Kayo Sugiyama

Ruptured coronary artery aneurysm with pulmonary artery fistulae

Fistulae to the pulmonary artery (PA) in adults are usually associated with aortic pathology. Coronary artery aneurysms may be located in close proximity to the left main trunk or communicate with other coronary vessels. It is rare to find a coronary artery aneurysm communicate with the PA. An 84-year-old female developed acute shortness of breath. In the emergency room, shewas noted to be hypotensive, and a transthoracic echocardiogram revealed a circumferential effusion resulting in cardiac tamponade (Figure 1A). A coronary angiogram demonstrated a small, proximal right coronary artery (RCA) aneurysm (Figure 1B), and a larger left anterior descending (LAD) artery aneurysm with flow into the PA (Figure 1C). The patient underwent emergency surgery with cardiopulmonary bypass via a median sternotomy, at which time the hole in the LAD aneurysm was detected (Figure 2). Following

Rupture of the Anterolateral Papillary Muscle Caused by a High Lateral Branch Occlusion

Although necrosis of the left ventricular papillary muscles during acute myocardial infarction is common, rupture of the anterolateral papillary muscle due to occlusion of high lateral branch is rare. We present a rare case of anterolateral papillary muscle rupture caused by occlusion of a high lateral branch of the left coronary artery. Although the patient was in cardiogenic shock on admission, she was successfully treated by emergency mitral valve replacement after percutaneous catheter intervention and intra-aortic balloon pumping support. This case implies that the anterolateral papillary muscle can have a single blood supply and that it can be ruptured by an occlusion of a high lateral branch. Prompt diagnosis, immediate mechanical stabilization and aggressive surgical treatment are essential to save this group of patients.

Successful Management of Pulmonary Tumor Embolism from Renal Cell Carcinoma

Although invasion of renal cell carcinoma (RCC) into the inferior vena cava is common, pulmonary tumor embolism is rare. We present a case of a pulmonary tumor embolism from type II papillary renal cell carcinoma successfully treated using a staged approach. Such staged procedures are particularly effective in cases of massive renal tumors. Pulmonary tumor embolectomy using normothermic cardiopulmonary bypass is considerably less invasive than under deep hypothermic circulatory arrest.

Severe Compression of the Left Main Coronary Artery in a Patient with Chronic Thromboembolic Pulmonary Hypertension

Extrinsic compression of the left main coronary artery (LMCA) can occur in patients with an enlarged pulmonary artery trunk secondary to severe pulmonary hypertension (PH). This phenomenon rarely occurs in PH; moreover, few reports have shown that chronic thromboembolic PH can be a triggering factor for this syndrome. Herein, we describe a patient with extrinsic compression of the LMCA with chronic thromboembolic PH who underwent pulmonary endarterectomy and coronary artery bypass grafting successfully. Intravenous ultrasonography (IVUS) was effective for detecting and assessing the compression.

Direct Repair of Localized Aortic Dissection with Critical Malperfusion of the Left Main Trunk

Background: Localized aortic dissection on the left coronary cusp with critical malperfusion of the left main trunk (LMT) is rare and carries a high risk of death. Case presentation: We report a case of a 48-year-old patient who developed localized aortic dissection of the left coronary cusp complicated by critical malperfusion of the LMT of the coronary artery. After percutaneous coronary intervention (PCI) for the LMT, a Koster–Collins-like direct repair of the localized aortic dissection was carried out by closure of the false channel using BioGlue (CyroLife, Inc., Kennesaw, GA, USA) with the reinforcement of double Teflon felt strips. Conclusion: The aortic repair using a modified Koster–Collins technique was successful.

A case of ruptured infective coronary artery aneurysm

Infective coronary artery aneurysm is extremely rare and ruptured aneurysm is life-threatening. We report a case of ruptured coronary artery aneurysm, which was successfully treated by the patch closure technique and coronary artery bypass grafting. Pathological examination revealed purulent inflammation in the aneurysmal wall. Prompt diagnosis and appropriate treatment were essential.

Influence of Severe Chronic Kidney Disease on Outcomes of Endovascular Therapy for Peripheral Artery Disease

Background: The influence of hemodialysis (HD) on limb salvage and survival in patients with peripheral artery disease (PAD) has been reported. However, whether severe chronic kidney disease (CKD) may increase the risk of outcomes in patients with PAD undergoing endovascular revascularization is unknown. In this present study, we evaluated the influence of CKD grade on outcomes, including amputation-free survival (AFS) and major adverse limb events (MALEs) + 30-day perioperative death (POD), after endovascular treatment (EVT) in patients with PAD. Methods: Only patients with primary intervention were included. The eGFR was calculated automatic for each patient and patients were then stratified into two groups for comparative analysis: those with severe CKD (classes 4 and 5; eGFR <30) vs. those with lesser degrees of low-grade CKD (eGFR ≥ 30). Results: Severe CKD was associated with a significantly higher proportion incidence of diabetes mellitus, HD, critical limb ischemia (CLI), and infrainguinal lesions. AFS and MALEs+POD were significantly better in low-grade CKD than in severe CKD. In multivariate analysis, showed that HD and CLI were found to negatively impact affects AFS. In multivariate analysis, only CLI was found to negatively affect MALEs+POD. Conclusions: The presence of severe CKD did not independently influence AFS and MALEs+POD. Appropriate revascularization should be considered in CKD patients before developing irreversible renal insufficiency.