Patients older than 64 years with hematocrit less than 39% and/or peripheral vascular disease should be treated routinely using preoperative storage of autologous blood whenever the patient's condition permits. For patients undergoing emergency surgery, further studies are required, including lowering transfusion threshold and using determinants other than hematocrit.
A 62-year-old man was brought to the emergency room of our hospital because of chest pain. Computed tomography revealed a right aortic arch and an aberrant left subclavian artery with Kommerell diverticulum and acute aortic dissection (Stanford type A). Total arch replacement was performed emergently through a median full sternotomy. A stomach feeding tube was placed postoperatively for the patient to receive nutrition, and esophageal bleeding was observed postoperatively. The patient died because of the bleeding. Autopsy findings showed a communication between the esophagus and Kommerell diverticulum. Rupture of Kommerell diverticulum and perforation of the esophagus were indicated.
A thirty-three-year-old male with malignant hemangiopericytoma of the right ventricular outflow tract and the pulmonary artery associated with pseudoaneurysm formation at the latter is presented. Contrast computed tomography was helpful in diagnosing the pseudoaneurysm of the pulmonary artery. The positional change of the murmur, with a tumor plop caused by the pedunculated tumor of the right ventricular outflow tract, was detected.
We describe a patient in whom stenosis of the left main coronary ostium completely regressed after steroid treatment following surgical revascularization. A 46-year-old woman with unstable angina underwent double coronary artery bypass grafting. Although she did not fulfill diagnostic criteria for Takayasu's disease, we began postoperative steroid therapy on postoperative day 14 based on clinical manifestations and histological findings. Coronary angiography 33 days after surgery showed the ostial stenosis of the left main coronary artery had disappeared. Steroid therapy for suspected Takayasu's disease should be considered even after surgical revascularization.
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