Stent Graft Collapse after Zone 0 Landing Thoracic Endovascular Aortic Repair.

A zone 0 landing thoracic endovascular aortic repair was performed on a 69-year-old man with a saccular aortic arch aneurysm. Seven days after the surgery, the patient experienced diminished consciousness and lower limb paralysis. Stent graft collapse was seen on a computed tomography scan.

Brachial plexus injury and upper rib fracture after median sternotomy in cardiac surgery.

Objectives: Sternal retractors utilized during open-heart surgeries through median sternotomy can cause upper rib fractures which sometimes further leads to brachial plexus injury. We aimed to investigate the incidence of brachial plexus injury and upper rib fractures in open-heart surgeries and how these injuries are associated with each other.

Methods: We investigated 1050 cases during the past five years.

Endovascular Therapy for Isolated Brachiocephalic Pseudoaneurysm.

In this study, we present a successful endovascular therapy using a small-diameter stent graft for a 73-year-old man who developed asymptomatic pseudoaneurysm of the brachiocephalic artery. An 8F sheath was placed in the brachial artery, and a stiff guidewire was advanced to the descending aorta. The stent graft was delivered to the brachiocephalic artery via the brachial approach.

Complete post-operative resolution of "temporary" end-stage kidney disease secondary to aortic dissection without static renal artery obstruction: a case study.

Background: Acute kidney injury (AKI), which may progress to end-stage kidney disease (ESKD), is a potential complication of aortic dissection. Notably, in all reported ESKD cases secondary to aortic dissection, imaging evidence of static obstruction of the renal arteries always shows either renal artery stenosis or extension of the dissection into the renal arteries.

Case Presentation: We present the case of a 58-year-old man with hypertension who was diagnosed with a Stanford type B aortic dissection and treated with medications alone because there were no obvious findings indicative of dissection involving the renal arteries.

[Treatment of Mediastinitis after Open Heart Surgery Using Negative Pressure Wound Therapy with Irrigation].

Mediastinitis occurs after open heart surgery in a small number of cases. When it occurs, early diagnosis and treatment are important. A 69-year-old male patient suffered from mediastinitis after total aortic arch replacement.

Perioperative airway management for aortic valve replacement in an adult with mucopolysaccharidosis type II (Hunter syndrome).

We herein report anesthetic management during aortic valve replacement for aortic valve regurgitation in a patient with adult mucopolysaccharidosis type II (MPS type 2) (Hunter syndrome). This disorder is rare and related to the accumulation of a mucopolysaccharide in lysosomes. It affects various organs, including the airways, heart, and central nerves.

Intimal sarcoma of aortic arch treated with proton therapy following surgery.

Management of a rare case of intimal sarcoma of the aortic arch is reported, which was diagnosed unexpectedly after total arch replacement for pseudoaneurysm. The prognosis for this condition is poor, with death usually within a few months from diagnosis. The newly developed proton-beam radiation therapy was applied to treat a local recurrence of the sarcoma following surgery.

Open stent-grafting: aborted procedure in a patient with mega aorta syndrome.

Objective: Open stent-grafting is a recent technical modification of endoluminal stent-grafting, in which a stent-graft is inserted into the descending thoracic aorta through an opening in the aortic arch, to treat distal arch aneurysms or aortic dissection. Controversy remains as to whether patients with mega aorta syndrome, or those with very wide aneurysm necks, could be candidates for stent-graft treatment--open or endoluminal.

Methods: We recently attempted open stent-grafting in a patient with mega aorta syndrome who had a distal aortic arch aneurysm.

Effect of prophylactically administered edaravone during antegrade cerebral perfusion in a canine model of old cerebral infarction.

Objective: Reactive free radical species are thought to be involved in postoperative neurologic dysfunction after antegrade selective cerebral perfusion in brains with old infarction. We assessed the brain protective effect of prophylactically administered edaravone, a free radical scavenger, for antegrade selective cerebral perfusion in brains with or without old infarction in a canine model.

Methods: A canine model of old cerebral infarction was created by injecting cylindric silicone embolus into the middle cerebral artery.

Aortic arch replacement using selective cerebral perfusion.

Background: The present study was conducted to report our clinical experience with aortic arch replacement using selective cerebral perfusion (SCP) and determine the independent predictors of in-hospital mortality and neurologic outcome.

Methods: We studied 472 consecutive patients who underwent aortic arch replacement using SCP between January 1986 and February 2006. All operations were performed with the aid of hypothermic extracorporeal circulation, SCP, and in most cases, systemic circulatory arrest for open distal anastomosis.

Aorto-right atrial fistula following acute type A aortic dissection repair.

This report describes a rare case of aorto-right atrial fistula caused by rupture of a huge pseudoaneurysm that developed at the proximal aortic anastomotic site after total aortic arch replacement for acute type A aortic dissection. Preoperative aortography revealed that the fistula communicated with the right heart, but it was intraoperative Doppler transesophageal echocardiography that confirmed its course into the right atrium. Repeat total aortic arch replacement with concomitant direct closure of the fistula was performed successfully.

Total aortic arch replacement in patients with arch vessel anomalies.

Background: The presence of anomalous arch vessels has considerable impact on aortic arch reconstruction techniques and cerebral protection methods when the separated graft technique is adopted to perform total arch replacement. We analyzed our experience of total arch replacement in patients with arch vessel anomalies.

Methods: Among the 220 patients undergoing total arch replacement at our institution, 21 patients (9.

Right aortic arch with aberrant left subclavian artery symptomatic in adulthood.

