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1.
Article in English | MEDLINE | ID: mdl-38822182

ABSTRACT

OBJECTIVES: The aim of this study is to analyze long-term results of the total aortic arch replacement with the frozen elephant trunk technique for primary chronic type B aortic dissection. METHODS: Among 322 patients who had the frozen elephant trunk technique, 43 (13.4%) patients (median age, 64.0 years) with primary chronic type B aortic dissection were analyzed. The patients underwent surgery at a median of 27.0 months after the onset of aortic dissection. The false lumen was patent in 30 (69.8%) patients preoperatively. RESULTS: Two patients suffered paraplegia and another died of cerebral infarction. Complete thrombosis of the peri-stent false lumen was achieved in 36 (83.7%) patients. Overall survival, freedom from aortic events, and freedom from aortic reintervention were 83.5%, 37.2%, and 42.2% at 5 years, respectively. Survival rates of the patients with or without aortic events were 75.0% and 95.8% at 5 years (Log-rank, p = 0.22). Late aortic events occurred in 19 (44.2%) patients including distal stent graft-induced new entry, type Ib endoleak, and false lumen dilation. The ratio of the stent graft diameter to the preoperative short axis diameter of the true lumen (hazard ratio, 1.90; 95% confidence interval, 1.01-3.59), and the maximal diameter of a postdissection aneurysm (1.07; 1.01-1.12) were the significant multivariate risk predictors of late aortic events. CONCLUSIONS: Late aortic events occurr fairly frequently, and new strategies need to be explored to enhance the effectiveness of this procedure in the future.

2.
Heart Vessels ; 2024 May 11.
Article in English | MEDLINE | ID: mdl-38733397

ABSTRACT

Various surgical approaches address complex heart disease with arch anomalies. Bilateral pulmonary artery banding (bPAB) is a strategy for critically ill patients with complex arch anomalies. Some reports argued the potential effect of bPAB on the growth of the left ventricular outflow tract (LVOT) during inter-stage after bPAB. This study aimed to analyze the LVOT growth for biventricular repair candidates with arch anomaly and systemic ventricular outflow tract (SVOT) for univentricular repair candidates with arch anomaly. This retrospective study analyzed 17 patients undergoing initial bPAB followed by arch repair. The Z-scores of LVOT and SVOT were compared between pre-bPAB and pre-arch repair. Patient characteristics, transthoracic echocardiogram data, and PAB circumferences were reviewed. The diameter of the minimum LVOT for biventricular repair (BVR) candidates, the pulmonary valve (neo-aortic valve, neo-AoV) and the pulmonary trunk (the neo-ascending aorta, neo-AAo) for univentricular repair (UVR) candidates, and the degree of aortic or neo-aortic insufficiency in each candidate was statistically analyzed. 17 patients were divided into the UVR candidates (group U) with 9 patients and the BVR candidates (group B) with 8 patients. In group B, the median value of the Z-score of the minimum LVOT increased from -3.2 (range: - 4.1 ~ - 1.0) at pre-PAB to -2.8 (range: - 3.6 ~ - 0.3) at pre-arch repair with a significant difference (p = 0.012). In group U, the median value of the Z-score of the neo-AoV increased from 0.5 (range: - 1.0 ~ 1.7) at pre-bPAB to 1.2 (range: 0.2 ~ 1.9) at pre-arch repair with a significant difference (p < 0.01). The median value of the Z-score of the neo-AAo was also increased from 3.1 (range: 1.5 ~ 4.6) to 4.3 (range: 3.1 ~ 5.9) with a significant difference (p = 0.028). The growth of the LVOT for BVR candidates and SVOT for UVR candidates during the inter-stage between bPAB and arch repair was observed. These results suggest the potential advantage of bPAB in surgical strategies. Further research is needed to validate these findings and refine surgical approaches.

3.
Vasc Endovascular Surg ; 58(4): 457-460, 2024 Apr.
Article in English | MEDLINE | ID: mdl-38019846

ABSTRACT

A 66-year-old man presented with hemolytic anemia, which required frequent blood transfusion, 6 months after surgical repair of an ascending aortic pseudoaneurysm. Hemolysis was attributed to luminal stenosis caused by graft kinking by laboratory test, CT and four-dimensional magnetic resonance imaging. First, an Excluder cuff was placed at the stenotic site under rapid pacing, but it migrated distally. Thereafter a Palmaz XL stent was placed at the stenotic site, which led to resolution of anemia. In this case, a Palmaz XL stent was successfully used to treat hemolytic anemia caused by graft kinking following ascending aortic surgery.


