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ABSTRACT: A 32-year-old woman with Marfan syndrome experienced acute superior vena cava syndrome due to aortic dissection. The patient had previously undergone a Bentall operation. The aneurysm from the ascending to the transverse aorta compressed the superior vena cava, the right pulmonary artery, and the trachea. The rare and life-threatening neurological complication in this patient may have been related to brain edema, which was revealed by preoperative computed tomography. The induction of general anesthesia aggravated the symptoms of the superior vena cava syndrome and led to a fatal condition. Additional cannulation in the right subclavian vein was mandatory to alleviate the symptoms because the venous drainage from the upper half of the body created only by the femorofemoral bypass was not adequate. Total arch replacement was performed. The postoperative course was uneventful.
General Thoracic and Cardiovascular Surgery 05/2012;
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ABSTRACT: An asymptomatic 50-year-old Japanese man was diagnosed with an aortic subannular left ventricular aneurysm during a routine
physical checkup. Operative findings showed the subaortic aneurysm had developed beneath the noncoronary cusp of the aortic
valve and expanded into the epicardium between the aortic root and left atrium. The operation involved patch closure of the
orifice of the annular subaortic aneurysm, aortic valvuloplasty, and plication of the dilated ascending aorta.
The Japanese Journal of Thoracic and Cardiovascular Surgery 04/2012; 49(5):324-326.
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The Journal of thoracic and cardiovascular surgery 06/2011; 142(5):1272-3. · 3.41 Impact Factor
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ABSTRACT: Preference for arterial inflow during surgery for type A acute aortic dissection remains controversial. Antegrade central perfusion prevents malperfusion and retrograde embolism, and the ascending aorta provides arterial access for rapid establishment of systemic perfusion, especially if there is hemodynamic instability. It has not been used routinely, however, because of the disruption caused to the aorta. We evaluated the safety and efficacy of routine cannulation of the dissected aorta for the repair of type A dissection.
Surgical results were analyzed for 83 consecutive patients with type A acute aortic dissection between 2002 and 2009. They were treated surgically by prosthetic graft replacement under hypothermic circulatory arrest. The ascending aorta was routinely cannulated using the Seldinger technique with epiaortic echocardiographic guidance; antegrade systemic perfusion was evaluated by color Doppler ultrasound.
Systemic antegrade perfusion via the dissected ascending aorta was performed safely in all cases. There was no malperfusion or thromboembolism as a result of ascending aortic cannulation. Epiaortic 2-dimensional and color Doppler imaging provided real-time monitoring adequate for the placement and for proper systemic perfusion. There were 5 in-hospital deaths (5/83=6.0%) and 8 strokes (preoperative 6/83=7.2%, postoperative 2/83=2.4%). A total of 78 patients (78/83=94%) were discharged and have been followed up without major adverse cardiac events for a mean duration of 31.8 months.
Ascending aortic cannulation is a simple and safe technique that provides a rapid and reliable route of antegrade central systemic perfusion in type A aortic dissection.
The Journal of thoracic and cardiovascular surgery 02/2011; 141(2):354-60. · 3.41 Impact Factor
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ABSTRACT: Previous aortic valve replacement (AVR) is considered to be an independent risk factor for late acute type A aortic dissection (AAAD). However, the predictors of late AAAD at the time of AVR have not been characterized.
A total of 285 patients who underwent isolated AVR were followed for 7.6 ± 8.1 years (mean ± SD). These 285 patients were divided into two groups. Group A consisted of 275 patients who did not develop late aortic complications after AVR, and group B consisted of 10 patients (3.5%) who developed late AAAD after AVR.
The mean time interval between initial AVR and developing late AAAD was 6.1 ± 5.2 years. The diameter of the ascending aorta at the time of AVR was significantly greater in group B than those of group A (47.7 ± 4.6 vs. 35.6 ± 6.3 mm; P < 0.001). Univariate analysis identified other predictors as well: aortic regurgitation (P = 0.029), systemic hypertension (P < 0.001), thinning or fragility of the aortic wall (P < 0.001), and male sex (P = 0.039).
Aortic regurgitation combined with systemic hypertension, male sex, and thinned or fragile aortic walls in patients with ascending aortic dilatation (≥45 mm diameter) at the time of AVR may be predisposing factors for postsurgical aortic complications. These patients should be considered for concomitant replacement of the ascending aorta unless the patient has a high operative risk or older age.
General Thoracic and Cardiovascular Surgery 12/2010; 58(12):601-5.
