Satoshi Kamihira

Congenital pericardial defect associated with ruptured type a aortic dissection

Congenital pericardial defect is a rare and little-known anomaly. Here we describe the unique clinical presentation of a 64-year-old man with partial defect of the left pericardium associated with ruptured acute type A aortic dissection manifesting massive left hemothorax. In this patient, the pericardial defect played the role of a pericardial draining window, which incidentally prevented the heart from cardiac tamponade. Emergent surgery was successfully performed with a prosthetic graft replacement.

Simultaneous Minimally Invasive Direct Coronary Artery Bypass and Repair of a Penetrating Atherosclerotic Ulcer of the Descending Thoracic Aorta: Report of a Case

Abstract A 70-year-old man with a descending aortic aneurysm was admitted to the hospital because of an abnormal chest X-ray. The chest computed tomography and magnetic resonance angiography findings showed a saccular aneurysm at the descending thoracic aorta. A preoperative coronary arteriogram showed 75% stenosis of the left anterior descending coronary artery and 99% stenosis of the right coronary artery. A simultaneous minimally invasive direct coronary artery bypass (MIDCAB for two vessels) and a descending aortic aneurysm repair were performed without any complications. A pathological examination showed the aneurysm to be a pseudoaneurysm originating from a penetrating atherosclerotic ulcer.

Left ventricular-free wall rupture after successful coronary intervention: Report of a case

We experienced the case of a left ventricular-free wall rupture (LVFWR) following successful coronary intervention for acute myocardial infarction (AMI). A 73-year-old woman was hospitalized because of chest oppression that had been continuing for 8 days. She was diagnosed to have AMI, and percutaneous coronary intervention (PCI) was performed. PCI was successful. However, immediately following PCI, she developed electromechanical dissociation secondary to tamponade because of blow-out-type LVFWR. The perforation tear was initially closed by a direct suture, followed by reinforcement using bovine pericardium patches sealed with GRF glue. The patient died of irreversible brain damage on postoperative day 3, but no re-bleeding or aneurysmal dilatation was detected at autopsy.

Resection of a cardiac tumor extending into the inferior vena cava presenting as Budd-Chiari syndrome

This report describes the successful treatment of a case of cardiac adenocarcinoma with the clinical presentation as Budd-Chiari syndrome. Complete surgical excision of the atriocaval mass was successfully achieved under deep hypothermic circulatory arrest. Histopathological diagnosis of this tumor was tubular adenocarcinoma with positive immunostaining by carcinoembrionic antigen. Subsequent systemic search could not detect any evidence of extra-cardiac primary site and distant metastatic lesion. A 2-year follow-up without any adjuvant therapy revealed no sign of recurrence.

A Case of Emergency Surgery for Ruptured Descending Thoracic Aortic Aneurysm into the Left Lung in an Elderly Patient.

超高齢者の胸部下行大動脈瘤肺内穿破症例を経験した. 症例は85歳, 女性. 突然の喀血, 胸背部痛にて当院入院. 胸部CTで左下葉に穿破する胸部下行大動脈嚢状瘤を認めた. 血液型がAB・Rh (-) であったが, 部分体外循環下に人工血管置換術と左肺下葉切除術を施行した. 術後は人工呼吸器からの離脱が遷延し一時気管切開を要したが, 重篤な感染症を起こすことなく独歩退院できた. 救命のポイントは術後呼吸機能低下は予想されたものの, 肺炎および graft 感染の温床となる血腫を残さぬよう, 十分な肺切除を施行したことと考えられた. われわれが行った肺下葉切除は区域切除と比較し, 出血量が少なく, また手術時間も短く, 本症例のような超高齢者の大血管手術においては適切な処置と考えられた.