Morphologic prognostic factor for thoracoabdominal aortic dilation after acute type A dissection repair.

Objectives: Risk factors for late-term aortic dilation after acute type A aortic dissection repair have not been well examined. The goal of this study was to determine the relationship between the abdominal aortic true lumen location and thoraco-abdominal aortic dilation after surgical repair for acute type A aortic dissection.

Methods: Patients who were preoperatively diagnosed with acute type A aortic dissection between April 2014 and July 2022 were included in this study.

Fenestrated and covered frozen elephant trunk technique for management of chronic aortic dissection.

Background: Reintervention for residual dissection after repaired type A aortic dissection remains challenging. When a frozen elephant trunk (FET) is used, the incidence of distal stent graft-induced new entry (d-SINE) is reportedly high in chronic dissection.

Aims: We report a case of successful redo arch repair using fenestrated and covered FET techniques for chronic residual aortic dissection.

Reconstruction of the left subclavian artery in arch repair: An end-to-side anastomosis technique.

Background: The left subclavian artery (LSCA) is deeply located and difficult to visualize in some cases of total arch replacement.

Aims: We report an end-to-side anastomosis technique that enables safer and easier anatomical reconstruction of the LSCA.

Materials And Methods: Under Hypothermic circulatory arrest, the origin of the LSCA was ligated and pulled caudally.

Bicuspidalization of the Native Tricuspid Aortic Valve: A Porcine in Vivo Model of Bicuspid Aortopathy.

: To examine early histologic changes in the aorta exposed to bicuspid flow. : A porcine bicuspid aortopathy model was developed by suturing aortic cusps. Of nine pigs, eight underwent sham surgery (n=3) or bicuspidalization (n=5); one was used as an intact control.

Covered frozen elephant trunk technique for prevention of distal stent graft-induced new entry.

Distal stent graft-induced new entry is not rare after frozen elephant trunk implantation. We report a case of covered frozen elephant trunk placement for prevention of distal stent graft-induced new entry. Coverage of the rigid distal stent edge using a graft reduces mechanical stress on the intima and radial force of the distal stent; therefore, this technique can potentially prevent distal stent graft-induced new entry.

Influence of residual primary entry following the tear-oriented strategy for acute type A aortic dissection.

Objectives: Although a tear-oriented strategy has contributed to improving short-term surgical outcomes of acute type A aortic dissection (ATAAD), long-term clinical influences of residual entry tear in the downstream aorta have not been fully investigated. The goal of this study was to assess the long-term surgical outcomes of ATAAD with or without a residual entry tear in the downstream aorta.

Methods: Medical records of 1107 patients with ATAAD who underwent emergency surgery between 1990 and 2018 were retrospectively reviewed.

Bail-Out Pull-Through Pull-Back Technique for Accidental Coverage of the Left Common Carotid Artery During Thoracic Endovascular Aortic Repair.

Purpose: We describe a pull-through pull-back technique to revascularize the left common carotid artery (LCCA) that was unintentionally covered during thoracic endovascular aortic repair (TEVAR).

Case Report: A 69-year-old man presented with back pain secondary to acute type B aortic dissection with an intimal tear in the proximal descending aorta. Serial computed tomography (CT) revealed an enlarged descending aorta and proximal progression of the aortic dissection.

Clinical outcomes of a fenestrated frozen elephant trunk technique for acute type A aortic dissection.

Objectives: We investigated the outcomes of a fenestrated frozen elephant trunk (FET) technique performed without reconstruction of one or more supra-aortic vessels for aortic repair in patients with acute type A aortic dissection.

Methods: We investigated 22 patients who underwent the fenestrated FET technique for acute type A aortic dissection at our hospital between December 2017 and April 2020. The most common symptom was chest pain and/or back pain.

Double-patch and glue repair of a postinfarction left ventricular pseudoaneurysm.

An 85-year-old man with appetite loss, lightheadedness, and leg edema was referred to our institution. Computed tomography and transthoracic echocardiography revealed a left ventricular pseudoaneurysm with a maximal diameter of 80 mm and severe mitral regurgitation. Coronary angiography showed 90% stenosis and total occlusion of the left circumflex artery at segments 11 and 12, respectively.

Clinical outcome of acute thoracic aortic syndrome in nonagenarians.

