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1.
Circ J ; 87(11): 1635-1642, 2023 10 25.
Artigo em Inglês | MEDLINE | ID: mdl-37197976

RESUMO

BACKGROUND: Grafting the right gastroepiploic artery (GEA) to the right coronary artery (RCA) is effective, but preoperative evaluation of arterial conduit availability has not been established. By comparing the midterm graft results, we aimed to assess the efficacy of preoperative evaluation of the GEA using computed tomography (CT).Methods and Results: We retrospectively examined patients who underwent isolated coronary artery bypass grafting surgery between April 2010 and December 2020, and those whose GEA was grafted to the RCA were selected: 55 patients were included in the study analysis. Postoperative evaluations were performed during the early phase, 1 year postoperatively, and at follow-up evaluations. The outer diameter of the proximal GEA was compared with the midterm graft patency grade on CT and patients were classified as Functional (Grade A) or Dysfunctional (Grades O or B). The proximal GEA outer diameters were significantly different between the Functional and Dysfunctional groups (P<0.001). Furthermore, multivariate Cox regression analysis revealed that this diameter was an independent predictor of graft functionality (P<0.001). Patients with outer proximal diameters larger than the cutoff value had superior graft results at 3 years postoperatively. The rate of freedom from a dysfunctional graft at 3 years postoperatively was 95.5% and 45.5% for the Larger and Smaller diameter subgroups, respectively (P<0.001). CONCLUSIONS: Preoperative evaluation of the outer diameter of the proximal GEA, excluding calcified GEA, using CT is a minimally invasive and useful method, and may improve midterm results of in-situ GEA grafting, even in severe stenotic lesions.


Assuntos
Artéria Gastroepiploica , Humanos , Artéria Gastroepiploica/diagnóstico por imagem , Estudos Retrospectivos , Ponte de Artéria Coronária/métodos , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Tomografia Computadorizada por Raios X , Grau de Desobstrução Vascular
2.
Gen Thorac Cardiovasc Surg ; 71(11): 665-673, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36964855

RESUMO

BACKGROUND: We developed a new sternal fixation device, Super FIXSORB WAVE®, a corrugated plate made of u-HA/PLLA, to improve sternal stability after sternotomy. This present study aimed to evaluate the new device clinically. METHODS: This prospective, single-blinded, multicenter trial randomized 69 patients to either wire cerclage only (group C, n = 30) or wire cerclage plus Super FIXSORB WAVE® (group W, n = 39). The primary endpoint was a degree of sternal displacement at six months. Displacement of the sternal halves in the anteroposterior and lateral directions was measured using computed tomography horizontal section images at the third costal and fourth intercostal levels. The secondary endpoints were sternal pain and quality-of-life over 6 months. RESULTS: Group W showed significantly reduced sternal anteroposterior displacement at both the third costal (0 [0-1.9] mm vs. 1.1 [0-2.1] mm; P = 0.014) and fourth intercostal (0 [0-1.0] mm) vs. 1.0 [0-1.8] mm; P = 0.015) levels than group C. In group W, lateral displacement was suppressed without a significant increase from 2 weeks to 6 months, while it increased in group C. There was no significant difference in postoperative sternal pain and quality-of-life between the two groups. No adverse events, such as infection, inflammation, or foreign body reaction, were observed with this device. CONCLUSIONS: Using Super FIXSORB WAVE®, sternal displacement was significantly suppressed in both the anteroposterior and lateral directions. The use of this device results in safe and easy sternal reinforcement without any adverse events, and sternal healing can be accelerated. CLINICAL TRIAL REGISTRY NUMBER: This study was registered in the Japan Registry of Clinical Trials (February 21, 2019; jRCTs032180146).

