanalization of the false lumen was revealed by contrast CT and D.S.A. 3 days after admission. In case 3, a 52-year-old woman, cardiac tamponade occured on the 30th admission day even though anti-hypertensive treatment had been effectively performed immediately after onset. Emergency D.S.A. revealed an“ulcer like projection” in the ascending aorta, so following pericardiocentesis, we resected and directly anastomosed the ascending aorta at the entry site 34 days after onset. Generally, acute thrombosed aortic dissections should be treated conservatively. Here we reported 3 operations for acute thrombosed Stanford A type aortic dissections even under good B.P. control, suggesting the importance of careful and long term observation for acute thrombosed aortic dissections.