[A Simulation Surgery of Valve-sparing Aortic Root Replacement Using a Three-dimensional Printed Model].

Aortic valve-sparing surgery is a delicate procedure that requires specialized skills to control aortic valve regurgitation. Therefore, simulating the surgery before performing it on a patient is good practice for inexperienced surgeons. Herein, we present our experience of a simulation surgery using a three-dimensionally printed aortic root model of a 60-year-old man with severe aortic regurgitation and aortic root enlargement. We fabricated the model using multi-slice computed tomography data. The model revealed the two pitfalls:unbalanced commissure position and lower coaptation height of the right coronary cusp. We completed the simulation surgery from the proximal suture and valve reimplantation to coronary ostial reconstructions during approximately three hours with medical staffs. In the actual operation, the aortic valve regurgitation completely disappeared by accurately reconstructing the commissure in the Valsalva graft and adjusting the height of the right coronary cusp using central plication procedure. We believe that carrying out simulations before the actual surgery improves the surgeon's confidence and the patient's outcomes.

Multicenter investigation of the incidence of inferior vena cava filter fracture.

PURPOSE: Inferior vena cava filter fracture (FF) may cause life-threatening complications, including cardiac tamponade, although the actual prevalence remains unclear. Therefore, we investigated the incidence of FF. MATERIALS AND METHODS: Data on fracture incidence with filter brands, filter positions [suprarenal (SR) vs. infrarenal (IR)], and follow-up durations were collected from the databases of eight hospitals. RESULTS: Of 532 patients, Günther Tulip (GT), Trap/OptEase (TE/OE), ALN and VenaTech (VT) were implanted in 345, 147, 38 and 2 patients, respectively. Of these, filter retrieval was attempted in 110 (21.7%) patients and was successful in 106 (96.4%). Of the remaining 426 patients, FFs were observed in two (0.7%) of 270 GT filters and 19 (14.1%) of 135 TE/OE filters. Fragment embolization occurred in one patient with a GT filter (50.0%) and three with a TE/OE filter (15.8%) with a total follow-up interval of 718.0 ± 1019.4 days. FF occurred more frequently in TE/OE than in GT filters (p < 0.001). Kaplan-Meier estimates showed significantly higher fracture-free rates for GT than TE/OE (p < 0.001) and IR-TE/OE than SR-TE/OE (p < 0.05). CONCLUSIONS: TE/OE filters are not suitable for permanent implantation due to the relatively early and high fracture rates.

Apixaban versus Warfarin for the Prevention of Periprocedural Cerebral Thromboembolism in Atrial Fibrillation Ablation: Multicenter Prospective Randomized Study.

INTRODUCTION: Stroke can be a life-threatening complication of atrial fibrillation (AF) catheter ablation. Uninterrupted warfarin treatment contributes to minimizing the risk of stroke complications. METHODS AND RESULTS: This was a prospective, open-label, randomized, multicenter study assessing the safety and efficacy of apixaban for the prevention of cerebral thromboembolism complicating AF catheter ablation. Two hundred patients with drug-resistant AF were equally assigned to take either apixaban (5 mg or 2.5 mg twice daily) or warfarin (target international normalized ratio, 2-3) for at least 1 month before AF ablation. Neither drug regimen was interrupted throughout the operative period. Diffusion-weighted magnetic resonance imaging was performed for all patients to detect silent cerebral infarction (SCI) after the ablation. Primary outcomes were defined as the occurrence of stroke, transient ischemic attack, SCI, or major bleeding that required intervention. The secondary outcome was minor bleeding. The groups did not statistically differ in patients' backgrounds or procedural parameters. During AF ablation, the apixaban group required administration of more heparin to maintain an activated clotting time > 300 seconds than the warfarin group (apixaban, 14,000 ± 4,000 units; warfarin, 9,000 ± 3,000 units). Three primary outcome events occurred in each group (apixaban, 2 SCI and 1 major bleed; warfarin, 3 SCI, P = 1.00), and 3 and 4 secondary outcome events occurred in the apixaban and warfarin groups (P = 0.70), respectively. CONCLUSION: Apixaban has similar safety and effectiveness to warfarin for the prevention of cerebral thromboembolism during the periprocedural period of AF ablation.

A rare case: bioprosthetic tricuspid valvuloplasty dramatically improved hepatic encephalopathy.

A 51-year-old woman was diagnosed as severe stenosed tricuspid bioprosthetic valve. She had developed an encephalopathy due to elevated serum ammonia concentration caused by congestive hepatic failure. Re-tricuspid valve replacement was deemed too risky, and balloon bioprosthetic valvuloplasty was instead planned. This procedure was successfully performed using a standard mitral valvuloplasty protocol. The 30-mm INOUE-BALLOON was inflated five times. The mean pressure gradient across the bioprosthetic valve decreased from 7.8 to 3.5 mmHg, and the tricuspid valve orifice area increased from 1.09 to 3.13 cm(2), without worsening of the tricuspid valve regurgitation. Finally, her hepatic encephalopathy was dramatically improved.

A Comparison of Heart Rate Response between 12 hours Caffeine Abstinence and 24 hours in Adenosine Stress Myocardial Perfusion Imaging.

The aim of this study was to examine whether the heart rate response to adenosine differs after 12 hours [Good control (Good-C)] versus 24 hours [Excellent control (Exc-C)] of caffeine abstinence in adenosine stress thallium-201 (TL) myocardial perfusion imaging (MPI). Patients (n=729) with suspected ischemic heart disease underwent adenosine TL-MPI after 12 (n=226) and 24 (n=503) hours of caffeine abstinence. There was not significant differences between the heart rate of Exc-C and Good-C in 0-2 min after adenosine infusion (0 min 63.7±9.5 versus 63.7±10.0, 1 min 66.4±10.6 versus 65.3±10.5, 2 min 72.3±11.2 versus 70.6±11.4). The heart rate of Exc-C was higher compared to Good-C in 3-6 min after adenosine infusion (3 min 75.6 ±11.7 versus 73.3±11.6 p=0.013, 4 min 79.2±12.9 versus 76.7±12.2 p=0.012, 5 min 79.4±12.6 versus 76.8±12.4 p=0.009, 6 min 79.4±12.5 versus 77.0±12.3 p=0.016). Therefore, the longer caffeine abstinence, namely 24 hours self-restraint, is effective in adenosine TL-MPI.

[Intravenous adenosine and radiopharmaceutical injection in the same line was feasible in adenosine stress myocardial perfusion. imaging].

Adenosine stress myocardial perfusion imaging was performed with an intravenous adenosine and radiopharmaceutical injection in the same line. A syringe containing 720 µg/kg of adenosine in 40 ml of saline was prepared and injected at the constant infusion rate of 400 ml/h. Adenosine was temporarily stopped by the stopcock when 1.5 ml of thallium was injected for 0.5 second from the three-way stopcock with two ways opened. Thereafter, the stopcock was returned to the original position in 0.5 second, and adenosine flow returned to the constant flow rate again. In this method, 0.75% of adenosine total dose was injected at a rate of 3.0 ml/s and adenosine was stopped for 3.6 second. There were no significant differences in either effects and adverse events of adenosine between this method and two intravenous injection line method. Adenosine stress in one venous line method would be an easy method maintaining the dose effect and safety.