Aortic valve replacement through left thoracotomy after esophageal operation.

A 67-year-old man was referred for aortic valve surgery due to aortic valve regurgitation. He underwent an aortic valve replacement through a left thoracotomy, since he had a history of esophageal surgery with substernal gastric tube reconstruction and lymph node dissection through a right thoracotomy 14 years ago. The aortic valve was successfully replaced with excellent visualization using vacuum-assisted venous drainage on a cardiopulmonary bypass.

Wavelet analysis of valve closing sound detects malfunction of bileaflet mechanical valve.

Several studies have reported the asynchronous closure of normal bileaflet valves (NBVs), resulting in a split in its closing sound; however, the clinical significance of this split has never been studied in malfunctioning bileaflet valves (MBVs). The study comprised 218 valves in 184 patients, including normal monoleaflet valves (n = 10), NBVs (n = 198), and MBVs (n = 10). Valve function was confirmed by cinefluoroscopy prior to analysis of the valve sound by the Morlet continuous wavelet transform (CWT).

Recommendation for appropriate use of GRF glue in the operation for acute aortic dissection.

Background: Because an excessive use of activator (formaldehyde + glutaraldehyde) is supposed to be responsible for later adverse events after the use of gelatin resorcin formalin (GRF) glue in surgery for acute aortic dissection, we have tried to use a minimum dose of activator when the GRF glue was applied. We compare our midterm surgical results for acute aortic dissection with and without the use of GRF glue.

Methods: Forty-nine consecutive operated cases with Stanford type A acute aortic dissection within 48 h from onset from 1992 to 2005 were retrospectively analyzed.

Off-pump aortic arch repair through a median sternotomy for type B interrupted aortic arch with single ventricle physiology.

Background: The aortic arch repair for interrupted aortic arch (IAA) with the hypoplastic ascending aorta through a median sternotomy requires cardiopulmonary bypass (CPB), which is very invasive in neonates and complicates pulmonary artery banding (PAB) is staged repair.

Methods: A 22-day-old neonate with a type B IAA having a functional single ventricle underwent arch repair and PAB through a median sternotomy without CPB. A partial occlusion clamp could be placed on the ascending aorta without cerebral malperfusion and the descending aorta could be directly anastomosed to the ascending aorta in an end-to-side fashion under stable circulatory condition.

Management of vital organ malperfusion in acute aortic dissection: proposal of a mechanism-specific approach.

Objective: We report our strategy for malperfusion accompanying acute aortic dissection, especially that involving the abdominal organs, which is based on the mechanism and includes percutaneous management.

Methods: From 1991 through October 2005, a total of 38 of 135 (28%) patients with acute dissection presented with organ malperfusion. Altogether, 31 had type A dissection.

Wavelet analysis of bileaflet mechanical valve sounds.

It has been reported that asynchronous leaflet closure in a bileaflet mechanical valve causes a split in the valve closing sound. We have previously reported that the continuous wavelet transform (CWT) with the Morlet wavelet as modified by Ishikawa (the Morlet wavelet) is the most suitable method among the CWTs for detecting a split in the bileaflet mechanical valve sound because this method can detect the highest frequency signal among the CWT methods with higher time resolution. This is the first article which discusses the acoustic properties of five types of bileaflet valves using the Morlet CWT.

Apicoaortic valved conduit for a patient with porcelain aorta.

A 69-year-old woman had severe aortic stenosis with a circumferentially calcified aorta from the ascending aorta to the aortic arch, and moderately impaired left ventricular function. Implantation of an apicoaortic valved conduit was performed as aortic clamping was not feasible. The early results were excellent.

Proximal aortic replacement with ascending-descending bypass for a diffuse aneurysm: report of a case.

We performed successful ascending-arch aortic replacement and concomitant ascending-to-descending aorta bypass with exclusion of a descending thoracic aneurysm, via median sternotomy, for a ruptured aortic aneurysm involving the entire thoracic aorta. The patient was an 80-year-old man with cardiopulmonary dysfunction and a history of lung tuberculosis. This operation, which has been used for complex descending thoracic aortic lesions such as recoarctation, is a feasible option for a diffuse thoracic aortic aneurysm when single-stage repair is mandatory.

