Ligation is Not Enough to Secure the Aortic End of the Anomalous Systemic Artery
A 23-year-old non-smoking man was referred to our hospital because of recurrent hemoptysis that he began experiencing 2 years ago without any particular cause. Computed tomography (CT) scan revealed a few asymmetrical dilated vessels in the left lower lobe and the CT angiogram demonstrated an enlarged tortuous artery arising from the descending aorta and perfusing the left basal segments. He underwent a video-assisted thoracoscopy assisted operation to eliminate the symptoms. After dissection, the anomalous vessel was doubly ligated with No. 1 silk suture at the proximal end. A transfixation suture ligation was made between the two ligatures before division and then, the left lower lobe was removed. After the operation, the patient was transferred to intensive care unit ward. Two hours later, the massive blood, suddenly drained out (about 3000 ml) from the chest tube and the blood pressure dropped sharply to zero within several minutes. Emergency operation was performed promptly, revealing the ruptured aortic stump of the divided aberrant vessel. Although repair was accomplished with a continuous No. 4-0 Prolene suture, the patient died from the shock and the cardiac arrest unfortunately.