No abstract

A 38-year-old man with polyarteritis nodosa presented with exertional chest pain. Coronary angiography revealed 3-vessel coronary artery disease. We performed 2-vessel coronary artery bypass grafting with the saphenous vein because the left internal thoracic artery was in poor condition. Histological examination of the left internal thoracic artery showed a strong effect of polyarteritis nodosa.

To overcome malperfusion syndromes associated with acute aortic dissection, recognition of diverse branch perfusion patterns through a universal classification system is imperative.

We report two cases of total arch replacement with open stent graft for the aberrant right subclavian artery ARSA. Case 1 was a thoracic artery aneurysm with an ARSA. We thought it would be difficult to perform in-situ reconstruction of ARSA via median sternotomy, so we performed total arch replacement with the open stent-grafting technique. Therefore the right axillary artery was reconstructed by extraanatomical bypass and coil embolization of the ARSA proximal to the vertebral artery to achieve complete thrombosis of the ARSA. The postoperative course was uneventful. Case 2 was a Stanford type A acute aortic dissection involving an ARSA with the entry located near the ARSA. Total arch replacement was performed using the open stent-grafting technique to close the entry site and origin of the ARSA. Then the right axillary artery was reconstructed by extra-anatomical bypass and coil embolization of the ARSA. The postoperative course was uneventful. The open stent-grafting technique might be an effective alternative management of thoracic aortic disease with ARSA.

Our new fluorescence technique in a clinical setting involving a PDD endoscope system™ vitamin B2 enabled accurate and safe anatomic pulmonary segmentectomy, with enough strong and long fluorescence in living pig lungs.