[Embolization Using a Debranched Left Common Carotid Artery Stump for Gutter Endoleak After Thoracic Endovascular Aortic Repair with the Double-debranching and Chimney Technique].

An 88-year-old male underwent thoracic endovascular aortic repair (TEVAR) with the double-debranching and chimney technique for arch aortic aneurysm. When the aforementioned procedure was performed, the left common carotid artery was closed and transected, and the left subclavian artery was embolized and bypassed, respectively. However, postoperatively, the gutter endoleak persisted, and the aneurysm enlarged;therefore, requiring additional surgery. A skin incision was made on the left side of the neck, and the closed and dissected left common carotid artery stump was detected. A sheath was placed at the stump and an angiographic catheter and guidewire were used to retrograde cannulate the gutter beside the chimney graft, and coil embolization was performed. No endoleak was observed at postoperatively and 6-month follow up computed tomography( CT). We believe that embolization from a deblanched left common carotid artery stump is useful for endoleaks after TEVAR employing the chimney and debranching technique.

[Re-operation Using Bovine Pericardium for Infective Endocarditis after Aortic Valve Neocuspidization;Report of a Case].

A 70-year-old man, who had undergone aortic valve neocuspidization using his own pericardium 8 months before, complained of back pain, and was diagnosed with pyrogenic spondylitis. As the result of blood culture, Enterococcus faecalis was found to be the causative bacterium, and antibiotic therapy was started. Six days after admission, hemodynamics collapsed suddenly, and percutaneous cardio-pulmonary support was established. Echocardiography showed severe aortic valve regurgitation, and he was diagnosed with active infective endocarditis. We performed re-do aortic valve neocuspidization using bovine pericardium. There was a tear on the non-coronary cusp and the cusps were thickened because of infection. Aortic annular tissue was not destroyed and we could fix the neo-valve directly to the annulus. After these procedures, severe reduction of antero-septal wall motion was noted, which suggested dissection of the main trunk of the left coronary artery. Coronary artery bypass grafting to the left anterior descending and the circumflex branches was added. The patient came off percutaneous cardio-pulmonary support 5 days after surgery. Although trivial aortic regurgitation remained, he was discharged after 2 months of rehabilitation.

[Reports of 12 Cases of Stanford Type A Acute Aortic Dissection Emergent Surgery for Jehovah's Witnesses patients].

The Jehovah's Witnesses (JW) is well known for declining blood transfusions. Especially, cardiovascular surgery on JW poses unique challenges. We herein report 12 JW emergent cases of Stanford type A acute aortic dissection which underwent graft replacement between 2003 and 2019. Graft replacement of ascending aorta was performed in all cases. Operative time and anesthetic time were 344±100 and 396±109 minutes respectively. The mean intraoperative hemoglobin nadir was 4.9±1.2 g/dl. The postoperative hemoglobin nadir was 6.3 ±2.4 g/dl. There were 2 deaths within 24 hours after surgery. We did not transfuse any packed red blood cells, fresh frozen plasma or platelets for JW patients of Stanford type A acute aortic dissection surgery.

[Aortoesophageal Fistula with Infected Thoracic Aortic Aneurysm Rupture;Report of a Case].

A 67-year-old man was referred to our hospital because of fever and discomfort of the throat. Gastrointestinal endoscopy revealed hematoma at the middle thoracic esophagus. Computed tomography revealed posterior mediastinal hematoma extending the descending aorta. Bacillus was detected in the blood culture. Aortoesophageal fistula with an infected thoracic aortic aneurysm rupture was diagnosed. First, thoracic endovascular aortic repair (TEVAR) was performed. Resection of the thoracic esophagus and omentopexy was conducted 15 days after TEVAR. Esophageal reconstruction using a gastric tube was performed 43 days after esophagectomy. He has been doing well since then.

[Thoracic Endovascular Aortic Repair for a Descending Thoracic Aneurysm Associated with Pseudocoarctation of the Aorta;Report of a Case].

