Valsalva sinus aneurysm and double-chambered right ventricle are both rare congenital cardiac anomalies. Ventricular septal defect may be present in approximately 50%-60% of patients with Valsalva sinus aneurysm or approximately 70%-80% of patients with double-chambered right ventricle. However, Valsalva sinus aneurysm, double-chambered right ventricle, and ventricular septal defect rarely coexist in the same patient. As these diseases progress, patients often complain of symptoms of heart failure, due to the shunt flow. The case of a patient with Valsalva sinus aneurysm, double-chambered right ventricle, and ventricular septal defect without symptoms of heart failure had never been reported until now.
This unique technique is safe and effective. It is a very attractive procedure that can contribute to maintaining a good long-term quality of life for octogenarians with distal aortic arch aneurysm.
The frozen elephant trunk (FET) procedure enables easier replacement of the entire aortic arch because it does not require reaching the distal part of the left subclavian artery (LSCA). However, it requires additional management for reconstruction of the LSCA, which is associated with bleeding events. However, the fenestrated FET technique confers a risk of endoleakage from the fenestration site. We report our unique novel technique in which the proximal side of the hybrid stent graft is cut into V-shape around the subclavian artery and sutured continuously around the orifice of the subclavian artery during aortic stump fixation.
A 46-year-old male and a 53-year-old female each required a second surgery because of dilatation of the distal aortic arch (> 55 mm) approximately 5 years after ascending replacement for acute type A dissection. Both patients showed patent false lumen associated with endoleakage from the distal anastomosis. We performed distal arch to descending aorta replacement through a left thoracotomy using femorofemoral cardiopulmonary bypass with a 50% assist rate. The dissecting flaps were excised from both the proximal and distal aortic stumps, and polyester grafts were anastomosed in a double-barrel fashion under the aortic cross-clamps. No changes in the aortic arch diameters were observed 1 year after surgery. Here, we report the efficacy of proximal double-barrel anastomosis for residual dissecting aneurysm caused by endoleakage from distal anastomosis after emergency repair for type A dissection.
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