Tatsuya Murakami

Coil Embolization of Symptomatic Persistent Sciatic Artery Aneurysm: A Case Report

Persistent sciatic artery is a rare congenital vascular anomaly of the lower extremity. This artery is predisposed to atherosclerosis or aneurysm formation. Persistent sciatic artery aneurysm often causes limb-threatening ischemia owing to its thrombosis or its mural thrombus. We report a case of successful transcatheter coil embolization for persistent sciatic artery aneurysm. An 89-year-old woman presented to our hospital, suffering from severe ischemia of the right leg and a pulsatile mass in the right buttock. Angiography and enhanced computed tomography revealed right persistent sciatic artery aneurysm with mural thrombus and complete occlusion of the distal end. After she underwent major amputation because of the advanced ischemia following unsuccessful thrombectomy, we performed coil embolization for the aneurysm successfully. Endovascular treatment including transcatheter embolization for persistent sciatic artery aneurysm is safe, effective, and less invasive than surgery. Its application gives various therapeutic options for the treatment of persistent sciatic artery aneurysm.

Aortic valve aneurysm responsible for acute congestive heart failure and histological findings: A case report

We experienced a case of acute congestive heart failure in a 73-year-old man who had been followed up due to mild-to-moderate aortic stenosis and moderate-to-severe aortic regurgitation. A huge aortic valve aneurysm was found to extend from his right coronary cusp to a left ventricular outflow tract, resulting in moderate subaortic obstruction and severe aortic regurgitation. Surgical repair was performed and a perforated aneurysm of right aortic cusp was identified. Histological examinations suggested that healed infective endocarditis was responsible for the formation of an aneurysm in the aortic valve. <Learning objective: Aortic valve aneurysm is an uncommon complication of infective endocarditis. The infective process of a cardiac valve is thought to augment valvular tissue injury, resulting in aneurysmal formation and perforation of the valvular aneurysm. We report an uncommon case of aortic valve aneurysm that was histologically suggested to be caused by subclinical infective endocarditis. The subaortic obstruction and aortic regurgitation were successfully treated using a surgical procedure.>.

A Case of Horner's Syndrome after Coronary Artery Bypass Graft Surgery

胸骨正中切開による開心術後にHorner症候群を発症することはまれであり,本邦での報告例はほとんどない.症例は77歳,女性.頻回な労作時胸痛を訴え精査したところ,陳旧性下壁梗塞,重症3枝病変,虚血性僧帽弁閉鎖不全症と診断された.手術は仰臥位,左上肢80度水平外転位で開始した.胸骨正中切開後,Delacroix-Chevalier開胸器を用いて約14cm開胸し,胸骨左縁を挙上して左内胸動脈を採取した.左上肢は左橈骨動脈採取後,体側に密着させた.Octo Base開胸器に替え,人工心肺,心停止下に僧帽弁リングによる僧帽弁輪縫縮術および冠動脈バイパス術3枝を行った.術後,覚醒遅延があったが脳梗塞はなく,術後2日目にICUを退出した.同日左眼の眼瞼下垂,縮瞳,眼球陥凹を認め,左Horner症候群と診断した.翌日より左上肢全体の疼痛・しびれ感も出現した.胸部X線写真で左第1肋骨骨折を認めた.これらの神経障害は第1肋骨骨折による頸部交感神経幹および腕神経叢の直接損傷が原因と考えられた.術後21日目退院時には神経症状は軽度となり,術後6ヵ月以内に自然軽快した.このような合併症を防止するため,開胸器による胸郭開大時や内胸動脈剥離時には胸骨・肋骨に過度な外力をかけないよう常に愛護的に操作する必要がある.