Density of fresh wall of acute aortic dissection with synchrotron-based x-ray phase tomography.

Objectives: The mechanisms behind the onset of acute aortic dissection have not been fully elucidated. We developed dynamic synchrotron-based X-ray phase-contrast tomography to quantitatively study the dynamics of biological samples and applied it to the fresh aortic wall in acute type-A aortic dissection (ATAAD).

Methods: Fresh, ring-shaped aortas undergoing aortic repair in ATAAD were measured in a container filled with normal cold saline within 24 h of surgery.

Giant Patent Ductus Arteriosus Aneurysm Compressing the Esophagus.

It is extremely rare to observe aneurysmal changes in patients with patent ductus arteriosus (PDA), especially in adults. If left untreated, a PDA aneurysm can increase the risk of life-threatening complications, including rupture, dissection, esophageal fistula, and infection. Following is a description of successful surgical repair in a 55-year-old man with PDA aneurysm compressing the esophagus.

Mechanism of sac expansion without evident endoleak analyzed with X ray phase-contrast tomography.

Objective: Synchrotron radiation-based X ray phase-contrast tomography (XPCT) was used in this study to evaluate abdominal aorta specimens from patients with sac expansion without evidence of an endoleak (endotension) following endovascular aortic repair (EVAR) for an abdominal aortic aneurysm (AAA). The aim of this study was to analyze the morphologic structure of the aortic wall in patients with this condition and to establish the cause of the endotension.

Methods: Human aortic specimens of the abdominal aorta were obtained during open repair, fixed with formalin, and analyzed among three groups.

The role and timing of cardiopulmonary bypass in the surgical repair of traumatic cardiac injury.

Objectives: The management of traumatic cardiac injury (TCI) may require a prompt treatment, including the use of cardiopulmonary bypass (CPB) followed by surgical repair. This study evaluated the surgical outcomes among TCI patients.

Methods: From August 2003, 21 patients with TCI were underwent emergent surgical repair.

Impact of High-Resolution Epiaortic Ultrasonographic Imaging on Evaluating Aortic Wall Pathology.

There has been no definitive method, other than pathological findings, to identify the degeneration of the tunica media in the aortic wall (TM). We describe how high-resolution intraoperative epiaortic ultrasonographic imaging identifies changes in the TM of patients with aortic dissection. This method shows great promise in facilitating presymptomatic diagnoses of various aortic wall pathologies.

Decision making and management of acute type-A dissection presenting with shock or cardiac arrest.

While the outcome of aortic repair for acute type-A aortic dissection has improved, overall mortality among patients who developed acute type-A aortic dissection remains extremely high. Hypotension in acute type-A aortic dissection patients is a critical condition that is associated with increased in-hospital mortality and neurologic events. The underlying causes of shock include acute aortic regurgitation, cardiac tamponade, and myocardial infarction.

Retrospective study of thoracic endovascular aortic repair as a first-line treatment for traumatic blunt thoracic aortic injury.

Objective: This study sought to confirm if thoracic endovascular aortic repair (TEVAR) was an appropriate therapeutic strategy for blunt thoracic aortic injury (BTAI).

Methods: Between 3/2005 and 12/2020, 104 patients with BTAI were brought to our hospital. The severity of each trauma case was evaluated using the Injury Severity Score (ISS); aortic injuries were classified as type I to IV according to Society for Vascular Surgery guidelines.

Impact of time from symptom onset to operation on outcome of repair of acute type A aortic dissection with malperfusion.

Objectives: We analyzed patients with acute type A aortic dissection complicated by malperfusion syndrome to establish whether the timing of operative treatment and the location of malperfusion are factors in determining outcomes.

Methods: A total of 331 patients with acute type A aortic dissection were treated surgically between August 2003 and May 2019. Eighty-four patients (25%) presented with preoperative malperfusion syndrome.

Evaluation of Ductal Tissue in Coarctation of the Aorta Using X-Ray Phase-Contrast Tomography.

We assessed the histological accuracy of X-ray phase-contrast tomography (XPCT) and investigated three-dimensional (3D) ductal tissue distribution in coarctation of the aorta (CoA) specimens. We used nine CoA samples, including the aortic isthmus, ductus arteriosus (DA), and their confluences. 3D images were obtained using XPCT.

Acute Type A Aortic Dissection With Cardiopulmonary Arrest at Presentation.

Background: Management of acute type A aortic dissection (AADA) presenting with cardiopulmonary arrest (CPA) may require aggressive cardiopulmonary resuscitation (CPR), including extracorporeal CPR followed by aortic repair. This study evaluated the early and long-term outcomes of patients with preoperative CPA related to AADA.

Methods: Between September 2003 and August 2019, 474 patients with AADA were brought to our hospital, 157 (33.

Synchrotron Radiation-based X-ray phase-contrast imaging of the aortic walls in acute aortic dissection.