Subject(s)
Anemia, Hemolytic , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Male , Humans , Aged , Blood Vessel Prosthesis/adverse effects , Treatment Outcome , Aorta/diagnostic imaging , Aorta/surgery , Stents/adverse effects , Blood Vessel Prosthesis Implantation/adverse effects , Anemia, Hemolytic/diagnostic imaging , Anemia, Hemolytic/etiology , Endovascular Procedures/adverse effects
5.
Clin Case Rep ; 10(2): e05427, 2022 Feb.
Article in English | MEDLINE | ID: mdl-35369383

ABSTRACT

A 52-year-old woman with a past history of anterior myocardial infarction 15 years previously was found to have a pedunculated mobile thrombus with a narrow stalk originating from the left ventricle, and a huge laminated mural thrombus. Surgical extraction of the two organized thrombi was successfully performed with transmitral approach using a novel, flexible, self-retained, and reusable leaflet retractor, which was originally developed for exposure of the subvalvular apparatus during mitral valve repair. Excellent access, exposure, and visualization of the left ventricle were achieved by this heart valve retractor and an endoscope for removal of a huge mural thrombus.

6.
Ann Thorac Surg ; 114(4): e283-e285, 2022 10.
Article in English | MEDLINE | ID: mdl-34995570

ABSTRACT

Osler's disease is an autosomal dominant disorder characterized by epistaxis, telangiectases, and arteriovenous malformations of the internal organs. Herein, we report the first published case of dissecting thoracoabdominal aortic aneurysm repair in a 66-year-old woman with hereditary hemorrhagic telangiectasia associated with ACVRL1 gene mutations. We maintained the activated clotting time around 400 seconds during cardiopulmonary bypass to avoid lethal hemorrhage from telangiectases or arteriovenous malformations. The Adamkiewicz artery could not be identified on imaging studies preoperatively. Therefore, we used the snake technique for intercostal revascularization, which was effective in preventing paraplegia.


Subject(s)
Aortic Aneurysm, Thoracic , Arteriovenous Malformations , Telangiectasia, Hereditary Hemorrhagic , Telangiectasis , Activin Receptors, Type II , Aged , Animals , Aortic Aneurysm, Thoracic/complications , Aortic Aneurysm, Thoracic/diagnosis , Aortic Aneurysm, Thoracic/surgery , Arteriovenous Malformations/complications , Female , Humans , Snakes , Telangiectasia, Hereditary Hemorrhagic/complications , Telangiectasia, Hereditary Hemorrhagic/surgery , Telangiectasis/complications
7.
J Cardiothorac Surg ; 17(1): 13, 2022 Jan 29.
Article in English | MEDLINE | ID: mdl-35093156

ABSTRACT

BACKGROUND: Aortic valve neocuspidization (AVNeo) has emerged as a promising aortic valve procedure, and is expected to have a larger effective orifice area (EOA) than commercially available bioprostheses. It is, however, unclear which indices could facilitate left ventricular (LV) reverse remodeling after AVNeo. The aim of this study is to verify the impact of global left ventricular afterload on the LV reverse remodeling following AVNeo. METHODS: Data-available consecutive 38 patients (median age, 77; interquartile range, 72.8-82.0) undergoing AVNeo for severe aortic stenosis were enrolled in this study. Preoperative and the last follow-up echocardiographic data were retrospectively analyzed including the valvuloarterial impedance (Zva), a marker of global LV afterload. Reduction in LV geometry index (LVGI) and relative wall thickness (RWT) were used as an indicator for LV reverse remodeling. RESULTS: The Zva reduced in 24 patients (63.2%) during the follow-up period (median, 12 months). Reduction in Zva significantly correlated to improvement of LV geometry (LVGI (r = 0.400, p = 0.013) and RWT (r = 0.627, p < 0.001)), whereas increase in EOA index did not significantly correlate to LVGI (r = 0.009, p = 0.957), or RWT (r = 0.105, p = 0.529)). The reduction in Zva was the multivariate predictor of LV reverse remodeling. CONCLUSIONS: Low global LV afterload led to significant LV reverse remodeling even after AVNeo, which could achieve better valve performance than the conventional bioprostheses.


