Surgical Treatment of Simultaneous Common Femoral and Profunda Femoris Artery Aneurysms.

Profunda femoris artery aneurysms (PFAAs) are rare because of the histo-anatomical characteristics of the profunda femoris arteries. We present a case of simultaneous PFAA and common femoral artery aneurysm (CFAA) incidentally detected on computed tomography in a 58-year-old man with diverticular bleeding. Images revealed a 37-mm right PFAA and a 24-mm right CFAA.

Right Parasternal Approach for Aortic Valve Replacement After Presternal Gastropexy.

Due to bicuspid aortic valve aortic stenosis, a 78-year-old man with a history of esophagectomy and presternal gastric tube reconstruction required aortic valve replacement (AVR). AVR with a bioprosthetic valve was performed through a right parasternal thoracotomy. Despite the unfavorable conditions for conventional median sternotomy, AVR was successfully performed through an alternate approach.

Papillary Fibroelastoma of the Aortic Valve:Acute Coronary Syndrome Due to Dynamic Obstruction of the Right Coronary Artery Ostium.

A 59-year-old woman, who had a history of acute coronary syndrome (ACS) but without obstructive coronary lesions 2 years previously, presented with vertigo. MRI revealed a left cerebellar embolism. TEE detected a mobile aortic valve tumor, suggesting a papillary fibroelastoma (PFE).

Ex vivo evaluation of 3 different right ventricular outflow tract substitutes.

Objectives: The Ross procedure represents an excellent treatment option in younger patients with aortic stenosis but is limited by poor availability of homografts. In this study, we investigated the hydrodynamic performance of 3 different types of right ventricular outflow tract replacement with pericardium or synthetic material.

Methods: Three different types of valved conduits were constructed using pericardium and/or synthetic material (Group PEPE: pericardial cusps and pericardial conduit, Group PEPR: pericardial cusps and Dacron conduit, Group PRPR: expanded polytetrafluoroethylene cusps and Dacron conduit).

Impact of heart rate, aortic compliance and stroke volume on the aortic regurgitation fraction studied in an ex vivo pig model.

Introduction: Drug therapy to reduce the regurgitation fraction (RF) of high-grade aortic regurgitation (AR) by increasing heart rate (HR) is generally recommended. However, chronic HR reduction in HFREF patients can significantly improve aortic compliance and thereby potentially decrease RF. To clarify these contrasts, we examined the influence of HR, aortic compliance and stroke volume (SV) on RF in an ex vivo porcine model of severe AR.

A practical, predictable, and reliable method to select shades for direct resin composite restorations.

Objective: This article describes a practical, predictable, and reliable method to select shades for direct composite restorations using custom shade guides made of resin composite at hand using a process of elimination CLINICAL CONSIDERATIONS: Esthetics in direct resin composite restorations depends on the clinician's ability to reproduce the shape and shade of natural teeth, thus appropriate shade selection is a must. This method presented in this article simplifies the process of shade selection for direct resin composite restorations. The use of custom shades tabs made of commecially available resin composites, its arrangment and a process of elimination of tabs during shade selection allows the practitioner to obtain the best possible resin composite shade available for every case.

Fracture strength, pull-out bond strength, and volume of luting agent of tooth-colored CAD-CAM post-and-cores.

Statement Of Problem: Little is known about the fracture strength, retention, and adaptation of post-and-cores fabricated with novel tooth-colored materials by computer-aided design and computer-aided manufacturing (CAD-CAM).

Purpose: The purpose of this in vitro study was to investigate the fracture strength, pull-out bond strength (POBS), and volume of luting agent of endodontically treated premolars restored with post-and-cores milled from different CAD-CAM materials.

Material And Methods: Post spaces were prepared in 80 human premolars in which post-and-cores fabricated with polyetheretherketone (PK; Ceramill PEEK), nanohybrid composite resin (BB; Brava Block), polymer-infiltrated ceramic (EN; VITA Enamic), and fiber-reinforced epoxy resin (GF; Fiber Cad Post & Core) CAD-CAM materials were luted (n=20).

Impact of high-pressure balloon aortic valvuloplasty on the hydrodynamic result after a transcatheter valve-in-valve procedure.

Objectives: The aim of this study was to investigate the degree of functional improvement of a transcatheter heart valve (THV) for valve-in-valve after bioprosthetic valve fracture (BVF) of three small surgical aortic valve bioprostheses (SAVBP) using high-pressure balloon aortic valvuloplasty (HP-BAV) under standardized ex-vivo-conditions.

