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Internal mammary artery (IMA) aneurysms are very rare, have a high risk of rupture, and can cause hemothorax. Here, we report the case of a 33-year-old man with metachronal and bilateral IMA aneurysms. He had Marfan syndrome diagnosed by genetic testing. We carried out endovascular repair with coil embolization. He has survived without additional treatment for 7 years. Endovascular repair of metachronal and bilateral IMA aneurysms is feasible even in a patient with Marfan syndrome.

Background: Pulmonary endarterectomy (PEA) is the treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH) but can result in respiratory and cardiac complications that may require extracorporeal membrane oxygenation (ECMO). We reviewed our experience with ECMO in patients undergoing PEA. , 35 patients underwent PEA for CTEPH. In all, four patients (11%) required veno-arterial (V-A) ECMO support due to severe cardiac and respiratory failure, including severe reperfusion pulmonary edema and persistent pulmonary hypertension. No significant differences in preoperative characteristics were found between patients who required ECMO and those who did not require ECMO. ECMO support was associated with a significantly higher incidence of postoperative respiratory complications, a longer intensive care unit stay, increased in-hospital mortality, residual pulmonary hypertension, and postoperative balloon pulmonary angioplasty (BPA). The postoperative mean pulmonary artery pressure and pulmonary vascular resistance were significantly higher in patients requiring ECMO. All patients requiring ECMO were successfully weaned off ECMO support (100%), and three of them were discharged from the hospital alive (75%).Conclusions: Patients with CTEPH may benefit from ECMO after PEA for cardiac and respiratory complications. A prompt decision to use V-A ECMO is critical for a successful outcome in these patients. K E Y W O R D S chronic thromboembolic pulmonary hypertension, extracorporeal membrane oxygenation, pulmonary endarterectomy, reperfusion pulmonary edema 1 | INTRODUCTION Pulmonary endarterectomy (PEA) is the treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH). Severe respiratory complications after PEA make it difficult to wean patients off cardiopulmonary bypass (CPB). Extracorporeal membrane oxygenation (ECMO) may be required for patients with severe respiratory complications. Risk factors for requiring ECMO postoperatively are still unknown, and whether veno-arterial (V-A) ECMO or veno-venous (V-V) ECMO is preferable remains controversial. We J Card Surg. 2019;34:428-434. wileyonlinelibrary.com/journal/jocs PVR, dynes/s/cm −5 622 (291-1822) 891 (620-1067) 559 (291-1822) 0.42 Post PEA CO, L/min 4.2 (2.3-8.5) 4.2 (2.3-7.5) 4.2 (2.8-8.5) 0.72 mPAP, mmHg 18.0 (8-44) 39.0 (38-44) 17.5 (8-39) <0.0001 PVR, dynes/s/cm −5 210 (114-696) 552 (363-696) 202.5 (114-556) <0.0001Abbreviations: CO, cardiac output; ECMO, extracorporeal membrane oxygenation; mPAP, mean pulmonary arterial pressure; PEA, pulmonary endarterectomy; mPAP, mean pulmonary arterial pressure PVR, pulmonary vascular resistance; V-A, venous-arterial.

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