Vascular graft infection with duodenal fistulization 10 years after hybrid endovascular aortic repair with renovisceral debranching: a case report.

Background: A secondary aortoenteric fistula after an aortic graft replacement or endovascular aortic repair is a rare but devastating complication that leads to extremely high morbidity and mortality. Because reports of vascular graft infection with enteric fistulization complicating in a hybrid aortic repair with renovisceral debranching are limited, the management method such as the extent of removal of the infected graft, reconstruction procedures, and the ideal type of graft are still debatable.

Case Presentation: We report a successful case of a 73-year-old man presenting a vascular graft infection with duodenal fistulization, 10 years after hybrid endovascular aortic repair with renovisceral debranching for a 60-mm diameter of supra-renal abdominal aortic aneurysm.

Pioglitazone-incorporated microspheres targeting macrophage polarization alleviates cardiac dysfunction after myocardial infarction.

Objectives: Excessive and chronic inflammation after a myocardial infarction (MI) is associated with left ventricular remodelling and impaired cardiac function. Among inflammatory cells, macrophages play a critical role in polarizing proinflammatory M1 or the reparative M2 subtype. Pioglitazone (PGZ) is reported to regulate macrophage polarization to the M2 subtype.

[One-stage Radical Surgery for Aortoesophageal Fistula after Graft Replacement of Descending Aorta].

A 31-year-old woman was referred to our institution because of aortoesophageal fistula (AEF) six months after the descending aortic replacement for acute aortic dissection. We operated one-stage repair of the AEF. Thoracoscopic esophagectomy was firstly performed in prone position from right thoracic cavity, and then the esophagus was reconstructed with gastric conduit via posterior mediastinal route with omental flap.

Management of retrosternal adhesion after median sternotomy by controlling degradation speed of a dextran and ε-poly (L-lysine)-based biocompatible glue.

Objective: Retrosternal adhesion after median sternotomy possibly raises the risk of cardiac injury at resternotomy. A biodegradable glue "Lydex" is composed of food additives, dextran and ε-poly (L-lysine), and the degradation speed can be controlled by the composition. In the present study, we evaluated the preventative effect of Lydex on retrosternal adhesion and the relationship between degradation speed and the progression of retrosternal fibrosis.

[Emergent Re-do Mitral Valve Replacement for Prosthetic Valve Endocarditis with Increasing Obstruction of Mitral Valve].

We report a surgical case of active infective prosthetic biologic mitral valve endocarditis with hemodynamic deterioration with increasing obstruction of mitral valve. The patient developed rapid hemodynamic deterioration, therefore, we performed emergent re-do mitral valve replacement using SJM prosthetic valve in the setting of supra-annular position. The postoperative course was uneventful.

Safety and efficacy of sustained release of basic fibroblast growth factor using gelatin hydrogel in patients with critical limb ischemia.

As a form of therapeutic angiogenesis, we sought to investigate the safety and efficacy of a sustained-release system of basic fibroblast growth factor (bFGF) using biodegradable gelatin hydrogel in patients with critical limb ischemia (CLI). We conducted a phase I-IIa study that analyzed 10 CLI patients following a 200-μg intramuscular injection of bFGF-incorporated gelatin hydrogel microspheres into the ischemic limb. Primary endpoints were safety and transcutaneous oxygen pressure (TcO2) at 4 and 24 weeks after treatment.

[Surgical treatment for infective prosthetic mitral valve endocarditis with cardiogenic shock; report of a case].

We report a surgical case of active infective prosthetic mitral valve endocarditis with cardiogenic shock. The causative organism was methicillin-resistant coagulase negative Staphylococci (MRCNS) During medical treatment, the prosthetic valve was abruptly detouched partially from the mitral annulus, and the patient developed rapid hemodynamic deterioration. We performed emergency re-do mitral valve replacement.

[Total arch replacement for ruptured Stanford type B aortic dissection with thrombosed pseudolumen presenting hemodynamic deterioration].

We report 2 cases of ruptured type B aortic dissection with thrombosed pseudolumen presenting hemodynamic deterioration which is a life-threatening condition. In such cases, surgical treatment often resulted in high mortality rates. We underwent total arch replacement via median sternotomy.

[Valve replacement for tricuspid infective endocarditis presenting paradoxical cerebral embolism].

Tricuspid valve infective endocarditis( IE) accounts for 5 to 10% of all IE. We encountered a 50-year old man who suffered from tricuspid valve IE presenting paradoxical multiple cerebral embolism with intracranial hemorrhage. On 6th day from his admission, we performed valve replacement for intractable tricuspid infective endocarditis regardless of acute phase of intracranial hemorrhage.

[Surgical ventricular restoration for functional mitral regurgitation].

Background: This study evaluated the effectiveness and limitations of the surgical ventricular restoration(SVR)procedure in patients with functional mitral regurgitation(FMR)due to severe leaflet tethering.

Methods: From 2008 to 2012, FMR was treated in 39 patients by either mitral annuloplasty(MAP)alone( group M:n=17) or MAP combined with SVR( group S:n=22). Preoperatively, patients in group S had lower ejection fraction( EF), larger left ventricle, and more severe mitral regurgiation( MR) comparing to group M.

A novel detachable filter to prevent thromboembolism during endovascular surgery.

Objective: Thromboembolism remains a serious complication during endovascular surgery. Commercially available filter devices, which are unified with the stenting systems, provide short-time performance owing to the adhesion of thrombus to the filters themselves. We have, therefore, developed a new detachable filter that can be used in all major aortic branches and shows greater longevity.

[Surgical treatment for ischemic mitral regurgitation].

Background: Ischemic mitral regurgitation (IMR) is characterized by annular dilation and restricted leaflet closure with increased leaflet tethering caused by displaced attachment of the papillary muscles. Our surgical strategy for IMR consists of mitral annuloplasty (MAP) and additional left ventricular restoration procedures as needed. When the left ventricular dilation and mitral tethering are mild, we perform MAP alone.

Topical application of a biodegradable disc with amiodarone for atrial fibrillation.

Background: Amiodarone is a potent anti-atrial fibrillation (AF) agent; however, its systemic administration induces serious side effects such as interstitial pneumonia. To avoid such effects, we developed a local sustained-release system for amiodarone.

Methods: A biodegradable, cross-linkable dextran disc was developed as a sustained-release carrier for amiodarone.

Excimer laser-assisted retrieval of Günther Tulip vena cava filters: a pilot study in a canine Model.

Purpose: Although most Günther Tulip filters (GTFs) can be safely retrieved within a few months after implantation, their recommended safe retrieval period is within a few weeks. This study aims to assess the feasibility of excimer laser-assisted retrieval of GTFs incorporated into the inferior vena cava (IVC) wall in a canine model.

Materials And Methods: Six GTFs were implanted in six mongrel dogs and retrieved after four weeks.

A novel approach to prevent spinal cord ischemia: Inoue stent graft with a side branch of small caliber for the reconstruction of the artery of Adamkiewicz.

Objectives: Paraplegia remains a serious complication after endovascular repair of thoracic aortic aneurysms, and it has been reported that paraplegia might be due to ischemia of the artery of Adamkiewicz. This study investigates the feasibility of an Inoue stent graft with a side branch of a small caliber for the reconstruction of the intercostal artery branching the artery of Adamkiewicz.

Methods: Branched Inoue stent grafts were implanted into the thoracic aorta and 11th intercostal artery of 5 mongrel dogs.