Protracted course of coronavirus disease with severe acute respiratory distress syndrome: a case report.

BACKGROUND: Coronavirus disease (COVID-19) is a growing concern worldwide. Approximately 5% of COVID-19 cases require intensive care. However, the optimal treatment for respiratory failure in COVID-19 patients is yet to be determined. CASE PRESENTATION: A 79-year-old man with severe acute respiratory distress syndrome due to COVID-19 was admitted to our intensive care unit. Prone ventilation was effective in treating the patient's hypoxemia. Furthermore, the patient received lung protective ventilation with a tidal volume of 6-8 mg/kg (predicted body weight). However, the patient's respiratory failure did not improve and he died 16 days after admission because of multiple organ failure. Serial chest computed tomography revealed a change from ground-glass opacity to consolidation pattern in both lungs. CONCLUSIONS: We report a protracted case of COVID-19 in a critically ill patient in Japan. Although prone ventilation could contribute to treating hypoxemia, its efficacy in preventing mortality from COVID-19 is unknown.

Staged hybrid aortic procedure for chronic type B aortic dissection in two patients with Marfan syndrome.

We here report two patients with Marfan syndrome treated by a combination of surgical grafting and endovascular repair in our hospital. One was a 32-year-old woman who underwent thoracoabdominal aortic replacement for a Crawford type III dissected aortic aneurysm. Subsequently, the Bentall procedure and total arch replacement was performed for an aortic root and arch aneurysm. Finally, thoracic endovascular aortic repair bridging implanted grafts was performed. The second was a 67-year-old woman with Stanford type A acute aortic dissection who underwent the Bentall procedure and total arch replacement at the age of 64. Subsequently, she underwent thoracoabdominal replacement for a dilated dissected aortic aneurysm and finally, bridging endovascular aortic repair was performed. This procedure is less invasive than open repair for patients with Marfan syndrome.

Functional assessment of improvement of myocardial ischemia using coronary flow velocity reserve after coronary artery bypass surgery in hemodialysis.

BACKGROUND: In patients with end-stage renal disease requiring hemodialysis (HD patients), myocardial ischemia after coronary artery disease is a major cause of mortality. Coronary pathophysiology, namely myocardial microvascular dysfunction, appears to differ from patients not requiring HD (non-HD patients). OBJECTIVES: We compared functional improvement of myocardial ischemia after coronary artery bypass surgery (CABG) between HD and non-HD patients by transthoracic coronary flow velocity reserve (CFVR). METHODS: We retrospectively reviewed isolated CABG patients from between 2008 and 2017. Finally, 161 patients were enrolled; each underwent pre- and postoperative CFVR assessment, and left anterior descending (LAD) artery revascularization with "in-situ" internal mammary artery (IMA). Graft patency was confirmed, and after successful CABG, postoperative CFVR improvement between the two groups was compared. RESULTS: Preoperative CFVR value in group H was 1.81 ± 0.52, group N was 1.93 ± 0.66. There was no significant difference between the groups. IMA to LAD grafts were patent in postoperative evaluation in all patients. Postoperative CFVR in group H was 2.48 ± 0.72 and group N was 2.83 ± 0.73 (P = .042). Significant difference was observed. CONCLUSION: In both groups, CFVR values improved after successful CABG, but postoperative CFVR values were significant different. In younger populations CFVR values are generally higher. Our HD group was significantly younger than the non-HD group, but CFVR values were postoperatively significantly lower. CFVR values are reportedly affected by both epicardial and microcoronary circulation. In this study population, as all grafts to the LAD were patent, the lower CFVR value in the HD group was considered to have resulted in microvascular disorders.

[Early Postoperative Hemodynamics of Mitral Valvuloplasty Using Colvin-Galloway Future Band].

The Colvin-Galloway( CG) Future annuloplasty band is a new semirigid partial band, which was introduced in 2012 in Japan. A total of 60 consecutive patients who underwent mitral valve repair with the CG Future Band were assessed by echocardiography in terms of residual mitral regurgitation and diastolic mitral function postoperatively. Intraoperative 3-dimensional echocardiography beautifully demonstrated the physiological change of the aortic curtain during the cardiac cycle. 30 mm was used in 18 patients, 32 mm in 17, 28 mm in 15, 34 mm in 5, 36 mm in 2, and 26 mm in 2. There were 2 patients with mild residual mitral regurgitation and 58 patients with less than mild. The mean gradient of diastolic mitral pressure gradient was 2.8±1.3 mmHg. Early results of mitral valve repair with a CG Future Band were acceptable in terms of residual mitral regurgitation and diastolic mitral function after repair.