Lessons Learned from an Erroneous Surgery : Inversely Implanted Apicoaortic Valved Conduit / 日本心臓血管外科学会雑誌

A 62-year-old woman with severe aortic stenosis underwent apicoaortic bypass grafting. The graft was implanted inversely at first ; on the next day, it was re-implanted in the right direction. She recovered once from heart failure ; however, on postoperative day (POD) 74, she died from respiratory failure. On POD 16, an in-house multidisciplinary investigatory commission reviewed the human factors that had led to the surgical error. Throughout the investigation, we provided relevant information about the event and explanations. We presented our apologies the patient's family and offered to compensate them for their losses.

Implante de conducto apicoaórtico en paciente con estenosis aórtica severa post reemplazo valvular protésico / Apicoaortic valved conduit implanted in a patient with severe aortic stenosis due to mismatched aortic valve prosthesis

Introducción: La estenosis aórtica fibrocálcica es el tipo de valvulopatía más frecuente, especialmente en los adultos mayores, siendo el reemplazo valvular aórtico el tratamiento definitivo. Un mal resultado post operatorio puede deberse a un mal funcionamiento de la válvula protésica. Caso clínico: Paciente de 42 años de edad sometido a reemplazo valvular aórtico por presentar estenosis aórtica severa fibrocálcica en una válvula bicúspide y aorta de pared muy fina. Evoluciona asintomático durante 4 años, al cabo de los cuales y luego de abandonar su tratamiento anticoagulante consulta por disnea y dolor anginoso. Un ecocardiograma muestra estenosis severa de la válvula protésica. Dado los antecedentes de su cirugía previa se decide implantar un conducto de dacrón valvulado ápico-aórtico a través de toracotomía posterolateral izquierda. Evolución post operatoria muy satisfactoria permaneciendo asintomático, con un seguimiento de 15 meses. La recidiva de la estenosis aórtica severa post reemplazo valvular protésico tiene en el bypass ápico-aórtico una excelente alternativa de tratamiento efectivo, especialmente cuando el recambio valvular tradicional implica un alto riesgo quirúrgico.

Introduction: The most frequent surgical procedure of severe left ventricular outflow tract obstruction due to severe aortic stenosis is aortic valve replacement, but there is an alternative and less conventional method described by Cooley used in patients with previous aortic valve replacement and severe aortic wall calcification that bypasses the left ventricular outflow tract through the implant of an apicoaortic valved conduit. Clinical case: We describe the case of 42 years old patient with severe aortic stenosis due to mismatched valve prosthesis previously installed treated by of apicoaortic conduit implanted through left posterolateral thoracotomy.

Apico-basal polarity complex and cancer.

Apico-basal polarity is a cardinal molecular feature of adult eukaryotic epithelial cells and appears to be involved in several key cellular processes including polarized cell migration and maintenance of tissue architecture. Epithelial cell polarity is maintained by three well-conserved polarity complexes, namely, PAR, Crumbs and SCRIB. The location and interaction between the components of these complexes defines distinct structural domains of epithelial cells. Establishment and maintenance of apico-basal polarity is regulated through various conserved cell signalling pathways including TGFβ, Integrin and WNT signalling. Loss of cell polarity is a hallmark for carcinoma, and its underlying molecular mechanism is beginning to emerge from studies on model organisms and cancer cell lines. Moreover, deregulated expression of apico-basal polarity complex components has been reported in human tumours. In this review, we provide an overview of the apico-basal polarity complexes and their regulation, their role in cell migration, and finally their involvement in carcinogenesis.

Study of the effectiveness of paico (Chenopodium ambrosioides) as an anthelmintic, in specimens kept in captivity Home of Passage for Wildlife of the Amazonia University / Estudio de la eficacia del paico (Chenopodium ambrosioides) como antihelmíntico, en especímenes silvestres mantenidos en cautiverio en el Hogar de Paso de Fauna Silvestre de la Universidad de la Amazonía / Estudo da eficácia do “paico” (Chenopodium ambrosioides) como antihelmíntico, em espécies silvestres mantidas em cativeiro no Lar de Passo de Fauna Silvestre da “Universidad de la Amazônia” (Universidade do Amazonas”

For the development of the advanced research a therapeutic trial was carried out, which evaluated the effectiveness of paico (Chenopodium ambrosioides) as an anthelmintic in wild specimens kept in captivity in the foster home of the Amazonia University. The product was provided orally, in two equal doses with an interval of eight days. Due to its low palatability, it was supplied through liquefied or plant extract, mixed with the first day’s feed ration. From a descriptive statistical analysis of the results, it was found that paico has a 100% effective for the control of helminths in wild specimens kept in captivity.

Para el desarrollo de la investigación se adelantó un estudio terapéutico en el que se evaluó la efectividad del paico (Chenopodium ambrosioides) como antihelmíntico, en especímenes silvestres mantenidos en cautiverio en el hogar de paso de la Universidad de la Amazonía. El producto se suministró por vía oral, en dos dosis iguales con intervalode ocho días. Debido a su baja palatabilidad, su administración fue ofrecida a través de licuado o extracto de la planta, mezclado con la primera ración de alimento del día. A partir de un análisis estadístico descriptivo de los resultados se encontró que el paico presenta una efectividad del 100% para el control de helmintos en especímenes silvestres mantenidos en cautiverio.

Para o desenvolvimento da pesquisa, foi adiantado um estudo terapêutico no que se avaliou a efetividade do “paico” (Chenopodium ambrosioides) como antihelmíntico, em espécies silvestres mantidas em cativeiro no lar de passo da Universidade da Amazônia. O produto foi subministrado por via oral, em duas doses iguais com intervalo de oito dias. Devido a sua baixa palatabilidade, sua administração foi oferecida a través de líquido ou extrato da planta, misturado com a primeira ração de alimento do dia. A partir de uma análise estatística descritiva dos resultados se encontrou que o “paico” apresenta uma efetividade de 100% para o controle de helmintos em espécies silvestres mantidas em cativeiro.

Use of Aortic Valved Grafts for Apico-aortic Conduit Bypass / 日本心臓血管外科学会雑誌

We describe the case of a 60-year-old woman with severe aortic stenosis and severe calcification of the thoracic aorta, who underwent an apico-aortic conduit bypass using an aortic valved graft. Because of stenosis of the annulus of the aortic valve and severe calcification of the thoracic aorta (porcelain aorta), we did not perform ordinary aortic valve replacement. Instead, apico-aortic conduit bypass surgery was performed using a St. Jude Medical Aortic Valved Graft (19-20 mm : St. Jude Medical, St. Paul, MN, USA) and cardiopulmonary bypass (CPB) surgery was performed using descending aortic perfusion and left pulmonary artery drainage, while the subject was in the right decubitus position. The descending aorta was clamped and a 20-mm graft (Hemashield Platinum ; Boston Scientific/Medi-tech, Natick, MA, USA) was sutured to it. Under ventricular fibrillation, the left ventricular apex was circularly resected using a puncher with a diameter identical to that of the 20-mm graft, in order to create a new outflow for the conduit bypass. The graft was sutured to the outflow, and a torus-shaped equine pericardial sheet was used to reinforce the suture line. After recovery of the heartbeat, the aortic valved graft was first sutured to the graft at the outflow and then to the graft at the descending aorta. The CPB time was 285 min and ventricular fibrillation time was 36 min. Therefore, the benefits of using an aortic valved conduit for apico-aortic conduit bypass are reduced operation time, since there is no need to prepare a handmade valve conduit, and easy management of the grafts which are made of the same material.