Ruptured aortic arch aneurysm with hemorrhagic cardiac tamponade: report a case]

The ruptured thoracic aortic aneurysm has had severely high mortality. A 71-year-old male who suddenly fainted away was admitted to our hospital. He was in shock on arrival. Computed tomography and echo cardiogram demonstrated ruptured aortic arch aneurysm with hemorrhagic cardiac tamponade. Aortic arch replacement was performed using the selective cerebral perfusion under deep hypothermia. The recovery of his consciousness was delayed, and he had right hemiplegia postoperatively, but his state was improved gradually. Finally he complained only slight degree of aphasia, paralysis. An immediate and aggressive emergency operation is a only method to salvage the patient who has ruptured aneurysm of the thoracic aorta.     

A case report: successful treatment of acute type B aortic dissection with renal and leg ischemia

A 56-year-old patient of acute type B aortic dissection with renal and leg ischemia successfully underwent emergency replacement of the descending thoracic aorta. Prior to this operation, we reperfused the ischemic legs in a controlled manner using a cardiopulmonary bypass circuit. This controlled limb reperfusion method could reduce reperfusion injury. Postoperatively, the patient also suffered from renovascular hypertension due to stenosis of the right renal artery. Renal stent angioplasty, performed 10 days after the operation, stabilized his blood pressure. Controlled limb reperfusion and renal stent angioplasty may be useful for managing branch complications associated with aortic dissection.     

Fatal cardiac tamponade associated with posterior spinal instrumentation. A case report

STUDY DESIGN: Case report of a fatal complication of pedicle screw instrumentation and review of the literature. OBJECTIVE: To describe the clinical and postmortem findings in a 35-year-old man who sustained a T11 burst fracture that was managed by transpedicular posterior instrumentation and who died 12 days after surgery of cardiac tamponade caused by a prick injury of the right coronary artery. SUMMARY OF BACKGROUND DATA: Posterior pedicle screw instrumentation is considered a safe and effective method for stabilizing a spinal motion segment. Nevertheless, there are several rare but significant complications that may occur. This is the first report of a heart tamponade after transpedicular screw insertion. METHODS: A 35-year-old man was treated for a T11 burst fracture with posterior transpedicular stabilization. The surgery was uncomplicated. RESULTS: Twelve days after the intervention, the patient died of cardiogenic shock. Postmortem examination showed a heart tamponade of 350 mL blood originating in a prick injury of the right coronary artery. Histologic findings showed evidence that the injury was caused during surgery by a Kirschner wire. CONCLUSION: There are numerous possible intraoperative complications in posterior pedicle screw fixation, such as nerve root and spinal cord injuries. This case of a fatal heart tamponade after transpedicular screw insertion is rare. It shows that the surgeon must be aware of potential risks associated with such a procedure and have a comprehensive three-dimensional understanding of the anatomic structures involved.     

A case of Stanford type A acute aortic dissection associated with a distal aortic arch atherosclerotic aneurysm

We report a rare case of Stanford type A acute aortic dissection associated with a distal aortic arch atherosclerotic aneurysm. A 71-year-old female was referred to us with the diagnosis of thrombosed Stanford type A acute aortic dissection, however on the next day transesophageal echocardiography revealed the false lumen has been recanalized. In the operation, there was a distal aortic arch atherosclerotic aneurysm which was unidentified at the preoperation. It is very rare that the dissection originated from atherosclerotic aneurysm and proceeded to proximal and distal portion of the aorta.     

Acute aortic dissection complicated with acute myocardial infarction--a case report of successful operation for the case of DOA

A 61-year-old woman who suddenly manifested chest and back pain was admitted after the diagnosis of acute type A dissection complicated with acute inferior myocardial infarction at another hospital. While being transported to our hospital by ambulance, her ECG repeatedly demonstrated ventricular fibrillation of cardiac arrest. She was in the state of dead on arrival (DOA) when arrived at our hospital. ECG demonstrated complete A-V block and cardiac arrest alternately. However, soon after right ventricular pacing was done, her blood pressure increased and she recovered consciousness. We therefore performed an emergency operation. We performed reconstruction of the ascending aorta and right coronary bypass grafting, since she had aortic dissection and conus brach avulsion. The postoperative course was uneventful.     

