Ruptured aortic arch aneurysm with hemorrhagic cardiac tamponade: report of a case

A 67-year-old female was sent into our hospital for ruptured thoracic aneurysm with hemorrhagic cardiac tamponade. Computed tomography (CT) showed pericardial effusion and ruptured aortic arch aneurysm. We performed urgent graft replacement of the aortic arch using selective cerebral perfusion under mild hypothermia. Postoperative course was uneventful.     

An elderly case of ruptured aortic arch aneurysm with hemorrhagic cardiac tamponade

We reported a case of successful aortic arch replacement using selective cerebral perfusion for ruptured distal aortic arch aneurysm (DAAA) with cardiac tamponade. A 80-year-old man who had preoperative episode of severe chest pain. Computed tomography showed saccular DAAA and pericardial effusion. He was diagnosed as ruptured DAAA with hemorrhagic cardiac tamponade. We performed urgent graft replacement of the aortic arch using selective cerebral perfusion. Postoperatively he had no complication. Thirty days after the operation he was discharged from the hospital and he is now leading a normal life.     

Ruptured syphilitic ascending aortic aneurysm; report of a case

Syphilitic cardiovascular disease has become a rarity today. It most commonly affects the ascending aorta and aortic arch. A case is reported of a 50-year-old female with a ruptured syphilitic ascending aortic aneurysm who underwent an emergency operation. The patient was emergently admitted with complaint of severe dyspnea, circulatory shock due to cardiac tamponade was observed in the emergency room. Bentall's procedure was performed. Intraoperative findings showed multi-cystic dilatation of an aortic root. Penetration was existed on right side posterior wall of an aortic root. Postoperative pathological examination of the aneurysmal wall revealed the characteristic finding of syphilitic aortitis. The postoperative course was uneventful and the patient has been doing well at period of 3 years after operation.     

Congenital kinking of the aortic arch associated with aortic arch aneurysm: a case report

A surgical case of congenital kinking of the aortic arch associated with aortic arch aneurysm, which had been observed as the mediastinal tumor for 15 years, was reported. Twenty-two surgical cases of the aortic lesion, which were diagnosed pseudocoarctation or congenital kinking, have been reported in the literature. This paper focused on the pathogenesis, surgical treatment and terminology of this anomaly.     

Ruptured thoracic aortic aneurysm presenting as massive epistaxis; report of a case

An 80-year-old woman was transported to the emergency room at our hospital by the ambulance, suffering from massive epistaxis. As the patient was hemodynamically stable, otolaryngologist attempted to perform tamponade using nasal packing. However, the patient's condition deteriorated, with the development of dyspnea and a reduction in oxygen saturation to 90%. A chest X-ray performed at this point revealed left lung consolidation and pleural effusion while chest computed tomography (CT) demonstrated that rupture of a descending aortic aneurysm with periaortic hematoma and extension of hemorrhage into the left lower lobe of the lung. Emergency surgery was performed under partial extracorporeal circulation, established by cannulation of the right femoral artery and vein. In addition to the replacement of the descending aorta with a prosthetic conduit, left lower lobectomy was necessary because of severe adhesion to the descending aorta. The postoperative course was largely uncomplicated apart from development of chylothorax, which resolved with a short period of total parenteral nutrition and she was discharged 50 days after surgery.     

Distal arch aneurysm and acute aortic dissection with bicuspid aortic valve; report of a case

A 49-year-old man was admitted to our institution with acute chest and back pain. Chest and abdominal computed tomography (CT) showed type A aortic dissection from the ascending aorta to the bilateral common iliac arteries and a distal arch aneurysm with a diameter of 65 mm. Echocardiogram showed a bicuspid aortic valve with severe regurgitation. We performed total arch replacement and aortic valve replacement. Pathological examination of the aortic wall revealed a typical cystic medial necrosis. After 3 months, we performed the 2nd stage operation for the distal arch aneurysm and descending aortic dissection. Here, we report a rare case of bileaflet aortic valve with aortic aneurysm and aortic dissection.     

