Procedural selection strategy and clinical outcomes in mitral valve surgery with concomitant aortic valve replacement in elderly patients.

Introduction: In the context of double-valve surgery for elderly high-risk patients involving both the aortic and mitral valves, a clinically significant problem has been that no clear criteria or surgical strategies have been reported for the selection of mitral valve plasty (MVP) or mitral valve replacement (MVR) for mitral valve disease management during surgical aortic valve replacement (SAVR) to achieve better clinical outcomes. This study investigated valve durability and survival using our surgical strategy for mitral valve disease with concomitant SAVR in elderly patients.

Methods: Eighty-six patients aged > 65 years (mean 75 years) who underwent a double-valve procedure for mitral valve surgery with concomitant SAVR from 2010 to 2022 were reviewed.

Long-term outcome of extensive mitral valve reconstruction with autologous pericardium and artificial chordae for treatment of destructive active infective endocarditis of the mitral valve.

Objective: Mitral valve (MV) repair is a well-accepted surgical approach for infective endocarditis (IE). In our hospital, extensive MV reconstruction with fresh autologous pericardium (AP) and artificial chordae (AC) has been performed for patients with profoundly extensive and destructive IE in which valve reconstruction would be extremely challenging, especially in young patients to avoid mechanical valve replacement. Long-term outcome including the future performance of the newly created leaflet has not been established.

Successful surgical treatment of delayed left ventricular pseudoaneurysm related to infection after repair of ventricular septal rupture complicating acute myocardial infarction.

Left ventricular (LV) pseudoaneurysm is a rare complication after postinfarction repair of ventricular septal rupture (VSR), and surgical treatment of this condition due to mycosis has rarely been reported. We report a rare case of successful surgical treatment of delayed LV pseudoaneurysm related to infection after repair of VSR due to myocardial infarction. A 75-year-old woman was admitted for fever and severe inflammatory reaction.

Blood flow modification might prevent secondary rupture of multiple pancreaticoduodenal artery arcade aneurysms associated with celiac axis stenosis.

A pancreaticoduodenal artery arcade aneurysm (PDAA) is rare and often associated with celiac axis stenosis by the median arcuate ligament. Although rupture risk of the PDAA is not related to its size, treatment guidelines are absent. Here we describe a 59-year-old woman with multiple ruptured PDAAs associated with celiac axis stenosis who was successfully treated with coil embolization.

The Cattell-Braasch maneuver might be a good option for a huge abdominal aortic aneurysm.

Endovascular repair is often difficult in the case of a huge abdominal aortic aneurysm for anatomic reasons. Here, we describe open repair of a huge infrarenal abdominal aortic aneurysm. Open repair was performed through laparotomy with the Cattell-Braasch maneuver, a technique for right-sided medial visceral rotation.

Venovenous extracorporeal membrane oxygenation for the management of critical airway stenosis.

Venovenous extracorporeal membrane oxygenation (VV-ECMO) is used not only support gas transfer of patients suffering from respiratory failure, but also to manage hypoxic patients with critical airway obstruction during various procedures. We present a case in which we electively used VV-ECMO to facilitate tube placement and tracheal biopsy in a 67-year-old female with critical tracheal stenosis. The patient was transferred to our hospital for a surgical treatment after emergent tracheostomy for postoperative management of cerebral hemorrhage in right putamen.

[Structural Deterioration of a Bovine Pericardial Valve in a Tricuspid Position 14 Years Postoperatively;Report of a Case].

Although nonstructural dysfunction of a bioprosthesis caused by pannus formation or native valve attachment has been well described, structural valve deterioration( SVD) caused by calcification or tear of a bioprosthesis, especially a bovine pericardial valve, is very rare in the tricuspid position. We report a case of redo tricuspid valve surgery for SVD 14 years after tricuspid valve replacement( TVR) using a Carpentier-Edwards Perimount (CEP) pericardial valve. A 71-year-old woman was referred to our hospital because of exertional dyspnea and pre-syncope.

Emergency valve surgery for infective endocarditis complicated by acute intracranial hemorrhage: A case report.

Introduction: Optimal timing of surgical treatment for infective endocarditis (IE) complicated by intracranial hemorrhage remains controversial.

Presentation Of Case: A 43-year-old man with IE received appropriate antibiotic therapy but had recurrence of cerebral infarction and intracranial hemorrhage (ICH). Emergency valve surgery was performed 2days after ICH onset because of heart failure and recurrence of cerebral complications.

Enlargement of aortic arch vessels after surgical repair of type A aortic dissection.

Background: Information on the growth rate of the diameter of the residual dissected supra-aortic trunk after surgical repair of type A aortic dissection is limited.

Methods: We retrospectively reviewed 95 consecutive postsurgical patients with type A aortic dissection (acute, 91; chronic, 4) between 2005 and 2016 who were followed up with computed tomography. The diameter of the residual dissected supra-aortic trunk was measured by axial images and multiplanar reformatting, and the growth rate was calculated.

Retrograde type A dissection after thoracic endovascular repair due to the barb.

We present a case of retrograde ascending aortic dissection in a 65-year-old man 8 months after emergency thoracic endovascular repair of an atherosclerotic aneurysm. Intraoperative findings identified a retrograde ascending aortic dissection due to the barb of the stent-graft. Retrograde type A dissection is a rare but fatal complication after thoracic endovascular aortic repair.

Early outcomes of extra-thoracic debranching thoracic endovascular aortic repair for distal aortic arch disease.