Right coronary artery dissection and acute infarction due to blunt trauma: report of a case

Coronary artery dissection occurring after a nonpenetrating chest trauma is extremely rare. We describe herein the case of a 43-year-old man who suffered traumatic myocardial infarction after an intimal tear of the right coronary artery had been inflicted by a horse stepping on his back.     

A surgical case of acute three-channeled aortic dissection in Marfan syndrome

We surgically treated a 35-year-old male with acute 3-channeled aortic dissection in Marfan syndrome. He had acute type A aortic dissection, and underwent Bentall's type operation, simultaneous graft replacement of the ascending aorta and total aortic arch. Pain recurred 5 years and 9 months after the first operation. CT scan showed two adjacent false lumens in the descending aorta. The morphology of the first and second dissections was Stanford type A + B. The second dissection was acute. In the second false lumen, a re-entry formation was observed in the abdominal aorta. Because severe pain was persistent, we immediately replaced the descending aorta using a femoro-femoral partial cardiopulmonary bypass. The patient was doing well and was discharged. When pain recurs in a Marfan patient with an aortic dissection, a 3-channeled aortic dissection should be suspected, and we recommend emergency surgery.     

Unexplained fever and aortic regurgitation: a rare presentation of Takayasu's aortitis--a case report

Takayasu's aortitis is rare in male patients. The authors describe the case of a 48-year-old man with a fever of unknown origin, progressive general fatigue, and dyspnea due to aortic regurgitation. A severely thickened aorta was noted during aortic valve replacement. The diagnosis was based on a histologic examination of an operative specimen of the ascending aorta. Takayasu's aortitis should be considered even in male patients with fever of unknown origin and progressive aortic regurgitation.     

Superior vena cava syndrome as initial manifestation of acute aortic dissection: a case report and review of the literature

Aortic dissection usually presents with chest pain, abnormal pulses and a widened mediastinum on chest radiograph. It is rarely associated with the superior vena cava syndrome as the first manifestation. This paper presents a patient who had a superior vena cava syndrome as a result of a painless aortic dissection and compared with other previously reported cases.     

Bronchogenic carcinoma associated with right aortic arch and postaortic left brachiocephalic vein--report of a case

61-year-old male was admitted to our hospital for surgical treatment of bronchogenic squamous cell carcinoma arising from left B8. The patient had right aortic arch with aberrant left subclavian artery and postaortic left brachiocephalic vein. Intraoperatively, left ligamentum arteriorsus forming vascular ring between the left subclavian artery and the pulmonary artery was found, however the ligamentum arteriorsus was not divided because no symptom of esophago-tracheal compression was observed. The left brachiocephalic vein was located between the ascending aorta and the arterial ligament. The lower lobe of the left lung was resected, and lymph nodes in the left side of the mediastinum were dissected easily because the aortic arch was positioned on the other side. Preoperative assessment of the type of branching and the course of arteries and veins is important for safe operation.     

Cardiac tamponade secondary to chylopericardium following cardiac surgery: case report and review of the literature

Only four instances of isolated chylopericardium following cardiac operation have been reported previously. We encountered this complication in a young patient who was operated on for infundibular pulmonary stenosis. The etiology appears to be related to a combination of intraoperative lymphatic injury and catheter-related subclavian vein thrombosis, the latter potentially elevating pressure within the thoracic duct and thereby resulting in an accumulation of chyle within the pericardial space. Therapy for this problem usually includes partial pericardiectomy with or without ligation of the thoracic duct.     

