Ascending aortic aneurysm associated with a quadricuspid aortic valve.

We report here a rare case of ascending aortic aneurysm associated with a tricuspitalized quadricuspid aortic valve. A 45-year-old man had a fusiform ascending aortic aneurysm with aortic valve regurgitation. Transthoracic echocardiography revealed grade III aortic regurgitation.

Successful valve repair in traumatic aortic valve regurgitation.

Case 1 was a 20-year-old male who had been involved in a traffic accident and developed aortic regurgitation (AR) eight months later. He was admitted with dilatation of the left ventricle. Transesophageal echocardiography (TEE) showed severe AR with perforation of the right coronary cusp.

[Strategies for prevention from spinal cord ischemia during thoracic endovascular aortic repair].

Spinal cord ischemia (SCI) is one of the most serious complications in patients who undergo thoracic endovascular aortic repair (TEVAR). The incidence of SCI after TEVAR has been supposed to be lower than the one after traditional open surgical repair. However, not a few cases regarding SCI after TEVAR have been reported recently.

Multidisciplinary approach to prevent spinal cord ischemia after thoracic endovascular aneurysm repair for distal descending aorta.

Background: This article discusses the multidisciplinary approach to prevent spinal cord ischemia (SCI) with reference to the incidence of SCI after thoracic endovascular aneurysm repair (TEVAR) associated with closure of the intercostal-lumbar artery that supplies the Adamkiewicz artery (ICA-AKA).

Methods: We reviewed 60 patients [49 men, 57 to 89 years old] who underwent TEVAR (TAG [W. L.

Is conventional aortic arch surgery justifiable in octogenarians?

Objective: Although the surgical result of conventional aortic arch replacement has been improved with sophisticated techniques, it is still a deeply invasive procedure. On the other hand, advanced age has been reported as a factor of increased morbidity and mortality in patients undergoing cardiovascular surgery. The number of octogenarians, however, is steadily increasing.

Spinal cord injury is not negligible after TEVAR for lower descending aorta.

Objectives: To clarify the incidence of spinal cord injury (SCI) after thoracic endovascular aneurysm repair (TEVAR), we investigate the intercostal/lumbar arteries that supply the Adamkiewicz artery (ICA-AKA).

Patients: Among 81 patients subjected to TEVAR, we retrospectively reviewed the clinical records of 50 patients (range: 57-86 (median age: 77) years, 41 males) who underwent TEVAR for part of or the whole distal descending aorta (T7 to L2) after identification of ICA-AKA by magnetic resonance angiography (MRA) or computed tomography angiography (CTA).

Results: The 50 patients were classified into group A: 17 patients whose patent ICA-AKA was not covered, group B: 24 patients whose ICA-AKA was covered and group C: nine patients in whom no patent ICA-AKA was identified.

[Long-term outcome of aortic valve sparing procedures in connective tissue disorders].

Objectives: The aim of this study is to determine the long-term outcome of aortic valve sparing procedures for patients having connective tissue disorder.

Methods: Between 1993 and 2008, the aortic valve sparing surgery was performed in 94 patients having aortic root dilatation. Eighty patients of them (37.

Mutation of ACTA2 gene as an important cause of familial and nonfamilial nonsyndromatic thoracic aortic aneurysm and/or dissection (TAAD).

Approximately 20% of aortic aneurysm and/or dissection (AAD) cases result from inherited disorders, including several systemic and syndromatic connective-tissue disorders, such as Marfan syndrome, Ehlers-Danlos syndrome, and Loeys-Dietz syndrome, which are caused by mutations in the FBN1, COL3A1, and TGFBR1 and TGFBR2 genes, respectively. Nonsyndromatic AAD also has a familial background, and mutations of the ACTA2 gene were recently shown to cause familial AAD. In the present study, we conducted sequence analyses of the ACTA2 gene in 14 unrelated Japanese patients with familial thoracic AAD (TAAD), and in 26 with sporadic and young-onset TAAD.

Is prompt surgical treatment of an abdominal aortic aneurysm justified for someone in their eighties?

Objectives: The aim of this study is to review the early and long-term results and quality of life after abdominal aortic aneurysm (AAA) surgery in octogenarians to justify our prompt surgical intervention.

Patients And Methods: We reviewed the consecutive 444 patients who underwent graft replacement of AAA in our center from October 1997 to September 2002. The median age of the patients was 72.

Composite valve graft replacement of the aortic root: twenty-seven years of experience at one Japanese center.

Background: The aim of this study was to evaluate the early and long-term results of a composite valve graft root replacement for various aortic root diseases.

Methods: Between 1978 and 2005, 273 patients with various disorders of the aortic root underwent a composite valve graft root replacement. The mean age of the patients was 47.

Evolving selective cerebral perfusion for aortic arch replacement: high flow rate with moderate hypothermic circulatory arrest.

Background: Although hypothermic circulatory arrest (HCA) combined with selective cerebral perfusion (SCP) is a safe strategy for aortic arch surgery, neither the optimal temperature of hypothermia nor the optimal SCP flow rate has been clearly determined. We have since 2002 gradually elevated the temperature of HCA from 20 degrees C to 28 degrees C for aortic arch surgery. This study explored the impact of different temperatures during HCA with SCP on neurologic complications.

