Background
A saccular aneurysm located at the bifurcation of the left main coronary artery (LMCA) is an extremely rare condition. A major cause of left main coronary aneurysm is atherosclerosis, and common complications include thrombosis, embolism, and rupture. Despite the serious nature of this condition, the ideal operative approach to LMCA aneurysm (LMCAA) has not been established. Furthermore, little is known about resection of the saccular aneurysm and closure using a small internal thoracic artery patch.
Case presentation
Here, we present the case of a 66-year-old woman who had significant stenosis in the left anterior descending artery and a saccular aneurysm at the bifurcation of the LMCAA, which was repaired using a small internal thoracic artery patch during coronary artery bypass grafting. Postoperative multislice computed tomography revealed the complete disappearance of the aneurysm and a successful repair with no luminal stenosis of the internal thoracic artery patch. In addition, the left internal thoracic artery graft was found to be patent.
Conclusions
Resection of the saccular LMCA aneurysm and closure using a small internal thoracic artery patch is safe and offer excellent results.
A 79-year-old woman had undergone mitral valve replacement(Omnicarbon(OC)valve : 31 mm) due to rheumatic mitral stenosis with regurgitation and tricuspid annuloplasty at the age of 54. The patient developed anemia and congestive heart failure with pleural effusion and an elevated LDH level in 25 years late up without any valve-related cardiac event. Echocardiography revealed perivalvular leakage near the anterolateral commissure. The patient received re-mitral valve replacement(CEP valve : 25 mm)and a tricuspid valve ring annuloplasty(MC 3 Tricuspid ring : 28 mm). The annulus was covered with marked calcification and fibrosis with a partial deficit at the anterior part of antero-lateral commissure. Despite the thorough pathological examination, we could not clarify the etiology of sudden onset of hemolysis.The patient was discharged uneventfully on the 28th day after operation. In general, the OC valve can work without serious complications for a long time. We report a rare case of perivalvular leakage 25 years after mitral valve replacement with hemolysis and congestive heart failure. Jpn. J. Cardiovasc. Surg. 42 : 219-222(2013) Keywords:Omnicarbon valve, re-mitral valve replacement, perivalvular leakage, hemolytic anemia
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