A repair of the aortic pseudoaneurysm after ascending aortic grafting in acute type A dissection--a case report

A postoperative pseudoaneurysm of the ascending aorta is reported. The patient was a 73-year-old female with a history of graft replacement of the ascending aorta for acute type A dissection 5 years ago. She was referred to our hospital because of chest pain. Preoperative radiographic examination revealed a large pseudoaneurysm of the ascending aorta close to the distal anastomotic site of the graft as well as an aneurysm of transverse arch. During surgery, the pseudoaneurysm originated from a intimal defect in the aortic wall 1 cm distal to the suture line. It is suggested that the pseudoaneurysm was caused by a clamp injury during the initial operation. Replacement of the ascending aorta and transverse arch was successfully performed under selective cerebral perfusion. We should keep the clamp injury in mind when we apply an aortic clamp to a fragile dissected aorta.     

Percutaneous coronary angioplasty of unprotected left main stem: a case report

We describe the case of a 60-year-old man with unstable angina and a critical stenosis of an unprotected left main stem. The patient was also affected with oligophrenia and Paget's disease that contraindicated surgical revascularization. We performed a percutaneous transluminal coronary angioplasty in the cardiac surgery operating room, preparing a femoro-femoral cardiopulmonary bypass by means of a portable X-ray system. The final results were good and they were confirmed by an angiographic control performed three months later as well as during the six-month follow-up. Angioplasty of the unprotected left main stem is feasible and adequate technologic support can reduce the risks for the patient.     

Successful surgical treatment for type B aortic dissection with Marfan's syndrome after aortic root and mitral valve replacement: report of a case

A 30-year-old female with Marfan's syndrome underwent aortic root replacement for annuloaortic ectasia and mitral valve replacement for mitral regurgitation. She remained well until 16 months postoperatively when she had sudden onset of pain. Preoperative angiogram showed Stanford B aortic dissection. Thoracoabdominal aortic replacement was performed successfully under deep hypothermic bypass.     

A case report on a reconstructive operation of a traumatic tricuspid regurgitation with a congenital defect of the left pericardium

We reported a successful tricuspid valve replacement in a 58-years old man, who had easy fatiguability after 14 years of a blunt chest trauma. The preoperative examination revealed a marked cardiomegaly with deformation of both ventricles and grade 4 tricuspid regurgitation caused by the prolapse of the anterior leaflet. The operative inspection revealed a left pericardial defect with a diameter of 10 cm and a torn anterior papillary muscle. Since a usual plastic procedure did not improve the regurgitation, a Carpentier-Edward bioprosthetic valve was implanted in the supra annular position. Atrioventricular conduction was preserved. The tricuspid valve was not resected to preserve the ventricular function. The patient recovered his own activity.     

Surgical treatment of acute type A aortic dissection with an intraluminal sutureless graft

The surgical treatment of acute type A aortic dissection remains a great challenge to all cardiac surgeons. From January 1991 to June 1993, 21 consecutive patients (13 men and eight women, aged 34 to 74 years) underwent emergency operations to repair acute type A aortic dissection, with the aid of hypothermic circulatory arrest. The intima tear was located in the ascending aorta in 13 patients, in the aortic arch in five patients, and in the descending aorta in three patients. The dissected ascending aorta was replaced with sutureless, intraluminal vascular grafts in all 21 patients. The intima tears in the aortic arch of five patients were primarily repaired. Modified Cabrol's shunts were created in seven patients for hemostasis, and Dacron grafts were used to wrap the ascending aorta in 18 patients. Retrograde cerebral perfusion during circulatory arrest was performed on 15 patients. The circulatory arrest time was 37 +/- 10 minutes (mean +/- SD). All patients survived the operation and regained consciousness in the early postoperative period without neurologic deficit. Post-treatment follow-ups (mean, 18.2 months) were completed in all patients except one, who died 12 months after the operation as a result of a traffic accident. All of the surviving patients are doing well without any further aortic operations. Our experience suggests that surgical repair of the acute type A aortic dissection can be a simple and safe procedure if sutureless intraluminal grafts are used and hypothermic circulatory arrest and retrograde cerebral perfusion are utilized.