Ruptured Saccular Aneurysm Associated with a Coronary Artery to Pulmonary Artery Fistula / 日本心臓血管外科学会雑誌

We report successful operative treatment of a ruptured coronary artery saccular aneurysm associated with a coronary-pulmonary artery fistula. A 66-year-old woman experienced sudden onset of unconsciousness due to cardiac tamponade. Echocardiogram and chest CT on admission showed pericardial effusion and a 50-mm diameter saccular coronary artery aneurysm. Coronary angiogram revealed coronary artery aneurysm which arose on the conus branch of the right coronary artery. The connection between the aneurysm and the pulmonary artery was not clarified. Cardiac tamponade due to rupture of the saccular coronary artery aneurysm was suspected and emergency operation was performed. Operative findings revealed coronary-pulmonary artery fistula. Closure of the orifice of the draining artery to the pulmonary artery, and aneurysmorrhaphy were performed. Postoperative coronary angiogram and chest CT showed no residual fistula, and the postoperative course was uneventful.

A Case of Platypnea-Orthodeoxia Syndrome Caused by a Patent Foramen Ovale / 日本心臓血管外科学会雑誌

We encountered a patient with platypnea-orthodeoxia syndrome. This rare syndrome is characterized by right-to-left shunt, which appears in the upright position. A 76-year-old woman with symptomatic hypoxemia was referred for evaluation and treatment. She did not complain of dyspnea while in a supine position, but experienced dyspnea with severe hypoxemia in a sitting or standing position. She did not have any pulmonary diseases that can be cause of dyspnea. Echocardiography revealed a patent foramen ovale and mild left-to-right shunt when the patient was supine. However in an upright position, right-to-left shunt appeared and the arterial oxygen saturation dropped from 95% to 80% with dyspnea. Cardiac catheterization revealed normal pulmonary artery pressure and right-to-left shunt through the patent foramen ovale in the sitting position. We then diagnosed platypnea-orthodeoxia syndrome. The chest CT showed deformity of the right atrium caused by compression of the elongated ascending aorta. The patent foramen ovale was closed and the ascending aorta was shortened by open heart surgery. Her dyspnea and hypoxemia in the upright position was completely resolved after surgery.