Surgical treatment for ruptured aneurysm of a coronary artery to pulmonary artery fistula; report of a case

We reported a successful operative case of ruptured coronary artery aneurysm associated with coronary artery to pulmonary artery fistula. The patient was a 74-year-old woman who was admitted for syncope and chest oppression. Echocardiogram and chest CT scan revealed cardiac tamponade. Ruptured coronary aneurysm, 3 cm in diameter, was found at emergent operation. After emergent coronary angiography, which demonstrated an aneurysm arising from the left anterior descending coronary artery and draining into the pulmonary artery, orifice of draining artery to the aneurysm was closed and coronary artery fistula was ligated. She recovered smoothly and post operative angiogram revealed disappearance of the aneurysm.     

Intracranial ruptured aneurysm accompanying moyamoya phenomenon

Summary Three cases of moyamoya phenomenon associated with an aneurysm in the periphery of a lateral ventricle presenting with intracranial haemorrhage are reported.In Case 1 the aneurysm was located in the right basal ganglia, and the patient improved under conservative management. The aneurysm had increased in size on the second angiogram, and disappeared on the third angiogram obtained nine months after the attack. In Case 2 the aneurysm was located in the peripheral portion of the left posterior cerebral artery, and was surgically excised. Pathological examination on surgical material revealed collagenous tissue and laminae only in part of the aneurysmal wall. In Case 3 the aneurysm was located in the peripheral portion of the right anterior choroidal artery. This patient died, and the autopsy revealed an angiomatous lesion in the choroid plexus of the right lateral ventricle, but the aneurysm itself could not be identified.These findings indicate that an aneurysm has formed in a portion of a weakened vascular group represented by an abnormally dilated collateral pathway, and that the most likely reason for this would be haemodynamic stress.     

A case of surgical treatment for cardiac tamponade caused by a ruptured coronary aneurysm accompanied by a coronary artery-pulmonary artery fistula

A 67-year-old woman experienced a sudden severe pain in the area of her left shoulder and back. Three days later the pain recurred, after which she fell into shock and was taken to another hospital by ambulance. A plain chest CT scan showed a cardiac tamponade, while an enhanced chest CT scan demonstrated a coronary aneurysm in the left anterior descending branch draining to the pulmonary artery. Coronary arteriography revealed a saccular type aneurysm, 5 cm in diameter, with a coronary artery-pulmonary artery fistula. After pericardiocentesis, she recovered from her state of shock. The patient was then transferred to our hospital, where she underwent emergency surgery. Under a cardiopulmonary bypass, the stem of the aneurysm and the fistula were ligated and resected. She recovered smoothly and was discharged on the 24th postoperative day.     

Surgical management of a circumflex aneurysm with fistula to the coronary sinus

We report the successful management of a circumflex coronary artery aneurysm with fistula to the coronary sinus. Our strategy aimed at closing the fistula and grafting the obtuse marginal artery. The calcified aneurysm was left intact, and showed secondary thrombus formation on the postoperative angiogram.     

Successful treatment of a ruptured mycotic coronary artery aneurysm

Documented mycotic aneurysms of the coronary arteries are unusual, and antemortem identification of such an aneurysm is rare. We present the case of a patient who had successful management of a ruptured mycotic aneurysm of a coronary artery.     

Surgical treatment of coronary artery fistula with aneurysm

Two operations for coronary artery aneurysm with fistula are reported. This rare congenital malformation can be associated with acute and chronic complications. Surgical treatment is generally recommended. The surgical strategy remains controversial and is discussed. Retrograde cardioplegic cardiac arrest and retrograde dissection of the fistula are favoured. Conservative treatment of the dilated coronary segments was adopted. In both cases, the postoperative course was uneventful and no residual shunts were diagnosed at postoperative echocardiography.     