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The Lancet 05/2010; 375(9725):1578. · 38.28 Impact Factor
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ABSTRACT: A 67-year-old woman with peripheral arterial occlusive disease in both lower extremities, secondary to an abdominal aortic aneurysm, developed chronic total occlusion of the abdominal aortic aneurysm during the 3-year follow-up period. She suffered from sudden onset of paraplegia 3 months after palliative axillobifemoral bypass grafting and died of pneumonia. The paraplegia was considered to have been caused by thrombosis of lumbar arteries that might have served as an important collateral pathway in the distal spinal cord, due to proximally propagated infrarenal aortic thrombosis. It is necessary to recognize that chronically thrombosed abdominal aortic aneurysm (AAA) still has a risk of causing serious complications with a high mortality rate, especially in cases treated medically or with palliative operations.
Annals of Vascular Diseases 01/2010; 3(3):240-3.
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ABSTRACT: A few successful reports exist of late revascularisation of an 'occluded' left anterior descending coronary artery (LAD) with no angiographically visible collateral circulation. Epicardial high-frequency ultrasound and colour Doppler mapping can directly provide accurate anatomical landmarks and also detect very slow coronary flow velocities, with greater sensitivity than coronary angiograms. Late revascularisation of a chronically occluded LAD was performed successfully in two diabetic patients using high-frequency epicardial echo guidance. This had a positive effect on the left ventricular ejection fraction in the hibernating myocardial segments, and there were no subsequent cardiac events as well. These results indicate that the poor prognosis in diabetic patients with very severely reduced left ventricular function and reduced myocardial viability may be improved by late surgical revascularisation of chronic total occlusion (CTO) with no retrograde collateral channel.
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 09/2009; 37(1):239-41. · 2.40 Impact Factor
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ABSTRACT: Acute compressive hemomediastinum due to type A acute aortic dissection in a 70-year-old man caused acute simultaneous obstruction of pulmonary artery and superior vena cava, leading to sudden death, presenting acute progressive bruising of the upper half of the body and subsequent massive hemoptysis. Computed tomography scanning revealed acute severe stenosis of the superior vena cava and right pulmonary artery by mediastinal hematoma. Mediastinal hematoma combined with simultaneous obstruction of pulmonary artery and superior vena cava is a rare entity and should be recognized as one of the acutely fatal signs of type A dissection.
Interactive cardiovascular and thoracic surgery 12/2008; 8(2):275-6.
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ABSTRACT: This study assessed the effects of prosthesis-patient mismatch (PPM) after aortic valve replacement (AVR) using mechanical prostheses in patients with aortic stenosis.
A total of 124 patients with aortic stenosis who underwent AVR with mechanical prostheses were followed (mean 9.1+/-4.9 years). The patients were divided into two groups based on the effective orifice area index (EOAI): Group A did not have significant PPM, defined as an EOAI>or=0.85 cm2/m2; and the PPM group had significant PPM, defined as an EOAI<0.85 cm2/m2.
In all, 25 patients (20.2%) had PPM. The operative mortality was 6.1% in group A and 12.0% in the PPM group; the difference between the groups was not significant. Moreover, the difference in overall survival rates between group A and the PPM group was not statistically significant (15-year postoperative survival: group A 78.5% vs. PPM group 81.3%). Although there were four late deaths in the PPM group, only one was valve-related. PPM had no effect on late survival. Postoperatively, cardiac function and physical activity levels improved in both groups; the extent of improvement was not dependent on the presence or severity of PPM.
Although PPM may affect operative mortality, the effect of PPM appears to decrease over time. PPM had no effect on late survival.
General Thoracic and Cardiovascular Surgery 12/2008; 56(12):577-83.
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ABSTRACT: We performed coronary artery bypass grafting in an urgent and rare case of acute coronary syndrome with moyamoya disease in a 75-year-old female. Because of collateral dependent severe cerebrovascular obstruction, additional support for brain protection was necessary; we used high pressure pulsatile perfusion assist to maintain cerebral circulation with an intra-aortic balloon pump support throughout the cardiopulmonary bypass, giving a successful outcome.
Interactive cardiovascular and thoracic surgery 06/2008; 7(3):522-3.
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ABSTRACT: Antegrade perfusion for type A acute aortic dissection prevents malperfusion and retrograde cerebral embolism during cardiopulmonary bypass. Prompt establishment of antegrade perfusion via ascending aorta may improve the surgical results of type A dissections, especially in the situations of hemodynamic instability. Thus, we evaluated the efficacy of use of the dissected ascending aorta as an alternative arterial inflow.
Between 2002 and 2006, 32 patients underwent prosthetic graft replacement of the ascending aorta or hemiarch for acute type A aortic dissection. The ascending aorta was routinely cannulated, in addition to the femoral artery, with a heparin-coating flexible cannula for arterial inflow, using Seldinger technique, and by epiaortic ultrasonographic guidance (n=6). Antegrade systemic perfusion via ascending aorta was performed.
