A 50-year-old woman presented to our hospital with shortness of breath on exertion and nocturnal dyspnea. She had undergone total aortic arch replacement for Stanford type A aortic dissection 17 years previously and was taking prednisolone for systemic lupus erythematosus. Computed tomography showed that the 63-mm ascending aorta near the proximal anastomosis site compressed the superior vena cava and right atrium. Cardiac catheterization showed occlusion of the left anterior descending branch. The patient underwent urgent surgery for ascending aortic aneurysm and coronary artery occlusion. Microscopic examination revealed that the aneurysm was true. This report highlights that in patients with systemic lupus erythematosus, aortic aneurysms can reoccur even after total arch replacement.

Surgical pulmonary artery thrombectomy is a well-established emergency treatment for massive pulmonary embolism (PE) in which fibrinolysis or thrombolysis cannot happen. However, surgery for massive PE that requires peripheral pulmonary artery thrombus removal remains challenging. We established a simple and secure pulmonary artery thrombectomy method using cardiopulmonary bypass and cardiac arrest. In this procedure, the surgical assistant arm, typically used for coronary artery bypass grafting, is used to obtain a feasible working space during thrombectomy. We present seven consecutive massive PE cases treated with the present surgical method and successfully weaned from cardiopulmonary bypass or extracorporeal membrane oxygenation postoperatively. This procedure can be used to prevent right ventricular failure after surgery as surgeons can remove the thrombus up to the second branch of the pulmonary artery with direct vision.

Surgery for extensive thoracic aortic aneurysms is challenging. We report the case of a young woman with Takayasu’s arteritis who developed aortic dissection and was successfully treated with our novel extended arch repair method, which we termed “parabronchial approach”. Surgery was performed via a simple sternotomy. The left pulmonary artery was compressed caudally by a surgical assistant arm typically used for coronary artery bypass grafting. This method simplified the creation of a distal anastomosis to the descending aorta behind the left bronchus. Postoperative computed tomography revealed a distal anastomosis at the sixth thoracic vertebra . This parabronchial approach could reduce the frequency of choosing a highly invasive approach and can be a potential minimally invasive approach in cases requiring extensive thoracic aortic aneurysm repair.