Colon ischemia accompanying ruptured abdominal aortic aneurysm

Myocardial, cerebral, and renal ischemia are recognized as serious sequelae in patients surviving repair of ruptured abdominal aortic aneurysms. Colonic ischemia, though a documented consequence of aortic reconstruction, has received less emphasis in these patients. In a 5-year review of a single hospital's experience, 50 patients underwent an emergency operation for ruptured abdominal aortic aneurysm. Ninety-six percent of the patients were in shock preoperatively. Of the 37 patients who survived the initial surgical procedure, 12 (32%) were subsequently found to have colon ischemia diagnosed by proctoscopy, repeat laparotomy, or autopsy. Among 20 of the initial survivors who later died at intervals up to 6 weeks after aneurysm repair 8 (40%) had colon ischemia as the sole or major contributing cause of death. Because of the high incidence of this serious but remediable problem in patients undergoing emergency operation for ruptured abdominal aortic aneurysm, we now routinely perform: (a) intraoperative Doppler examination of the colonic arterial tree, with consideration of mesenteric revascularization if necessary, (b) daily postoperative sigmoidoscopy and examination of the stool for blood, and (c) aggressive “second-look” laparotomy in patients exhibiting any signs or symptoms suggesting colonic infarction. Our experience suggests that large bowel infarction is a common, lethal, and underemphasized complication following successful repair of ruptured abdominal aortic aneurysms.     

A fistula between the circumflex artery and the coronary sinus mimicks coronary artery disease in a 63-year-old woman

A 63-year-old woman presented with angina and shortness of breath (NYHA III). Selective coronary angiography revealed a gross AV-fistula between the circumflex artery and the coronary sinus. The patient underwent operative closure of the fistula and was discharged home without symptoms.     

Diagnosis by computed tomography of arteriovenous fistula complicating ruptured iliac artery aneurysm

Isolated iliac artery aneurysms comprise less than 1% of all arteriosclerotic aneurysms. Spontaneous iliac arteriovenous fistula is a rare complication of these aneurysms with only 16 cases previously described. The diagnosis depends on a strong clinical suspicion and usually requires angiography for confirmation. We report a case in which CT with contrast medium showed clear findings of a spontaneous iliac arteriovenous fistula complicating rupture of an isolated iliac artery aneurysm. CT findings included: (1) iliac artery aneurysm, (2) vena caval dilatation, (3) rapid flow of contrast medium from the arterial side into the dilated inferior vena cava on dynamic scanning, (4) increased density of the inferior vena cava similar to that of the aorta caused by entry through the fistula of blood with a high concentration of iodinated contrast medium, and (5) the actual fistula connecting the two vessels.     

Hematuria from arteriovesical fistula: unusual presentation of ruptured iliac artery aneurysm

Iliac artery aneurysm rupture can be rapidly fatal if not diagnosed immediately. These aneurysms usually present in patients with other aneurysmal diseases of the aortoiliac arterial system. If not diagnosed and surgically repaired, iliac artery aneurysms can proceed to expand and ultimately rupture, usually presenting with back, flank, or abdominal pain and, possibly, signs of systemic shock. We present an unusual case report of a common iliac artery aneurysm rupture presenting as gross hematuria due to an arteriovesical fistula. Only three other cases of arteriovesical fistulae have been reported previously. Unlike the case presented, all three of these cases involved trauma or surgical instrumentation or manipulation of the bladder.     

Surgical treatment of coronary artery-pulmonary artery fistula with coronary aneurysm]

We experienced 4 cases of coronary artery-pulmonary artery fistula with coronary aneurysm, three patients had symptoms of chest pain, and 1 patient had cardiac murmur. Coronary arteriography showed that three patients had fistulas from the left coronary artery to the pulmonary artery; and that 1 patient had a fistula from both the right and left coronary arteries to the pulmonary artery. Moreover, 1 patient had 90% diameter stenosis of segment 7. The maximum diameter of the coronary aneurysm ranged from 12 to 20 mm (average: 15.3 mm). One patient underwent closure of the opening of the fistula, 2 patients underwent multiple ligatures of fistulas, and 1 patient underwent multiple ligatures of fistulas with coronary artery bypass grafting. The postoperative course of every patient was uneventful. There have been 42 reports on this abnormality in Japan. We should treat the fistula as early as possible to prevent cardiac complications such as myocardial ischemia and rupture of coronary aneurysm.     

A surgical repair of ruptured atherosclerotic coronary artery aneurysm; report of a case

We reported a successful surgery for the huge ruptured coronary aneurysm resulting in cardiac shock. The rupture of atherosclerotic coronary aneurysm is extremely rare except congenital cardiac disease and as a coronary artery-pulmonary artery fistula or a coronary arterio-venous fistula. Excision of the aneurysm, closure of the coronary ostium and coronary artery bypass using saphenous vein graft was performed. The post operative course was uneventful. The histological findings revealed atherosclerotic coronary aneurysm.