[show abstract][hide abstract] ABSTRACT: Gastric antral vascular ectasia (GAVE) has been recognized as one of the important causes of occult and obscure gastrointestinal bleeding. The diagnosis is typically made based on the characteristic endoscopic features, including longitudinal row of flat, reddish stripes radiating from the pylorus into the antrum that resemble the stripes on a watermelon. These appearances, however, can easily be misinterpreted as moderate to severe gastritis. Although it is believed that capsule endoscopy (CE) is not helpful for the study of the stomach with its large lumen, GAVE can be more likely to be detected at CE rather than conventional endoscopy. CE can be regarded as "physiologic" endoscopy, without the need for gastric inflation and subsequent compression of the vasculature. The blood flow of the ecstatic vessels may be diminished in an inflated stomach. Therefore, GAVE may be prominent in CE. We herein describe a case of active bleeding from GAVE detected by CE and would like to emphasize a possibility that CE can improve diagnostic yields for GAVE.
World journal of gastrointestinal endoscopy. 03/2013; 5(3):138-40.
[show abstract][hide abstract] ABSTRACT: OBJECTIVES: Postoperative infection control is one of the most important issues for infected aortic aneurysms, and the methods of preventing recurrent infection remain controversial. We previously reported that omental flaps could prevent or reduce the occurrence of infection after implanting an artificial aortic graft. However, the long-term outcomes of this strategy are unknown. We used imaging modalities to evaluate whether wrapping prosthetic grafts with omentum prevents postoperative graft infection over the long-term. METHODS: We surgically treated 521 patients with thoracic aortic aneurysm (TAA) at our hospital between July 1995 and May 2012. Of these, 22 (3.9%) (male, n = 17; mean age, 68.2 ± 11.4 years) had infectious TAA. All infectious aneurysms were resected, all patients received in-situ grafts and 16 grafts were wrapped with omentum. We followed up all survivors annually using computed tomography. We also used angiography to investigate blood circulation in omental flaps over the long-term. RESULTS: Five patients died in-hospital (operative mortality, 26.3%). The operative mortality rates of patients with and without omental wrapping were 12.5 and 50.0%, respectively (P = 0.06, NS), and the 5-year event-free survival rates were 84.6 and 33.3% (P = 0.025), respectively. Omental flaps around prosthetic grafts and their blood circulation were well-preserved over the long-term. CONCLUSIONS: Wrapping implanted artificial aortic grafts with omental flaps could prevent or reduce the occurrence of subsequent infection. Furthermore, blood circulation in the flaps must be well-preserved to improve the long-term outcomes.
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 12/2012; · 2.40 Impact Factor
[show abstract][hide abstract] ABSTRACT: A right-sided aortic arch associated with an aberrant subclavian artery is a rare anomaly. Regardless, this condition is clinically relevant because mortality is associated with rupture, morbidity results from compression of mediastinal structures, and the surgery is complex. We describe the successful surgical repair of this vascular anomaly by totally debranching the neck vessels and placing an endovascular stent-graft to exclude the ruptured Kommerell's diverticulum.
Asian cardiovascular & thoracic annals 10/2012; 20(5):587-90.
[show abstract][hide abstract] ABSTRACT: Background: Oxidative stress due to reactive oxygen species (ROS) is thought to play a considerable role in ischemia/reperfusion (I/R) injury that impairs cardiac function. The present study examined oxidative damage in I/R injury and investigated the correlation between oxidative stress and impaired cardiac function after I/R injury of the isolated rat heart.Methods: Hearts isolated from male Sprague-Dawley rats were mounted on a Langendorff apparatus. Hearts arrested using St. Thomas cardioplegic solution and then they were reperfused. The hearts were divided into three groups depending on the frequency (0-2) of I/R. After I/R, left ventricular developed pressure (LVDP), left ventricular end-diastolic pressure (LVEDP), positive maximum left ventricular developing pressure (max LV dP/dt) and coronary flow (CF) were measured. Creatine kinase (CK) was measured in the coronary effluent and 8-hydroxy-2'deoxyguanosine (8OHdG), a marker of oxidative DNA damage, was measured. Adenosine triphosphate (ATP) was measured from frozen myocardial tissue after experiment. Results: We immunohistochemically demonstrated and quantified levels of 8-OHdG after I/R injury of the heart. The frequency of I/R injury and cardiac dysfunction significantly and negatively correlated. The ATP products were similar among the three groups. The incidence of ventricular arrhythmias was not by affected oxidative stress.Conclusion: The frequency of I/R injury had more of an effect on 8-OHdG products and on impaired cardiac function with less myocyte damage than ischemic duration within 30 minutes of ischemia.
Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 08/2012;
[show abstract][hide abstract] ABSTRACT: Rapid restoration of flow into the true lumen and obliteration of a false lumen is considered the optimal approach to treating malperfusion syndrome due to acute aortic dissection. However, organ malperfusion can occasionally persist after proximal aortic graft replacement despite redirecting blood flow into the true lumen. A 35-year old man underwent the modified Bentall procedure for Stanford type A acute aortic dissection without organ malperfusion. Ischaemia of the visceral and lower extremities developed on postoperative day 8. Enhanced computed tomography (CT) revealed a thrombus in the false lumen interfering with the true lumen above the celiac trunk. We immediately performed a left axillary-to-bilateral femoral artery bypass. The patient recovered uneventfully and was discharged on postoperative day 28. Although organ malperfusion persisting after proximal aortic graft replacement despite redirecting blood flow into the true lumen is rare, close observation remains imperative after central repair of type A dissection.
Interactive cardiovascular and thoracic surgery 07/2012; 15(4):794-6.
[show abstract][hide abstract] ABSTRACT: We describe concomitant Marfan syndrome and Takayasu's arteritis complicating a pseudoaneurysm of the left ventricular outflow that developed after aortic root reconstruction. A patient was admitted with a high fever four months after initial root reconstruction that included valve sparing (reimplantation) as well as coronary artery reconstruction using a Carrel's button technique. Computed tomography revealed a pseudoaneurysm at the posterior side of the aortic root. We applied a modified Bentall procedure including coronary artery reconstruction using the Piehler technique. Pathological assessment of a specimen of the aorta revealed no central medial necrosis, but significant lymphocytic infiltration and thick fibrous adventitia indicating Takayasu's arteritis. This case was unique in terms of having simultaneous Takayasu's arteritis and cardiovascular manifestations of Marfan syndrome that were surgically treated.
[show abstract][hide abstract] ABSTRACT: Objective: Late cardiac and aortic reoperation after CABG is indispensable for patients with atherosclerotic disease, but reoperations are still associated with high morbidity rates. Patients and methods: Between January 2002 and December 2010, 459 patients underwent coronary artery bypass grafting. Six patients (males; mean age, 65.0 ± 5.7 years) with previous arterial bypass grafts (mean, 2.8 ± 1.2 per patient) required reoperation for cardiac and aortic disease (3, valvular disease; 3, acute type I aortic dissection) during long-term follow-up. The mean interval between the initial operation and reoperation was 5.4 ± 2.0 years. Grafts visualized by preoperative enhanced computed tomography were harvested as pedicles and clamped for myocardial protection. The total arch or ascending aorta was replaced in three patients. The aortic valve was replaced in two patients, and the aortic and mitral valves were replaced in one. Results: Durations for surgery, total cardiopulmonary bypass, and cardiac ischemia were 611.5 ± 172.6, 223.2 ± 88.4, and 133.4 ± 58.0 minutes, respectively. Perioperative myocardial infarction did not develop, and all patients recovered uneventfully with no neurological deficits. Conclusion: Bypass grafts should be preoperatively visualized and carefully exposed. Cardiac damage must be avoided during reoperation after coronary artery bypass grafting.
Annals of Vascular Diseases 01/2011; 4(4):299-305.
[show abstract][hide abstract] ABSTRACT: The prevention of cerebral injury is an important consideration during the repair of an aortic arch aneurysm, and this is a major goal of cerebral protection techniques. We describe extended thoracic aortic aneurysms treated by use of our current surgical strategy.
From January 2001 to June 2008, a total of 17 patients (12 men and 5 women; mean age 67.3 ± 7.3 yrs) underwent total arch replacement using bilateral axillary arterial perfusion. Six and 11 had nondissecting and dissecting aneurysms, respectively. Four patients (23.5%) with an impending ruptured aneurysm of the arch aorta or acute type A dissection underwent emergency surgery. We used bilateral axillary arteries for systemic as well as selective cerebral perfusion during the procedures.
One patient died in the hospital (mortality rate, 5.9%) because of multiple organ failure. Mechanical ventilation was required after surgery for 4.6 ± 3.1 days. Permanent neurological dysfunction did not arise in this series. Although prolonged mechanical ventilation support was necessary, all patients recovered uneventfully from the procedures.
