Recurrent brachial artery embolism caused by a crutch-induced axillary artery aneurysm: report of a case

We report a case of axillary artery aneurysm with brachial artery embolism in a 60-year-old man who had walked with the assistance of axillary crutches all of his life since poliomyelitis during infancy had left him with lower limb paralysis. We performed bypass grafting from the axillary to brachial artery with exclusion of the aneurysm. An axillary artery aneurysm is rare, but potentially lethal for the upper extremity; therefore, surgical treatment should be considered.     

Agenesis of the left internal carotid artery associated with right anterior cerebral artery A1 segment bifurcation aneurysm: a case report.

Agenesis of the internal carotid artery occurs in less than 0.01% of the population. Intracranial aneurysms accompany agenesis in 25-43% of the patients. We present a unique patient with a saccular aneurysm of the anterior communicating artery associated with agenesis of contralateral internal carotid artery.     

A case of right internal thoracic artery aneurysm

Internal thoracic artery aneurysms are extremely rare vascular anomalies with very few cases reported so far. Relevant sources of the literature show only a few reported cases. Here we present a case of incidentally diagnosed case of right internal thoracic/mammary artery (RIMA) aneurysm.     

A case of left atrial myxoma associated with atrial septal defect

Cardiac myxoma is the most frequent primary tumor of the heart. However, it is rarely associated with congenital cardiac anomalies such as atrial septal defect in the literature. We present a 72-year-old woman referred to the emergency department with loss of consciousness and finally diagnosed as a pedinculated mobile left atrial myxoma and concomitant occurrence of an ostium secundum type atrial septal defect. The mass was successfully excised, and atrial septal defect was safely repaired by primary suture. The patient is currently well after surgery. Atrial myxoma should be considered in the differential diagnosis when patients present with neurological consequences of systemic embolization.     

Type A: right atrial thrombus associated with a sub-massive pulmonary embolism

The increased use of echocardiography in patients with pulmonary thrombo-embolic disease has led to the recognition of sub-massive pulmonary embolism (SMPE) and concurrent right-heart thrombus (RHT). When these findings coincide, they are associated with a poor prognosis, identifying a high-risk group that often requires a rapid management. Since echocardiographers become the “first responders” in this clinical scenario, it is important to raise awareness and familiarize the readers regarding the importance played by the echocardiography laboratory in the prompt diagnosis and management of this entity. We describe two patients presenting with SMPE with an associated simultaneous RHT and discuss their management.     

An aberrant left subclavian artery aneurysm with right aortic arch: Report of a case

The case of a 41-year-old man who developed an aneurysm in his aberrant left subclavian artery is described. The patient had a right aortic arch. After a successful aortosubclavian artery bypass, symptoms due to brain ischemia disappeared. This is a very rare disease that is sometimes associated with an aortic anomaly, therefore the optimal therapeutic procedure need to be carefully selected, including the operative indications and approach.     

Congenital aneurysm of the left atrial wall in infancy

A 5-month-old male infant with congenital left atrial aneurysm is reported. The youngest patient previously reported was 2 1/2 years old. This case is unusual because the patient was an infant and because of the degree of mitral insufficiency and acute cardiac decompensation observed in the patient.     

A case of traumatic aneurysm of innominate artery with occlusion of right subclavian artery

A 42-year-old woman with history of chest blunt trauma from an automobile accident 250 days earlier had suffered easy fatigability of the right upper extremity. She had difference of blood pressure between upper extremities, 94/60 mmHg in the right and 126/70 mmHg in the left. Chest CT showed dilation of the innominate artery which compressed the trachea. Aortography showed an aneurysm of the innominate artery and occlusion of the right subclavian artery at its origin. The aneurysm of the innominate artery was resected and replaced with a 6 mm Dacron graft with aid of the external shunt. The right subclavian artery was also reconstructed with same graft. The aneurysm of the innominate artery should be suspected as a rare complication in blunt trauma of the chest.     

A case of right femoral anastomotic aneurysm accompanied by obstruction of left iliac and femoral artery

The case was a 66-year-old man. Three years ago under a diagnosis of Arteriosclerosis obliterans he received: right aorto-femoral bypass grafting. This time left intermittent clandication was observed and we performed resection of aneurysm and femorofemoral cross over bypass grafting following a diagnosis of right aorto-femoral anastomotic aneurysm accompanied by obstruction of left iliac and femoral artery. Anastomotic aneurysm is one of the complications after prosthetic bypass grafting. In this paper we discussed the causes, precautions and treatment of anastomotic aneurysms.     

