Here we describe a case involving an elderly man with Citrobacter freundii-associated infectious rupture of a dissecting thoracoabdominal aortic aneurysm. We performed emergency thoracoabdominal aortic replacement using a rifampicin-soaked prosthetic graft and omental flap wrapping. The patient was discharged on postoperative day 255, although he experienced pseudomembranous enteritis and paraplegia.
Simultaneous thoracic and abdominal aneurysms comprise approximately 10–20% of all cases of aortic aneurysms. Whether simultaneous or staged therapy can be used to treat multilevel aortic aneurysms remains controversial. Herein, we report the case of a 79-year-old woman with both huge abdominal and saccular thoracic aortic aneurysms who was referred to our hospital. Multiple stenotic lesions were observed in the major cerebral arteries; moreover, triple-vessel disease was observed on the coronary angiogram. Although this case required immediate primary surgery, cardiopulmonary bypass was difficult due to multiple stenoses in the cerebral arteries. We performed simultaneous surgery with total debranching thoracic endovascular aortic repair, endovascular aortic repair, and off-pump coronary artery grafting. Total debranching thoracic endovascular aortic repair is useful for avoiding neurological complications in cases where cardiopulmonary bypass is difficult. Furthermore, it helps devise an intraoperative cervical branch reconstruction method.
A 77-year-old man with diabetes, dyslipidemia, and a smoking history presented with asymptomatic gross hematuria and left hydronephrosis. Computed tomography (CT) angiography revealed a left ureteral tumor and abdominal aortic aneurysm. Cardiac catheterization revealed right coronary artery (RCA) stenosis. First, a left nephroureterectomy was performed via a midline abdominal incision. To achieve minimal invasiveness, a median sternotomy was avoided, and off-pump coronary artery bypass grafting of the RCA was performed with the great saphenous vein graft, using the left renal artery as the graft inflow. Y-grafting was subsequently performed. Without any postoperative complications, CT angiography confirmed graft patency. This procedure has potential use for removing ureteral tumors by surgeons and clinicians in clinical settings.
Objectives: To elucidate the impact of regulation of tricuspid regurgitation (TR) using tricuspid annuloplasty on postoperative changes in right ventricular (RV) systolic and diastolic functions. Methods: We enrolled 69 patients who underwent aortic or mitral valve surgery between July 2016 to March 2018 without recurrence. Patients with concomitant coronary artery bypass grafting or a history of previous cardiovascular surgery were excluded, remaining 45 patients enrolled. Patients were divided into 2 groups according to concomitant tricuspid annuloplasty (T: n=12 vs non-T: n=33). RV global longitudinal strain (RVGLS), RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE) and early tricuspid inflow velocity/early diastolic tricuspid annular velocity ratio (tricuspid E/e’) were assessed as functional indices at preoperative, postoperative and 1-year follow-up periods. Results: RVFAC deteriorated postoperatively but recovered at follow-up in group T, whereas that in group non-T showed gradual deterioration overtime. RVGLS and TAPSE showed similar temporary deterioration and recovery between groups. Tricuspid E in group T increased postoperatively and showed significant difference, which was kept until follow-up period. Tricuspid e’ decreased postoperatively, and recovered slightly in both groups. As a result, postoperative RV diastolic function (tricuspid E/e’) showed significant difference between groups. This difference was maintained until follow-up. Conclusions: RV systolic function deteriorated postoperatively, but there was a tendency to improve at follow-up regardless of tricuspid annuloplasty. RV diastolic function may potentially be impaired when TR was regulated by tricuspid annuloplasty.