ABSTRACT
Background@#and Purpose To assess the long-term outcomes of intracranial dural arteriovenous fistula (DAVF) treated with stereotactic radiosurgery (SRS) alone or embolization and SRS (Emb-SRS) and to develop a grading system for predicting DAVF obliteration. @*Methods@#This multi-institutional retrospective study included 200 patients with DAVF treated with SRS or Emb-SRS. We investigated the long-term obliteration rate and obliteration-associated factors. We developed a new grading system to estimate the obliteration rate. Additionally, we compared the outcomes of SRS and Emb-SRS by using propensity score matching. @*Results@#The 3- and 4-year obliteration rates were 66.3% and 78.8%, respectively. The post-SRS hemorrhage rate was 2%. In the matched cohort, the SRS and Emb-SRS groups did not differ in the rates of obliteration (P=0.54) or post-SRS hemorrhage (P=0.50). In multivariable analysis, DAVF location and cortical venous reflux (CVR) were independently associated with obliteration. The new grading system assigned 2, 1, and 0 points to DAVFs in the anterior skull base or middle fossa, DAVFs with CVR or DAVFs in the superior sagittal sinus or tentorium, and DAVFs without these factors, respectively. Using the total points, patients were stratified into the highest (0 points), intermediate (1 point), or lowest (≥2 points) obliteration rate groups that exhibited 4-year obliteration rates of 94.4%, 71.3%, and 60.4%, respectively (P<0.01). @*Conclusions@#SRS-based therapy achieved DAVF obliteration in more than three-quarters of the patients at 4 years of age. Our grading system can stratify the obliteration rate and may guide physicians in treatment selection.
ABSTRACT
Surgical management is recommended for a patient with intractable pericardial effusion indicating medical treatment resistance and cardiac tamponade. We report our experience of surgical treatment applying a Denver shunt for intractable pericardial effusion. A 60-year-old woman suffered pericarditis accompanying pericardial effusion complications of systemic lupus erythematosus. She had repeatedly undergone pericardial drainage, however, there was a possibility of increased cardiac tamponade. Surgical treatment consisted of pericardial fenestration with thoracoscopic assist and right pleuro-peritoneal shunt using a Denver shunt. The heart failure symptoms disappeared and pericardial effusion considerably decreased after surgery. The postoperative course was uneventful without recurrence after 1-year of follow up. In the literature, postoperative complications such infection and shunt obstruction have been reported. Careful follow up is mandatory and selection of self-manageable cases is important.
ABSTRACT
<p>We report a rare case of a large thrombus in the ascending aorta with acute arterial occlusive disease. A 61-year-old man was transferred to our hospital with sudden pain and cyanosis. Contrast-enhanced computed tomography detected left ulnar arterial occlusion and a large mass in the ascending aorta, so we performed surgery to remove the large thrombus under cardiopulmonary bypass. Histologically, the mass was a fibrin thrombus. In addition, thickened endothelial lining and slight atheromatous degeneration was detected in the resected aortic wall. The patient was discharged from the hospital on postoperative day 22.</p>
ABSTRACT
A 55-year-old man was referred to our hospital for hemolytic anemia 21 months after an ascending aortic replacement for acute type A aortic dissection. The enhanced CT revealed an aortic pseudoaneurysm formation at the proximal anastomosis. The cause of hemolysis was verified to be the pressure by an aortic pseudoaneurysm formation at the vascular graft stenosis. At the reoperation, the previous vascular graft was found to have partially detached from the aortic stump over the non-coronary cusp. Ascending aortic replacement was performed with a tailoried vascular graft in a scallop shape, corresponding to the non-coronary cusp. The postoperative course was uneventful and hemolysis diminished soon after the operation.
ABSTRACT
The objective of this study was to evaluate the inflammatory responses in patients who received 1 of 2 different types of woven Dacron grafts. Abdominal aortic surgery was performed in 154 patients between 2002 and 2006, and 102 patients were enrolled in this study. Sealed woven Dacron grafts (INTERGARD<sup>TM</sup> woven graft, Group I) were implanted in 77 patients and non-sealed woven Dacron grafts (UBE woven graft, Group N) were implanted in 25 patients. All patients received either a bifurcated graft or straight graft replacement. Body temperature (BT), white blood cell counts (WBC), and C-reactive protein (CRP) levels were measured preoperatively and on postoperative days 1, 3, 5, 7 and 14, and were compared between the 2 groups. There were no differences in the patient's mean ages, 73±9 and 71±7 years, or operation time, 213±57 and 210±63 min, between Groups I and N, respectively. Postoperative changes in BT and WBC were similar in both groups. CRP levels were higher in Group N than Group I on postoperative days 5 and 7, but these differences were clinically insignificant. Prolonged inflammatory response which lasted longer than 2 weeks occurred in 2 patients in Group I and in 1 patient in Group N. All patients eventually returned to baseline conditions without special treatments. Thus the postoperative inflammatory responses to coated and non-coated woven Dacron grafts were similar in abdominal aortic surgery.
