[Thoracic Endovascular Aortic Repair for Stanford Type B Acute Aortic Dissection with Right Leg Malperfusion:Report of a Case].

We report a case of complicated Stanford type B acute aortic dissection with malperfusion to the right leg. The patient received conservative treatment in a previous hospital. However, he complained of pain in the right leg, which had been gradually turning pale. The patient was diagnosed with complicated Stanford type B acute aortic dissection with right leg malperfusion and was transferred to our hospital for treatment. Thoracic endovascular aortic repair (TEVAR) to close the entry to the distal aortic arch was performed, and we embolized the left subclavian artery to prevent type Ⅱ endoleak and to extend the stent-graft landing zone. We implanted a bare stent into the right external iliac artery to enlarge its true lumen. The patient was discharged from our hospital 22 days postoperatively. After the operation, computed tomography( CT) scan showed an aortic false lumen remodeling.

Biological control of the Japanese pear rust mite, Eriophyes chibaensis (Acari: Eriophyidae) and the Kanzawa spider mite, Tetranychus kanzawai (Acari: Tetranychidae) with Euseius sojaensis (Acari: Phytoseiidae).

Euseius sojaensis (Ehara) is an effective indigenous natural enemy of some eriophyid mites and spider mites in Japan. However, pesticides that are toxic to it are frequently applied in commercial Japanese pear orchards until early summer, when the predator densities are at their peak. Here, we examined the suppressive effect of inoculative release of E. sojaensis on Eriophyes chibaensis Kadono and Tetranychus kanzawai Kishida under conservation control using selective pesticides from late April to late June. The densities of E. sojaensis peaked in early June. In E. sojaensis-release plots, phytoseiid populations were larger, E. chibaensis and T. kanzawai populations were smaller, and rates of leaf mosaic and russeting caused by E. chibaensis were significantly lower than in control plots. These results suggest that E. sojaensis can control E. chibaensis and T. kanzawai populations simultaneously. As it may be difficult to suppress E. chibaensis densities below the control threshold of 50 mites per leaf only by conservation using selective pesticides, enhancement and augmentation of E. sojaensis for sustainable control of mites should be considered as an option in commercial Japanese pear orchards.

Coarctation of the aorta with total anomalous pulmonary venous connection: a case report.

Total anomalous pulmonary venous connection (TAPVC) and coarctation of the aorta (CoA) rarely occur together. In affected patients, blood is supplied to the lower body by saturated ductal flow. Preoperative echocardiography may not show an acceleration of flow at the isthmus (coarctation), and the oxygen saturation (SpO2) at the feet may be satisfactory. Consequently, the severity of CoA is often underestimated before performing surgery. A 6-day-old boy weighing 2.6 kg with a diagnosis of supracardiac TAPVC was referred for surgical correction of his anomaly. The atrial septal defect (ASD) was 6.7 mm in diameter. There was a large patent ductus arteriosus (PDA) without flow acceleration at the preductal entry into the descending aorta. Only the TAPVC repair was planned, but immediately following ligation of the large PDA, the blood pressure in the lower extremity dropped to around 30 mmHg. The ligation was removed. The reason for the blood pressure discrepancy between the upper and the lower body was not clear as there was no arterial line in the upper extremity and a 6.7-mm-diameter ASD can support sufficient blood flow to the lower body without the PDA. A suspected CoA was found and repaired, followed by the TAPVC repair. Caution is necessary when repairing a TAPVC and coexisting large PDA as the severity of the CoA can easily be underestimated due to nonsignificant flow acceleration.

Daily transient discontinuation of extracorporeal LVAD to prevent thromboembolism of mechanical aortic valve prosthesis.

Patients with mechanical aortic valves are generally contraindicated for left ventricular assist device (LVAD) insertion because the prosthetic valve often becomes fixed in closed position. A 41-year-old woman with mechanical aortic valve prosthesis experienced sudden chest pain and developed cardiogenic shock. A paracorporeal pulsatile LVAD and a monopivot centrifugal pump as a right VAD (RVAD) were implanted. The mechanical aortic valve was intentionally left in place. Soon after the operation, LVAD support was discontinued daily for few seconds to allow the mechanical aortic valve to open and to avoid thrombus formation. The patient was successfully weaned off RVAD and received anticoagulation therapy with warfarin. On postoperative day 141, she was transferred to a university hospital where a HeartMate II LVAD was implanted, and the aortic valve was successfully replaced with a bioprosthetic valve. The patient is currently awaiting heart transplantation.

