A 70-year-old man with no outpatient history visited the local doctor with complaints of weakness of the limbs and abdominal pain on the following day after vomiting on the previous night. He was suspected to have a ruptured abdominal aortic aneurysm from a simple CT scan of the abdomen, and was transported to our hospital for emergency treatment. After a contrast-enhanced CT scan at our hospital, a thrombosed type B aortic dissection and ruptured abdominal aortic aneurysm were diagnosed, and emergency surgery was performed on the same day. Although the dissection had extended to the abdominal aortic aneurysm, abdominal aortic endovascular repair (EVAR) was performed because it was a thrombosed type B aortic dissection. After admission to the intensive care unit (ICU), the patient showed intra-abdominal hypertension and oliguria. So, we performed an emergency decompressive laparotomy against abdominal compartment syndrome (ACS). He was discharged from the ICU on the 8th day and transferred to rehabilitation on the 38th day. We report a case of a ruptured abdominal aortic aneurysm associated with thrombosed acute type B aortic dissection that was successfully treated.

We report a case of endovascular revascularization for visceral malperfusion associated with acute type A dissection. A 53-year-old man presented with chest pain, and contrast enhanced computed tomography revealed type A dissection with an occluded superior mesenteric artery (SMA). No pericardial effusion or aortic valve insufficiency was detected. Due to concerns about the progression of bowel ischemia, we performed endovascular revascularization. Stenting the SMA resulted in improved blood flow. Additionally, a central repair (total arch replacement) was performed. The patient was discharged 20 days postoperatively without any complications.

A 52-year-old man presented himself to his family doctor for uremia associated with prerenal acute renal failure. A 12 Fr vascular access catheter was inserted via the right internal jugular vein for emergency dialysis. A contrast-enhanced computed tomography (CT) scan revealed that the catheter had penetrated the right internal jugular vein, perforated the right subclavian artery, and reached the ascending aorta. Under general anesthesia, we completed the procedure with a pull-through technique between the bilateral brachial arteries. A vascular occlusion balloon was inserted from the left brachial artery and a GORE VIABAHN stent graft was inserted from the right brachial artery. The postoperative course was good and he has been free from hemorrhagic episodes. He was transferred to the referring hospital on postoperative day 2.

A 27-year-old woman who suffered loss of consciousness twice after left femoral pain in the 25th week of gestation was referred to the obstetrics and gynecology department of our hospital. A structure with an attachment on the atrial wall was found in both atria on echocardiography, leading us to suspect impending paradoxical embolism (IPE). Judging from the shape of the thrombus in the atria, we thought that there was a high possibility of further embolism although rescue of the baby was feasible via cesarean section, so we decided to carry out emergency surgery. After delivering the infant by cesarean section, we used a heart-lung machine to incise the right atrium under hypothermia and remove the thrombus. As intraoperative esophageal echocardiography showed embolization in the right pulmonary artery, we cut the right pulmonary artery and removed the emboli. After surgery, a femoral vein thrombus was observed on echocardiography of the lower extremity vein, and we inserted an inferior vena cava filter. The patient was discharged on the 16th postoperative day. The situation whereby a thrombus is trapped in the foramen ovale without embolism of the arterial system is the rare pathological condition known as IPE. As no cases of surgical thrombectomy to treat IPE arising from complications of pregnancy have been reported thus far, the case described herein fittingly augments the literature.

A 58-year-old man underwent renal transplantation 26 years previously and had been treated with immunosuppressive drugs. He presented at the local hospital with backache symptoms during the waiting period prior to repair of an abdominal aortic aneurysm. Computed tomography revealed a retroperitoneal hematoma around the abdominal aortic aneurysm. He was admitted to our hospital and emergency straight graft replacement was performed. After clamping of the aorta, we performed axillo-common iliac perfusion to protect the transplanted kidney. The patient recovered without transplanted kidney dysfunction.

For A 38-year-old male diagnosed a congenital complete atrioventricular block in the neonatal period, epicardial lead and pacemaker was implanted through left thoracotomy. Although we tried to implant a pacemaker through the subclavian vein as an adult, it was unsuccessful because of obstruction of the bilateral subclavian vein. For this reason, we performed a pacemaker implantation with transatrial-endocardial lead through the right thoracotomy due to save the generator electric power. This is one of the useful techniques for cases with obstruction of the upper extremity vein.

We describe a case of ruptured coronary artery aneurysm with a coronary artery to a pulmonary artery fistula. An 89-year-old woman with general fatigue and dyspnea was admitted. At the visit she went into shock and was restored by rehydration therapy. Enhanced computed tomography shows a coronary aneurysm (maximum diameter of 50 mm) at the left side of pulmonary artery and mild pericardial effusions. She was scheduled for an emergency operation due to the ruptured coronary artery aneurysm with a coronary artery to pulmonary artery fistula. We performed aneurysmectomy and ligation of the coronary artery to the pulmonary artery fistula under cardiopulmonary bypass. We also reviewed 23 cases of ruptured coronary artery aneurysm with coronary artery extending to a pulmonary artery fistula in Japan. The disease is a rare clinical state and regarded as an indication for emergency surgery.

A 64-year-old man originally underwent Bentall procedure for annulo-aortic ectasia for the first time at the age of 38 years. The surgery was to repair a pseudoaneurysm at the anastomotic site of the left coronary artery by direct closure 11 years after the first Bentall procedure. The anastomosis of the right coronary artery was normal at the time of the first reoperation. However, he had surgery to repair a pseudoaneurysm at the anastomotic site of the right coronary artery 26 years after the first operation ; this was accomplished using the button technique. However, seven months after the second reoperation, he again manifested a pseudoaneurysm at the anastomotic site of the left coronary artery and died of rupture of the pseudoaneurysm. We report the case of pseudoaneurysms at the right and left coronary artery anastomoses that occurred three times after the first Bentall procedure.

A 37-year-old man who fell from a truck had chest pain and we diagnosed blunt chest trauma. A chest computed-tomography displayed a traumatic cardiac tamponade. The patient was transported to our hospital for emergency surgery. After median sternotomy, there was no injury of heart and great vessels in the pericardial sac but a rupture of the pericardium. Bleeding and hematoma were found in the anterior mediastinal space. The cardiac tamponade was caused by the bleeding from anterior mediastinal space. Usually, blunt cardiac tamponade was caused by the bleeding from cardiovascular organs, however, we encountered a very rare cardiac tamponade due to the bleeding from the anterior mediastinal space.

We describe a case of an intracardiac foreign body that was treated by surgery. A 27-year-old man sustained a neck injury by a nail fired from a pneumatic nail gun, and was admitted to a hospital. Chest radiography did not show any abnormality, and his injury healed after 1week. A radiography performed during a routine medical checkup after 2 months indicated that a nail was located within the heart. He was subsequently admitted to our hospital for further examinations. Chest computed tomography (CT) revealed the presence of a nail-like foreign body in the right ventricle. We diagnosed the patient with an intracardiac foreign body that was related to the injury sustained 2 months previously, although the underlying mechanism was unknown. He underwent emergency surgery, and the foreign body was removed under cardiopulmonary bypass without any complications. When a rigid substance impacts the body at high speeds, we should consider that some fragments could remain embedded in the body. CT scans are very useful for the diagnosis and identification of foreign bodies.