Total aortic arch replacement for aortic arch aneurysm in a 90-year-old woman; report of a case

A 90-year-old woman was transferred to our hospital because of severe chest and back pain. Chest computed tomography (CT) scan showed impending rupture of the true aneurysm of the aortic arch. Emergent operation was performed under deep hypothermia and retrograde cerebral perfusion through median sternotomy. Ascending and transverse aorta were totally replaced with arch graft with 4 branches using the arch vessels first technique. Postoperative course was uneventful expect for urinary tract infection. She discharged from our hospital 76 days after the operation and is now doing well.     

Ruptured thoracic aortic aneurysm complicated by acute aortic dissection and aortic valve regurgitation; report of a case

An 87-year-old man was found loss of consciousness after falling. He was found in a state of shock. Computed tomography showed rupture of aneurysm of the ascending aorta and aortic arch with acute aortic dissection. Echocardiography revealed aortic valve regurgitation and cardiac tamponade. As the result of emergency operation, a large hematoma in the mediastinum and pleural cavity as well as massive serous pericardial effusion were found. The dissection was seen in aneurysm of the ascending aorta and aortic arch with an intimal tear located in the aortic arch. After aortic valve replacement was performed, the ascending aorta and aortic arch were replaced, and reconstruction of 3 cervical vessel branches was performed under deep hypothermic circulatory arrest with selective cerebral perfusion. Despite the complex clinical state and serious condition in the elderly patient, emergency surgery saved the life of the patient without complications.     

Ruptured bronchial artery aneurysm; report of a case

A 74-year-old man who went into shock following an acute hemomediastinum and left hemothorax was operated on. Postoperative angiographies revealed a saccular aneurysm of the left bronchial artery of 2.0 cm in diameter. Sixty days after the initial operation, the aneurysm was resected under F-F bypass. A saccular aneurysm was found at the root of the left bronchial artery, which had a very short segment between the aneurysm and the aorta. Pathological study of aneurysm revealed thinning of the wall and lack of tunica media.     

Ruptured distal aortic arch aneurysm associated with arteriosclerosis obliterans.

A 73-year-old man with a ruptured distal aortic arch aneurysm into the pericardial space, mediastinum and right pleural space is described. The patient underwent a successful total aortic arch replacement using deep hypothermia, systemic circulatory arrest and selective cerebral perfusion. Extracorporeal circulation was established with right axillar arterial perfusion due to arteriosclerosis obliterans (ASO). Presentation and management are discussed.     

Total aortic arch replacement for distal aortic arch aneurysm with adhered left lung: report of a case

A 76-year-old man with a history of pleuritis and a cerebral infarct underwent a total arch replacement for an aneurysm of the distal aortic arch. Computed tomography revealed a true aneurysm having a maximum diameter of 70 mm as well as pleural thickening and calcification. Total arch replacement with selective cerebral perfusion was performed through median sternotomy and left thoracotomy. The myocardial ischemic time was shortened by reperfusion from the right axillary artery after the anastomosis of the proximal ascending aorta and the brachiocephalic artery. After the other branches of the arch were anastomosed, a distal anastomosis through the left thoracotomy was then performed using the pull-through method, enabling minimal decortication of the adhered lung. Our surgical procedure for distal arch aneurysm with adhered lung involves the addition of a left thoracotomy, but the reduction in the myocardial ischemic time and lung injury are of benefit.     

Emergent surgical management of aortic dissecting aneurysm, type A Stanford, complicated with acute cardiac tamponade; report of a case

A 52-year-old woman, who had been treated medically for 31 days with the diagnosis of type A aortic dissection, suddenly fell in shock because of acute cardiac tamponade. Emergent operation was performed two hours after the onset of shock. Entry and perforation were located in the ascending aorta. Ascending aorta was opened without cross-clamping under profound hypothermic low flow perfusion through femoral artery, and intraluminal grafting with a double ringed graft was completed. Combined technique of open distal anastomosis and ringed graft is useful in such an emergent case as cardiac tamponade of aortic dissection.     