Methods: A THV 26 mm (Evolut R) and SAVBP 21 mm (Perimount Magna Ease, Trifecta, and Epic supra [n = 4] were used. Mean pressure gradient (MPG), effective orifice area (EOA), geometric orifice area (GOA), minimal internal diameter (MID), and pinwheeling index (PWI) were analyzed before and after HP-BAV of the SAVBP using a noncompliant balloon.

Functional performance of 8 small surgical aortic valve bioprostheses: an in vitro study.

Objectives: Selection of a surgical aortic valve (SAV) bioprosthesis model for the treatment of aortic valve disease remains controversial. The aim of this study was to characterize the functional performance of 8 SAV models in a standardized in vitro setting.

Methods: The hydrodynamic performance of 8 SAVs with labelled size 21 mm (Avalus™, Hancock® II, Mosaic® Ultra™, Perimount®, Perimount® Magna Ease, Epic™ Supra, Trifecta™ GT; Freestyle®), was investigated in a pulse duplicator.

Ex vivo evaluation of the Ozaki procedure in comparison with the native aortic valve and prosthetic valves.

Objectives: We investigated the hydrodynamic performance and cusp kinematics of the Ozaki neocuspidized aortic valve in comparison with the native aortic and prosthetic valves in an ex vivo study.

Methods: Native aortic valves of swine hearts were replaced by aortic valve substitutes, and their hydrodynamic performance (effective orifice area and mean pressure gradient) was evaluated in a mock circulation under defined conditions. The following aortic valve substitutes were investigated: native aortic valve, Ozaki valve, Perimount Magna Ease, Trifecta and St.

The figure-of-8 aortic valve suturing technique optimizes the effective orifice area of a small aortic annulus-an ex vivo study.

Objectives: Surgical aortic valve replacement (SAVR) in small annuli carries an elevated risk for the patient-prosthesis mismatch. In this study, we systematically investigated the influence of different implantation techniques including annular enlargement (AE) on the functional result after SAVR in small annuli using a standardized ex vivo model.

Methods: SAVR using the PERIMOUNT Magna Ease® (PME) 21 mm was performed in small porcine aortic roots using 4 implantation techniques: non-everting pledgeted (NE) suture, single interrupted (SI) suture, continuous suture (CS), figure-of-8 (F8) suture, as well as the PME 23 mm after AE using the Nunez method and the NE suture technique (PME23 AE).

Impact of different valve-in-valve positions on the hydrodynamic performance of the newest-generation self-expanding transcatheter heart valve.

Objectives: Transcatheter aortic valve-in-valve (ViV) procedures are increasingly performed for the treatment of degenerated surgical aortic valves with a high risk for a redo operation. For an optimal functional result, precise positioning of the transcatheter heart valve (THV) inside the SHV is crucial. The aim of this study was to systematically investigate the impact of implantation depth on the functional result after a ViV procedure in a standardized in vitro setting.

An ex vivo evaluation of two different suture techniques for the Ozaki aortic neocuspidization procedure.

Objectives: We investigated the Ozaki procedure using a single interrupted suture technique (SST) and compared this with the standard continuous suture technique (CST) with regard to hydrodynamic valve performance. In addition, both techniques were compared with the native aortic valve (NAV).

Methods: Effective orifice area, mean pressure gradient and leakage volume were evaluated in the NAV as well as after an Ozaki procedure using SST or CST in fresh swine aortic roots using a mock circulation loop.

[Utility of the Contrast Injection Technique Using the Diluted Test Injection Method and the Test Bolus Tracking Method in the Coronary CT Angiography].

Although the test bolus tracking method is available as a predicting method of scan timing in the coronary computed tomography (CT) angiography, it is known that there is a problem of scan timing due to the use of a part of test bolus method. The diluted test bolus method was adopted for test bolus, and as a result of using in combination with the test bolus tracking method, it showed a higher contrast enhancement compared with the test bolus tracking method; a stable contrast enhancement with less variation in CT number was obtained. The CT number at the peak in the test scan and the CT number of the main scan showed a high correlation.

Florida sleeve technique for a right sinus of Valsalva aneurysm: a case report.

Background: Florida sleeve technique was reported by Hess et al. as a new technique of valve sparing aortic root replacement without the requirement of entire aortic root wall resection and coronary artery reconstruction. We present a rare case of an unruptured aneurysm of the right sinus of Valsalva that was successfully treated with resection of the aneurysm and the Florida sleeve technique.

