Tsung-Po Tsai

Endovascular Repair of Iatrogenic Subclavian Artery Perforations Using Stent-Graft: Report of a Case

Purpose: To report a case of iatrogenic subclavian artery perforation treated with Vascular Stent-Graft.Case Report: A 54-year-old married male was admitted to Chung Shin Hospital with the chief complaint of severe sharp pain in his right clavicular region after a traffic accident on April 6, 2009. Fracture of the right clavicle was diagnosed after X-ray examination. The patient immediately underwent open reduction and internal fixation (ORIF) with a Kirschner wire with an uneventful postoperative course. The K-wire was removed 4 weeks later, on May 8, 2009. However, pain in the right clavicular area recurred and lasted for almost one month. A repeated X-ray was showed ”Non-union of the right clavicular fracture”. The patient underwent a ”redo” open reduction (ORIF) on June 2, 2009. During the operation, the patient sustained an accidental right subclavian artery injury resulting in active bleeding and pseudo-aneurysm formation there of; he was transferred to Chung Shan Medical University Hospital, and after CT angiography, he underwent endovascular repair of his right subclavian artery perforation.Results: The endovascular prosthesis (Fluency Plus Vascular Stent Graft 10 60 mm, Bard®) was successfully deployed at the site of the pseudoaneurysm via ipsilateral femoral artery access. No signs of endograft occlusion, migration, deformation, or fracrture have been observed during the follow-up period of eleven months.Conclusion: Endovascular repair of the subclavian artery injury may be an acceptable alternative to other more invasive modes of therapy. A sufficiently long follow-up, however, is needed to determine if the design of this endograft will resist compression in this vascular location.

Early Surgical Management of Anatomically Complete Vascular Rings Brief Title: Screening for Anatomically Complete Vascular Rings

Background Adults with potentially life-threatening congenital vascular anomalies due to tracheoesophageal compression and aneurysmal rupture are often misdiagnosed as having asthma or recurrent bronchopulmonary infection. However, the early recognition and treatment of these anomalies can help to achieve a low mortality rate. Early surgical treatment critically depends on early diagnosis, which still presents a challenge to doctors as it depends on an index of high clinical suspicion. We showed two-dimensional echocardiography (2DE) to be an effective tool for heart and great vessel examinations as it has a higher success rate and eliminates human error to a large extent. Purposes We explored the use of 2DE for the early diagnosis of anatomically complete vascular rings (ACVR) and its use as a tool to help plan a surgical strategy by determining possible surgical complications. Methods Two-dimensional echocardiography was used to diagnose anatomically complete vascular rings (including double aortic arch and right aortic arch with left ligamentum arteriosum) in 96 patients. They underwent a barium esophagogram, spiral CT and/or MRI to confirm the existence of the vascular rings. Demographics, historical objectives and the results of physical examinations were all taken into account when performing the clinical diagnosis, as opposed to the conventional methods that are used when diagnosing ACVR. Those patients with overt clinical symptoms of tracheoesophageal compression were then earmarked for surgical treatment. Results Among the patients diagnosed with ACVR, 64 received surgical treatment after ACVR was confirmed. Right aortic arch (RAA) with Kommerells divertiuculum (KD) with left ligamentum arteriosum was found to be the most common type of ACVR (80.3% of cases). The diagnostic accuracy of 2DE was higher than conventional methods that depend on the clinical suspicion of symptoms of tracheoesophagal compression. Two-dimensional echocardiography was found to have a 100% overall sensitivity and a 100% specificity with regard to its ability to diagnose ACVR. Recurrent bronchopulmonary infections and asthmatic cough were the dominant symptoms of tracheal compression and all of these patients who underwent surgical treatment were well without morbidity and mortality. Conclusions Two-dimensional echocardiography is an effective primary diagnostic method with a high sensitivity and specificity. Early surgical management of ACVR is safe and easily achieved.

Right Atrial Metastatic Synovial Sarcoma

Synovial sarcoma metastatic to the heart is rare. We report a case of synovial sarcoma metastatic to the right atrium in a 12-year-old boy who presented with signs and symptoms of superior vena cava obstruction. Echocardiography and magnetic resonance imaging (MRI) demonstrated a large, mobile intraluminal mass extending from the superior vena cava into the right atrium and obstructing the tricuspid orifice during diastole. Because of worsening clinical condition, surgery was performed and a well-encapsulated right atrial tumor was excised. Signs and symptoms of caval obstruction rapidly resolved. Six months after surgery, patients New York Heart Association (NYHA) functional classification had improved from Class VI to Class I.