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1.
Minim Invasive Ther Allied Technol ; 32(6): 345-347, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37729442

RESUMO

A 68-year-old man with a history of valve-sparing aortic root replacement and endoscopic aortic valve replacement was admitted to our hospital with dyspnea. Transthoracic echocardiography revealed severe pulmonary valve regurgitation. The patient had undergone cardiac surgery twice, through median sternotomy and right thoracotomy; therefore, we planned endoscopic pulmonary valve replacement via the left thoracic approach. The patient was placed in a modified right lateral decubitus position and underwent mild hypothermic cardiopulmonary bypass. An on-pump beating-heart technique was used during surgery. The 3D endoscopic system and trocars for surgical instruments were inserted through the left 3rd and 4th intercostal spaces. After incision of the pulmonary artery, the pulmonary cusps were resected. A 27-mm St Jude Medical Epic heart valve was implanted in the intra-annular position. Subsequently, the left atrial appendage was resected. The patient was discharged without complications. To our knowledge, this is the first case of totally endoscopic pulmonary valve replacement.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Valva Pulmonar , Masculino , Humanos , Idoso , Implante de Prótese de Valva Cardíaca/métodos , Valva Pulmonar/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Endoscopia , Valva Aórtica/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos
2.
Kyobu Geka ; 76(6): 463-467, 2023 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-37258026

RESUMO

A 60-year-old woman was admitted to our institution for exertional dyspnea. Transthoracic echocardiography revealed a 1.6 cm secundum atrial septal defect( ASD) and a 4.2×3.1 cm mobile left atrial mass originating from the ASD. The tumor migrated to the mitral valve during diastole and to the atrial septal defect during systole. A totally endoscopic approach via a small right thoracotomy was adopted to resect the mass and close the ASD with a Hemashield patch. Histopathologic examination of the excised mass was consistent with myxoma. The postoperative course was uneventful. A 2-year follow-up revealed no recurrence of the myxoma and ASD.


Assuntos
Fibrilação Atrial , Neoplasias Cardíacas , Comunicação Interatrial , Mixoma , Feminino , Humanos , Pessoa de Meia-Idade , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/cirurgia , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Ecocardiografia , Mixoma/diagnóstico por imagem , Mixoma/cirurgia
3.
J Cardiothorac Surg ; 17(1): 305, 2022 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-36510240

RESUMO

BACKGROUND: Descending aortic replacement often involves making large incisions; thus, it results in massive invasions. We report the case of a patient with dilated descending aorta treated using endoscopic-assisted descending aortic replacement with essentially minimal invasions. CASE PRESENTATION: We performed endoscopic-assisted descending aortic replacement with a single incision involving six wounds by trocar puncturing on a 59-year-old man who was diagnosed with dilated descending aorta by stent graft-induced new entry. Subsequently, the patient was discharged on postoperative day 11 without any complications. CONCLUSIONS: Despite minor incisions, our approach can be indicated to almost the same group of patients in whom the conventional approach can be performed. Our procedure involved a single incision of only 8 cm and six wounds by trocar puncturing. Thus, endoscopic-assisted surgery can be a useful option in descending aortic surgery.


Assuntos
Aneurisma da Aorta Torácica , Dissecção Aórtica , Implante de Prótese Vascular , Masculino , Humanos , Pessoa de Meia-Idade , Stents , Aorta/cirurgia , Endoscopia , Reimplante , Aneurisma da Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/complicações , Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos
4.
Gen Thorac Cardiovasc Surg ; 68(9): 1027-1030, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31538285

RESUMO

We present the case of a 75-year-old man with repeated lower limb hematoma caused by consumptive coagulopathy from a type B chronic aortic dissection. His abdominal aorta was replaced with a Y-shaped graft 30 years prior to admission. As his previous aortic stent graft treatment failed, he underwent open surgical prosthetic graft replacement of the descending aorta under deep hypothermia. To reduce intra- and postoperative bleeding, we avoided cutting the ribs and intercostal arteries. The aneurysm was approached only through the 8th intercostal space; however, as the proximal descending aorta was inaccessible from this site, total endoscopic or endoscopic-assisted procedure was performed to approach the proximal descending aorta. All intercostal arterial orifices were securely closed by suture. The postoperative course was uneventful, and he was discharged home on postoperative day 11. The endoscopic surgery reduced impairment of collateral vessels during surgery and might have reduced the risk of paraplegia.


Assuntos
Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Dissecção Aórtica/cirurgia , Endoscopia/métodos , Stents , Idoso , Humanos , Masculino , Reimplante
5.
Gen Thorac Cardiovasc Surg ; 66(8): 492-494, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29616462

RESUMO

Frozen elephant technique is an effective procedure used to repair complex thoracic aortic disease involving the aortic arch and the descending aorta, or to treat aortic dissection. However, the technique often requires some creativity to properly place the stent graft and anastomose the graft to the aorta. We recently used the J Graft FROZENIX® (Japan Lifeline Co., Ltd., Tokyo, Japan) in total arch replacement, and devise a technique for distal anastomosis (called "reverse stepwise anastomosis") that was simple and easy and caused minimal bleeding.


