A 66-year-old female who complained severe abdominal pain with hemorrhagic shock underwent emergency laparotomy. Further inspection revealed a ruptured aneurysm (φ3cm) of the main trunk of the right renal artery. To avoid the prolonged hemorrhagic shock status, a right nephrectomy was performed. The pathological examination revealed the fusiform atherosclerotic aneurysm of the renal artery located at 1cm proxymal from the hilm of the right kidney. Convalescence was uneventful. In previous reports, most cases with ruptured aneurysm of the renal artery underwent the nephrectomy. Although it is important to serve the renal function, we also performed the nephrectomy to limit the duration of shock status. The procedures such as aneurysmectomy with revascularization may apply on further cases, if possible.

Horseshoe kidney (HSK) occurs in about 0.25% of the population. Coincidence of HSK with abdominal aortic aneurysm (AAA) is rare. We describe a 70-year-old man with an infrarenal AAA coexistence with HSK diagnosed by 3D-CTA. Preoperative 3D-CT and Angiography showed two major renal arteries and an accessory artery arising from the anterior wall of aneurysm. The aneurysm was successfully replaced by knitted Dacron bifurcated graft without resection of the isthmus. The accessory renal artery was reconstructed to the graft. Renal infarction and renal dysfunction did not occur and the postoperative course was uneventful.

We report a case of cholesterol crystal embolism (CCE) after coronary bypass surgery. A 65-year-old man with unstable angina and abdominal aortic aneurysm (AAA) underwent coronary artery bypass grafting (CABG). Coronary angiography (CAG) was performed at 30 days after surgery. Two weeks after the CAG, plantar cyanosis of both feet was observed and a renal dysfunction developed. A skin biopsy of the cyanotic lesion demonstrated characteristic cholesterol clefts in small submucosal arteries. Methylprednisolone (MPSL) and prostaglandin E 1 (PGE 1) were given for 3 days and 2 weeks, respectively. The patient's condition improved remarkably. Two months after the CAG, resection of AAA was performed and the postoperative course was uneventful. Diagnosis of CCE is difficult and its prognosis still remains poor. Therefore, we should keep this unusual complication in mind.

Fourteen cases (ranged 4 days to 5 months old, mean=40 days old) of coarctation of thoracic aorta underwent subclavian flap aortoplasty were between Jan. 1986 and Dec. 1990. Early postoperative course in these patients was reviewed retrospectively. In 9 cases of these patients, complex intracardiac anormalies co-existed (VSD in 7, ECD in one, single ventricle with MA in one). Preoperative pressure gradients between upper and lower extremities were 40±7mmHg and the gradients were significantly reduced after the repair of coarctation (8±4mmHg). Serum creatinine phosphokinase (CPK) increased postoperatively reaching peak levels by day 3 (12, 315 ±8, 462IU/l) and then gradually decreased. Gultamic oxaloacetic transaminase (GOT), glutamicpyruvic transanmiase (GPT), serum urea nitrogen (BUN) and serum creatinine (S-Cr) also increased postoperatively. When patients were divided into two group following the maximum CPK levels (group A: >4, 000; group B: <4, 000IU/l), the duration of mechanical ventilation (A: 117±21; B: 20±9hr), max. S-Cr levels (A: 2.16±0.64; B: 0.47±0.13mg/dl) and max. GPT (A: 323±127; B: 58±24IU/l) were significantly increased in group A. There was no significant correlation between these factors and postsurgical residual pressure gradients. An increase in these factors did not depend on the operation time, age, body weight and additional surgical procedures such as pulmonary arterial banding. These data suggest that the transient unbalanced blood distribution might exist even under no pressure gradients between upper and lower extremities. This might be important in the management of postoperative patients after repair of coarctation.