Subject(s)
Aortic Valve Stenosis , Aortic Valve , Aged , Aortic Valve/diagnostic imaging , Aortic Valve/surgery , Electric Impedance , Humans , Retrospective Studies , Ventricular Remodeling
8.
Trauma Case Rep ; 35: 100515, 2021 Oct.
Article in English | MEDLINE | ID: mdl-34401440

ABSTRACT

Blunt trauma may cause cardiac perforation requiring emergency surgical repair. Cardiac perforations are usually diagnosed by the presence of a pericardial effusion on echocardiography. However, cardiac perforations and pericardial effusions are sometimes too small to detect, resulting in underdiagnosis. In this case report, we describe a 22-year-old man who was involved in a traffic accident, admitted in a state of shock, and was initially treated for tension pneumothorax and liver and spleen injuries. His initial computed tomography scans revealed a small region of enhancement, corresponding to a small pericardial effusion, indicative of a cardiac perforation. Thus, an emergency median sternotomy was performed. He was diagnosed with perforation of the left atrial ear and right atrium, which were repaired surgically. His liver and spleen injuries were also treated, and the patient was discharged 44 days after admission. The detection of a small pericardial effusion on enhanced computed tomography enabled rapid diagnosis of a cardiac perforation and ensured emergency surgical repair could be performed as soon as possible. LEARNING OBJECTIVES: •To acknowledge the difficulty of diagnosing cardiac perforation in patients with pericardial injury, based on conventional signs of blunt cardiac injury, such as sternal fracture, serum cardiac enzymes, and hemothorax.•To recognize that a small pericardial effusion on enhanced computed tomography scans is an important finding that should raise suspicion of cardiac perforation and pericardial injury.

9.
J Card Surg ; 35(12): 3575-3577, 2020 Dec.
Article in English | MEDLINE | ID: mdl-33047365

ABSTRACT

An urgent surgery was performed for a 28-year-old man who sustained a traumatic descending thoracic aortic injury in an automobile collision. Severe respiratory failure was encountered during surgery, which did not allow for single-lung ventilation for adequate exposure of the descending aorta. We used venopulmonary artery extracorporeal lung assist by main pulmonary artery cannulation with concurrent distal aortic perfusion using a single centrifugal pump. Cannulating the easily accessible main pulmonary artery for venopulmonary artery extracorporeal lung assist is a safe and feasible technique in patients complicated with profound respiratory failure undergoing aortic surgery via left thoracotomy.


Subject(s)
Aortic Aneurysm, Thoracic , Aortic Diseases , Adult , Aorta, Thoracic/diagnostic imaging , Aorta, Thoracic/surgery , Aortic Aneurysm, Thoracic/surgery , Catheterization , Humans , Lung , Male , Thoracotomy
10.
Asian Cardiovasc Thorac Ann ; 28(7): 384-389, 2020 Sep.
Article in English | MEDLINE | ID: mdl-32757655

ABSTRACT

OBJECTIVES: We retrospectively analyzed our experience of mitral valve repair for native mitral valve endocarditis in a single institution. METHODS: From January 1991 to October 2011, 171 consecutive patients underwent surgery for infective endocarditis. Of these, 147 (86%) had mitral valve repair. At the time of surgery, 98 patients had healed (group A) and 49 had active infective endocarditis (group B). Repair procedures included resection of all infected tissue and thick restricted post-infection tissue, leaflet and annulus reconstruction with treated autologous pericardium, chordal reconstruction with polytetrafluoroethylene sutures, and ring annuloplasty if necessary. Fifty-two (35%) patients required concomitant procedures. The study endpoints were overall survival, freedom from reoperation, and freedom from valve-related events. The median follow-up was 78 months. RESULTS: There was one hospital death (hospital mortality 0.7%). Survival at 10 years was 88.5% ± 3.5% with no significant difference between the two groups (p = 0.052). Early reoperation was required in 4 patients in group B due to persistent infection or procedure failure. Freedom from reoperation at 5 years was 99% ± 1.0% in group A and 89.6 ± 4.0% in group B (p = 0.024). Event-free survival at 10 years was 79.3% ± 4.8% (group A: 83.4% ± 5.9%, group B: 72.6% ± 6.9%, p = 0.010). CONCLUSIONS: Mitral valve repair was highly successful using autologous pericardium, chordal reconstruction, and ring annuloplasty if required. Long-term results were acceptable in terms survival, freedom from reoperation, and event-free survival. Mitral valve repair is recommended for mitral infective endocarditis in most patients.


