Outcomes of Late Partial Conversion With Graft Replacement for Sac Enlargement After Endovascular Abdominal Aortic Aneurysm Repair.

PURPOSE: Outcomes of late open conversion with graft replacement for enlargement after endovascular aortic repair remain unclear. Here, we report the outcomes of graft replacement after endovascular aortic repair. MATERIALS AND METHODS: Fourteen patients who underwent graft replacement after endovascular aneurysm repair between November 2016 and October 2022 were included. Graft replacement was indicated in cases of rupture and enlargement of the aneurysm sac and when reintervention with endovascular therapy could not be performed. RESULTS: The mean age at graft replacement was 80 ± 7 years. The follow-up period from endovascular aortic repair to graft replacement was 73 ± 41 months. The endoleaks that caused enlargement of the aneurysm sac were type I in 8 patients and type II in 6 patients. Ruptures were observed in 5 patients. One patient had paraplegia as a postoperative complication, and 2 patients died within 30 days. Morbidity and mortality were observed in cases of rupture, and no morbidity or mortality was observed in any elective surgery cases. CONCLUSION: Late open conversion with graft replacement after endovascular aortic repair is a feasible elective surgery. However, morbidity and mortality have been observed in cases of rupture. CLINICAL IMPACT: In elective surgery, postoperative outcomes are good for late open conversion with graft replacement after endovascular aortic repair. On the other hand, morbidity and mortality were observed in case of rupture. Therefore, it is important to perform elective surgical reintervention at the appropriate time.

A case of aortic root replacement for annuloaortic ectasia due to Takayasu's arteritis in active inflammatory phase.

A 39-year-old man was admitted with acute heart failure due to severe aortic regurgitation induced by annuloaortic ectasia associated with Takayasu's arteritis. Because of the active inflammatory phase associated with Takayasu's arteritis, surgery is typically performed following immune suppression by steroid therapy. Herein, we report a favorable recovery in the active inflammatory phase. Steroid therapy was initiated shortly following surgery. The decision to perform aortic root replacement without prior steroid therapy was made because the patient's risk of subsequent heart failures was deemed high and was complicated by other comorbidities.

Combined mitral valve replacement and coronary artery bypass grafting through a left thoracotomy after retrosternal oesophageal reconstruction.

A 74-year-old man with a history of retrosternal oesophageal reconstruction was referred for surgical treatment of mitral valve regurgitation and coronary artery disease. He underwent mitral valve replacement combined with coronary artery bypass grafting through a left thoracotomy. Combined mitral valve replacement and coronary artery bypass grafting through a left thoracotomy were feasible in this patient with a retrosternal neo-oesophageal conduit.

Anomalous Origin of the Left Anterior Descending Coronary Artery in an Adult.

An anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart disease. Among the variants, an anomalous origin of the left anterior descending coronary artery from the pulmonary artery (ALADPA) is extremely rare. Here, we report a case of ALADPA in an adult that was treated with coronary artery bypass grafting using the left internal thoracic artery.

[Mitral Valve Repair Using a New Artificial Ring which Enables to Decide the Length of Artificial Chordae].

Recently, mitral valve repair has been the mainstream of the operation for the treatment of mitral valve regurgitation. In particular, chorda reconstruction with artificial chordae is useful for the anterior leaflet. However, there has been no established method determining the length of chordae. In this report, we performed mitral valve repair using Memo 3D ReChord ring which enables to decide the length of chordae more easily. It is based on the concept of folding leaflet technique by Garcia et al. We used this ring in 7 patients (of which 2 were reoperation) in our institution. There was no postoperative death nor complication. Postoperative transthoracic echocardiography showed class 0~ Ⅰ mitral valve regurgitation in each case at discharge. This ring helps to make the repair more reproducible and we consider that it enables to decide the length of chordae more easily even in reoperative cases.

[Aortic Valve Repair for Bicuspid Aortic Valve (BAV) Regurgitation Combined with Stanford Type A Acute Aortic Dissection].

A 44-year-old male developed Stanford type A acute aortic dissection combined with bicuspid aortic valve( BAV) regurgitation. Aortic valve repair was performed by central plication and subcommissural annuloplasty. Additionally, replacement of the ascending aorta and the aortic root were performed with hemi-remodeling technique by replacing the non-coronary sinus. In this procedure, the angle of the 2 commissures were set at 180°. Postoperative transesophageal echocardiography revealed no aortic valve regurgitation. Changing the commissural orientation is considered to be important for the treatment of BAV regurgitation.

[Cavernous hemangioma of the right cardiac chamber;report of a case].

Cardiac cavernous hemangioma is an extremely rare benign tumor. A 53-year-old female had undergone resection of left breast cancer 9 years before, and her clinical course had been uneventful for nearly 9 years. She then experienced sudden fatigability and palpitations. Pericardial effusion and a tumor-like lesion, pressing the right side of the heart, were detected by echocardiography, computed tomography and magnetic resonance imaging. Though her symptoms were ameliorated with pericardial puncture, she was referred to our department for a definitive diagnosis and, if indicated, tumor resection. At surgery the tumor was poorly demarcated and most of it was resected under extracorporeal circulation. The histopathological examination revealed it was cavernous hemangioma. The patient's postoperative course has been uneventful without recurrence for approximately 2 years.

[Cadiac lipoma of the right atrium;report of a case].

Cardiac lipoma is a rare benign tumor. A 42-year-old male was referred to our hospital to undergo thorough examination and treatment of a space-occupying right atrial lesion, detected incidentally by chest computed tomography(CT). After admission, it was diagnosed as cardiac lipoma by echocardiography, CT, and magnetic resonance imaging. We resected the tumor under cardiopulmonary bypass and reconstructed the right atrium using a bovine pericardial patch. The histopathological examination reveaed that the tumor was lipoma. The postoperative course has been uneventful without recurrence for nearly 2 years.

[Subacute thrombosis of drug eluting stent immediately after off-pump coronary artery bypass grafting].

A 70-year-old male underwent the implantation of sirolimus-eluting stent at our hospital for total occlusion of the right coronary artery, which had caused acute myocardial infarction. Off-pump coronary artery bypass grafting (OPCAB) was performed for residual stenosis of the left anterior descending artery and the diagonal branch 10 days later. Though the operation was successfully performed, acute myocardial infarction recurred in the early postoperative period. Emergency coronary angiography showed subacute thrombotic occulusion of the drug eluting stent (DES). Percutaneous catheter intervention restored the stent patency. Attention should be paid to subacute thrombosis (SAT) in cases with the history of DES implantation.