Surgical repair of Stanford type A acute aortic dissection with extreme tuberculosis-related mediastinal deviation.

In this article, we report on the case of an 85-year-old woman with a history of left pulmonary tuberculosis, who was referred for Stanford type A acute aortic dissection. A preoperative chest X-ray and computed tomography revealed extreme mediastinal deviation to the left. We decided to perform surgery with left rib-cross thoracotomy.

Breast reconstruction with absorbable mesh sling: dynamic infrared thermography of skin envelope.

Background: To immediate reconstruct ptosis breasts, we used polyglactin (Vicryl; Ethicon Inc., Somerville, NJ, USA) mesh as an inferolateral sling. However, Vicryl mesh is absorbable and losing function as a supporting structure.

Enlargement of the Excluded Left Atrial Appendage With Thrombus.

We report progressive enlargement of the excluded left atrial appendage (LAA) with a thrombus in a patient who had undergone valve surgery and endocardial suture closure of the LAA previously. Echocardiography and CT detected no communication between the LAA and the left atrium. Magnetic resonance imaging showed the LAA was filled with fresh and old thrombi.

Successful Surgical Treatment of a Huge Candida albicans Aortic Fungus Ball with Pseudoaneurysm.

A 70-year-old woman with a history of aortic valve replacement and coronary artery bypass grafting (CABG) was transferred to the authors' hospital for further management of a three-month fever of unknown origin. Computed tomography showed a huge mass in the ascending aorta with pseudoaneurysm. Blood β-D-glucan levels were significantly high, and blood culture showed the growth of Candida albicans.

Structural valvular deterioration of Hancock standard valve in the mitral position 33 years after initial implantation.

A 77-year-old woman who had undergone mitral valve replacement (MVR) with a 29 mm Hancock standard (H-S) bioprosthesis (Model 242) and tricuspid annuloplasty (Kay's method) at the age of 44 years was admitted urgently with acute heart failure. Echocardiography showed severe transvalvular leakage of the prosthesis and moderate tricuspid regurgitation. The patient underwent reMVR with a 29 mm Carpentier-Edwards Perimount Magna Mitral bioprosthesis and tricuspid annuloplasty with a 30 mm MC3 ring.

Carbon Ion Radiation Therapy With Concurrent Gemcitabine for Patients With Locally Advanced Pancreatic Cancer.

Purpose: To determine, in the setting of locally advanced pancreatic cancer, the maximum tolerated dose of carbon ion radiation therapy (C-ion RT) and gemcitabine dose delivered concurrently and to estimate local effect and survival.

Methods And Materials: Eligibility included pathologic confirmation of pancreatic invasive ductal carcinomas and radiographically unresectable disease without metastasis. Concurrent gemcitabine was administered on days 1, 8, and 15, and the dose levels were escalated from 400 to 1000 mg/m(2) under the starting dose level (43.

Long term results and predictors of left ventricular function recovery after aortic valve replacement for chronic aortic regurgitation.

Objectives: In most patients with aortic regurgitation (AR), aortic valve replacement (AVR) improves left ventricular (LV) function, but some patients will not have favorable remodeling. Our objectives were to review long term clinical results of AVR for AR and to examine what factors affect the normalization of LV function after AVR for chronic AR.

Methods: Between 1989 and 2010, 177 patients underwent isolated AVR for chronic pure AR.

Phase 1 trial of preoperative, short-course carbon-ion radiotherapy for patients with resectable pancreatic cancer.

Background: The authors evaluated the tolerance and efficacy of carbon-ion radiotherapy (CIRT) as a short-course, preoperative treatment and determined the recommended dose needed to reduce the risk of postoperative local recurrence without excess injury to normal tissue.

Methods: Patients radiographically defined with potentially resectable pancreatic cancer were eligible. A preoperative, short-course, dose-escalation study was performed with fixed 8 fractions in 2 weeks.

A long-term controlled trial of endoscopic pancreatic stenting for treatment of main pancreatic duct stricture in chronic pancreatitis.

Background/aims: Endoscopic pancreatic stenting (EPS) has been used to treat main pancreatic duct (MPD) stricture in chronic pancreatitis (CP), with favourable reported results. However, most studies were retrospective and uncontrolled. We conducted a longterm prospective controlled study of EPS for treatment of MPD stricture in CP.