Severe tracheal compression resulting from atherosclerotic aortic arch aneurysm; report of a case

A 70-year-old woman presented with severe respiratory insufficiency similar to an asthma attack. Computed tomography (CT) revealed an atherosclerotic aneurysm (maximum diameter 106 mm) on the aortic arch which resulted in a severe tracheal compression. We performed an aortic arch replacement. After the operation, we tried to manage breathing without a respirator twice without success. We then performed a tracheotomy on the 12th day after operation. The patient could breathe independently on the 19th day after the first operation. Peri-and postoperative respiratory management was difficult but the patient was discharged on the 86th day after operation without further complication.     

Cardiac tamponade secondary to rupture of a distal aortic arch aneurysm

We report the rare rupture of a distal aortic arch aneurysm protruding into the pericardial cavity. A 70-year-old woman who suddenly lost consciousness and was transferred to our hospital by ambulance in profound shock was found in emergency computed tomography and echocardiography to have a dilated distal aortic arch and massive pericardial effusion. Suspecting that a distal aortic arch aneurysm had ruptured, causing cardiac tamponade, we undertook an operation. We found a defect in the aneurysmal wall leading to the pericardium near the main pulmonary artery that was plugged temporarily with an atheromatous mass. We conducted total arch replacement successfully under selective cerebral perfusion and moderate hypothermia.     

A case report of atypical coarctation of the aortic arch with thoracic aortic aneurysm

A 30-year-old woman was admitted to our hospital because of the abnormal shadow on chest X ray film and paralysis of right fingers. The preoperative aortogram and DSA showed atypical coarctation of the aortic arch with thoracic aortic aneurysm. We successfully performed extra-anatomical bypass with a 14 mm Cooley low porosity Ducron graft between ascending aorta and discending aorta. Her postoperative course was uneventful and discharged one month after the operation.     

Treatment of infected aortic arch aneurysm by in situ total arch replacement with omental wrapping; report of a case

We report a rare case of infected aortic arch aneurysm. 70-year-old man was admitted to our hospital for persistent high fever and blood culture demonstrated Streptococcus milleri group. Computed tomography revealed an aortic aneurysm. At the take off of the brachiocepharicartery. We performed a total aortic arch replacement with omental wrapping to prevent postoperative graft infection. The operative course was uneventful and discharged on postoperative day 65 with no signs of infection.     

Aortic arch aneurysm with aortopulmonary fistula; report of a case

A 77-year-old female was admitted to our hospital due to congestive heart failure. Computed tomography and angiography showed a saccular aneurysm with aortopulmonary fistula in the aortic arch. The patient underwent total arch replacement and patch closure of the pulmonary artery in an urgent operation. She was discharged after uneventful postoperative course, although staged sternal closure and 5 days of respiratory management were needed. A few cases of aortic arch aneurysm with perforation to the pulmonary artery are operated with success, which depends on severity of congestive heart failure and urgency. Therefore, it should be diagnosed exactly and rapidly. In the operation, special care should be taken to avoid right heart failure and postoperative respiratory distress.     

Ruptured abdominal aortic aneurysm and horseshoe kidney. A case report

A patient with a ruptured abdominal aortic aneurysm associated with a horseshoe kidney is reported on. The treatment included aneurysmectomy and insertion of an aortic Dacron prosthesis without division of the isthmus of the kidney. The postoperative course was complicated by a stroke and mild renal failure, but the patient made excellent progress and was discharged from hospital 1 month after admission.     

Ruptured abdominal aortic aneurysm associated with an aorto-enteric fistula. A case report

A patient with a ruptured abdominal aortic aneurysm and a primary aortoduodenal fistula is reported on. Treatment included aneurysmectomy, suture of the duodenal fistula, closure of the proximal and distal abdominal aortic stumps, and construction of an axillobifemoral bypass. The postoperative course was complicated by spinal cord ischaemia and pataplegia, Gram-negative septicaemia, secondary intra-abdominal haemorrhage and multiple abscess formation.