Endovascular Aortic Repair for Thoracic Aortic Compression Resulting From Chance Fracture of the Thoracic Spine.

Blunt aortic injury is a serious condition with a high mortality rate. Although rare, blunt aortic injury associated with spinal fracture has also been reported, and appropriate management of aortic disease is key to a good outcome. This report is a case of a 78-year-old man who was found to have a transverse fracture (Chance fracture) in the ninth thoracic vertebra, with a sharp bone fragment compressing the thoracic aorta.

Pleural Approach to Aberrant Right Subclavian Artery in Aortic Surgery.

An aberrant right subclavian artery usually arises from the aortic arch just distal to the left subclavian artery and crosses behind the esophagus on its way to the right axillary artery. Several reconstructive techniques of this artery in aortic surgery have been reported but mostly resulted in troublesome procedures. Here, we describe an alternative strategy presenting the occlusion of the aberrant right subclavian artery through the right pleural approach followed via extraanatomical axillary artery bypass.

Surgery for Bacterial Endocarditis Complicated by Diffuse Alveolar Hemorrhage.

Diffuse alveolar hemorrhage is a very rare but potentially lethal condition resulting from various disorders. We report the case of a patient who suffered diffuse alveolar hemorrhage subsequent to bacterial endocarditis and survived aortic valve replacement, which was applied after improvement in respiratory distress. We believe that the strategy of respiratory functional recovery by aggressive rehabilitation is essential for the achievement of a successful surgical outcome in patients with alveolar hemorrhage.

Adjunctive Ischemic Lower-Limb Perfusion during Aortic Repair with Cardiopulmonary Bypass Prevents Fatal Reperfusion Injury.

Acute aortic dissection can be complicated by malperfusion syndromes, including ischemia of the lower limbs. In some cases, delayed correction of leg ischemia leads to reperfusion injury, potentially resulting in renal failure. We describe the case of a 64-year-old woman who presented with acute aortic dissection manifesting itself as lower-limb ischemia.

Successful Treatment of Iatrogenic Subclavian Artery Pseudoaneurysm by Ultrasound-Guided Thrombin Injection.

Ultrasound-guided thrombin injection has been well described as a safe and effective treatment for pseudoaneurysms of the femoral artery. However, cases for subclavian artery pseudoaneurysm are rare. An 82-year-old man developed an iatrogenic right subclavian artery pseudoaneurysm.

Successful resection of a huge metastatic liposarcoma in the pericardium resulting in improvement of diastolic heart failure: a case report.

Although liposarcoma often metastasizes to various organs, cardiac metastasis, including to the pericardium, is rare. We present a case of a third recurrence of pericardial metastasis from the thigh, which required surgical resection because of cardiac failure. Surgery was effective for improving cardiac function and reintroducing chemotherapy.

Tricuspid regurgitation resulting from acute type A aortic dissection.

Proximal extension of acute type A aortic dissection can affect the aortic valve but seldom affects the tricuspid valve. We report the case of an octogenarian who underwent successful surgical repair of an aortic dissection that was accompanied by tricuspid regurgitation. We believe that the tricuspid regurgitation was attributable to displacement of the valve resulting from aortic dissection.

Repair of acute aortic dissection in an octogenarian with prior thoracoplasty.

Cardiovascular surgery is challenging in patients who have previously undergone thoracoplasty because of severe chest deformity and impaired pulmonary function. We report a case of an octogenarian with prior left thoracoplasty, who successfully underwent surgical repair of an acute aortic dissection through a standard median sternotomy. We suggest that prior thoracoplasty might not necessarily be an exclusion criterion for aortic surgery in cases with adequate pulmonary function.

Aortic valve replacement in a porcelain aorta using endo balloon occlusion.

Aortic valve surgery carries increased risks in patients with an extensively calcified aorta. We describe a technique in which we maintain systemic perfusion via bilateral axillary artery perfusion in conjunction with endoaortic balloon occlusion, and limit the circulatory arrest time.

Repair of a ductal aneurysm using a hemi-clamshell incision in an elderly patient.

Spontaneous ductal aneurysm is rare in adults, although it is diagnosed sporadically, even in the elderly. Commonly, patients with a ductal aneurysm undergo an aneurysmectomy followed by patch-plasty through a lateral thoracotomy. However in older patients, more extensive surgery is often required due to more developed atherosclerotic lesions, requiring total arch replacement.

Cor triatriatum repair to eliminate suffering from paroxysmal atrial fibrillation.

Development of atrial fibrillation is one of the primary indicators of cor triatriatum in adults. Here we describe a case of a patient suffering cor triatriatum coexistent with frequent paroxysmal atrial fibrillation. Paroxysms of arrhythmia were not encountered after surgical correction.

Multiple infected aortic aneurysms repaired by staged in situ graft replacement.

The development of multiple infected aortic aneurysms is extremely rare, and treatment remains challenging. We report here a 72-year-old man with multiple infected aortic aneurysms in whom a staged in situ graft replacement for the aortic arch and pararenal abdominal aorta was successfully performed. A rifampicin-bonded graft seemed to be effective in preventing postoperative infection.

