HighlightsCT or MRI scan is crucial in the diagnosis of adventitial cystic disease (ACD).Surgery is the first line in the treatment of ACD at the popliteal artery.The short saphenous vein was successfully employed in bypass graft surgery.
Use of the SRAP is a promising strategy for improving initial outcomes in patients with rAAAs.
Background: Isolated coronary sinus atrial septal defect (ASD) is defined as a coronary sinus unroofed in the terminal portion without a persistent left superior vena cava and other anomalies. This defect is rare and part of a wide spectrum of unroofed coronary sinus syndromes. Recently, several reports have described this finding. We searched the hospital’s database to determine the incidence of this defect, and to raise awareness of this condition, we discussed the findings from five patients with coronary sinus ASD who underwent surgical repair.Case presentation: The patients were three women and two men with an age range of 63–77 years. All patients underwent transthoracic echocardiography and computed tomography, and one underwent magnetic resonance imaging. In two patients, the defect was found unexpectedly intraoperatively; left-to-right shunting was apparent in the other three patients preoperatively. The pulmonary-to-systemic blood flow ratio ranged from 1.42 to 3.1 following cardiac catheterization, and oxygen saturation step-up was seen on the right side of the heart. Valvular regurgitation was seen in 4/5 patients with the mitral, tricuspid, and aortic valves involved in different combinations and to different degrees. Right atrial and ventricular dilation were seen in 4/5 patients; three patients had left atrial dilation. Three patients experienced atrial fibrillation, and one of these also experienced paroxysmal ventricular contractions. All patients underwent surgical repair, and some underwent multiple procedures. One patient who had previously undergone kidney transplantation died approximately 1 year postoperatively; the remaining four patients are currently experiencing good activities of daily living without symptoms. Conclusions: Coronary sinus ASD (Kirklin and Barratt–Boyes type IV unroofed coronary sinus syndrome) comprised 1.3% of adult congenital heart surgeries and 0.07% of adult open-heart surgeries in our hospital from 1999 to 2019. Our hospital performs cardiac surgery mainly for patients with acquired cardiac disease, and coronary sinus ASD is rare. Early diagnosis and, in symptomatic patients (especially those with blood access shunts, which may overload the heart), early surgical repair are important. The poorly prognostic case in our series is noteworthy, as similar cases have not been reported previously.
Background An isolated coronary sinus (CS) atrial septal defect (ASD) is defined as a CS unroofed in the terminal portion without a persistent left superior vena cava or other anomalies. This defect is rare and part of the wide spectrum of unroofed CS syndrome (URCS). Recently, several reports have described this finding. The database of New Tokyo Hospital was searched to determine the incidence of this defect. Additionally, to raise awareness of this condition, the findings from five patients with CS ASD who underwent surgical repair at New Tokyo Hospital are discussed. Case presentation The patients were three women and two men with an age range of 63–77 years. All patients underwent transthoracic echocardiography and computed tomography, and one underwent magnetic resonance imaging. In two patients, the defect was found unexpectedly intraoperatively; left-to-right shunting was apparent in the other three patients preoperatively. The pulmonary-to-systemic blood flow ratio ranged from 1.42 to 3.1 following cardiac catheterization, and oxygen saturation step-up was seen on the right side of the heart. Valvular regurgitation was seen in 4/5 patients with different combinations and degrees of mitral, tricuspid, and aortic valve involvement. Right atrial and ventricular dilation were seen in 4/5 patients; three patients had left atrial dilation. Three patients experienced atrial fibrillation, and one of these also experienced paroxysmal ventricular contractions. All patients underwent surgical repair, and some underwent multiple procedures. One patient who had previously undergone kidney transplantation died approximately 1 year postoperatively; the remaining four patients are currently experiencing good activities of daily living without symptoms. Conclusions CS ASD (Kirklin and Barratt–Boyes type IV URCS) comprised 1.3% of adult congenital heart surgeries and 0.07% of adult open-heart surgeries at New Tokyo Hospital from 1999 to 2019. At New Tokyo Hospital, cardiac surgery is performed mainly for patients with acquired cardiac disease, and CS ASD is rare. Early diagnosis is important, as well as early surgical repair in symptomatic patients, especially those with blood access shunts, which may overload the heart. The case of a poor prognosis in this series is noteworthy, as similar cases have not been reported previously.
Frozen elephant technique has been used to treat extensive aortic pathology (EAP) in either one or two stage procedures. Rapid expansion of the downstream aorta following frozen elephant technique was not reported. A 28-year-old man was referred to our clinic with a dilated abdominal aorta. He had a family history of Marfan syndrome. Contrast-enhanced computed tomography of the body revealed an EAP, including annuloaortic ectasia, an aortic aneurysm in the distal thoracic aorta, and a thoracoabdominal aortic aneurysm (Crawford type IV). Transthoracic echocardiography demonstrated mild aortic regurgitation.The patient underwent aortic root replacement (Bentall procedure) and total arch replacement (TAR) with the frozen elephant technique using a FROZENIX-open stent-graft. On postoperative day 8, the patient reported backache; computed tomography of the chest revealed the expansion of the descending aorta and pericardial effusion. We suspected an impending rupture of the thoracic aortic aneurysm and cardiac tamponade. He underwent an emergent reoperation, including a pericardial window for drainage and thoracic endovascular aortic repair (TEVAR) for the rapid expansion of the thoracic descending aorta. The postoperative course was uneventful. To the best of our knowledge, this is the first case of rapid expansion of the descending aortic aneurysm following TAR with the frozen elephant technique, which was successfully treated with an additional endovascular re-intervention. Endovascular re-intervention could be safely completed because of the stented graft used for the frozen elephant technique. Although frozen elephant technique (FET) is technically favorable for additional TEVAR, close follow-up of all patients undergoing FET is warranted.
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