Ascending aorta cannulation was safely performed in all cases. There was no malperfusion or thromboembolism due to ascending aorta cannulation. Cardiopulmonary bypass was established within 30 min after skin incision. There was one in-hospital death due to duodenal bleeding (1/32=3.1%), two cases of cerebral infarction (2/32=6.3%), and one case of pulmonary embolism. Twenty-nine patients (29/32=90.6%) were discharged in New York Heart Association class I and have been followed up uneventfully for a mean of 17 months.
Antegrade perfusion via the ascending aorta was successfully performed with low mortality and morbidity. With ultrasound-guided Seldinger technique, ascending aorta cannulation has a potential to be a simple and safe option that enables rapid establishment of antegrade systemic perfusion in patients with acute type A aortic dissection.
European Journal of Cardio-Thoracic Surgery 07/2007; 31(6):976-9; discussion 979-81. · 2.55 Impact Factor
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ABSTRACT: Complete removal of a previously implanted dysfunctional mitral bioprosthesis could result in extensive damage. Therefore, a 66-year-old female patient with a deteriorated mitral bioprosthesis had leaflet excision, and a "new" mechanical valve was sewn onto the previously implanted bioprosthetic sewing cuff. On postoperative echocardiography, the implanted valve had good hemodynamic performance with no paravalvular leakage. The patient's clinical condition improved after surgery.
General Thoracic and Cardiovascular Surgery 05/2007; 55(4):167-9.
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ABSTRACT: Left ventricular outflow obstruction may result from preserving the anterior leaflet after mitral valve replacement. A 79-year-old woman, who had a mitral valve replacement with the native mitral leaflets left intact 16 years before, was admitted to our hospital with severe dyspnea due to heart failure. Echocardiography showed systolic anterior motion of preserved anterior mitral leaflet, and continuous wave Doppler detected severe left ventricular outflow tract jets during systole without mitral chordal rupture. Surgical incising of the anterior mitral leaflet through the aortic root relieved the obstruction without removing the prosthetic mitral valve.
The Annals of thoracic surgery 09/2006; 82(2):735-7. · 3.74 Impact Factor
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ABSTRACT: Pulmonary vein isolation is a simple procedure, which has recently been reported as an effective treatment for the termination of atrial fibrillation. Although there are several clinical reports of beating-heart epicardial ablation, the optimal temperature has not been experimentally investigated. We evaluated the effective temperature for the placement of circular lesions around the pulmonary vein-left atrial junction.
Twelve swine underwent epicardial ablation to create linear conduction block lesions around the pulmonary vein-left atrial junction by a seven-electrode ablation catheter. The ablation was performed at 60 degrees C (group I), 70 degrees C (group II), 80 degrees C (group III), and 90 degrees C (group IV) for 120 seconds. The creation of a firm conduction block across the ablated lesion under pacing was compared.
Complete conduction block was observed in all groups except group I. However, heat injury to adjacent structures in group IV and transient discoloration of the tissue surrounding coronary arteries in groups III and IV were observed.
The effective temperature for epicardial radiofrequency pulmonary vein isolation was 120 minutes and above 70 degrees C.
The Annals of thoracic surgery 08/2004; 78(1):308-11; discussion 312. · 3.74 Impact Factor
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Nihon Naika Gakkai Zasshi 02/2004; 93(1):142-4.
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ABSTRACT: A 71-year-old Japanese woman with severe chest pain was diagnosed with Stanford type A acute aortic dissection. After 3 months of medical treatment, she was operated on under a diagnosis of dissecting aneurysm of the ascending aorta and severe aortic regurgitation. Operative findings showed prolapse of the redundant aortic leaflets and a dilated ascending aorta without intimal tears. Operative and computed tomography findings differed from those of a classical dissection, which was the primary diagnosis of this patient, and were compatible with a diagnosis of aortic intramural hematoma (IMH). Few reports of IMH include concomitant aortic regurgitation. Surgery involved aortic root remodeling and prosthetic graft replacement of the ascending aorta.
The Japanese Journal of Thoracic and Cardiovascular Surgery 06/2003; 51(5):198-200.
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ABSTRACT: We successfully treated a 54 year old woman suffering pulmonary stenosis with chronic and drug resistant atrial flutter by means of intraoperative radiofrequency ablation. Ablation applied to the cavotricuspid isthmus by a visible monopolar electrode is easy to perform as a concomitant procedure during repair of congenital structural heart disease.