Repair of an infected aortic aneurysm using an aortic allograft and a venous autograft: report of a case.

We describe the successful surgical treatment of an unusual type of infected aortic aneurysm. The aneurysm emerged around the distal part of the ascending aorta and the proximal part of the arch and involved the innominate artery. The infection was attributed to prolonged catheter placement in the right jugular vein for intravenous hyperalimentation several years earlier.

Evolving arch surgery using integrated antegrade selective cerebral perfusion: impact of axillary artery perfusion.

Objective: The study objective was to determine the impact of integrated antegrade selective cerebral perfusion with right axillary artery perfusion during arch surgery.

Methods: All surgeries were performed through a median sternotomy. Direct cannulation of the right axillary artery in the axilla was used for cardiopulmonary bypass and antegrade selective cerebral perfusion under hypothermia.

Replacement of the descending aorta: recent outcomes of open surgery performed with partial cardiopulmonary bypass.

Objective: Surgical replacement is our standard treatment for descending aortic aneurysm, despite the advent of thoracic endoprostheses. We retrospectively analyzed outcomes of descending aortic replacement performed with partial cardiopulmonary bypass.

Methods: Since 1994, a total of 113 patients in our institution (mean age 68 +/- 12 years, n = 75 male) have undergone graft replacement of the descending aorta for nondissecting aneurysm.

Rapid and safe establishment of cardiopulmonary bypass in repair of acute aortic dissection: improved results with double cannulation.

There is no agreement at present as to which is the optimal site for artery cannulation for cardiopulmonary bypass in repair of acute aortic dissection (AAD). We have employed right axillary artery cannulation (RAAC) in combination with femoral artery cannulation to overcome the drawbacks of single cannulation. From January 2000 to August 2006, 88 patients underwent emergency surgical repair of the aortic arch (mean age 65+/-13 years, 37 men) for AAD.

Hemolytic anemia after operation for aortic dissection using teflon felt strips.

We report three cases of hemolytic anemia caused by anastomotic stenosis after surgical treatment for aortic dissection in which internal and external Teflon (DuPont, Wilmington, DE) felt strips were used for reinforcement of the aortic stump. To detect this complication, laboratory findings typical of red cell fragmentation syndrome as well as appropriate imaging modalities are necessary. As a precaution, it is necessary to be meticulous when stitching the internal felt strip.

Easy technique for placing anchoring sutures for aortic root reimplantation.

In the aortic valve-sparing reimplantation technique, insertion of the anchoring sutures beneath the valve is a crucial but difficult step because the spared aortic cusps obscure the field of view. We present a novel and easy method of placing these anchoring stitches with good exposure of the subvalvular tissue.

Dilatation of the aneurysmal sac after total arch replacement.

In our institution, total arch replacement for distal arch aneurysms is performed through a median sternotomy with antegrade selective cerebral perfusion. The distal anastomosis to the completely transected descending aorta is made through the aneurysmal sac. We report on three interesting cases presenting late dilatation of the aneurysmal sac due to collateral flow after total arch replacement.

Multiple and repetitive anastomotic pseudoaneurysms with polyarteritis nodosa.

We report a rare case of a 50-year-old man with multiple and repetitive anastomotic pseudoaneurysms associated with polyarteritis nodosa. The pseudoaneurysms were located at the aortic root and the ascending aorta. Infectious and congenital etiologies, as well as nonbacterial inflammatory diseases, were ruled out.

Total arch replacement through re-median sternotomy after coronary surgery.

We report the case of 78-year-old-man who required graft replacement of an aortic arch aneurysm. He previously had undergone off-pump coronary artery bypass grafting with the right internal thoracic artery bypassed to the left anterior descending artery. For this difficult case, we successfully performed total arch replacement using selective antegrade cerebral perfusion through a re-median sternotomy without injuring the right internal thoracic artery, which was the only blood source for the left and right coronary arteries.

A case of acute type B aortic dissection: limited role of laboratory testing for the diagnosis of mesenteric ischemia.

A 30-year-old man with severe back and abdominal pain was referred to our hospital because of a recurrence of acute type B aortic dissection. A computed tomography scan showed a 3-channel dissection and a severe narrowing of the true lumen of the descending aorta to the abdominal aorta because of the expansion of the newly formed second false lumen. Although laboratory testing, including creatine phosphokinase, lactate dehydrogenase, and lactate levels, indicated no visceral ischemia, abdominal pain requiring narcotics treatment had to be continued for more than 1 week.

Is emergency total arch replacement with a modified elephant trunk technique justified for acute type A aortic dissection?

Background: We assess the outcome of emergency total arch replacement with a modified elephant trunk technique for acute type A aortic dissection to clarify whether our aggressive approach is justified in certain patients.

Methods: Between 2000 and 2006, 54 patients (55.1% of all) underwent emergency total arch replacement for acute type A aortic dissection.

Spinal cord malperfusion caused by using the segmental clamp technique during descending aortic repair for chronic type B aortic dissection.

Several effective strategies for spinal cord protection have been advocated in descending and thoracoabdominal aortic repairs. The segmental clamp technique has been known as a useful adjunct to shorten the duration of spinal cord ischemia. However, we experienced two cases of spinal cord malperfusion during segmental aortic clamping in descending aortic repair for chronic type B aortic dissection.