Non-aneurysmal ascending aorta diameter changes after aortic valve replacement in patients with stenotic bicuspid and tricuspid aortic valve.

OBJECTIVE: The appropriate timing of aortic repair in patients with bicuspid aortic valve-related aortopathy remains controversial. We describe the changes in diameter of the non-aneurysmal ascending aorta after aortic valve replacement for bicuspid or tricuspid aortic valve stenosis. METHODS: This retrospective review included 189 patients who had undergone aortic valve replacement for severe stenotic aortic valve with a non-aneurysmal ascending aorta diameter of 45 mm or less between January 2008 and December 2018. A linear mixed-effect model was used to analyze and compare the enlargement rates of the non-aneurysmal ascending aorta at the tubular portion after aortic valve replacement in bicuspid and tricuspid aortic valve patients. RESULTS: The enlargement rate of the non-aneurysmal ascending aorta after aortic valve replacement was significantly greater in the bicuspid aortic valve group than in the tricuspid aortic valve group (0.36 mm/year vs. 0.09 mm/year, p < 0.001). The specific form of bicuspid aortic valve also affected aorta diameter enlargement: the enlargement rate of 0.85 mm/year in the Type 0 (according to Sievers' classification) group was approximately five times that in the Non-Type 0 group (p < 0.001). No aortic events were observed, and no patients needed reoperations for the ascending aorta, in either the bicuspid or tricuspid aortic valve groups. CONCLUSION: The persistent possibility of progressive ascending aortic dilatation after aortic valve replacement for bicuspid aortic valve stenosis, especially in Type 0 bicuspid aortic valve patients, demands careful post-procedural evaluation of the ascending aorta.

Advances in gravity analyses for studying volcanoes and earthquakes.

This report highlights the usefulness and applicability of various gravimetric methods for studying earthquakes and volcanic activities. A high-resolution gravity anomaly map of Japan reveals areas with very steep horizontal gradients, where potential seismic faults are likely to be buried. Such traditional geoprospecting is coupled with novel cosmic-ray radiography to produce a fine-resolution (<100 m) three-dimensional density structure of a volcano. On the other hand, temporal gravity changes provide invaluable information about the process of earthquake faulting, volcanic eruptions, caldera formation, etc. Specifically, in this report we present our previous work on gravity research for solid earth science: (1) the first detection of coseismic gravity changes, (2) the virtual visualization of the rising and falling of magma in a conduit of Asama volcano, and (3) the large-scale lateral movement of magma during the Miyake-jima eruption in 2000.

Valve-sparing partial root repair for aortic dissection limited to the right coronary sinus of Valsalva.

BACKGROUND AND AIM OF THE STUDY: To reveal a technical feasibility and safety of valve-sparing partial aortic root repair for spontaneous aortic dissection limited to the right coronary sinus of Valsalva. METHODS: A 68-year-old woman presented with chest pain. Twelve-lead electrocardiogram revealed atrioventricular dissociation and ST-segment elevation on II, III, and aVF. Enhanced computed tomography images showed aortic dissection limited to the right-coronary sinus and the other non-dilated sinuses of Valsalva. Localized aortic dissection was repaired by valve-sparing partial aortic root repair using a trimmed U-shaped Dacron graft and a felt strip, and the right coronary artery was revascularized by coronary artery bypass grafting using saphenous vein graft. RESULTS: The patient was discharged on postoperative day 12 with no complications. CONCLUSION: Valve-sparing partial aortic root repair with the patch and coronary artery bypass grafting for aortic dissection limited to the right coronary sinus of Valsalva were technically feasible and safe.

[Acute Aortic Insufficiency due to the Avulsion of Aortic Valve Commissure;Report of a Case].

A 61-year-old man with a history of hypertension and cerebral infarction, presented to a clinic with sudden dyspnea at rest. He was diagnosed with heart failure and referred to our hospital. Echocardiography and three-dimensional computed tomography showed acute heart failure and aortic insufficiency due to avulsion of the aortic valve commissure between the right coronary cusp and the non-coronary cusp. He had no symptoms such as fever or infection and no history of rheumatic disease. He underwent intima fixation of the avulsed commissure and aortic valve replacement using a tissue valve because acute left heart failure was refractory to medical treatment. Postoperative echocardiography demonstrated good left ventricular contraction without any aortic regurgitation. He was discharged on the 35th postoperative day.