Subject(s)
Endocarditis/surgery , Heart Valve Diseases/surgery , Heart Valve Prosthesis Implantation , Mitral Valve Annuloplasty , Mitral Valve/surgery , Pericardium/transplantation , Adult , Aged , Endocarditis/diagnostic imaging , Endocarditis/physiopathology , Female , Heart Valve Diseases/diagnostic imaging , Heart Valve Diseases/physiopathology , Heart Valve Prosthesis , Heart Valve Prosthesis Implantation/adverse effects , Heart Valve Prosthesis Implantation/instrumentation , Hemodynamics , Humans , Japan , Male , Middle Aged , Mitral Valve/diagnostic imaging , Mitral Valve/physiopathology , Mitral Valve Annuloplasty/adverse effects , Mitral Valve Annuloplasty/instrumentation , Postoperative Complications/surgery , Recovery of Function , Reoperation , Retrospective Studies , Risk Factors , Time Factors , Treatment Outcome
11.
Ann Vasc Dis ; 13(3): 330-334, 2020 Sep 25.
Article in English | MEDLINE | ID: mdl-33384741

ABSTRACT

Pancreaticoduodenal artery aneurysm (PDAA) is a rare disease without treatment guidelines. We present two patients with PDAA. The first patient was a 70-year-old man with a pseudoaneurysm in the anterior superior pancreaticoduodenal artery (ASPDA), for which we achieved exclusion by endovascular coil embolization. The second patient was a 63-year-old woman with a PDAA in the ASPDA with celiac axis obstruction. Endovascular coil embolization of the aneurysm and the ASPDA was successful without visceral organ ischemia. Endovascular treatment is effective for PDAAs, but careful evaluation of collateral circulation is vital in PDAAs with celiac axis obstruction.

12.
Ann Cardiothorac Surg ; 8(3): 351-361, 2019 May.
Article in English | MEDLINE | ID: mdl-31240179

ABSTRACT

BACKGROUND: Systolic aortic root expansion is reported to facilitate valve opening, but the precise dynamics remain unknown. A sonometric study with a high data sampling rate (200 to 800 Hz) was conducted in an acute ovine model to better understand the timing, mechanisms, and shape of aortic valve opening and closure. METHODS: Eighteen piezoelectric crystals were implanted in 8 sheep at each annular base, commissures, sinus of Valsalva, sinotubular junction, nodulus of Arantius, and ascending aorta (AA). Geometric changes were time related to pressures and flows. RESULTS: The aortic root was hemodynamically divided into left ventricular (LV) and aortic compartments situated, respectively, below and above the leaflets. During isovolumetric contraction (IVC), aortic root expansion started in the LV compartment, most likely due to volume redistribution in the LV outflow tract below the leaflets. This expansion initiated leaflet separation prior to ejection (2.1%±0.5% of total opening area). Aortic compartment expansion was delayed toward the end of IVC, likely related to volume redistribution above the leaflets due to accelerating aortic backflow toward the aortic valve and coronary flow reduction due to myocardial contraction. Maximum valve opening during the first third of ejection acquired a truncated cone shape [leaflet free edge area smaller than annular base area (-41.5%±5.5%)]. The distal orifice became clover shaped because the leaflet free edge area is larger than the commissural area by 16.3%±2.0%. CONCLUSIONS: Aortic valve opening is initiated prior to ejection related to delicate balance between LV, aortic root, and coronary dynamics. It is clover shaped at maximum opening in systole. A better understanding of these mechanisms should stimulate more physiological surgical approaches of valve repair and replacement.

13.
Surg Case Rep ; 5(1): 40, 2019 Mar 12.
Article in English | MEDLINE | ID: mdl-30874919

ABSTRACT

BACKGROUND: Coronary artery aneurysm (CAA) is defined as dilatation exceeding 1.5 times the width of the normal adjacent coronary artery segments. CAA usually causes few symptoms, and rupture is rare, but can be lethal due to cardiac tamponade when it does occur. CASE PRESENTATION: A 79-year-old woman presented with presyncope and back pain. Emergency surgery was performed based on a diagnosis of cardiac tamponade due to either rupture of coronary arteriovenous fistula or CAA. At surgery, a rupture site was located on the wall of the giant CAA, with a diameter of 55 mm, originating from the ostium of the right coronary artery. Suture closure of the inflow and outflow of the aneurysm was performed, and the aneurysmal cavity was obliterated by multiple sutures. The patient made an uneventful recovery and was discharged from hospital on postoperative day 13. CONCLUSION: On the basis of this case, we propose considering rupture of a CAA as one of the causes of cardiac tamponade.