Bileaflet mechanical valve sound analysis using a continuous wavelet transform.

Bileaflet mechanical valve closing sounds have splits, the duration of which is not constant in normally functioning valves. However, no reports have discussed the influences of valve malfunction on the split interval, neither have any studies discussed the fact that mechanical valve closing sound signals must be analyzed using a time-frequency analysis because they are nonstationary signals. The continuous wavelet transform (CWT), a time-frequency analyzing method using mother wavelets modified by scale numbers, was selected in this study for analyzing bileaflet valve closing sounds because it is easy to understand and has no limitations such as the cross-terms in the Wigner-Ville distribution or the tradeoff between time and frequency resolutions of the short-time Fourier transform.

Novel technique for volume reduction of giant left atrium: simple and effective "spiral resection" method.

Despite some controversial studies, an enlarged left atrium has an impact on postoperative complications, and surgical correction should be considered, particularly in patients with a markedly enlarged left atrium. We present herein 2 patients with a giant left atrium (left atrial dimensions of 107 and 93 mm on echocardiograms), and describe an effective and simple procedure, the "spiral resection" method, to reduce any part of the dilated wall of the left atrium with a single incision.

[Novel stent/CEA strategy for patients with bilateral carotid artery stenosis and coronary artery disease: report of 2 cases].

Recently, there are increasing numbers of patients with occlusive carotid artery disease and coronary artery disease. Simultaneous or two-staged surgery for both lesions has been recommended for these patients to reduce the incidence of perioperative complications. However, therapeutic options for the patients with bilateral carotid artery stenosis and coronary artery disease have not been established.

Improved healing of small-caliber, long-fibril expanded polytetrafluoroethylene vascular grafts by covalent bonding of fibronectin.

Purpose: To evaluate the intermediate performance of small-caliber, long-fibril expanded polytetrafluoroethylene (ePTFE) vascular grafts pretreated with covalent bonding of fibronectin in dogs.

Methods: Small-caliber (4 mm), long-fibril (60 microm), ePTFE vascular grafts, 10 cm in length, were pretreated by covalent bonding of fibronectin. Bilateral iliac grafting was done in dogs using a fibronectin-bonded graft on one side and a nonbonded control graft on the other side.

Postoperative renal function after elective abdominal aortic aneurysm repair requiring suprarenal aortic cross-clamping.

Purpose: To examine postoperative renal function after suprarenal aortic cross-clamping performed without renal hypothermia in patients undergoing elective abdominal aortic aneurysm (AAA) surgery.

Methods: Between 1991 and 2000, 18 patients underwent surgery for a juxtarenal AAA, which required a suprarenal aortic cross-clamp. All AAAs were repaired with a proximal anastomosis just below the renal arteries.

Surgical results for active endocarditis with prosthetic valve replacement: impact of culture-negative endocarditis on early and late outcomes.

Objective: Surgical treatment of active infective endocarditis requires not only hemodynamic repair, but also special emphasis on the eradication of the infectious focus to prevent recurrence. This goal can be achieved by the combination of aggressive debridement of infective tissue and appropriate and adequate antibiotic treatment. We reviewed our experience with active endocarditis and identified factors determining early and late outcomes, particularly focusing on the factor of culture-negative endocarditis.

Bilateral coronary ostial patch angioplasty with autologous pericardium in Takayasu arteritis: a case requiring replacement of the aortic valve and ascending aorta.

Since the lesions and stages of Takayasu arteritis vary with each patient, surgical treatment of this disease requires meticulous planning for the timing of operation, technique, material used, and postoperative medication. We report a rare complex lesion of Takayasu arteritis, which required simultaneous repairs for aortic regurgitation, a dilated ascending aorta and bilateral coronary ostial stenosis. Such multiple lesions have not been reported previously.

Relationship between fibril length and tissue ingrowth in the healing of expanded polytetrafluoroethylene grafts.