A 77-year-old man with a descending thoracic aneurysm associated with pseudocoarctation of the aorta underwent thoracic endovascular aortic repair (TEVAR). Computed tomography demonstrated kinking of the descending thoracic aorta. The aneurysm was located distal to a kinking and constricting aortic isthmus. TEVAR was performed because of the patient's comorbidity such as valvular heart diseases and postradiation status for the thoracic Hodgkin disease. TEVAR was successful but small aortic dissection was occurred distal to the stentgraft. Computed tomography at 1 year after TEVAR demonstrated reduction of the aneurysmal diameter and no change in the small dissection. TEVAR is becoming the treatment of first choice for this disease.

Nutritional status and management of risks due to physical therapy in patients hospitalized for long periods.

[Purpose] This study aimed to understand the nutritional status of patients hospitalized for long periods and the risk of physical therapy (PT) for such patients. [Subjects and Methods] Participants were selected from patients who were hospitalized at a designated medical long-term care sanatorium. The participants were divided into 5 groups (A-E) depending on their mode of energy intake and ambulatory ability during PT. The serum albumin level, energy intake, total daily energy expenditure, and total daily energy expenditure per session of PT (EEPT) were evaluated for each group. [Results] Protein-energy malnutrition was observed in 69.6% of the participants. No significant association was identified between the serum albumin level and body mass index. Energy intake was significantly higher in Groups D and E, whose energy intake was via ingestion, than in Groups A and B, whose intake was via tube feeding. EEPT was highest in patients of Group E who had gait independence different from the ability of those in groups A-D. [Conclusion] The actual energy intake is lower with tube feeding than with ingestion. Risk management and energy intake should be revisited in elderly patients who have been hospitalized for long periods and subsequently obtain gait independence.

[New prosthesis implant technique of aortic root abscess; circumferential transmural sutures].

A patient with aortic root abscess was successfully treated with a newly developed suture technique named "circumferential transmural sutures". This suture technique provides 1)a tight attachment of the prosthesis to the aortic wall and 2)a secure healing of infection by exposure of the abscess cavity to blood flow without complicated procedures. This technique would be a useful alternative for the aortic root abscess without left ventriculo-aortic disruption.

The impact of systemic vascular resistance on the accuracy of the FloTrac/Vigileo™ system in the perioperative period of cardiac surgery: a prospective observational comparison study.

FloTrac/Vigileo™ system is based on arterial pressure waveform analysis arterial pressure-based CO (APCO). Therefore, systemic vascular resistance (SVR) can influence the accuracy of APCO. The purpose of this study is to evaluate the relationship between SVR and the accuracy of APCO. We managed 50 consecutive patients in the perioperative period of cardiac surgery with FloTrac/Vigileo™ system (v. 3.02) and Swan-Ganz catheter/Vigilance™ system pulmonary artery catheter-based CO (PAC-CO) simultaneously. Continuous hemodynamic measurement using both methods was performed every 20 s from the induction of anesthesia to PAC removal 4 h after extubation. A total of 11,092 (intraoperative), 38,455 (postoperative, pre-extubation), and 44,235 (postoperative, post-extubation) data pairs were finally analyzed. Bland-Altman analysis revealed that in the intraoperative [postoperative pre-extubation, post-extubation] period, the bias was 0.5 [0.1, 0.0] L/min and the limits of agreement ranged from -2.4 to 3.3 [-2.2 to 2.4, -2.4 to 2.3] L/min. The percentage error was 60.3 [54.5, 48.5] %. Regression analysis of the systemic vascular resistance index (SVRI) and the bias between APCO and PAC-CO showed that the bias was positively correlated to the SVRI. Subanalysis based on SVR with Lin's concordance correlation coefficient revealed that relatively satisfactory concordance was found in the normal-SVR group (concordance correlation coefficient ρ c = 0.51-0.56) regardless of vasoactive agent use. The accuracy of the FloTrac/Vigileo™ System (v. 3.02) is relatively satisfactory in the condition with normal SVR regardless of vasoactive agent use. Positive correlation between the bias and SVR can be the clue to the more effective use of FloTrac/Vigileo™ system.

[Endovascular repair for coarctation of the aorta in an adult].

