A rare case of posttraumatic aortic rupture, treated with an endovascular stent graft implantation and complicated with esophageal rupture.

BACKGROUND: Esophageal necrosis and perforation after thoracic endovascular aortic repair (TEVAR) for ruptured traumatic aortic aneurysm is extremely rare. It is difficult to manage, and patients rarely survive without treatment. Although, there is no certain consensus in relation with the optimal treatment we present a subsequent successful management of both life-threatening conditions. CASE PRESENTATION: A 52-year-old man experienced a blunt chest trauma after motor vehicle collision with mild symptoms of pain and fractured ribs. On the 12th day he had severe chest pain and computed tomography (CT) revealed a ruptured traumatic thoracic aortic aneurysm with massive mediastinal hematoma. An emergency thoracic endovascular aortic repair (TEVAR) was performed. Several days later the patient developed a fever. CT suspected a pneumomediastinum, a sign of esophageal rupture, but no confirmation from esophagography and esophagoscopy was achieved. Because of deteriorated septic condition, patient was referred for exploratory thoracotomy. The rupture was found and esophagectomy was performed, with an esophagostomy and gastrostomy to enable enteral nutrition. Almost one year after the esophagectomy, gastric conduit reconstruction through the retrosternal route was performed. The patient was still alive and symptom-free more than 1 year after the reconstruction and no infection of the stent graft was observed. CONCLUSION: We successfully managed a rare case of esophageal necrosis after TEVAR for ruptured traumatic thoracic aortic aneurysm. It is essential to diagnose the esophageal necrosis at an early stage and provide appropriate treatment to increase survival.

A Case of Acute Left Main Coronary Obstruction Following Transcatheter Aortic Valve Implantation.

Transcatheter aortic valve implantation (TAVI) is a highly effective procedure in selected patients with severe degenerative aortic valve stenosis at high risk for conventional surgery. Coronary occlusion is a periprocedural life-threatening complication that despite its low frequency (˂1%) is poorly predictable and requires immediate diagnosis and treatment. Herein, we report a coronary obstruction after transcatheter implantation of valve prosthesis, followed by coronary intervention with successful recanalization.

Endovascular repair of dissecting thoracic aortic aneurysm in a patient with Turner syndrome.

PURPOSE: To report a rare case of dissecting thoracic aortic aneurysm in a young patient with Turner syndrome owing to complete or partial monosomy of the X chromosome. CASE REPORT: A 22-year-old patient with Turner syndrome presented with a 2-month history of voice loss and dysphagia. Multislice computed tomography (MSCT) disclosed a large (53x75-mm) aneurysm with focal dissection affecting the distal part of the aortic arch and the proximal descending aorta, partially involving the left subclavian artery. A TAG endoprosthesis was implanted without complications. MSCT scans at 3 and 6 months after the procedure showed good position and patency of the stent-graft, with total exclusion and shrinkage of the aneurysm. After 1 year of follow-up, she is doing well, without voice disturbances or dysphagia. CONCLUSION: Although cardiovascular malformations are common in patients with Turner syndrome, dissecting thoracic aortic aneurysm is unusual. Stent-graft repair would appear to be feasible in this situation, but long-term implantation in young patients has not been explored.