Totally endoscopic pulmonary valve replacement.

A 68-year-old man with a history of valve-sparing aortic root replacement and endoscopic aortic valve replacement was admitted to our hospital with dyspnea. Transthoracic echocardiography revealed severe pulmonary valve regurgitation. The patient had undergone cardiac surgery twice, through median sternotomy and right thoracotomy; therefore, we planned endoscopic pulmonary valve replacement the left thoracic approach.

[Totally Endoscopic Surgery for the Left Atrial Myxoma and the Atrial Septal Defect:Report of a Case].

A 60-year-old woman was admitted to our institution for exertional dyspnea. Transthoracic echocardiography revealed a 1.6 cm secundum atrial septal defect( ASD) and a 4.

Endoscopic-assisted descending aortic replacement through a small intercostal incision: a case report.

Background: Descending aortic replacement often involves making large incisions; thus, it results in massive invasions. We report the case of a patient with dilated descending aorta treated using endoscopic-assisted descending aortic replacement with essentially minimal invasions.

Case Presentation: We performed endoscopic-assisted descending aortic replacement with a single incision involving six wounds by trocar puncturing on a 59-year-old man who was diagnosed with dilated descending aorta by stent graft-induced new entry.

Endoscopic-assisted aortic replacement of the descending aorta through the 8th intercostal space to preserve collateral vessels: a case report.

We present the case of a 75-year-old man with repeated lower limb hematoma caused by consumptive coagulopathy from a type B chronic aortic dissection. His abdominal aorta was replaced with a Y-shaped graft 30 years prior to admission. As his previous aortic stent graft treatment failed, he underwent open surgical prosthetic graft replacement of the descending aorta under deep hypothermia.

Devising a technique for distal anastomosis during total arch replacement using the frozen elephant trunk technique: reverse stepwise anastomosis.

Frozen elephant technique is an effective procedure used to repair complex thoracic aortic disease involving the aortic arch and the descending aorta, or to treat aortic dissection. However, the technique often requires some creativity to properly place the stent graft and anastomose the graft to the aorta. We recently used the J Graft FROZENIX® (Japan Lifeline Co.

Pathological analysis of a case with peri-stent contrast staining after BMS implantation.

A 68-year-old female underwent bare-metal stent (BMS) implantation in the right coronary artery (RCA) for ST-segment elevation myocardial infarction. Recurrent refractory restenosis with peri-stent contrast staining (PSS) formation was observed in the stented lesion at follow-up angiography at 7, 11, and 14 months after the index stent implantation. After 2 repeated interventions, this patient was referred to coronary artery bypass grafting due to occlusion of RCA and progression of proximal left anterior descending coronary artery lesion at 15 months after stent implantation.

Aortic root subadventitial hematoma.

A 51-year-old woman was operated on for aortic valve regurgitation 3 months after experiencing chest tightness awakening her from sleep. Intraoperative findings included turbid dark brown pericardial fluid and a nipple-shaped protrusion on the external aspect of the noncoronary sinus of Valsalva. Histologically, the lesion was enclosed by intact media and adventitia, and represented an organized hematoma.

Reversal of delayed-onset paraplegia with thrombectomy of an interposed graft for the intercostal artery after thoracic descending aortic aneurysm repair.

A 78-year-old woman who had previously undergone prosthetic graft replacement of the total aortic arch was admitted to repair a chronic expanding type IIIb dissecting aneurysm. Firstly the patient's abdominal aorta was replaced with a prosthetic graft without any complications, then the thoracicdescending aorta was repaired five months later. Surgery for the thoracic descending aorta was performed with distal perfusion, cerebrospinal fluid drainage, somatosensory evoked potential (SEP) monitoring and reimplantation of three pairs of intercostal arteries.

Effect of prostaglandin E1 on ischemia-reperfusion injury during abdominal aortic aneurysm surgery.

Objective: Abdominal aortic aneurysm (AAA) surgery subjects the lower extremities to ischemia and reperfusion. Although it is not extensive or prolonged, ischemia of the lower extremities during aortic cross-clamping is gradually and steadily induced. We studied the effects of prostaglandin E1 (PGE1) on ischemia-reperfusion injury of the lower extremities during AAA repair.

Successful surgical treatment of heart failure and ventricular tachycardia in a patient with arrhythmogenic right ventricular dysplasia with cardiomyopathy.

A 70-year-old male patient with arrhythmogenic right ventricular dysplasia/cardiomyopathy demonstrating frequent attacks of ventricular tachycardia (VT) as well as heart failure underwent surgical treatment. Although the patient had severe regurgitation at the mitral and tricuspid valves, the contractility of the right and left ventricles was almost maintained. Annuloplasty of both valves abolished the regurgitation and very effectively controlled heart failure.

MRSA aortic valve endocarditis treated by pericardium-lined Dacron patch and vancomycin-containing fibrin glue.

A 40-year-old man was admitted with a diagnosis of MRSA aortic valve endocarditis. He was treated conservatively with clindamycin and vancomycin for three days, but embolism occurred into the brain and the right lower limb, and urgent aortic valve replacement was performed. Resecting an aortic annular abscess resulted in a huge defect of the root.