14.
Ann Vasc Dis ; 11(1): 123-126, 2018 Mar 25.
Article in English | MEDLINE | ID: mdl-29682119

ABSTRACT

The combination of a double inferior vena cava (IVC), a retroaortic left renal vein, and azygos continuation of the IVC is extremely rare. Here we report the case of a 74-year-old man with this complex venous anomaly associated with a juxtarenal abdominal aortic aneurysm (AAA), who underwent a successful graft implantation with left renal artery reconstruction without injuring the retroaortic venous system. The venous anomaly was diagnosed using preoperative contrast-enhanced computed tomography (CT). Thus, contrast-enhanced CT can provide sufficient information on AAA and anomalous venous anatomy to avoid fatal complications during AAA surgery.

15.
J Card Surg ; 32(9): 530-536, 2017 Sep.
Article in English | MEDLINE | ID: mdl-28799252

ABSTRACT

BACKGROUND: Conventional indices such as prosthetic valve effective orifice area (EOA) or transvalvular pressure gradients (TPG) may be unreliable in predicting left ventricular (LV) reverse remodeling after aortic valve replacement (AVR). We hypothesized that the global LV afterload, including valvular and arterial impedance, could influence LV reverse remodeling after AVR. METHODS: Twenty-three consecutive aortic-stenosis patients (mean age, 76 ± 6.4 years) underwent isolated AVR using contemporary externally wrapped pericardial valves (19 mm, 10 patients; 21 mm 11; 23 mm, 2). Valvuloarterial impedance (Zva), a marker of global LV afterload, was measured on serial echocardiography in addition to indexed EOA, energy loss index (ELI), mean TPG, and stroke work loss. LV mass regression was used as a parameter of LV reverse remodeling. RESULTS: The Zva significantly decreased after AVR (5.05 ± 1.7 mmHg/mL/m2 , pre-operatively; 3.12 ± 1.0, postoperatively; 3.13 ± 0.89, at last follow-up) in parallel with increased indexed EOA (0.46 ± 0.13 cm2 /m2 ; 1.13 ± 0.24; 0.96 ± 0.19), ELI (0.55 ± 0.21 cm2 /m2 ; 1.74 ± 0.52; 1.47 ± 0.42), and decreased mean TPG (50.2 ± 19.6 mmHg; 11.1 ± 5.4; 14.7 ± 5.8). The stroke work loss also decreased (26.3 ± 8.5 %; 8.65 ± 4.0; 9.36 ± 3.4). The Zva at last follow-up was significantly correlated with LV mass regression (correlation coefficient, r = - 0.48; P = 0.002), and was a significant predictor of LV reverse remodeling on multiple regression analysis (adjusted odds ratio, -0.43; 95% confidence interval, -31.3 to -0.67, P = 0.042), while indexed EOA, ELI, mean TPG, or systemic arterial compliance were not. CONCLUSIONS: The postoperative Zva was significantly associated with LV mass regression after AVR. Maintaining low global LV afterload following AVR may enhance LV reverse remodeling.


Subject(s)
Aortic Valve Stenosis/physiopathology , Aortic Valve Stenosis/surgery , Aortic Valve/surgery , Heart Valve Prosthesis Implantation , Heart Ventricles/physiopathology , Ventricular Function, Left , Ventricular Remodeling/physiology , Aged , Aged, 80 and over , Aortic Valve Stenosis/diagnosis , Echocardiography , Female , Heart Valve Prosthesis Implantation/methods , Humans , Male , Postoperative Period
16.
J Cardiothorac Surg ; 11(1): 92, 2016 Jun 13.
Article in English | MEDLINE | ID: mdl-27297223