Thoracic endovascular aortic repair (TEVAR) combined with supra-aortic debranching is a promising approach for distal aortic arch disease, especially in high-risk patients. Most debranching TEVAR procedures for distal arch pathologies can now be performed by using extra-thoracic bypass and endovascular repair, without intra-thoracic manipulation needing sternotomy or thoracotomy. To compare the early outcomes of extra-thoracic debranching TEVAR with those of conventional arch replacement, we retrospectively reviewed data from 20 high-risk patients with distal aortic arch disease who underwent extra-thoracic debranching TEVAR and 16 patients who underwent total arch replacement from March 2009 to November 2011.

Surgical repair of severe mitral valve regurgitation complicated by incomplete cor triatriatum.

A 69-year-old woman with exertional dyspnea was referred emergently to our hospital for further evaluation. Transthoracic echocardiography showed severe mitral valve regurgitation and moderate tricuspid regurgitation, which were thought to be the main cause of her heart failure. An electrocardiogram showed paroxysmal atrial fibrillation.

Terumo-Triplex grafts for total arch replacement: analysis of postoperative graft performance.

We evaluated the performance of Terumo-Triplex (TRP) with a large-diameter vascular graft sealed with non-biodegradable material in 48 patients who underwent total arch replacement under selective cerebral perfusion between 2004 and 2009. TRP grafts were used in 13 patients (T group), Gelseal graft in 15 (G group), Hemashield graft in 10 (H group) and Intergard graft in 10 (I group). The total tube drainage, time to tube removal, graft dilation ratio and inflammation were evaluated postoperatively.

Cibenzoline intoxication necessitating implantation of a biventricular assist system in a patient with severe cardiomyopathy.

A 46-year-old man was admitted to our hospital in cardiogenic shock. A BVS-5000s biventricular assist system (BVAS) was implanted after establishment of extracorporeal membrane oxygenation. At admission, the patient's serum cibenzoline level was extremely high, 6336 ng/ml.

Fulminant apical ballooning syndrome after replacement of a prosthetic aortic valve.

A 70-year-old woman was readmitted to our hospital with a fever of 39 degrees C on the 30th day after replacement of a prosthetic aortic valve. She required percutaneous cardiopulmonary support for her heart failure and was weaned after 7 days. Echocardiography revealed an akinetic and aneurysmally dilated left ventricular apex and hyperdynamic basal segments.

Beneficial effects of mini-cardiopulmonary bypass on hemostasis in coronary artery bypass grafting: analysis of inflammatory response and hemodilution.

We compared the inflammatory response, hemodilution, and blood loss in patients who underwent mini-cardiopulmonary bypass (CPB) or conventional CPB during coronary artery bypass grafting (CABG). Ninety-eight consecutive patients with ischemic heart disease were randomly assigned to mini-CPB (n = 34) or conventional CPB (n = 64). Interleukin (IL) -8 and neutrophil elastase levels were measured before and after surgery.

Long-term outcomes after entry closure and aneurysmal wall plication for type B aortic dissection.

Objective: To examine the long-term outcomes after entry closure and aneurysmal wall plication for type B chronic dissecting aortic aneurysm. This procedure uses no artificial graft and preserves all intercostal arteries.

Methods: We reviewed the records of 40 consecutive patients who underwent this procedure between September 1983 and December 2002.

Simple method of left ventricular assist system exchange from a BVS-5000 to a Toyobo: case report of a patient with fulminant myocarditis.

We implanted a BVS-5000 biventricular assist system in a 29-year-old woman in cardiogenic shock due to fulminant myocarditis. Exchange of the left ventricular assist system (LVAS) from the BVS-5000 to a Toyobo LVAS and weaning from the right ventricular assist system were performed successfully without cardiopulmonary bypass. This simple, less invasive method may be useful for patients requiring LVAS exchange for long-term ventricular support.

Minimal cardiopulmonary bypass attenuates neutrophil activation and cytokine release in coronary artery bypass grafting.

The minimal cardiopulmonary bypass (mini-CPB) circuit, a closed system with neither cardiotomy suction nor an open venous reservoir and thus no air-blood interface, reportedly reduces blood loss and inflammatory reactions associated with coronary bypass surgery. We evaluated the inflammatory reactions in patients in whom coronary bypass operations were performed with conventional CPB or mini-CPB (n=15 each). Interleukin (IL)-6, IL-8, and neutrophil elastase levels; the neutrophil count; and the C-reactive protein value were measured before and immediately after surgery and on postoperative days 1 and 2.

Modified sandwich technique for acute aortic dissection.

We describe a new method for aortic anastomosis in the repair of acute type A aortic dissection. The anastomosis site is prepared with the adventitial inversion technique, which converts a dissected aorta into a conduit lined with tough adventitia. The end is reinforced with felt strip outside and anastomosed with interrupted everting mattress and running sutures, resulting in complete hemostasis.

Edaravone suppresses postoperative reperfusion injury in rat lower extremity: An immunohistological study.

Purpose: The present study evaluated whether the free radical scavenger edaravone (Radicut [Mitsubishi Pharma Co, Japan]) can suppress lower extremity postoperative reperfusion injury by evaluating muscle cell viability with immunohistological stain (cytochrome c oxidase stain).

Methods: Eight Lewis male rats (460 g to 510 g) were divided into two groups. In the control group, postoperative reperfusion injury models were created by clamping the bilateral common femoral arteries for 5 h and then releasing.

Unusually high serum levels of lactate dehydrogenase without perivalvular leakage following double valve replacement: predictor of tetany attack after thyroidectomy.

A 57-year-old woman who complained of exertional dyspnea was diagnosed as having severe aortic valve stenosis and mitral valve regurgitation. The patient underwent double valve replacement with a mechanical prosthesis. Postoperative laboratory data showed unusually high serum lactate dehydrogenase (LDH) levels, even though no perivalvular leakage was detected by echocardiography.