We consider that median sternotomy, along with the left anterolateral thoracotomy approach and perfusion from the bilateral axillary arteries, illustrates the safety of the method. Moreover, our results suggested that perfusion from the bilateral axillary arteries can help to prevent cerebral damage.
Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 08/2010; 16(4):259-63.
[show abstract][hide abstract] ABSTRACT: We describe total arch replacement after ascending aortic replacement for acute type II dissecting aneurysm with associated anomaly of the left vertebral artery. A female patient was recommended at 10 years of age after the initial operation because of an enlargement of the distal ascending aorta. Magnetic resonance angiography revealed an isolated left vertebral artery that arises distal to the left subclavian artery. Total arch replacement was proceeding using selective cerebral perfusion. The isolated artery was reconstructed with a saphenous vein graft interposed between the native left vertebral artery and the side of the graft branch anastomosed to the left subclavian artery. The patient recovered uneventfully after extensive surgical replacement of the thoracic aorta and remains asymptomatic at 1 year after the procedure. To prevent possible neurological complications, we find it critical to assess vascularization in this region prior to conducting surgical procedure. Careful examination and correct identification of the vessels are essential to avoid major complications.
Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 06/2010; 16(3):216-9.
[show abstract][hide abstract] ABSTRACT: We describe a case of pseudoaneurysm of the internal thoracic artery, which was probably caused by infection. Four weeks after aortic valve replacement and coronary artery bypass surgery, an 84-year-old woman suddenly developed painful sternal instability and hypotension, with active hemorrhage from a left parasternal swelling. Selective arteriography revealed a pseudoaneurysm of the left internal thoracic artery. It was surgically excised, and the patient recovered uneventfully.
Asian cardiovascular & thoracic annals 10/2009; 17(5):519-21.
[show abstract][hide abstract] ABSTRACT: Distal reoperations for aortic dissection are associated with high morbidity rates. We describe distal aortic enlargement that was treated using our surgical strategy.
From January 1997 to April 2008, 63 patients underwent ascending aortic replacement for acute type A aortic dissection. Four patients (7.4%; 3 males, 1 female; mean age, 67.8 +/- 4.6 years) required reoperation for distal enlargement after long-term follow-up. Individual 5- and 10-year rates of those remaining free of reoperation after the initial procedure were 94.9% and 83.0%, respectively. At reoperation, a median sternotomy with left anterolateral thoracotomy provided a good visual field, and bilateral axillary arteries were preferentially used for systemic as well as selective cerebral perfusion.
Mechanical ventilation was required after surgery for 3.0 +/- 1.4 days. No new phrenic or left recurrent laryngeal nerve palsy or permanent neurological dysfunction occurred in this series. Although the surgical duration and relative mechanical circulation time were significantly elongated, all patients recovered uneventfully.
We postulate that the surgical principle involved in treating aortic dissection is a resection of the aortic segment containing the initial intimal tear and graft replacement, especially in acute dissection. Our results showed that total arch replacement through a median sternotomy and left anterolateral thoracotomy seem to be helpful for extended replacement of the thoracic aorta, as well as in the distal reoperation for dissecting type A. Moreover, our results suggested that perfusion from bilateral axillary arteries is useful to prevent cerebral damage.
Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 10/2009; 15(5):318-23.
[show abstract][hide abstract] ABSTRACT: Prevention of cerebral injury is an important consideration during repair of aortic arch aneurysm, and the major goal of cerebral protection techniques. We describe our surgical strategy for treatment of extended thoracic aortic aneurysms. Between January 2001 and June 2008, 17 men and 6 women, with a mean age of 67.9 +/- 8.3 years, underwent total replacement of the arch and descending aorta. Six (26.1%) patients required emergency surgery. A median sternotomy with a left anterolateral thoracotomy provided a good visual field, and bilateral axillary arteries were preferentially used for systemic as well as selective cerebral perfusion. Two (8.7%) patients died in hospital. Prolonged mechanical ventilation was required for 7.3 +/- 8.4 days after surgery in 17 patients who all recovered uneventfully. Permanent neurological dysfunction developed in 1 (4.3%) patient who died of sepsis 2 years after the operation. Our results suggest that total arch replacement through a median sternotomy plus a left anterolateral thoracotomy is helpful for extended replacement of the thoracic aorta as well as distal reoperation for dissecting type A aortic aneurysm. Perfusion via bilateral axillary arteries may improve cerebral protection.
Asian cardiovascular & thoracic annals 09/2009; 17(4):373-7.