ABSTRACT

BACKGROUND: Pericardial effusion (PE) is a common finding in patients who had chronic cardiac failure, who had undergone cardiac surgery, or who had certain other benign and malignant diseases. PE ranges in severity from mild, asymptomatic effusions to cardiac tamponade. Although a thoracoscopic pericardial window (TPW) is a minimally invasive surgical option for patients with PE, there are few published data regarding the outcomes of TPW for PE. We investigated the contribution of the TPW to the treatment of PEs that are recurrent or difficult to drain percutaneously. METHODS: We conducted a retrospective chart review of the indications for TPW that included data on preoperative, intraoperative, and postoperative variables; morbidity; recurrence; and survival. Fourteen consecutive patients with PE that was recurrent or difficult to drain percutaneously and who underwent treatment with a TPW were enrolled in this study. Trocars for passage of the thoracoscope and surgical instruments were introduced through two or three incisions. Mini-thoracotomy was also performed in patients with hemopericardium and loculated fibrinous effusions. All patients were evaluated by face-to-face interviews, transthoracic echocardiography (TTE), and chest radiography 3-6 months after the TPW was obtained. RESULTS: The mean age of the patients was 70 years (range 28-83 years). The operative time was 72.1 ± 29.5 min. Six patients had undergone open heart surgery during the month prior to their presentation with PE. No intraoperative or postoperative complications occurred, although PE had recurred in one patient. Two patients died of malignant disease several months after the TPW. The cardiothoracic ratio (determined on chest radiographs) and the ejection fraction ratio (determined using TTE) had improved at the 3- and 6-month follow-up evaluations (p < 0.0001 and p = 0.012, respectively). Some patients could discontinue diuretics after the procedure, as assessed by the cardiologist based on symptom alleviation, chest radiography, and TTE findings. CONCLUSIONS: For patients with PEs that are recurrent or difficult to drain percutaneously, TPW is an effective, safe surgical approach in terms of cardiac function and radiological findings.


Subject(s)
Pericardial Effusion/surgery , Pericardial Window Techniques , Adult , Aged , Aged, 80 and over , Echocardiography , Female , Humans , Japan , Male , Middle Aged , Operative Time , Pericardial Effusion/diagnostic imaging , Pericardial Effusion/mortality , Postoperative Complications , Radiography, Thoracic , Recurrence , Retrospective Studies , Treatment Outcome
17.
J Heart Valve Dis ; 24(1): 89-91, 2015 Jan.
Article in English | MEDLINE | ID: mdl-26182625

ABSTRACT

Transaortic septal myectomy, known as Morrow's procedure, is a standard treatment for hypertrophic obstructive cardiomyopathy (HOCM). The case is described of a 58-year-old male patient who suffered a repetition of syncope due to HOCM, in whom septal myectomy was performed. As resection of the hypertrophied septum using Morrow's procedure was considered insufficient by palpation to release mitral regurgitation (MR) and systolic anterior motion of the mitral valve, the surgical approach was changed such that the right ventricular outflow tract and ventricular septum was incised. The residual hypertrophied septum was successfully resected to the base of the anterior papillary muscle under direct vision. Postoperative echocardiography demonstrated a dramatic improvement in the MR and left ventricular outflow tract obstruction. The patient's postoperative course was good, with cibenzoline and calcium channel blocker therapy stopped and beta-blocker therapy reduced after surgery. If resection of the hypertrophied septum using Morrow's procedure is considered insufficient, a trans-septal approach represents an adequate option to treat HOCM.


Subject(s)
Cardiac Surgical Procedures , Cardiomyopathy, Hypertrophic/surgery , Heart Septum/surgery , Cardiomyopathy, Hypertrophic/complications , Cardiomyopathy, Hypertrophic/diagnosis , Cardiomyopathy, Hypertrophic/physiopathology , Heart Septum/pathology , Heart Septum/physiopathology , Humans , Male , Middle Aged , Mitral Valve Insufficiency/etiology , Mitral Valve Insufficiency/surgery , Papillary Muscles/surgery , Recurrence , Syncope/diagnosis , Syncope/etiology , Treatment Outcome , Ventricular Outflow Obstruction/etiology , Ventricular Outflow Obstruction/surgery
18.
Kyobu Geka ; 68(13): 1041-4, 2015 Dec.
Article in Japanese | MEDLINE | ID: mdl-26759941

ABSTRACT

Three patients underwent left upper lobectomy with arterioplasty of left pulmonary artery trunk for lung cancer. For pulmonary arterioplasty, wide wedge resection and patch plasty with autologous pericardium was performed. No in-hospital death or no postoperative complications due to arterioplasty was encountered. The mean follow-up period was 3.6 years and long-term patency of the reconstructed pulmonary artery was confirmed by computed tomography in all patients.


