Outcomes After Aortic Valve Replacement for Asymptomatic Severe Aortic Regurgitation and Normal Ejection Fraction.

We investigated long-term outcomes following aortic valve replacement (AVR) in asymptomatic patients with severe aortic regurgitation (AR) and normal left ventricular (LV) function. We reviewed 268 patients who underwent isolated AVR for chronic severe AR from 1991 to 2010 and enrolled 162 asymptomatic patients with normal LV ejection fraction (≥50%) preoperatively. They were divided into 2 groups according to LV dimension at surgery, the early stage C group (indexed LV end-systolic diameter ≤25 mm/m and LV end-diastolic diameter ≤65 mm, n = 61), and late stage C group (indexed LV end-systolic diameter >25 mm/m and/or LV end-diastolic diameter >65 mm, n = 101).

Intermediate-term outcomes of our original multiple-knot technique using ePTFE sutures for anterior mitral leaflet prolapse.

Purpose: To define the outcomes of our original simple chordal replacement technique using ePTFE sutures for mitral regurgitation.

Methods: Between January, 2004 and March, 2014, 38 patients underwent mitral valve repair using our chordal replacement technique for anterior leaflet prolapse. The mitral regurgitation was caused by degenerative disease in 34 patients and infective endocarditis in 4 patients.

Beneficial effects of restrictive annuloplasty on subvalvular geometry in patients with functional mitral regurgitation and advanced cardiomyopathy.

Objectives: The effects of restrictive mitral annuloplasty (RMA) on subvalvular geometry remains unknown. We evaluated changes in left ventricular (LV) function, severity of mitral regurgitation (MR), and leaflet tethering parameters after RMA and clarified their associations.

Methods: In 44 patients with clinically relevant functional MR who underwent RMA, distances between papillary muscle (PM) tips and anterior mitral annulus (PM tethering distance), leaflet angles relative to lines connecting annuli, and interpapillary muscle distance (IPMD) were serially quantified.

Complete removal of infected devices and simultaneous implantation of new devices for infective endocarditis after pacemaker implantation.

Two cases of infective endocarditis after pacemaker implantation were reported. Complete removal of infected devices was performed under cardiopulmonary bypass, and simultaneous implantation of new devices was performed using epicardial leads and generator on the abdominal wall. The postoperative course was uneventful and recurrence was not recognized.

[Papillary fibroelastoma derived from the left ventricular wall just under the mitral leaflet; report of a case].

A 74-year-old male was referred to our department due to a mobile solid mass of 10 mm in diameter on the left ventricular interior wall just below the posterior leaflet of the mitral valve. Mild mitral regurgitation and moderate tricuspid regurgitation were also detected. A high serum level of IL-6 was detected(33.

Impact of Subxiphoid Video Pericardioscopy with a Rigid Shaft on Cardiac Hemodynamics in a Porcine Model.

OBJECTIVE: Single-port subxiphoid videopericardioscopy with a rigid shaft is useful for left atrial exclusion, left ventricular pacing lead implantation, and epicardial mapping, but it may interfere with the cardiac rhythm and adversely alter hemodynamics. We examined the impact of this technique on hemodynamic indices in a porcine model. METHODS: The videopericardioscopy device was introduced into the pericardial space of 5 pigs (35-45 kg) via a subxiphoid approach and navigated to 6 anatomical targets (right atrial appendage, superior vena cava, ascending aorta, left atrial appendage (anterior and posterior approaches), transverse sinus, and atrioventricular groove).

Newly developed tissue-engineered material for reconstruction of vascular wall without cell seeding.

Background: We have developed a tissue-engineered patch for cardiovascular repair. Tissue-engineered patches facilitated site-specific in situ recellularization and required no pretreatment with cell seeding. This study evaluated the patches implanted into canine pulmonary arteries.

Modified maze procedure combined with mitral valve surgery via septal-superior approach.

Although a septal-superior approach provides excellent exposure of the mitral valve, it requires novel strategies for concomitant ablation in patients with atrial fibrillation. Utilizing a combination of bipolar radiofrequency and cryothermy, we developed a novel technique for creating a biatrial lesion set via a septal-superior approach during mitral valve surgery. We treated 10 patients with functional mitral regurgitation and permanent atrial fibrillation with rhythm disturbance for a mean 87 months.

In situ tissue regeneration using a novel tissue-engineered, small-caliber vascular graft without cell seeding.

Objective: Various types of natural and synthetic scaffolds with arterial tissue cells or differentiated stem cells have recently attracted interest as potential small-caliber vascular grafts. It was thought that the synthetic graft with the potential to promote autologous tissue regeneration without any seeding would be more practical than a seeded graft. In this study, we investigated in situ tissue regeneration in small-diameter arteries using a novel tissue-engineered biodegradable vascular graft that did not require ex vivo cell seeding.

Novel technique for reimplantation of intercostal arteries using tailored patch graft.

We developed a simple and secure technique for reimplantation of the intercostal arteries (ICAs) using a patch graft during thoracoabdominal aneurysm repair. With our procedure, a sidearm branch with its base is tailored from a 24 mm one-branch Dacron graft, and then sutured as a patch graft to the trimmed wall of the descending aorta to cover the ICA orifices between Th9 and Th12. The proximal end of the patch graft is then anastomosed to the main tube graft, while the graft is perfused.

[A case of peritoneal metastasis of gastric cancer responding to TS-1, administered for four consecutive weeks with two-week rests].

We treated a patient with gastric cancer considered to be unresectable due to peritoneal metastasis, who responded remarkably to treatment with TS-1. The patient was a 62-year-old male. His diagnosis was gastric cancer, for which he underwent surgery on February 22, 2001.

Usefulness of continuous air tonometry for evaluation of splanchnic perfusion during cardiopulmonary bypass.

Although gastric mucosal tonometry has been reported as a useful method to assess splanchnic perfusion during cardiovascular surgery, the conventional discontinuous method of tonometry (saline tonometry) was cumbersome and prone to systematic errors. A new automated system of air tonometry (Tonocap; Datex Ohmeda, Helsinki, Finland) allows for frequent (every 10 minutes) measurement of gastric regional CO2 (PrCO2) and may be more suitable as a monitoring system in cardiac patients. We evaluated the usefulness of continuous air tonometry as a marker of splanchnic perfusion during cardiopulmonary bypass (CPB).

An alternative approach using long elephant trunk for extensive aortic aneurysm: elephant trunk anastomosis at the base of the innominate artery.

Background: Although a staged elephant trunk procedure has been widely used, the early mortality of the first stage operation as well as the interval mortality between operations remains unsatisfactory. We developed an alternative elephant trunk procedure to reduce mortality and morbidity.

Methods And Results: Ascending aorta and arch vessels were minimally dissected.