Congenital malformations of the aortic arch are rarely found in adulthood. We describe three cases of right aortic arch with aberrant left subclavian artery with left-sided ligamentum arteriosum presenting in adulthood as vascular rings with symptoms of tracheal compression. Varying presentation as well as surgical strategy which was individualized according to the pathological anatomy of each case are discussed.

Experimental study on the protective effects of edaravone against ischemic spinal cord injury.

Objective: Reactive free radical species are thought to be involved in ischemic spinal cord injury. We investigated the effects of edaravone (Mitsubishi Pharma Co, Tokyo, Japan), a free radical scavenger, on spinal ischemia-reperfusion injury in a rabbit model. We also sought to estimate free radicals in the spinal cord using the microdialysis method.

Endarterectomy and graft replacement of severely calcified (porcelain) ascending aorta with coronary ostial involvement in a patient requiring aortic valve replacement.

We report a successful aortic valve replacement within an extensively calcified (porcelain) aorta, involving the left coronary artery ostium. Clamping such an aorta can result in embolization, dissection, and mural laceration. A 72-year-old female presented with a severely calcified and stenotic aortic valve with a peak pressure gradient of 101 mmHg.

Emergency operation for distal aortic arch aneurysm in Behcet's disease.

Arterial complications of Behcet's disease rarely affect the thoracic aorta, and the incidence of aortic arch aneurysm is especially low. We present a patient who developed a rapidly expanding aneurysm of the distal aortic arch after 20 years of treatment of Behcet's disease. Emergency total arch replacement was performed with a favorable outcome.

Re-reconstruction of visceral arteries with thoracoabdominal aortic replacement using a branched graft.

A 44-year-old man, unaffected by Marfan's syndrome, had previously undergone thoracoabdominal replacement for a chronic, type B dissecting aneurysm. Reconstruction of the visceral arteries was performed using an island technique. However, approximately 3 years after the operation, the reconstructed part of the aorta containing the visceral arteries became dilated and an aneurysm formed.

NS-7, a novel Na+/Ca2+ channel blocker, prevents neurologic injury after spinal cord ischemia in rabbits.

Objective: We investigated the neuroprotective effect of NS-7 (4-[4-fluorophenyl]-2-methyl-6- [5-piperidinopntyloxy] pyrimidine hydrochloride), a novel Na(+)/Ca(2+) channel blocker, on transient spinal cord ischemia in rabbits.

Methods: Spinal cord ischemia was induced in New Zealand white rabbits by means of infrarenal aortic occlusion for 20 minutes. Four experimental groups were enrolled.

Thoracoabdominal aortic replacement for abdominal aortic aneurysm with atypical coarctation of thoracoabdominal aorta following mitral valve plasty.

We successfully treated a case of a 65-year-old female with an abdominal aortic aneurysm coexisting with an atypical coarctation of thoracoabdominal aorta and celiac axis and superior mesenteric artery occlusion. A dilated inferior mesenteric artery was supplying the celiac artery and superior mesenteric artery regions. The patient also had mitral regurgitation.

Repair of delayed left ventricular rupture after mitral valve replacement: report of a case.

Rupture of the left ventricle (LV) after mitral valve replacement (MVR) is a devastating complication, associated with high mortality. A 64-year-old woman with a type I delayed LV rupture, which occurred after MVR with a 27-mm St. Jude Medical mitral prosthesis for mitral stenosis, was successfully treated by a combination of intracardiac and extracardiac surgical repair techniques.

Comparison of pH management during antegrade selective cerebral perfusion in canine models with old cerebral infarction.

Objective: We sought to examine the influence on the brain, with or without old infarction, of pH management during antegrade selective cerebral perfusion in a canine model.

Methods: A cerebral infarct canine model was created by injecting a cylindrical silicone embolus. Dogs that had obvious neurologic deficits and had survived for 4 weeks or more were included in the model.

Surgical experience of full root replacement with freestyle bioprosthesis: indications, surgical technique, and results.

Purpose: We examined the postoperative clinical results and hemodynamic performance of full root replacement using a freestyle stentless bioprosthesis performed in patients with severe aortic stenosis or aortic root disease.

Methods: We performed 17 full root replacements with a stentless bioprosthesis. The mean age of the patients was 73.

Late reoperation for proximal aortic and arch complications after previous composite graft replacement in Marfan patients.

Background: Marfan patients who received composite graft replacement for proximal aortic disease frequently require late reoperation. The initial surgical technique for this lesion remains controversial.

Methods: Fourteen Marfan patients who received composite graft replacement for annuloaortic ectasia with or without aortic dissection required late reoperation thorough re-median sternotomy.

Total aortic arch replacement for thoracic aneurysm involving an isolated left vertebral artery.

We conducted 4 total aortic arch replacements in patients with an isolated left vertebral artery. In all 4, surgery was done using 4-branched arch grafts with moderately hypothermic selective cerebral perfusion and systemic circulatory arrest. All reconstructed isolated left vertebral arteries anastomosed to the native left subclavian artery or to the graft branch for this artery showed good patency.

Total and subtotal aortic replacement for extensive aortic dissection in patients with or without Marfan's syndrome.

Objectives: Extensive aortic dissection with multiple entries often found in Marfan's syndrome patients ultimately requires replacement of the whole aorta. We present a surgical strategy and results for total and subtotal aortic replacement.

Methods: Subjects were 18 patients, including 14 Marfan's patients undergoing total (n = 13) or subtotal (excluding aortic arch) aortic replacement (n = 5), for DeBakey type I aortic dissection (n = 13) and DeBakey type IIIb aortic dissection with annuloaortic ectasia (n = 5) between February 1991 and April 2001.