horacoabdominal aortic aneurysm (TAAA) is not considered on indication for endovascular stent-graft repair because of the need to revascularize the visceral vessels. This article details for the first time a case of TAAA repair in which an endovascular stent graft was placed after reconstruction of the visceral vessels.
We report a case of herpes simplex viral (HSV) pneumonia as a post-CABG pulmonary complication in a 70-year-old man. Chest radiography on postoperative day 9, showed a glass-like shadow and pleural effusion in the left lung field, and the man's condition began deteriorating rapidly. Bronchofiberscopy to detect the pathogen and a bronchoalveolar lavage with polymerase chain reaction (PCR) yielded a definitive diagnosis of HSV pneumonia. Once therapy with acyclovir was begun, his condition improved markedly. Our case suggests that 1 viral pulmonary infection should be considered as a possible cause in postoperative cardiac patients with unexplained progressive pulmonary infiltrates, and 2 DNA amplification using PCR is rapid--it can be completed within 1 day--and sensitive and specific in diagnosing such infections.
We report a case of a 55-year-old male with type B-chronic aortic dissection. Patient presented with intermittent claudication due to limb malperfusion resulting from expansion of a patent false lumen during walking regardless of normal range ankle-brachial index (ABI) at rest. Preoperative stress vascular ultrasonography was an effective modality for proper diagnosis. We should be concerned of reversible ischemia due to the dissection fl ap in patients with type B aortic dissection. Fenestration of the aorta can be a choice of treatment in such patients. The patient has been doing well with no ischemia for 3.5 years after the operation.
Key words: chronic aortic dissection, aortic fenestration, limb malperfusion
Case ReportA 55-year-old man with a history of type B aortic dissection suffered 1.5 years ago, presented with intermittent claudication was referred to our hospital. The ABI of this patient at rest in the supine position was within the normal range. Right ankle-brachial index (ABI) was 1.07, left one was 1.05. However, the ABI worsened after walking exercise (Fig. 1a). Right ABI turned down to 0.55, left ABI turned down to 0.57.Intermittent claudication started at distance of approximately 50 meters.Computed tomography revealed that the false lumen was patent and that a dissection fl ap extended to the terminal aorta. The true lumen was compressed by the false lumen and was narrowed.Mobile fl ap was detected near the terminal aorta by vascular ultrasonography, and blood fl ow to the bilateral limb was maintained without decrease in the ABI. However, a stress vascular ultrasonography performed after a 6-min walking exercise revealed that the subtotal occlusion of the true lumen in the terminal aorta caused by the expansion of a patent false lumen (Fig. 2). Furthermore, blood fl ow to the bilateral limb was reduced with simultaneous decrease in bilateral ABI.We performed surgical resection of the fl ap in the terminal aorta under laparotomy. During the procedure, the dissection fl ap was found extended to 15 mm in the proximal position to the terminal aorta bifurcation. The distal edge was blind with a mural thrombus, though a small re-entry was present (Fig. 3). After fenestration, aortotomy was closed with 4-0 Prolene sutures reinforced with a 10-mm-width felt strip.His symptom resolved following the operation. Achievement of functional recovery by this surgical treatment was confi rmed by a stress ABI (Fig.1b) and stress vascular ultrasonography performed after a 6-min walking exercise. Thermography after a walking test showed increased blood fl ow in the lower extremities, compared to the fl ow before the test. Enhanced computed tomography revealed
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