Limb ischemia and reperfusion during abdominal aortic aneurysm surgery.

Purpose: Abdominal aortic aneurysm (AAA) surgery involves ischemia and reperfusion of the lower extremities, but assessing the pathophysiological changes is difficult. We evaluated the extent and time course of ischemia-reperfusion injury of the lower extremities during AAA surgery.

Methods: To monitor oxygen metabolism, two near-infrared spectroscopy (NIRS) probes were positioned on each calf muscle of nine patients undergoing AAA surgery.

Improved hypertrophic obstructive cardiomyopathy by left ventricular apex epicardial pacing.

We report a case of severe hypertrophic obstructive cardiomyopahy (HOCM) that was markedly improved by left ventricular (LV) apex epicardial pacing. A 55-year-old woman with HOCM had suffered from dyspnea. Cardiac catheter examination showed a resting pressure gradient across the LV outflow tract of 198 mmHg despite combined medication.

Denervation and reinnervation of the heart after aortic surgery, estimated by 123I-metaiodobenzylguanidine scintigraphy.

Purpose: To investigate whether sympathetic nerve injury occurs during aortic surgery and how reinnervation takes place afterward.

Methods: Imaging with 123I-metaiodobenzylguanidine (MIBG) was performed in 12 patients (aortic group) who underwent aortic surgery (ascending replacement 3, ascending-arch replacement 9) before and 3 weeks after surgery. In 8 of 12 patients, MIBG scintigraphy was performed 1 and 2 years after surgery.

Pinhole rupture of aortic root aneurysm with severe atherosclerotic change.

We report two cases of the rupture of calcified aortic root aneurysms that were successfully treated by emergency operations. One patient underwent Bentall's operation, and for the other, we performed a valve-sparing operation. Because their aneurysms revealed pear-like configurations with aortic regurgitation, the findings were consistent with annuloaortic ectasia (AAE).

Patency of saphenous vein coronary artery bypass grafts from the vascular prosthesis of the ascending aorta.

Background: Patients who have Stanford type A aortic dissection with impaired coronary arteries or who have aneurysms from the ascending aorta to the aortic arch with coronary artery disease need coronary artery bypass grafting (CABG) with tube graft replacement of the ascending aorta simultaneously. When vein grafts are used for CABG in these patients, the proximal anastomoses of vein grafts are attached to the prosthetic tube graft of the ascending aorta. However, the validity of proximal anastomoses of vein grafts to the prosthetic tube graft of the ascending aorta has not been confirmed.

An implantation of DDD epicardial pacemaker through ministernotomy in a patient with a superior vena cava occlusion.

We successfully implanted a DDD epicardial pacemaker through a limited lower sternotomy in a patient whose superior vena cava had been occluded. Both epicardial leads were connected to the generator placed in the existing subcutaneous pocket on the left pectoral region through the second intercostal space. This approach provided excellent exposure and easy access to both the right appendage and the right ventricle.

Successful treatment of a Salmonella aortic arch aneurysm.

A 52-year-old man hospitalized for hoarseness and chest pain was found in chest computed tomography to have an impending aortic arch aneurysm rupture. Laboratory studies showed the presence of severe inflammation. Based on a clinical diagnosis of infected aortic arch aneurysm, we conducted total arch replacement.

Simplified elephant trunk graft technique for aortic arch replacement.

We refined the elephant trunk graft to facilitate and reinforce the distal anastomosis in aortic replacement operations. A cuff is created in a single four-branch graft, which is used for the distal anastomosis; the trunk below the cuff is inserted into the distal aortic stump. This method is feasible for repairing extensive aortic aneurysm with a fragile wall and for treating acute aortic dissection where thromboocclusion of the remaining false lumen is desired.

An easy, safe, and sure way of open stent grafting: chain-stitch bonding with a balloon catheter.

A modified transaortic graft insertion technique with a nephrostomy balloon catheter is presented herein. The graft, which has a Z stent at its end, is bound to the catheter with a chain stitch and then is inserted into the descending aorta under transesophageal echographic observation. Unlacing the chain stitch easily deploys the stented graft.

Successful open stent grafting of a right aortic arch and a descending aortic aneurysm originating from a Kommerell's diverticulum: report of a case.

The case of a 43-year-old man found to have an aneurysm developing from a Kommerell's diverticulum at the origin of an aberrant retroesophageal left subclavian artery is reported herein. The aneurysm was treated by the open stent grafting technique and complete revascularization was achieved.

Acute myocardial infarction due to left main coronary artery occlusion. Therapeutic strategy.

Objective: Acute myocardial infarction due to left main coronary artery occlusion remains catastrophic and mostly fatal due to severe cardiogenic shock and arrhythmia.

Methods: We studied 13 patients undergoing coronary artery bypass grafting for acute myocardial infarction due to left main coronary artery occlusion to clarify the optimal management of these difficult patients.

Results: In-hospital mortality was 46.