Transareolar Video-Assisted Approach to the Atrial Septal Defect and Tricuspid Valve.

Minimally invasive atrial septal defect closure and tricuspid annuloplasty in female patients are normally performed through a right submammary anterior minithoracotomy approach. However, when the aortic root is located higher, the direction of aortic cannulation becomes not ideal through the submammary incision. In such cases, transareolar approach is useful. Through this approach, aortic cannulation and tricuspid operation can be performed with endoscopic assistance, and ASD closure can be performed under direct vision.

Outcomes of patients who declined surgery for acute Stanford type A aortic dissection with patent false lumen of the ascending aorta.

OBJECTIVES: This study aimed to evaluate the outcomes of patients who did not undergo initial aortic surgery for acute Stanford type A aortic dissection with a patent false lumen of the ascending aorta. METHODS: Inpatient and outpatient records were retrospectively reviewed. RESULTS: We identified 195 patients with acute type A aortic dissection with a patent ascending false lumen between January 1998 and March 2016. Of these, 137 underwent aortic surgery, 16 died before surgery and 42 declined aortic surgery. The ages of the patients who underwent and those who declined aortic surgery were 60.0 ± 10.6 years and 72.3 ± 12.4 years, respectively. The mortality rate of those who underwent and those who declined aortic surgery was 15 and 62% at 30 days and 19% and 67 at 90 days, respectively ( P < 0.0001). In the 58 patients who did not undergo initial aortic surgery, the maximum aortic diameter was correlated with survival ( P = 0.0037). At follow-up (3.7 ± 4.5 years; range 0-16.4 years), survival at 1, 5 and 10 years in those who underwent and those who declined initial aortic surgery was 78, 68 and 49%, and 29, 24 and 12%, respectively ( P < 0.0001). CONCLUSIONS: In this study of patients with acute Stanford type A aortic dissection with a patent false lumen of the ascending aorta, the mortality of those who declined initial aortic surgery was 62% at 30 days and 67% at 90 days, respectively, and a smaller aortic diameter was significantly associated with better survival.

Epicardial Implantable Cardioverter-Defibrillator in a 2-Month-Old Infant.

We describe the implantation of an implantable cardioverter defibrillator (ICD) in a 2-month-old infant with frequent sustained ventricular tachycardia (VT) refractory to antiarrhythmic agents. An epicardial ICD shock coil lead and pacing leads were placed, as was a cumbersome device console that was stored in a pocket between the left external and internal oblique muscles. These methods were safe and feasible even for such a small infant, and possible adverse events were avoided.

Factors associated with a low initial cerebral oxygen saturation value in patients undergoing cardiac surgery.

Regional cerebral oximetry using near-infrared spectroscopy device, an INVOS 5100 C (Medtronic, Minneapolis, MN, USA), during cardiac surgery aims to avoid perioperative neurological impairment, especially during cardiopulmonary bypass. However, it is not uncommon to encounter critically low initial cerebral regional oxygen saturation or a low value unresponsive to intervention. Therefore, it is important to identify factors associated with low saturation value other than true cerebral hypoxia. We investigated the relationship between preoperative regional cerebral oxygen saturation and clinical variables during cardiac surgery. From January 2013 to May 2016, 462 patients underwent elective cardiac surgery. Patient's ≤12 years of age, with acute cerebral infarction, with previous intracranial hemorrhage or neurosurgery, with concomitant aortic surgery, and having off-pump coronary artery bypass surgery were excluded. The remaining 223 patients were monitored by intraoperative regional cerebral oximetry. Univariate analysis found that scalp-cortex distance, cerebrospinal fluid thickness, left ventricular ejection fraction, hemoglobin concentration, estimated glomerular filtration rate, and hemodialysis were significantly correlated with the initial regional oxygen saturation value. Multiple regression analysis revealed that scalp-cortex distance, left ventricular ejection fraction, hemoglobin, and hemodialysis remained as significant variables. A receiver operating characteristic analysis found that for a low initial regional oxygen saturation value of 40%, the thresholds of scalp-cortex distance, left ventricular ejection fraction, and hemoglobin concentration were 17.6 mm, 45.2%, and 7.5 g/dl, respectively. In conclusion, brain atrophy, poor left ventricular function, anemia, and hemodialysis were associated with low initial cerebral regional oxygen saturation values in adult cardiac surgery patients.