Background: Decision-making regarding the operability of thoracic aortic disease in nonagenarian patients remains controversial because outcomes of open surgical repair of the thoracic aorta are unclear. We investigated the surgical and nonsurgical outcomes of acute thoracic aortic syndrome treatment in nonagenarians.

Methods: After evaluating data in our institute from April 2016 to March 2020, we included 10 nonagenarians who needed surgical intervention on the thoracic aorta via a median sternotomy for acute thoracic aortic syndrome.

Total arch and descending aorta replacement via left thoracotomy for infected post-thoracic endovascular aortic repair type B aortic dissection.

A 38-year-old man underwent thoracic endovascular aortic repair for impending rupture of acute type B aortic dissection. Computed tomography revealed abscess formation around the proximal descending aorta 4 weeks after endovascular treatment. He underwent one-stage total arch and descending aorta replacement and omental wrapping via left thoracotomy.

Staged treatments of multiple pseudoaneurysms after total arch replacement.

Background: An aortic pseudoaneurysm after cardiovascular surgery can be fatal.

Methods/results: Here, we describe the staged successful treatments of three pseudoaneurysms in a 77-year-old female patient who underwent total arch replacement and coronary artery bypass grafting 5 years ago. Computed tomography revealed three pseudoaneurysms: in the distal anastomosis of the total arch replacement, in the anastomosis of the left common carotid artery, and in the proximal anastomosis of the saphenous vein graft.

Incidence of postoperative atrial fibrillation in transdermal β-blocker patch users is lower than that in oral β-blocker users after cardiac and/or thoracic aortic surgery.

Objective: Postoperative atrial fibrillation (POAF) after open heart surgery is associated with a high risk of mortality and morbidity. Although oral β-blockers are usually recommended to prevent POAF, the efficacy of a transdermal β-blocker patch in preventing POAF is unclear. We compared the incidence of POAF between users of oral and transdermal bisoprolol.

Postinfarction right ventricular wall dissection with left-to-right shunting.

Ventricular septal rupture is an uncommon fatal complication of acute myocardial infarction. In rare cases, the rupture can extend into the right ventricular free wall and cause intramyocardial dissection. We describe the case of a patient who developed postinfarction right ventricular free wall dissection with left-to-right shunting and successfully underwent patch repair.

Feasibility of low-frequency ultrasound imaging using pulse compressed parametric ultrasound.

When using high-frequency (HF) ultrasound in sonography, attenuation due to the viscosity of the medium limits the available imaging depth, and strong reflection and scattering from hard tissue, such as bone, render biological diagnosis very difficult. In order to resolve these problems, the feasibility of low-frequency (LF) parametric ultrasound imaging with high directivity was explored in the present study. A pulse compression technique was applied to chirp-modulated parametric ultrasound waves in the frequency band of 100-500 kHz generated from modulated primary ultrasound waves with a center frequency of 2.

Successful Aortic Banding for Type IA Endoleak Due to Neck Dilatation after Endovascular Abdominal Aortic Aneurysm Repair: Case Report.

A 69-year-old man with a type IA endoleak that developed approximately 21 months after endovascular abdominal aortic aneurysm repair (EVAR) of a 46 mm diameter aneurysm was referred to our department. He had impaired renal function, Parkinson's disease, and previous cerebral infarction. Computed tomography angiography showed a type IA endoleak with neck dilatation and that the aneurysm had grown to 60 mm in diameter.

Pulmonary Stenosis Caused by Ductus Arteriosus Aneurysm: A Case Report.

A 76-year-old woman with a 2-week history of dyspnea on exertion was admitted to our hospital. A computed tomography scan showed a 70-mm diameter aortic arch aneurysm containing a large thrombus that was compressing the pulmonary artery. Echocardiography showed severe pulmonary stenosis and no shunt flow.

Early and Late Surgical Outcomes of Acute Type A Aortic Dissection in Octogenarians.

Background: Although surgical outcomes of acute type A aortic dissection (ATAAD) have improved, it is still a high-risk procedure for octogenarians. This study analyzed early and late outcomes of surgical repair of ATAAD among octogenarians.

Methods: From 1990 through 2016, 1,260 consecutive patients with ATAAD were emergently admitted to Jichi Medical University Hospitals.