ABSTRACT
We report a successful case of fulminant myocarditis treated with central ECMO with a transapical left ventricular vent (TLVV). A 33-year-old man was diagnosed with fulminant myocarditis with acute biventricular failure. Using a cardio-pulmonary bypass, we introduced central ECMO with ascending aortic perfusion, right atrial venous drainage and TLVV. After ancillary circulation, his cardiac function gradually improved. The endotracheal tube was removed 5 days after the surgery (POD 5), and he was weaned from ECMO on POD 7 and discharged on POD 38. Although there are many cases in which peripheral veno-arterial ECMO (VA-ECMO) is used for fulminant myocarditis, there is a drawback to VA-ECMO : left ventricle (LV) unloading may be incomplete. Insufficient LV unloading may cause pulmonary congestion or disadvantage in myocardial recovery. TLVV can be used as a solution to unload the left ventricle. Central ECMO with TLVV should be useful therapy for fulminant myocarditis.
ABSTRACT
A 76-year-old man with a complaint of dyspnea was diagnosed with acute severe mitral regurgitation due to ruptured chordae tendineae. For improvement of pulmonary congestion, we introduced IMPELLA 5.0® and extra-corporeal membrane oxygenation before valve surgery. After two-days' IMPELLA 5.0® support, mitral valve replacement surgery with a bioprosthetic valve was performed and IMPELLA 5.0® was withdrawn. We report a successful case of a bridge to surgery using IMPELLA 5.0® with mitral valve regurgitation accompanied by acute left heart failure with severe respiratory failure.
ABSTRACT
Objective: To clarify the relationship between the proportion of severely insufficient vegetable intake frequency and 1) vegetable cultivation, 2) frequency of receiving vegetable among non-cultivators.Materials and Methods: Residents aged 20 to 74 years in three areas of a city in Gunma Prefecture, Japan, were invited to participate. In September 2016, two sets of self-administered questionnaires were mailed to all 2,260 households in the three areas. The survey items covered the frequency of vegetable intake, vegetable cultivation (as a farmer, as a non-farmer, or no-cultivation), frequency of receiving vegetable, and basic characteristics. For vegetable cultivators, we asked the proportion of cultivated vegetables for home consumption and for giving to neighbors. Binomial logistic regression models were used to analyze the data collected. The respondents were classified into two groups according to their vegetable intake frequency: fewer than three times per day (severely insufficient), and at least three times per day.Results: We had 796 valid responses. Using the no-cultivation group as reference, both of the other groups —vegetable cultivation as a farmer, and as a non-farmer— had a significantly smaller proportion of severely insufficient vegetable intake frequency. Among the no-cultivation group, using those who had never received vegetable in the past month as reference, those who rarely, sometimes, or often received vegetables had a significantly smaller proportion of severely insufficient vegetable intake frequency. These associations were similar in cases where vegetable juice was or was not included. The proportion of those who cultivated vegetables for home consumption was 96% among farmers and 100% among non-farmers, respectively, and for giving to neighbors was 84% among farmers and 62% among non-farmers, respectively.Conclusion: A negative association of the proportion of severely insufficient vegetable intake with vegetable cultivation, and with receiving vegetable among non-cultivators, was suggested.
ABSTRACT
Objectives: This study aimed at identifying the differences in the vegetable intake frequency among rural, suburban, and urban residents. It also intended to estimate the effects of vegetable cultivation, receiving vegetables, and purchasing vegetables at farmers’ markets on the differences in vegetable intake frequency. Based on the results, to promote vegetable intake, we discuss the value of supporting vegetable cultivation in the rural areas.Materials and Methods: We conducted a cross-sectional study targeting residents aged between 20 and 74, living in three parts of a city within the Gunma prefecture in Japan. The three locations were selected to represent the rural, suburban, and urban areas. We mailed two sets of anonymous self-administered questionnaires to all households in the three areas (a total of 2,260 households, comprising about 1,000 people aged between 20 and 74 in each area). The survey requested information on the vegetable intake frequency, vegetable cultivation, frequency of receiving vegetables, frequency of vegetable purchase at farmers’ markets, the subjective difficulty in food-store access, economic circumstances, health attitudes, and demographic characteristics. We used the analysis of covariance (ANCOVA) to examine the data obtained.Results: We received 873 responses (from 586 households), of which 90 were irrelevant, thus leaving a sample of 783 residents (257 rural, 259 suburban, 267 urban) available for statistical analysis. The results revealed that the rural residents had significantly greater vegetable intake frequency than the urban and suburban residents did. These regional differences became smaller after the adjustment of the following variables: vegetable cultivation, receiving vegetables, and vegetable purchase at farmers’ markets. No significant difference was observed in the vegetable intake frequency between the rural and urban respondents after this adjustment was made.Conclusions: Vegetable intake frequency was higher in the rural area than in the suburban and urban areas. Vegetable cultivation, receiving vegetables, and vegetable purchase at farmers’ markets were strongly linked to these regional differences.
ABSTRACT
Persistent massive air leak after pediatric cardiac surgery is a rare and possibly life-threatening complication which is difficult to treat. We report a 3-month-old boy with hypoplastic left heart syndrome that underwent Glenn take-down, suffered from pulmonary hemorrhage during surgery and needed mechanical ventilation with high airway pressure that caused bilateral pneumothorax. After pulmonary hemorrhage improved, pneumothorax with persistent air leaks did not resolve under prolonged chest tubes. This patient underwent an autologous “blood patch” pleurodesis on postoperative day 32. The procedure was repeated a second time 48 h after the application of the first blood patch. After these procedures, air leaks dramatically ceased. The patient was successfully weaned from the ventilator on postoperative day 70. Pleurodesis with an autologous blood patch is a safe and an effective technique for the treatment of persistent air leaks, even for a 3-month-old boy with hypoplastic left heart syndrome.
ABSTRACT
We describe our experience of surgical treatment in a patient with Takayasu's arteritis who required aortic root replacement because of perivalvular aortic regurgitation, developing 2 years after aortic valve replacement. A 65-year-old man underwent aortic valve replacement with a mechanical valve 3 years previously because of serious aortic insufficiency associated with Takayasu's arteritis. No steroids were given postoperatively. Three years after surgery, perivalvular aortic regurgitation developed. Reoperation was scheduled because of increased regurgitation and valve dehiscence. The sinus of Valsalva and the ascending aorta were enlarged, and a false aneurysm was found at the suture line of the aortotomy. Moderate mitral insufficiency was also present. The patient underwent aortic root replacement with a mechanical valve (J-graft Shield<sup>®</sup>, 24 mm ; and SJM Regent<sup>®</sup>, 21 mm), hemiarch replacement (J-graft Shield<sup>®</sup>, 24 mm), and mitral annuloplasty (IMR ET Logix<sup>®</sup> ring, 28 mm). Intraoperative examination showed very severe adhesion around the ascending aorta and marked wall thickening extending from the aortic root to the ascending aorta. The annulus was recognized to be very fragile after the mechanical valve was removed. The annulus was reinforced with autologous pericardium patch, furthermore, the subannulus was reinforced with a shortly cut artificial vessel graft. Aortic root replacement was then performed. After surgery, the patient received steroids. Inflammation was improved by steroids and the patient is being followed up on an outpatient basis. In patients with a fragile annulus and severe inflammation associated with aortitis, tissue reinforcement and postoperative management of inflammation are essential.