PMC5737948_01
Computed tomography showed (A) three problems at different sites (arrows): (B) distal aortic arch true aneurysm, (C) disruption of the original polyethylene terephthalate graft perforating the right atrium, and (D) pseudoaneurysm at the distal anastomosis site of abdominal aortic bypass grafting.
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Computed tomography showed three problems at various sites: disruption of the PET graft perforating the right atrium, pseudoaneurysm at the abdominal aortic bypass distal anastomosis site, and distal aortic arch true aneurysm (Fig. 1).
Operative findings. (A) Perforation site in the right atrium (white arrow), and holes in the guide line (black arrows). (B) Re-grafting and right atrium repair, (C) longitudinal rupture of the initial polyethylene terephthalate graft (white arrow), the hole in the guide line (black arrow), and (D) histological examination were performed. An initial graft specimen (C) was taken from the centre of the degradation site, which was just a few cm to the side of the perforation site in the right atrium (circle in A), and histological examination of the graft specimen was performed.
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The ruptured PET graft was approached directly through the re-median sternotomy under hypothermic circulatory arrest with CPB (Fig. 2A). There was longitudinal rupture of the PET graft, some holes in the guide line, and a 7 mm perforation in the right atrium (Fig. 2A and C). The first stage involved re-grafting with a 10 cm woven shield graft (J Graft SHIELD NEO), and right atrium repair with mattress sutures using Teflon felt pledgets (Fig. 2B). Histological examination of the ruptured initial graft revealed a chronic, foreign body, inflammatory reaction without evidence of infection (Fig. 2D).
Computed tomographic images from 1 year post-operatively. There was a thoracic aortic aneurysm at the distal arch (black arrow), and the initial graft still partially remained (red arrow). Re-grafting with a woven shield graft (J Graft SHIELD NEO) for the range A in the first stage operation, and for the range B in the second stage operation.
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