ABSTRACT
In this report, we present our initial experience of endoscopic saphenous vein harvesting (ESVH) using the Vasoview System. ESVH was performed in 72 patients between May 2006 and October 2007. The mean patient age was 73±6.7 years, and 54 (75%) were men. The success rate of ESVH was 98.6% (71/72). The mean harvest time was 36±11 min. The mean number of side branches requiring repair was 1.19±1.21. Comparing the first 5 cases with the last 5 cases, the time for harvesting time and the number of repaired branches improved significantly. Wound complications occurred in 2 patients (2.7%) postoperatively. The intraoperative mean graft flow was 25±13 ml/min. The early patency was 87% (47/54) as evaluated by postoperative angiography or CT. The intraoperative graft flow and early patency were satisfactory. ESVH is easy to adopt and has excellent cosmetic advantages.
ABSTRACT
A 65-year-old man was referred to our hospital for surgical treatment of left ventricular aneurysm (LVA) with mural thrombus. Systemic lupus erythematosus had been diagnosed when he was 57 and antiphospholipid syndrome (APS) had been diagnosed at age 61. Steroid and anticoagulant therapy with warfarin has been continuously performed. He suffered acute myocardial infarction at the age of 64, and percutaneous coronary intervention was performed to the diagonal branch. Seven months later, coronary angiography showed occlusion of the diagonal branch and left ventriculography showed a large LVA. Left ventricular reconstruction was performed and his postoperative course was uneventful. Cardiac surgery for the patients with APS was reported to have high morbidity and mortality. Perioperative anticoagulant management was very important for such patients.
ABSTRACT
Preoperative blood donation is well known as one approach to reducing complications caused by homologous blood transfusion. The purpose of this study is to evaluate whether preoperative blood donation prior to coronary artery bypass grafting (CABG) reduces homologous blood transfusion. The subjects were selected from 151 consecutive patients who underwent CABG between October 1996 and October 1998. Of the 151 patients, 76 made preoperative blood donations (group A). Results in this group were compared with those obtained in the control group consisting of the subjects who received CABG without preoperative blood donation (group B, <i>n</i>=75). Both groups were matched for age, sex, preoperative hematocrit, cardiopulmonary bypass time, blood transfusion index (BTI; body weight×preoperative hematocrit). There were no significant differences between the two groups in terms of age and mean bypass duration. Homologous blood requirements were significantly lower in group A (78.9%) compared to group B (61.0%). BTI in group A (2, 224±447) however, was higher than that in group B (2, 129±515). In our study, preoperative blood donation was very effective to reduce homologous blood transfusion in coronary artery bypass grafting.
ABSTRACT
A 69-year-old man was admitted for treatment of thoracic aneurysm. DSA revealed multiple aortic aneurysms: three true aneurysms which were located at the distal arch, the thoraco-abdominal aorta at the diaphragm level and the infrarenal abdominal aorta, 60mm, 55mm and 55mm in diameter, respectively and two pseudo-aneurysms which were located in the abdominal aorta just below the right renal artery and the right common iliac artery. We decided to perform a two-staged operation. Before the first operation, 1, 200ml of autologous blood was stored for perioperative blood transfusion. Initially, total arch replacement was performed using deep hypothermic circulatory arrest and antegrade selective cerebral perfusion. One month after the first operation, total thoraco-abdominal aorta replacement was performed by a retroperitoneal approach with mild hypothermia. The Th 9, 10 and 11 intercostal arteries were reconstructed. Distal anastomosis was performed at both common iliac arteries. Blood transfusion was not required for blood pooling and reduction of priming volume in the cardiopulmonary bypass system.
ABSTRACT
An isolated huge unruptured aneurysm of the right coronary sinus of Valsalva was detected incidentally in a 47-year-old man. Echocardiography and aortograms revealed severe aortic insufficiency with moderate stenosis, and mild dilatation of the lower ascending aorta without annulo-aortic ectasia. At operation, a sclerotic bicuspid aortic valve was confirmed. These abnormal findings necessitated a reconstruction of the aortic root with a valved conduit and reimplantation of the coronary arteries (Bentall operation with the Carrel patch technique). Pathologic examination of the resected aortic wall showed diffuse sclerotic change and partial medial degeneration.
ABSTRACT
Primary cardiac tumors are comparatively rare. Primary cardiac angiosarcoma is the most common cardiac malignant tumor and the most common site of this tumor is in the right atrium. It is usually difficult to diagnose and treat this condition before death. The present case of primary cardiac angiosarcoma was located in the left atrium, which is very rare. A cardiac malignant tumor was suspected in this 56-year-old man based on chest MRI examination. The operation was performed successfully but its outcome was very poor.