3.
Ann Thorac Cardiovasc Surg ; 28(1): 63-71, 2022 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-35034937

RESUMO

PURPOSE: Saphenous vein graft (SVG) is the most commonly used conduits in coronary artery bypass grafting (CABG), but the disadvantage of SVG is its tendency for progressive failure. We hypothesized that therapeutic-dose warfarin (international normalized ratio [INR] >1.6) plus aspirin improve SVG patency. This study aimed to evaluate the factors contributing to SVG patency. METHODS: Since 2010-2020, 199 patients who underwent isolated CABG using SVG were divided into two groups according to their INR values in the first year: group T (INR >1.6) and group L (INR <1.6). RESULTS: Group T had 162 SVGs (105 patients) and group L had 151 SVGs (94 patients). The 1-, 4-, and 7-year SVG patency rates were higher in group T than in group L (99%, 96%, and 92% vs. 93%, 86%, and 79%, respectively; p = 0.00378). The 1-, 4-, and 7-year freedom from repeat-revascularization was higher in group T than in group L (100%, 100%, and 99% vs. 98%, 95%, and 87%, respectively; p = 0.0264). Multivariate analysis showed that therapeutic-dose warfarin (p = 0.00204) and target vessel diameter (p <0.0001) were independent risk factors of SVG occlusion. CONCLUSION: Therapeutic-dose warfarin (INR >1.6) plus aspirin after CABG improved the long-term patency of SVG and decreased repeat-revascularization rate.


Assuntos
Veia Safena , Varfarina , Aspirina , Angiografia Coronária , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Humanos , Coeficiente Internacional Normatizado , Veia Safena/diagnóstico por imagem , Veia Safena/transplante , Resultado do Tratamento , Grau de Desobstrução Vascular
4.
Surg Case Rep ; 7(1): 75, 2021 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-33759073

RESUMO

BACKGROUND: Primary cardiac schwannoma in the left atrium and schwannomatosis are rare diseases. CASE PRESENTATION: We report the case of a 46-year-old asymptomatic man who had tumor resection for parapharyngeal schwannoma at another institute 1 year ago. He was presented to our hospital for further evaluation of an abnormal cardiac shadow that was found incidentally. Computed tomography and transesophageal echocardiography revealed a cardiac tumor originating from the posterior wall of the left atrium, an atrial septal defect, and two other mediastinal tumors. The cardiac mass was completely excised with normal margins of the surrounding atrial wall. The post-resection defect and atrial septal defect were repaired using bovine pericardium. Pathological findings were compatible with benign schwannoma, and a diagnosis of schwannomatosis was made based on his medical history. CONCLUSION: Primary cardiac schwannoma is an exceedingly rare tumor, and the incidence in schwannomatosis has not been reported in the literature.

5.
Kyobu Geka ; 71(13): 1118-1121, 2018 12.
Artigo em Japonês | MEDLINE | ID: mdl-30587754

RESUMO

We experienced an explantation of Wada-Cutter prosthetic tilting disk valve of 47 years after implantation. The patient was 53 years old female who underwent the 1st operation for Ebstein's anomaly, which included tricuspid valve replacement (TVR), closure of atrial septal defect (ASD) and posterior annulorrhaphy when she was 6 years old. She was doing well after the 1st operation without symptom,but dyspnea and systemic edema worsened recently though increased admission of diuretics. Echocardiography revealed severe tricuspid valve stenosis, severe tricuspid valve insufficiency, and increased right atrium volume. The tilting disk of the valve was almost fixed. The patient underwent repeat TVR. The explanted Wada-Cutter valve was covered by pannus the whole casing and disk. The structure of the valve was preserved but the occlusion disk was almost fixed by pannus formation, not distorted or dislodged.


Assuntos
Anomalia de Ebstein/cirurgia , Próteses Valvulares Cardíacas , Complicações Pós-Operatórias/cirurgia , Insuficiência da Valva Tricúspide/etiologia , Estenose da Valva Tricúspide/cirurgia , Valva Tricúspide/cirurgia , Criança , Análise de Falha de Equipamento , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Reoperação , Fatores de Tempo , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/cirurgia , Estenose da Valva Tricúspide/diagnóstico por imagem , Estenose da Valva Tricúspide/etiologia
6.
Ann Thorac Surg ; 103(2): e153-e155, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28109377

RESUMO

We describe a very rare case of a 67-year-old man with multiple saccular aortic aneurysms throughout the entire aorta due to antineutrophil cytoplasmic antibody-associated vasculitis (AAV). The patient underwent staged aortic surgical procedures, including stent-graft insertion for a left iliac artery aneurysm, thoracic endovascular aortic repair for a descending aortic aneurysm, and total replacement of the ascending aorta and aortic arch with the use of high-dose steroids to control inflammation. The histologic findings demonstrated that the damage to the vasa vasorum of the adventitia resulting from AAV caused ischemia of the media, resulting in the formation of saccular aneurysmal changes.