Adventitial Wrap Technique for Acute Type A Aortic Dissection.

We describe a simple and reproducible technique to achieve complete and immediate hemostasis of the distal anastomosis in total arch replacement with the frozen elephant trunk technique. The adventitia was left seamlessly 1.0 cm longer than the level of the suture line. The adventitial remnant covered most of the distal anastomosis line tightly while the distal anastomosis was completed with continuous sutures. The adventitia was thin and tough, making it suitable to cover the suture line. This technique can contribute to eliminating bleeding from the distal anastomosis independent of unreliable blood coagulability during aortic surgery for acute aortic dissection.

Impact of the size mismatch between saphenous vein graft and coronary artery on graft patency.

BACKGROUND: The saphenous vein graft (SVG) is widely used in coronary artery bypass grafting because of its availability and ease of use. However, the patency rate of the SVG grafted to the right coronary artery (RCA) is poor. Diameter mismatch between the coronary artery and SVG is an important cause of graft occlusion. In this study, we assessed how the degree of diameter mismatch affects SVG patency. METHODS: We reviewed the records of 123 patients who underwent aorto-right coronary artery bypass grafting with an SVG. The patency rate of the SVG, SVG diameter, RCA diameter and SVG-RCA diameter ratio (SR ratio) was assessed based on angiography and CT. RESULTS: The mean SVG diameter was 3.61 ± 0.72 mm, the mean RCA diameter was 1.57 ± 0.32 mm and the mean SR ratio was 2.37 ± 0.57. Cumulative patency rate of the SVG was 95.5 % at the early phase, 85.2 % at 1 year, and 70.2 % at 5 years. Multivariate analysis showed that the SR ratio was an independent predictor of SVG occlusion. The cutoff value of the SR ratio was 2.8, calculated from the point of maximal specificity (81.2 %) and sensitivity (64.7 %), and the area under the ROC curve was 0.734. When the SR ratio was ≤2.8, the 3-year patency rate was 86.1 %. CONCLUSIONS: A mismatch between SVG diameter and RCA diameter has an impact on the patency rate of the SVG. Evaluation of the saphenous vein before surgery and selection of a graft to minimize mismatch should improve SVG patency.

Right Atrial Calcified Ball Thrombus Mimicking a Myxoma.

An 80-year-old woman was admitted to our hospital because of congestive heart failure. Transthoracic echocardiography revealed severe aortic valve stenosis, and a mobile calcified mass was attached to the interatrial septum in the right atrium. We suspected that the mass was cardiac myxoma. We urgently performed aortic valve replacement and resection of the mass. The histological diagnosis of the mass was thrombus, and her post-operative course was uneventful. Although the mechanism of right atrial thrombus formation in our case was unclear, it is important to continue anticoagulation therapy after surgery to avoid recurrence. Furthermore, strict follow-up in this patient is needed.

Patch Repair for a Subepicardial Aneurysm With an Approach From Inside the Heart.

We present a case of subepicardial aneurysm that developed as a complication of acute myocardial infarction. Although the patient had stable hemodynamics, the diameter of the aneurysm tended to increase over time; thus, an operation was performed. We thought that approaching the aneurysm from outside the heart would injure the papillary muscle or distort the left ventricle and exacerbate mitral regurgitation. Therefore, we performed patch repair using bovine pericardium and approached the aneurysm from inside the heart. This is the first case report of a subepicardial aneurysm that was approached and repaired from inside the heart.

Ascending aortic false aneurysm formation associated with rupture of acute type a aortic dissection.

A 63-year-old man with ruptured acute type A aortic dissection was referred to our hospital. Computed tomography showed a false aneurysm arising from the false lumen located beside the ascending aorta. His hemodynamic status was stable inspite of the ruptured acute aortic dissection. We consider that the containment of the false aneurysm by thin mediastinal structures prevented worsening of his hemodynamic status, and this is extremely rare.

A network of superconducting gravimeters detects submicrogal coseismic gravity changes.

With high-resolution continuous gravity recordings from a regional network of superconducting gravimeters, we have detected permanent changes in gravity acceleration associated with a recent large earthquake. Detected changes in gravity acceleration are smaller than 10(-8) meters seconds(-2) (1 micro-Galileo, about 10(-9) times the surface gravity acceleration) and agree with theoretical values calculated from a dislocation model. Superconducting gravimetry can contribute to the studies of secular gravity changes associated with tectonic processes.