We describe a simple and reproducible technique to achieve complete and immediate hemostasis of the distal anastomosis in total arch replacement with the frozen elephant trunk technique. The adventitia was left seamlessly 1.0 cm longer than the level of the suture line. The adventitial remnant covered most of the distal anastomosis line tightly while the distal anastomosis was completed with continuous sutures. The adventitia was thin and tough, making it suitable to cover the suture line. This technique can contribute to eliminating bleeding from the distal anastomosis independent of unreliable blood coagulability during aortic surgery for acute aortic dissection.
Entrapment of an intravascular ultrasonography (IVUS) catheter is an infrequent but serious complication associated with percutaneous coronary intervention (PCI). A 67-year-old man who presented with exertional chest pain had an angiographic finding of 99 % stenosis of left circumflex coronary artery. PCI with stent implantation was performed successfully with an assessment by IVUS showing adequate stent expansion and apposition. When the IVUS catheter was retracted, it became trapped at the stent strut. The stent was deformed and the IVUS catheter became stuck there. Ventricular fibrillation suddenly occurred with deterioration of the coronary flow. He was transferred to the operating room just after insertion of intra-aortic balloon pumping. The IVUS catheter, the guidewire, and the deformed stent were all removed under cardiopulmonary bypass. Coronary artery bypass graft with a saphenous vein was also performed at the more distal segment from the entrapment site. The postoperative course was uneventful with no graft occlusion.
Takayasu's arteritis is a chronic inflammatory disease that affects the pulmonary artery, as well as the aorta and its major branches. A 59-year-old man presented with a 2-month history of progressive exertional dyspnea. Further examination revealed marked wall thickening of the pulmonary trunk and bilateral proximal pulmonary artery, resulting in severe stenoses with high pressure gradient of 60 mmHg. The patient underwent graft replacement of the bilateral pulmonary artery and the pulmonary trunk with a 16-mm ring-supported extended polytetrofluoroethylene graft under extracorporeal circulation. Histopathological findings were consistent with Takayasu's arteritis with pulmonary artery involvement. After the operation, the pressure gradient decreased to 6 mmHg and the patient was free from exertional dyspnea.
Anomalous origin of the left coronary artery (LCA) from the right sinus of Valsalva (RSOV) is an uncommon but clinically important feature. A 75-year-old man with progressive nocturnal dyspnea was diagnosed with severe aortic valve stenosis and moderate regurgitation. Preoperative computed tomographic scan revealed that the LCA originated from the RSOV separate from the right coronary artery and coursed into the ventricular septum. Because he did not experience any episodes of cardiac ischemia, isolated aortic valve replacement was performed using a 23-mm stented bioprosthesis without concomitant coronary revascularization. The postoperative course was free from coronary ischemia.
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