Assuntos
Anastomose Cirúrgica/métodos , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Dissecção Aórtica/cirurgia , Implante de Prótese Vascular/métodos , Aorta/cirurgia , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Reimplante , Stents
6.
J Thorac Cardiovasc Surg ; 155(1): 131-139.e3, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28728784

RESUMO

OBJECTIVE: The study objective was to quantify the effect of ring type, ring-annulus sizing, suture position, and surgeon on the forces required to tie down and constrain a mitral annuloplasty ring to a beating heart. METHODS: Physio (Edwards Lifesciences, Irvine, Calif) or Profile 3D (Medtronic, Dublin, Ireland) annuloplasty rings were instrumented with suture force transducers and implanted in ovine subjects (N = 23). Tie-down forces and cyclic contractile forces were recorded and analyzed at 10 suture positions and at 3 levels of increasing peak left ventricular pressure. RESULTS: Across all conditions, tie-down force was 2.7 ± 1.4 N and cyclic contractile force was 2.0 ± 1.2 N. Tie-down force was not meaningfully affected by any factor except surgeon. Significant differences in overall and individual tie-down forces were observed between the 2 primary implanting surgeons. No other factors were observed to significantly affect tie-down force. Contractile suture forces were significantly reduced by ring-annulus true sizing. This was driven almost exclusively by Physio cases and by reduction along the anterior aspect, where dehiscence is less common clinically. Contractile suture forces did not differ significantly between ring types. However, when undersizing, Profile 3D forces were significantly more uniform around the annular circumference. A suture's tie-down force did not correlate to its eventual contractile force. CONCLUSIONS: Mitral annuloplasty suture loading is influenced by ring type, ring-annulus sizing, suture position, and surgeon, suggesting that reports of dehiscence may not be merely a series of isolated errors. When compared with forces known to cause suture dehiscence, these in vivo suture loading data aid in establishing potential targets for reducing the occurrence of ring dehiscence.


Assuntos
Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral/cirurgia , Valva Mitral , Ajuste de Prótese , Técnicas de Sutura , Animais , Próteses Valvulares Cardíacas/efeitos adversos , Valva Mitral/patologia , Valva Mitral/cirurgia , Anuloplastia da Valva Mitral/efeitos adversos , Anuloplastia da Valva Mitral/instrumentação , Anuloplastia da Valva Mitral/métodos , Modelos Anatômicos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Desenho de Prótese/métodos , Ajuste de Prótese/efeitos adversos , Ajuste de Prótese/métodos , Ovinos
7.
Circ Cardiovasc Interv ; 9(10)2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27729419

RESUMO

BACKGROUND: Injectable, acellular biomaterials hold promise to limit left ventricular remodeling and heart failure precipitated by infarction through bulking or stiffening the infarct region. A material with tunable properties (eg, mechanics, degradation) that can be delivered percutaneously has not yet been demonstrated. Catheter-deliverable soft hydrogels with in vivo stiffening to enhance therapeutic efficacy achieve these requirements. METHODS AND RESULTS: We developed a hyaluronic acid hydrogel that uses a tandem crosslinking approach, where the first crosslinking (guest-host) enabled injection and localized retention of a soft (<1 kPa) hydrogel. A second crosslinking reaction (dual-crosslinking) stiffened the hydrogel (41.4±4.3 kPa) after injection. Posterolateral infarcts were investigated in an ovine model (n≥6 per group), with injection of saline (myocardial infarction control), guest-host hydrogels, or dual-crosslinking hydrogels. Computational (day 1), histological (1 day, 8 weeks), morphological, and functional (0, 2, and 8 weeks) outcomes were evaluated. Finite-element modeling projected myofiber stress reduction (>50%; P<0.001) with dual-crosslinking but not guest-host injection. Remodeling, assessed by infarct thickness and left ventricular volume, was mitigated by hydrogel treatment. Ejection fraction was improved, relative to myocardial infarction at 8 weeks, with dual-crosslinking (37% improvement; P=0.014) and guest-host (15% improvement; P=0.058) treatments. Percutaneous delivery via endocardial injection was investigated with fluoroscopic and echocardiographic guidance, with delivery visualized by magnetic resonance imaging. CONCLUSIONS: A percutaneous delivered hydrogel system was developed, and hydrogels with increased stiffness were found to be most effective in ameliorating left ventricular remodeling and preserving function. Ultimately, engineered systems such as these have the potential to provide effective clinical options to limit remodeling in patients after infarction.


Assuntos
Materiais Biocompatíveis , Ácido Hialurônico/administração & dosagem , Infarto do Miocárdio/tratamento farmacológico , Miocárdio/patologia , Função Ventricular Esquerda/efeitos dos fármacos , Remodelação Ventricular/efeitos dos fármacos , Animais , Fenômenos Biomecânicos , Biópsia , Reagentes de Ligações Cruzadas/química , Modelos Animais de Doenças , Ecocardiografia , Análise de Elementos Finitos , Ácido Hialurônico/química , Hidrogéis , Injeções , Imageamento por Ressonância Magnética , Masculino , Modelos Cardiovasculares , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/patologia , Infarto do Miocárdio/fisiopatologia , Recuperação de Função Fisiológica , Carneiro Doméstico , Volume Sistólico/efeitos dos fármacos , Fatores de Tempo
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