Bilateral axillary artery perfusion to reduce brain damage during cardiopulmonary bypass.

Background: Theoretically, a multiple perfusion approach, reducing detachment of atheromatous debris from the aortic intima and its flow into the cerebral circulation, should contribute to lessen a stroke, and may be applied to complex cardiac surgery with extensive aortic disease. The aim of the present study was to examine the value of bilateral axillary artery perfusion during thoracic aortic and cardiac surgery, and to evaluate the clinical results with a particular focus on cerebral damage.

Methods: From March 2002 through December 2007, 24 patients (16 male and eight female; age range, 43 to 84 years) underwent bilateral axillary artery perfusion through side grafts during cardiopulmonary bypass.

Missing left atrial thrombus: dislodgement or artifact?

Patients with a left atrial thrombus are considered at high risk of thromboembolism. Surgical treatment is generally recommended. We experienced a case of a patient with a history of cerebral embolism related to chronic atrial fibrillation in whom, unexpectedly, no thrombi were found at thrombectomy.

Aortic valve replacement in a patient with a brain tumor.

We report a case of aortic stenosis with a brain tumor in a 67-year-old man. Although he showed no clinical neurological abnormality, a computed tomography scan revealed a brain tumor. We performed aortic valve replacement under several management techniques to avoid cerebral injury.

Coronary artery bypass grafting in cerebral palsy with severe contractures of extremities.

We report on a 76-year-old man suffering from cerebral palsy who underwent coronary artery bypass grafting. Limitation of available bypass grafts and the approach of intra-aortic balloon pump insertion are of great concern because of his specific posture resulting from multiple articular contractures. We describe our planning to survive coronary surgery in this specific situation.

An unusual manifestation of brain tumor: development of delayed hemiplegia after cardiopulmonary bypass.

Cerebral swelling after cardiopulmonary bypass might trigger a critical cerebral consequence resulting from intracranial space-occupying lesion. We experienced a 75-year-old woman who suffered from a delayed left hemiplegia after mitral valve replacement. Urgent diagnostic imaging revealed the presence of a brain tumor with perifocal cerebral edema.

Bilateral axillary arterial perfusion in surgery on thoracic aorta.

Bilateral axillary arterial cannulation for selective cerebral perfusion might minimize cerebral embolic complications during surgery on the ascending aorta and aortic arch. From March 2002 through February 2004, bilateral axillary arterial perfusion was applied in 12 consecutive patients (mean age, 61.3 years).

A 10-year experience with the Carbomedics cardiac prosthesis.

Background: There are few reports on the long-term results of Carbomedics prosthetic heart valves.

Methods: Five hundred five patients who underwent valve replacement with this prosthesis in the aortic or mitral position were chosen for this study. Patients' mean age was 57 years.

Coronary artery bypass grafting and aortic valve replacement in a patient with a tracheostoma.

We report a 67-year-old man with a tracheostoma who successfully underwent coronary artery bypass grafting and aortic valve replacement. He had received both a tracheostoma just above the sternal notch after total laryngectomy. As the standard full sternotomy might cause mediastinitis, we performed the operation through a lower half sternotomy with a limited skin incision.

Coronary artery bypass grafting with absent right superior vena cava in visceroatrial situs solitus.

We report on a 63-year-old man with an absence of right superior vena cava in visceroatrial situs solitus who underwent coronary artery bypass grafting. Preoperative echocardiography showed a dilated coronary sinus, and venography confirmed an absent right and a persistent left superior vena cava. Perioperatively, placement of a pulmonary artery catheter, site of venous cannulation, and management of associated rhythm abnormalities were of great concern.

Extended total arch replacement for type B aortic dissection with ascending aneurysm following healed aortic dissection.

We describe a case of type B aortic dissection with large ascending aortic aneurysm occurring 12.8 years after aortic root replacement (Cabrol procedure) in a non-Marfan patient with cystic medial necrosis of the aorta. We have successfully performed an extended total aortic arch replacement using a four-branched graft through the "L-incision" approach (a combination of a left anterior thoracotomy and upper half median sternotomy).

A modified valve-on-valve approach for aortic root replacement.

We describe an alternative surgical technique for aortic root replacement in a patient whose aortic valve was previously replaced with a bioprosthesis. It consists of resecting the leaflets of the original bioprosthesis in situ, amputating the struts, and suturing the skirt of a composite graft on the preserved annulus of the original bioprosthesis. Coronary circulation is reconstructed according to the Cabrol modification.

Successful aortic valve replacement in severe pancytopenia related to myelodysplastic syndrome.

We report a 60-year-old man with myelodysplastic syndrome (MDS) whose aortic valve was replaced successfully. He suffered from dyspnea on exertion and was confirmed by echocardiography and cardiac catheterization to have severe aortic stenosis. A peripheral blood examination showed pancytopenia and a bone marrow examination showed MDS with a subtype of refractory anemia with excess blasts.