Objective: Synchrotron radiation-based X-ray phase-contrast tomography (XPCT) imaging is an innovative modality for the quantitative analysis of three-dimensional morphology. XPCT has been used in this study to evaluate ascending aorta specimens from patients with acute type A aortic dissection (ATAAD) and to analyze the morphologic structure of the aortic wall in patients with this condition.

Methods: Aortic specimens from 12 patients were obtained during repairs for ATAAD and were fixed with formalin.

Effect of Long-term Administration of Prostaglandin E on Morphologic Changes in Ductus Arteriosus.

Background: To improve survival of patients with hypoplastic left heart syndrome, combination therapy with bilateral pulmonary artery banding and prostaglandin E (PGE)-mediated ductal patency was developed as an alternative for high-risk neonates in Japan. However, the effect of long-term PGE administration on ductus arteriosus remains unclear. Synchrotron radiation-based X-ray phase-contrast tomography (XPCT) enables clear visualization of soft tissues at an approximate spatial resolution of 12.

Long-term Outcomes After Controlled Pericardial Drainage for Acute Type A Aortic Dissection.

Background: Cardiac tamponade with acute aortic dissection type A can cause fatal outcomes. We previously reported excellent outcomes using percutaneous pericardial drainage with controlled volumes of aspirated pericardial effusion (controlled pericardial drainage [CPD]) to stabilize patients with critical cardiac tamponade. This study evaluates the early and late outcomes using this approach.

Intact Imaging of Human Heart Structure Using X-ray Phase-Contrast Tomography.

Structural examination of human heart specimens at the microscopic level is a prerequisite for understanding congenital heart diseases. It is desirable not to destroy or alter the properties of such specimens because of their scarcity. However, many of the currently available imaging techniques either destroy the specimen through sectioning or alter the chemical and mechanical properties of the specimen through staining and contrast agent injection.

Three Dimensional Visualization of Human Cardiac Conduction Tissue in Whole Heart Specimens by High-Resolution Phase-Contrast CT Imaging Using Synchrotron Radiation.

Background: The feasibility of synchrotron radiation-based phase-contrast computed tomography (PCCT) for visualization of the atrioventricular (AV) conduction axis in human whole heart specimens was tested using four postmortem structurally normal newborn hearts obtained at autopsy.

Methods: A PCCT imaging system at the beamline BL20B2 in a SPring-8 synchrotron radiation facility was used. The PCCT imaging of the conduction system was performed with "virtual" slicing of the three-dimensional reconstructed images.

Impact of synchrotron radiation-based X-ray phase-contrast tomography on understanding various cardiovascular surgical pathologies.

At SPring-8, synchrotron radiation-based X-ray phase-contrast tomography (PCXI) has been developed to measure the inner structures of biological soft tissue without destroying them. To resolve the three-dimensional (3D) morphology, we have applied PCXI to various cardiovascular tissue samples, including the thoracic aorta, ductus arteriosus, and cardiac conduction system. In the aortic walls, PCXI demonstrated differences in 3D structures of tunica media of aortic dissection.

Mutations in a TGF-β ligand, TGFB3, cause syndromic aortic aneurysms and dissections.

Background: Aneurysms affecting the aorta are a common condition associated with high mortality as a result of aortic dissection or rupture. Investigations of the pathogenic mechanisms involved in syndromic types of thoracic aortic aneurysms, such as Marfan and Loeys-Dietz syndromes, have revealed an important contribution of disturbed transforming growth factor (TGF)-β signaling.

Objectives: This study sought to discover a novel gene causing syndromic aortic aneurysms in order to unravel the underlying pathogenesis.

Quantitative and dynamic measurements of biological fresh samples with X-ray phase contrast tomography.

X-ray phase contrast tomography using a Talbot grating interferometer was applied to biological fresh samples which were not fixed by any fixatives. To achieve a high-throughput measurement for the fresh samples the X-ray phase contrast tomography measurement procedure was improved. The three-dimensional structure of a fresh mouse fetus was clearly depicted as a mass density map using X-ray phase contrast tomography.

Therapeutic strategy for treating aortoesophageal fistulas.

Purpose: The development fistulas between the thoracic aorta and the esophagus are highly fatal conditions. We aimed to identify a therapeutic strategy for treating aortoesophageal fistula (AEF) in this study, by investigating all AEF cases presented in this special symposium at the 65th Annual Scientific Meeting of the Japanese Association for Thoracic Surgery.

Methods: Forty-seven AEF patients were included in this study.

Impact of controlled pericardial drainage on critical cardiac tamponade with acute type A aortic dissection.

Background: Cardiac tamponade is associated with fatal outcomes for patients with acute type A aortic dissection, and the presence of cardiac tamponade should prompt urgent aortic repair. However, treatment of the patient with critical cardiac tamponade who cannot survive until surgery remains unclear. We analyzed our experience of controlled pericardial drainage (CPD) managing critical cardiac tamponade.