ABSTRACT
A 26-year-old lady with Loeys Dietz syndrome had undergone 5 consecutive operations from 2007 to 2014. Finally, her total aorta was replaced by vascular grafts and stent grafts. The patient was admitted to our hospital with headache and dizziness in 2016. Computed tomography showed a giant pseudoaneurysm at the aortic arch with extravasation from the vascular graft. The proximal flares of thoracic stent grafts caused perforation of thoracic vascular grafts. Cerebral perfusion was not sufficient, because this aneurysm compressed the innominate, left carotid and left subclavian arteries. Decreasing of cerebral perfusion caused headache and dizziness. We performed total arch replacement. We started extracorporeal circulation before median sternotomy but the aneurysm ruptured during median sternotomy. We controlled the bleeding by manual compression and immediately started selective cerebral perfusion and induced cardiac arrest. After opening the distal portion, we cut down the proximal flares of thoracic stent graft and inserted an elephant trunk into the stent graft. We sutured between the new vascular graft and the stent graft and covered the suture line with another short vascular graft. As a result we could protect the vascular graft from the stent graft. Computed tomography demonstrated that the pseudoaneurysm and extravasation disappeared. Cerebral perfusion increased and the patient's symptoms improved. Postoperatively the patient was discharged from our hospital without any major complications at POD 11.
ABSTRACT
<p><b>Background</b> : There has been no ideal valve prosthesis for children from the point of view of thromboembolism and size mismatch, and the surgical repair of native mitral valve has always been our first priority in children. However, valve replacement becomes the inevitable surgical option if repair is impossible. The purpose of this study was to assess the long-term results of mitral valvuloplasty (MVP) and mitral valve replacement (MVR) for isolated mitral valve diseases in children under 15 years old. <b>Patients and Methods</b> : From 1981 to 2010, 30 patients underwent a total of MVPs (P group) and 26 consecutive patients underwent a total of MVRs (R group). The median age was 4.6 years (4 months to 16 years) in group P and 6.2 years (4 months to 13.7 years) in group R, and the median body weight was 13.4 kg (6 to 35.5 kg) in group P and 16.4 kg (4.8 to 50.7 kg) in group R. The etiology was congenital in 55 (98%) patients, and due to endocarditis in 1 (2%) patient. Isolated mitral regurgitation was present in 41 (73%) patients (group iMR), and isolated mitral stenosis was present in 15 (27%) patients (group iMS). Mechanical valves (bileaflet disc, <i>n</i>=26) were used in all initial MVR patients. <b>Results</b> : Overall hospital mortality was 0%. The median follow-up time was 9.3±7.8 years (4 months to 27.7 years). There were 6 reoperations in P group and 5 explants due to size mismatch in R group with patient growth, and no explant due to structural valve deterioration. Survival rates at 10 years were 100% in the P group and 88.0% in the R group, and there was a significant difference (<i>p</i>=0.043). Freedom from reoperation at 10 years was 77.6% in P group and 77.0% in R group. Freedom rate from cerebral events at 10 years were 100% in both groups, respectively, and there were no significant differences. Survival rates at 10 years were 100% in the iMR group and 53.3% in the iMS group, respectively, and there was a significant difference between the groups (<i>p</i><0.001). Freedom rates from reoperation at 10 years were 77.1% in the iMR group and 64.3% in the iMS group, respectively, there being no significant difference. Conclusions : The long-term results of pediatric mitral surgery were acceptable. Mitral valvuloplasty for patients with isolated mitral regurgitation were excellent. Mitral valve replacement can be performed with low initial mortality but should be reserved for medical and reconstruction failure because reoperation and late mortality are high, particularly for patients with isolated mitral stenosis.</p>
ABSTRACT
BACKGROUND/AIMS: To confirm the feasibility of using newly developed endoscopic ultrasound (EUS) with Zone sonography(TM) technology (ZST; Fujifilm Corp.). METHODS: Seventy-five patients with pancreatic disorders were enrolled: 45 with intraductal papillary mucinous neoplasm; 15 with ductal carcinoma; five with neuroendocrine tumors; three with serous cystic neoplasms; and seven with simple cysts. The endoscopes used were EG-530UR2 and EG-530UT2 (Fujifilm Corp.). Two items were evaluated: visualization depth among four frequencies and image quality after automatic adjustment of sound speed (AASS), assessed using a 5-scale Likert scale by two endosonographers blinded to disease status. Because sound speed could be manually controlled, besides AASS, image quality at sound speeds of 1,440 and 1,600 m/sec were also assessed. RESULTS: In all cases, sufficient images were obtained in the range of 3 cm from the EUS probe. Judgments of image quality before AASS were 3.49+/-0.50, 3.65+/-0.48, respectively. After AASS, A and B scored 4.36+/-0.48 and 4.40+/-0.49 (p<0.0001). There were significant differences in the data before and after AASS and plus 60 m/sec, but no significant difference between the datasets were seen after AASS and at sound speeds manually set for minus 100 m/sec. CONCLUSIONS: EUS with ZST was shown to be feasible in this preliminary experiment. Further evaluation of this novel technology is necessary and awaited.
Subject(s)
Humans , Endoscopes , Endosonography , Judgment , Mucins , Pancreatic DiseasesABSTRACT
We have used absorbable suture material for the repair of pediatric cardiovascular anomalies where subsequent growth of the suture line was requied since 1986. We reviewed long-term results of three groups of patients using absorbable suture (1. cardiovascular surgery in the high-pressure areas, 2. semicircular annuloplasty for mitral regurgitation, 3. cardiovascular surgery in the low pressure areas). In group 1, six patients after Jatene procedure using PDS<sup>®</sup> were examined. Subsequent growth of the neo-aortic anastomotis were well preserved without formation of pseudoaneurysm 6-56 (average 18.6) months after the operation. In group 2, seven patients with mitral regurgitation (mitral valve regurgitation 4, endocardial cushion defect 3) were examined. The semicircular annuloplasty was applied using Vicryl<sup>®</sup> and Dexon<sup>®</sup> and mitral regurgitation was improved and in two patients normal growth of the mitral annulus was recognized 4 and half years after the operation. In group 3, sixteen patients in the repair of total anomalous pulmonary venous drainage (Darling type I, III) using PDS<sup>®</sup> were examined. Pulmonary venous obstruction were encountered 1 and 5 months after the anastomotis between common pulmonary vein and left atrium in two patients and anastomotic stenosis was thought to be induced by tissue overgrowth. On the basis of our clinical experiences, we believe that application of absorbable suture in pediatric cardiovascular surgery in the high-pressure areas could be recommended as an alternative treatment, but that should be avoided in the neonatal small low-pressure areas on the assumption that anastomotic stenosis might be induced by tissue overgrowth.