We conducted a retrospective study on the results of 10 patients with distal arch aneurysm undergoing total arch implantation with open stent-placement(OSP) in comparison with 17 patients with distal arch aneurysm undergoing conventional total arch implantation(TAI). In the OSP group, postoperative intubation time and ICU stay were shorter than those of the TAI group, and there were no left recurrent nerve injury or left phrenic nerve injury. But there were one with spinal cord infarction and one with endoleak in the OSP group. While a new total arch implantation method with a stent graft offers less invasiveness than a conventional surgical method, this method may have a possibility of severe complica-tions. Consequently, this open stent-placement method must be indicated for only a high risk patient.
A 38-year-old man was sent to the emergency service of another hospital for an accidental nail-gun shot injury of the chest. Echocardiography and computed tomography showed that the left and right ventricle were penetrated by the nails. Emergency surgery was performed by median sternotomy, and the nail in the right ventricle was removed without cardio-pulmonary bypass and the nail in the left ventricle was removed under cardio-pulmonary bypass. He was discharged uneventfully 10 days after the accident.
Presentation of aortic dissection with neurological manifestation is uncommon and the prognosis of this disease must be guarded. We here report a case of 40-year-old man who underwent an emergency operation with ascending aorta replacement under the diagnosis of transient paraplegia with acute aortic dissection(type A). He had the history of hypertrophic cardiomyopathy with left ventricular dysfunction. It was most likely that our patient had ischemia to spinal cord following aortic dissection. On awakening from anesthesia, he was found to be flaccidity and hypersensitive of left lower extremity and dysuria. Nevertheless, he showed steady improvement with return of his neurological function and 83 days after the operation he walked from the hospital with little remaining neurological symptoms or signs.
Abdominal aortic aneurysm repair in kidney transplant recipients is still a surgical challenge. We performed surgical repair in a 53-year-old man who had a type B chronic aortic dissection and had undergone kidney transplantation 6 years earlier because of chronic glomerulonephritis. Since he had both a thoracic descending aortic aneurysm and a huge abdominal aortic aneurysm, a staged repair was planned. At operation, after dissection around the transplanted kidney, the kidney was perfused with cold Ringer's solution and albumin. Aortic revascularization was accomplished with a Y-shaped graft. After prolonged rehabilitation and antibiotic treatment, he was discharged and was awaiting second-stage repair of the thoracic descending aortic aneurysm.
A 42-year-old man was referred to our hospital due to a coronary artery aneurysm(8mm in diameter) after percutaneous coronary intervention. He had a history of acute myocardial infarction in the left anterior descending artery(LAD) and balloon angioplasty three months previously. Coronary artery bypass grafting (CABG) was performed using cardiopulmonary bypass and cardioplegia. At the operation, a pseudo-aneurysm was found between 1st and 2nd septal branch. A longitudinal incision of 40mm length was made on the LAD across the aneurysm and stenosis. The left internal thoracic artery(LITA) was anastomosed with 8-0 prolene sutures(on-lay patch). The 3 dimension computed tomography before discharge showed disappearance of the aneurysm and good patency of the LITA graft to the LAD. Although PCI-related coronary artery aneurysm was relatively rare. Once it is found, surgical treatment was recommended due to the threat of rupture. Although plication or ligation of the coronary aneurysm and distal coronary bypass have been recommended, on-lay patch CABG may be useful and can be an option to avoid sacrifice of the major branches near by the aneurysm.