A Case of Simultaneous Surgery for Distal Aortic Arch Aneurysm Complicated by Left Ventricular Aneurysm / 日本心臓血管外科学会雑誌

ABSTRACT

A 72-year-old man consulted a local physician due to an episode of loss of consciousness. When chest CT was performed after amelioration of symptoms, aneurysmal dilation was detected at the distal aortic arch. On CT, a distal aortic arch aneurysm appeared to be a sacciform aneurysm measuring 55mm in maximum diameter. In addition, coronary arteriography demonstrated complete obstruction of left anterior descending branch #6, while left ventriculography demonstrated left ventricular aneurysm due to old myocardial infarction. The left ventricular end-diastolic volume was increased to 285ml, and the end-systolic volume was increased to 224ml. Moreover, the left ventricular ejection fraction was markedly decreased to 21%. The distal aortic arch aneurysm was treated by total aortic arch replacement. Considering the postoperative development of cardiac failure, the left ventricular aneurysm was simultaneously treated by endoventricular patch plasty, the so-called Dor operation. The postoperative course of this patient was satisfactory, because the end-diastolic volume was decreased to 241ml, and the end-systolic volume was also decreased to 147ml. Furthermore, the left ventricular ejection fraction was increased to 39%, demonstrating an improvement in left ventricular function. In Japan, there have not been any reports describing simultaneous surgery for thoracic aortic aneurysm complicated by left ventricular aneurysm. Therefore, the present study reports the course of this patient, including the indications of endoventricular patch plasty.