We describe a rare case of surgical repair of a coronary artery aneurysm with arteriosclerotic changes accompanied by coronary arteriovenous fistula (CAVF) after 26 years of conservative therapy. A 71-year-old woman, diagnosed with CAVF 26 years previously, was admitted to our hospital for general fatigue and dyspnea on exertion. Physical examinations revealed that the CAVF originated from the distal portion of the left circumflex artery (LCX), draining into the coronary sinus (CS); it affected the coronary artery aneurysm with arteriosclerotic changes and was calcified from the left coronary main trunk to the distal portion of the LCX. Treatment without resection of the calcified coronary aneurysm was suggested because of fear of excessive bleeding. The CAVF was closed directly from inside the dilated coronary sinus under cardiopulmonary bypass. The dilated ostium of the left coronary artery was closed using a Xenomedica patch. Coronary artery bypass grafting was performed in the left anterior descending artery (LAD) and posterolateral branch (PL) of the LCX using saphenous vein grafts. Postoperatively, the coronary aneurysm was spontaneously thrombosed for low blood flow. The bleeding might have been uncontrolled if the arteriosclerotic and calcified coronary aneurysm had been incised. Therefore, we successfully thrombosed the calcified coronary aneurysm without resection, after reducing the systemic blood flow to the coronary aneurysm and sustaining the coronary blood flow, performed with CABG.
Serum S-100 beta protein elevated immediately after weaning from CPB correlated with bypass time but not with neurological symptoms. Physiological changes other than substantial brain damage caused by CPB may increase the serum S-100 beta protein level. Prebypass data on neonates and infants showed serum S-100 beta protein increased without brain damage supporting this hypothesis.
Infracardiac type total anomalous pulmonary venous connection (TAPVC) was diagnosed in a 1-day-old boy. We performed emergency total correction on day 1 and found 2 vertical veins draining to the infracardiac level separately.Each vertical vein was rerouted to the left atrium. On the first postoperative day, an extracorporeal membrane oxygenation was required because of respiratory failure. He died due to cerebral hemorrhage on the 5th day after the operation. Macroscopic findings showed the right sided vertical vein draining to the IVC, and the left sided one to the confluence of the hepatic vein and ductus venosus. Microscopic findings of the lung revealed markedly dilated lymphatics which was suspected as the cause of respiratory failure. Although cases with 2 separate vertical veins are very rare, the precise anatomy of PV return has to be checked intraoperatively when the preoperative identification has not been established.
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