Purpose: To determine whether fibril length is correlated with graft healing as well as cellular and capillary ingrowth in a canine carotid implantation model.

Methods: Expanded polytetrafluoroethylene (ePTFE) vascular grafts with three different fibril lengths (30, 60, and 90 microm) were implanted into the carotid artery in dogs. They were retrieved 4 weeks later, and subjected to histomorphometric analysis.

Use of bioresorbable membrane to prevent postoperative small bowel obstruction in transabdominal aortic aneurysm surgery.

Purpose: To evaluate the efficacy of Seprafilm (Genzyme, Cambridge, MA, USA), a bioresorbable membrane, in preventing or reducing early postoperative small bowel obstructions after transabdominal abdominal aortic aneurysm (AAA) surgery.

Methods: Fifty-one patients underwent aortic reconstruction via a midline transperitoneal approach for infrarenal AAAs. Twenty-one patients underwent surgery with Seprafilm (Seprafilm group) and the remaining 30 patients did not (control group).

Left atrioventricular valve regurgitation after repair of incomplete atrioventricular septal defect.

Background: Excellent surgical results have been reported for repair of incomplete atrioventricular septal defect; however, left atrioventricular valve regurgitation (ltAVVR) is a major cause of late morbidity. We reviewed our entire experience with incomplete atrioventricular septal defect in order to investigate long-term results of ltAVVR after repair and determine the factors influencing the progression of ltAVVR in late follow-up.

Methods: Between 1983 and 2002, 61 patients underwent surgical repair of incomplete atrioventricular septal defect, including 7 patients with intermediate forms.

Minimal access surgery for the repair of simple congenital heart defects: factors affecting hospital stay after surgery.

Objective: We reviewed our experience of minimal access surgery to elucidate the efficacy and safety of this approach and determine the factors affecting hospital stay.

Methods: Seventy-seven patients (age, 11.8 +/- 11.

Outcome of the perioperative use of percutaneous cardiopulmonary support for adult cardiac surgery: factors affecting hospital mortality.

Percutaneous cardiopulmonary bypass support (PCPS) has become a widespread standard modality for the treatment of circulatory collapse; however, its clinical use for postcardiotomy low cardiac output syndrome (LOS) has been reported to be unsatisfactory. We reviewed the clinical outcomes of twenty-three patients undergoing cardiac surgery and treated with PCPS. Solitary coronary artery grafting was undertaken for nine patients, while three had concomitant procedures.

Surgical management of aneurysms of the aortic arch vessels and their branches: report of four cases.

We review the cases of four patients with aneurysms of the aortic arch vessels and their branches. Two patients had a subclavian artery aneurysm, one had an innominate artery aneurysm, and one had a carotid artery aneurysm. We performed surgical reconstruction in all four patients in view of the life-threatening complications of these aneurysms.

Quantitative gated myocardial perfusion single photon emission computed tomography improves the prediction of regional functional recovery in akinetic areas after coronary bypass surgery: useful tool for evaluation of myocardial viability.

Objective: Assessment of myocardial viability in akinetic areas is essential in surgery for ischemic heart disease, including coronary artery bypass grafting and left ventriculoplasty. The aim of this study is to evaluate the utility of quantitative indices of perfusion uptake, wall motion, and wall thickening of each region calculated by quantitative electrocardiogram-gated single photon emission computed tomography (SPECT) for prediction of functional recovery after coronary artery bypass grafting.

Methods: Forty patients scheduled for coronary artery bypass grafting were prospectively included.

Simplified technique for patch augmentation and chorda reconstruction of left atrioventricular valve in complete atrioventricular septal defect.

Management of the left AV valve is the most crucial component of the repair of complete atrioventricular septal defect (cAVSD). A scarcity or deficiency of leaflet tissue may compromise satisfactory repair in a small number of patients with cAVSD, especially in patients with a normal karyotype. We describe the case of a 44-day-old baby who had cAVSD with severe left atrioventricular valve regurgitation due to dysplastic bridging leaflets.