A case of aneurysm of the inferior left ventricular wall

Aneurysms of the inferior left ventricular wall represent only a small fraction of all aneurysms that have been reported in surgical series. And in comparison to anterior left ventricular aneurysms, a comparatively higher percentage of reported inferior wall aneurysms was classified as false. A 73-year-old male was admitted for acute inferior myocardial infarction. Three weeks after admission, cardiac catheterization was carried out. Coronary arteriography revealed triple vessel disease and left ventriculography showed an aneurysm of the inferior left ventricular wall, whose feature near the mitral annulus was multiple fenestrations. Left ventricular aneurysmectomy and aortocoronary bypass grafting to the left anterior descending artery were simultaneously performed under cardiopulmonary bypass with moderate hypothermia. The pathological feature was a true aneurysm. The postoperative course was uneventful.     

Giant right atrial aneurysm with atrial fibrillation

Congenital right atrial aneurysm is a rare condition. Here we reported a 16‐year‐old male with giant right atrial aneurysm, atrial fibrillation, and atrial septal defect. Surgical resection of extensive right atrium, ASD repair, and maze procedure were performed. In the present case, we found extensive enlargement of right atrium protruding to the apex on the surface of the right ventricle. With the exist of atrial fibrillation, thrombus formation was always a lethal threat. Surgical treatment can provide excellent clinical results and further avoided life‐threatening complications.     

Coarctation of the aorta associated with left subclavian artery aneurysm: a case report

Aneurysm of the left subclavian artery (LSA) in association with coarctation of the aorta (CoAo) is a rare phenomenon, especially in the younger population. A 19-year-old male patient was admitted for lower extremity varices and diagnosed to have severe CoAo and a 45-mm LSA aneurysm after digital subtraction angiography following detection of nonpalpable lower extremity pulses on physical examination. Corrective surgery was performed from a left posterolateral thoracotomy through the 4th intercostal space, and a discrete ring-like coarctation tissue was observed in the aorta just below the level of the LSA orifice. Complete excision of the coarctation tissue was followed by aortoplasty with a Dacron patch. Additionally, the subclavian aneurysm was completely excised and a 10-mm Dacron tube graft interposition was performed. Prompt diagnosis and surgical treatment in particularly hypertensive patients precludes significant mortality and morbidity following a possible rupture.     

Congenital left atrial appendage aneurysm with unexpected course of left anterior descending coronary artery

The left atrial appendage (LAA) aneurysm is a rare condition that can produce local compressive effects and complications including supraventricular tachyarrhythmias, thromboembolic events and myocardial ischaemia. We present a rare case of a neonate with a congenital LAA aneurysm which resulted in local compressive effects on the left ventricle, severe mitral regurgitation and malposition of the left anterior descending (LAD) coronary artery. Intraoperatively, the LAD was found to be within the aneurysmal wall exterior to the left ventricular epicardium and was inadvertently injured during LAA aneurysm resection. Retrospective review of the preoperative computed tomography and echocardiography scans demonstrated the LAD lying within the wall of the LAA aneurysm, although this had not been well appreciated at that time. This highlights the importance of thorough multimodal preoperative imaging and intraoperative assessment for recognition of this rare association between the LAA aneurysm and LAD malposition, and prevention of inadvertent LAD injury during aneurysm resection.     

A case report of intrathoracic aneurysm of left subclavian artery

A case of intrathoracic aneurysm of the left subclavian artery is reported. The case was 68-year-old male. Chest CT and angiography revealed an aneurysm of left subclavian artery (LSA) located the proximal portion of LSA. The chest was opened by fourth intercostal thoracotomy. We evaluated the intima of distal aortic arch and LSA by introperative direct echography using a small probe (finger tip size). Since there was no calcification or mural thrombi at the distal aortic arch, the aneurysm was resected using partial cardiopulmonary bypass and the orifice of LSA was closed direct suture. LSA was reconstructed with knitted Dacron graft (8 mm). Postoperative course was uneventful.     

A case report of anomalous origin of right pulmonary artery from innominate artery associated with left sided unilateral pulmonary hypertension

A 7-year-old girl, who was diagnosed as anomalous origin of right pulmonary artery from innominate artery associated with left sided unilateral pulmonary hypertension due to left patent ductus arteriosus, was reported. The right pulmonary artery had a stenotic segment of it's origin containing ductal tissue. Operation was performed without the aid of cardiopulmonary bypass. The continuity between main and right pulmonary arteries was established by a pericardial roll graft. The postoperative course was uneventful and she is very well three years after correction. To our knowledge, this is a very rare case with such combination of congenital anomalies as anomalous origin of right pulmonary artery and left sided unilateral pulmonary hypertension to be reported in the literature in Japan.