A 27-year-old woman with Turner's syndrome who underwent successful endovascular treatment for coarctation of the aorta is presented. She was admitted to our hospital complaining of upper extremity hypertension. Computed tomography revealed discrete stenosis of the proximal descending aorta and developed collateral circulation. After endovascular repair with a balloon expandable stent, her transcoarctation gradient fell from 44 mmHg preoperatively to less than 10 mmHg. She was discharged with no complications on the 7th postoperative day. Coarctation of the aorta in an adult patient could be safely and effectively managed by endovascular treatment.

A New Case With Cortical Malformation Caused by Biallelic Variants in LAMC3.

Objective: In this study, we report the case of a 24-year-old man with intellectual disability and childhood-onset seizures. This patient had newly identified biallelic variants in the laminin subunit gamma 3 (LAMC3) gene with unreported cortical malformation. Methods: Exome sequencing. Results: Genetic analyses revealed new biallelic variants in the LAMC3 gene. An MRI examination of the brain revealed cortical malformations predominantly in the temporal lobes and mildly in the occipital, frontal, and parietal lobes. In addition, our patient also exhibited mild midline malformation in the ventral pons, which is unique to LAMC3 variants. Discussion: Patients with LAMC3 variants have been reported to exhibit cortical malformation predominantly in the occipital lobes, but this patient exhibited cortical malformation predominantly in the temporal lobes and mildly in the occipital, frontal, and parietal lobes. In addition, this patient also exhibited mild midline malformation in the ventral pons. These unique findings cast new light on the role of LAMC3 in brain development.

Clinical impact of 11C-Pittsburgh compound-B positron emission tomography in addition to magnetic resonance imaging and single-photon emission computed tomography on diagnosis of mild cognitive impairment to Alzheimer's disease.

ABSTRACT: This study aimed to evaluated the clinical impact of adding [11C] Pittsburgh compound-B (11C-PiB) PET for clinical diagnosis of mild cognitive impairment (MCI) to Alzheimer's disease (AD) dementia.Twenty six (mean age 78.5 ±â€Š5.18 years, 21 females) AD (n = 7), amnestic MCI (n = 12), non-amnestic MCI (n = 3), vascular dementia, progressive supranuclear palsy (PSP) with frontotemporal dementia (FTD), FTD (n = 1 each), and normal (n = 1) patients underwent 11C-PiB-PET, MRI, and SPECT scanning. 11C-PiB-PET was compared with MRI and SPECT for clinical impact.11C-PiB-PET showed positivity in 6, 9, and 0 of the AD, amnestic MCI, and non-amnestic MCI patients, respectively, and 0 of those with another disease. Parahippocampal atrophy at VSASD was observed in 5 AD patients, 6 amnestic and PiB-positive MCI patients, 1 amnestic and PiB-negative MCI patient, and 1 vascular dementia patient. Parietal lobe hypoperfusion in SPECT findings was observed in 6, 4, and 2 of those, respectively, as well as 1 each of non-amnestic MCI, vascular dementia, and normal cases. Sensitivity/specificity/accuracy for selecting PiB-positive patients among the 15 MCI patients for 11C-PiB-PET were 100% (9/9)/100% (6/6)/100% (15/15), for VSRAD were 66.7% (6/9)/83.3% (5/6)/73.3% (11/15), and for SPECT were 44.4% (4/9)/50.0% (3/6)/46.7% (7/15), while those were 88.9% (8/9)/33.3% (2/6)/66.7% (10/15)/for combined VSRAD and SPECT. 11C-PiB-PET accuracy was significantly higher than that of SPECT.11PiB-PET alone may be useful for selecting patients who will progress from MCI to AD in the future, although follow-up study is necessary to clarify the outcome of MCI patients.

Premovement facilitation of corticospinal excitability in patients with Parkinson's disease.

The purpose of this study was to investigate the abnormality of premovement facilitation in patients with Parkinson's disease. Seven patients with Parkinson's disease and seven healthy subjects participated in this study. The subjects attempted abduction of the index finger in response to a visual start cue, and motor-evoked potentials were recorded from the first dorsal interosseous muscle before movement onset. The rate of premovement facilitation in patients with Parkinson's disease was slower than that in healthy subjects. Additionally, the rate of premovement facilitation as a function of delay from the start cue was positively correlated with the reaction time. These findings indicate that premovement facilitation is abnormal in patients with Parkinson's disease. This abnormality may be partially related to akinesia.

