A 55-year-old woman underwent a Bentall operation and total arch replacement 18 years previously, because of chronic aortic dissection CAD , annuloaortic ectasia AAE , aortic valve insufficiency AI , and Marfan syndrome. In 1996, at age 37 years, she was admitted to our hospital with diagnoses of CAD, AAE, AI, and Marfan syndrome. That same year, we performed the Bentall operation and total arch replacement Carbomedics, 25 mm ; Hemashield, 28 mm. She then underwent Y-graft replacement for an abdominal aortic aneurysm in 2003, descending aorta replacement for a thoracic aortic aneurysm in 2007, and thoracoabdominal aorta replacement for thoracoabdominal aortic aneurysm in 2010. Afterward, both coronary arteries gradually dilated. The diameter of the left coronary artery was 17 mm, while that of the right coronary artery was 25 mm. Accordingly, in 2014, we surgically replaced both coronary aneurysms with the great saphenous vein. Pathological analysis showed that both coronary aneurysms were true aneurysms because the three-layered structure was preserved. We confirmed that the great saphenous vein grafts were patent by three-dimensional computed tomography. She was discharged 17 days postoperatively once her condition stabilized. We report a case of Marfan syndrome with both coronary true aneurysms, because we think this kind of report is very rare. Jpn. J.
The patient was a 68-year-old man. In January 2017, he underwent aortic valve replacement Carpentier-Edwards Perimount Magna, 25 mm, Edwards Lifescience Corporation, Irvine, USA for aortic stenosis and coronary bypass surgery with two saphenous vein grafts SVG #7 and SVG-4PD for asymptomatic myocardial ischemia. He was treated as an outpatient by a local physician for at least a week during November 2017, with a principal complaint of mild fever, but no other significant symptoms. Transthoracic echocardiography suggested prosthetic valve endocarditis, so he was referred to the author s hospital. The day after admission, he had symptoms of thoracic discomfort, and emergency cardiac catheter examination showed a lesion thought to be due to a thrombus in the left main coronary trunk ; so, thrombus aspiration was carried out. However, no improvement in blood flow was achieved, so balloon angioplasty was carried out, with the aim of improving blood flow in the left circumflex artery, where coronary artery bypass grafting had not been performed. Improvement in blood flow was achieved, and a culture was carried out using the aspirated thrombus. Streptococcus pasteurianus was detected in the culture.
We present a case of ruptured type A acute aortic dissection with pulmonary trunk compression by mediastinal hematoma. This condition mimicked a pulmonary embolism on the early arterial phase of computed tomography angiography, whereas the correct diagnosis was determined from the late arterial phase and unenhanced computed tomography. We highlight the importance of carefully interpreting triphasic computed tomography angiography to assess the status of aortic dissection.
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