Subject(s)
Lung Neoplasms/surgery , Pericardium/transplantation , Pulmonary Artery/surgery , Aged , Autografts , Follow-Up Studies , Humans , Male , Vascular Patency
19.
Kyobu Geka ; 67(4): 323-7, 2014 Apr.
Article in Japanese | MEDLINE | ID: mdl-24917164

ABSTRACT

A 62-year-old man was admitted to a local hospital for cervical abscess. He was given an antibiotic, but his symptoms worsened. Computed tomographic cervical and chest scan 6 days after hospitalization revealed that left cervical abscess extended to the mediastinum. He was transferred to our hospital following a diagnosis of descending necrotizing mediastinitis. Cervical and left transthoracic drainage through a left cervical incision and a left antero-axillary thoracotomy were performed on hospital day 1. On hospital day 2, chest radiograph revealed enlargement of the superior mediastinal shadow. Mediastinoscopic drainage was performed for the abscess in the paratracheal space on hospital day 3. Two mediastinal drainage tubes were placed in the upper and middle mediastinal space using mediastioscopy. Postoperatively, he required additional right transthoracic drainage by chest tube for pleural effusion on hospital day 5. Then his clinical and radiological findings gradually improved, and he was discharged from hospital day 37.


Subject(s)
Drainage/methods , Mediastinitis/surgery , Abscess/surgery , Humans , Male , Mediastinoscopy , Middle Aged , Neck/surgery , Necrosis , Thoracotomy
20.
J Thorac Cardiovasc Surg ; 148(5): 1978-82, 2014 Nov.
Article in English | MEDLINE | ID: mdl-24589200

ABSTRACT

OBJECTIVES: Current guidelines recommended surgery for patients with severe degenerative mitral regurgitation (MR) when specific left ventricular (LV) dimensions or ejection fraction (EF) are reached, based on previous postoperative survival studies. The aim of this study was to evaluate the incidence and predictors of long-term postoperative LV dysfunction, and investigate the preoperative parameters necessary to maintain or recover long-term LV function in the era of mitral valve (MV) repair. METHODS: We retrospectively reviewed 473 consecutive patients undergoing MV repair for severe degenerative MR for whom both preoperative and 3-year postoperative echocardiographic data were available in our institution. Preoperative and 3-year postoperative echocardiographic data and clinical outcomes were evaluated. RESULTS: Receiver operating characteristic analysis identified preoperative LVEF 63% or less (area under curve [AUC], 0.725; P<.001) and LV end-systolic dimension (ESD) 39 mm or greater (AUC, 0.724; P<.001) as cut-off values for predicting LVEF less than 50% 3 years after surgery. On multivariate analysis, both preoperative LVEF and LVESD were not significant predictors of 3-year postoperative LV dysfunction among patients with preoperative LVEF greater than 63% and LVESD less 39 mm, whereas preoperative LVESD (odds ratio [OR], 2.22; P=.004), higher age (OR, 1.03; P=.04), and atrial fibrillation (OR, 2.68; P=.01) were independent predictors among patients with preoperative LVEF 63% or less or LVESD 39 mm or greater. CONCLUSIONS: Early MV repair with LVEF greater than 63% and LVESD less than 39 mm preserved long-term postoperative LV function well, and smaller preoperative LVESD was associated with long-term LV function recovery, even in patients with preoperative LV dysfunction.


Subject(s)
Cardiac Surgical Procedures , Mitral Valve Insufficiency/surgery , Mitral Valve/surgery , Time-to-Treatment , Ventricular Dysfunction, Left/physiopathology , Ventricular Function, Left , Cardiac Surgical Procedures/adverse effects , Echocardiography, Doppler, Color , Humans , Mitral Valve/diagnostic imaging , Mitral Valve/physiopathology , Mitral Valve Insufficiency/diagnosis , Mitral Valve Insufficiency/physiopathology , Recovery of Function , Retrospective Studies , Risk Factors , Severity of Illness Index , Stroke Volume , Time Factors , Treatment Outcome , Ventricular Dysfunction, Left/diagnosis
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