Impact of Rotation Correction after Brace Treatment on Prognosis in Adolescent Idiopathic Scoliosis

STUDY DESIGN: Level 4 retrospective review. PURPOSE: Brace treatment is the standard nonoperative treatment for adolescent idiopathic scoliosis (AIS). Rotation correction is also important, because AIS involves a rotation deformity. The purpose of this study was to evaluate the impact of rotation correction after Osaka Medical College (OMC) brace treatment on clinical outcomes in AIS. OVERVIEW OF LITERATURE: Brace treatment has a significant effect on the progression of AIS. However, few reports have examined rotation correction after brace treatment. METHODS: A total of 46 patients who wore the OMC brace were retrospectively reviewed. The curve magnitude was determined according to the Cobb method, and the rotation angle of the apical vertebrae was measured by the modified Nash-Moe method. Based on the difference in the rotation angle before and after the initial brace treatment, patients were divided into two groups. Group A (n=33) was defined as no change or improvement of the rotation angle; group B (n=13) was defined as deterioration of the rotation angle. If the patients had curve or rotation progression of 5° or more at skeletal maturity, or had undergone surgery, the treatment was considered a failure. RESULTS: Differences of rotation angle between before and after the initial brace treatment were 2°±2° in group A and –3°±2° in group B (p<0.001). The rates of treatment failure were 42% in group A and 77% in group B (p<0.05). This study included 25 patients with Lenke type 1 (54%). Group A (24%) with Lenke type 1 also had a significantly better success rate of brace treatment than group B (75%) (p<0.05). CONCLUSIONS: Insufficient rotation correction increased brace treatment failure. Better rotation correction resulted in a higher success rate of brace treatment in patients with Lenke type 1.

A Case of Refractory Sustained Ventricular Tachycardia with Dilated-Phase Hypertrophic Cardiomyopathy Treated by Left Ventriculotomy / 日本心臓血管外科学会雑誌

A 63-year-old man had been receiving medical treatment for hypertrophic cardiomyopathy (HCM) for 20 years. Sustained ventricular tachycardia (VT) had often occurred over the previous 2 years in spite of the administration of antiarrhythmic drugs. He therefore received an implantable cardioverter defibrillator (ICD). However, his symptoms did not improve thus dilated-phase HCM was diagnosed. Because sustained VT often occurred subsequently, the ICD had to be frequently used. An electrophysiological study (EPS) using the CARTO electroanatomical mapping system revealed the earliest activation site to be in the posterolateral wall of the left ventricle (LV). VT did not stop despite 2 endocardial catheter ablation procedures. Therefore, the VT foci was thought to be a reentry circuit on the epicardial side of the posterolateral LV wall. A part of the posterolateral LV wall that involved the reentry circuit was therefore resected. Since undergoing this surgical procedure, the patient has experienced no recurrence of VT during a follow-up period of 14 months.

Ruptured Abdominal Aortic Aneurysm with Left-Sided Inferior Vena Cava: A Case Report / 日本心臓血管外科学会雑誌

We present a successful case of ruptured abdominal aortic aneurysm with left-sided inferior vena cava (IVC). A 74-year-old man, with complaints of abdominal pain and loss of consciousness, was referred to our hospital. Computed tomography revealed a ruptured aneurysm of the abdominal aorta, and the operation was performed immediately. At the operation, left-sided IVC was recognized to cross anteriorly over the abdominal aorta at the usual level of the left renal vein. Proximal anastomosis was safely performed with careful mobilization of the IVC in the appropriate direction. The patient was in acute renal failure after this procedure, with 9 days of continuous hemodiafiltration, but he recovered to discharge on the 46th postoperative day with normal renal function. The cardiovascular surgeon should be familiar with anomalies of the IVC in performing procedures of the abdominal aorta, especially in emergency operations, even if they are rare.

A Case of Surgical Repair of Ruptured Aneurysm of the Sinus of Valsalva with a Congenitally Bicuspid Aortic Valve / 日本心臓血管外科学会雑誌

We present a case of ruptured aneurysm of the sinus of Valsalva with congenitally bicuspid aortic valve and aortic regurgitation. A 50-year-old woman was admitted with congestive heart failure. Transesophageal echocardiography demonstrated that an aneurysm originating from the anterior sinus of Valsalva had ruptured into right ventricular outflow tract. With the aid of cardiopulmonary bypass, the aneurysm was repaired with direct closure through an aortotomy and aortic valve replacement with a Carbomedics 21mm was successfully performed. Because of the marked calcification of her cusps and shortening and thickening of the free-edge, valvuloplasty for the insufficient bicuspid valve was not applied in this case. However, valvuloplasty should be considered as the first surgical procedure of choice, even in cases of bicuspid aortic valve associated with ruptured aneurysm of the sinus of Valsalva and aortic regurgitation.