Assuntos
Angioplastia/métodos , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/complicações , Aneurisma da Aorta Torácica/imunologia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Angiografia por Tomografia Computadorizada/métodos , Idoso , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/diagnóstico , Aneurisma da Aorta Torácica/diagnóstico por imagem , Seguimentos , Humanos , Imageamento Tridimensional , Masculino , Doenças Raras , Medição de Risco , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/métodos
7.
Asian Cardiovasc Thorac Ann ; 23(7): 864-5, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24604550

RESUMO

Thoracic endovascular aortic repair is a valuable alternative treatment option for patients with thoracic aortic aneurysms and type B dissections. However, thoracic endovascular aortic repair is associated with the risk of previously unanticipated severe complications including retrograde ascending aortic dissection. We report the case of an 86-year-old man who developed retrograde ascending aortic dissection as a delayed complication of thoracic endovascular aortic repair. Open surgical repair resulted in a successful outcome.


Assuntos
Aneurisma da Aorta Torácica , Dissecção Aórtica , Implante de Prótese Vascular , Procedimentos Endovasculares , Idoso de 80 Anos ou mais , Dissecção Aórtica/diagnóstico , Dissecção Aórtica/etiologia , Dissecção Aórtica/fisiopatologia , Dissecção Aórtica/cirurgia , Aneurisma da Aorta Torácica/patologia , Aneurisma da Aorta Torácica/cirurgia , Aortografia/métodos , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/métodos , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/métodos , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Reoperação/métodos , Stents , Tomografia Computadorizada por Raios X , Resultado do Tratamento
8.
Kyobu Geka ; 65(2): 128-31, 2012 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-22314168

RESUMO

A 78-year-old female presented at a nearby hospital with hemorrhage and loss of consciousness. After examination by computed tomography (CT) scan, she was referred to our hospital on suspicion of an impending rupture of the descending thoracic aorta aneurysm. She underwent a 2 stage operation. At the 1st operation, graft replacement of the descending aorta and closing of the aneurysmal wall over the aortoesophageal fistula were performed. On the 2nd postoperative day, intrathoracic esophagogastrostomy was performed by the gastric tube interposition technique. On the 54th postoperative day, she was discharged to a rehabilitation hospital.


Assuntos
Aneurisma da Aorta Torácica/complicações , Doenças da Aorta/etiologia , Fístula Esofágica/etiologia , Fístula Vascular/etiologia , Idoso , Aneurisma da Aorta Torácica/cirurgia , Doenças da Aorta/cirurgia , Fístula Esofágica/cirurgia , Feminino , Humanos , Fístula Vascular/cirurgia
9.
Kyobu Geka ; 63(7): 594-7, 2010 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-20662243

RESUMO

Cardiac surgery in very elderly patients, especially in nonagenarians, has been a controversial issue of its relative risk, benefits and long-term survival. A 91-year-old woman was referred to our institution for an acute anterior myocardial infarction. Emergency coronary intervention was conducted and the occluded left anterior descending artery was successfully revascularized with a bare metal stent. Soon after reperfusion, her hemodynamics significantly collapsed and the subsequent left ventriculography revealed a large shunt to the right ventricle. Considering her self-sufficient daily life and the family's wishes, emergency surgical repair of anterior ventricular septal rupture was performed by infarct exclusion method using 2-patch technique. The patient recovered uneventfully and was discharged on postoperative day 24.


Assuntos
Ruptura Cardíaca Pós-Infarto/cirurgia , Idoso de 80 Anos ou mais , Emergências , Feminino , Septos Cardíacos/cirurgia , Humanos
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