Effects of transcranial magnetic stimulation over the cerebellum on triphasic electromyographic pattern.

The purpose of this study was to investigate the effects of transcranial magnetic stimulation (TMS) over the cerebellum on the triphasic electromyographic (EMG) pattern. Eight healthy subjects extended the left wrist as fast as possible in response to a start cue. TMS was delivered over the cerebellum 50 ms after the start cue. TMS over the cerebellum produced shortening of the latency in the first agonist burst, and an increase in the EMG activity of the antagonist burst. The triphasic EMG pattern may be partially under the control of the cerebellum.

Transcatheter aortic valve implantation after aortic valve neocuspidization using autologous pericardium: a case report.

BACKGROUND: Aortic valve neocuspidization (AVNeo), a novel surgical procedure used in the treatment of aortic valve diseases, including aortic stenosis (AS), involves the replacement of three aortic valve cusps by glutaraldehyde-treated autologous pericardium. Although reoperation risk is low, no case report on the deterioration of the AVNeo has yet been published. CASE SUMMARY: An 80-year-old woman who underwent AVNeo for severe degenerative tricuspid AS 6 years previously complained of shortness of breath. Echocardiographic assessment revealed the reconstructed aortic valve leaflet was elongated, thickened, and marginally calcified resulting in recurrent severe AS. Transcatheter aortic valve implantation using balloon-expandable transcatheter heart valve was successfully performed. DISCUSSION: To our knowledge, this is the first case report regarding the structural deterioration of the AVNeo resulting in restenosis 6 years after the first surgery. Transcatheter aortic valve implantation is possibly a suitable approach for post-procedural recurrence after AVNeo to avoid redo open-heart surgery which would be of prohibitive risk especially in an elderly population.

Chronic expanding intrapericardial hematoma after coronary artery bypass surgery presenting with congestive heart failure.

We report the successful treatment of a rare case of chronic expanding intrapericardial hematoma that had slowly developed into a large mass after coronary artery bypass surgery. An 85-year-old man with a history of coronary artery bypass surgery presented with dyspnea on exertion and leg edema in 2006. Chest roentgenograph demonstrated right pleural effusion and severe pulmonary edema. An echocardiographic study demonstrated a mass located posterior to the left ventricle that severely compressed the left ventricle toward the ventricular septum. Surgical resection of the mass was planned to release the symptoms and to confirm the diagnosis of the mass. The mass was completely resected through a left thoracotomy, and the histological findings confirmed the diagnosis of a chronic expanding intrapericardial hematoma. The patient's postoperative course was uneventful, and his symptoms improved markedly. There has been no sign of recurrence 1 year after the operation.

A patient with ataxia with a normal brain CT on admission.

A 60-year-old housewife noticed sudden onset left hemiparesis. On admission, she had left hemiparesis, more severe in the lower limb. A brain CT scan at this time was normal. After a few days, her hemiparesis was almost diminished, however, she had ataxia on the left side without paresis. She had no facial weakness and dysarthria.

Motion analysis of grip and release with fingers using simple magnetic detection system.

We have developed a magnetic grip-and-release motion detection system to measure time differences among fingers during motion. We designed a magnetic sensing system consisting of a magnetic oscillation coil, sensing coil, and circuit unit. We measured wave forms of grip-and-release motion (15 s) of seven healthy volunteers using the system. To provide the grip-and-release timing of each finger, we used the reference voltage of each subject in the state of grasping a rod with a 30 mm diameter. Using the reference voltage, the time differences in the finger movements of all volunteers were detected. The detected grip-and-release time difference of both dominant and nondominant hands had a main tendency in which the closing movement of the little finger is fast, within 10 ms, and the opening movement is slow, within 13 ms. Our data suggest that the new magnetic sensing system has the potential to detect the quantitative value of the time difference in grip-and-release motion among fingers.

Severely calcified constrictive pericarditis simulating a mediastinal tumor and obstructing the right ventricular inflow tract.

We report a rare case of constrictive pericarditis that stimulated a large mediastinal tumor obstructing the right ventricular inflow tract. A 58-year-old woman was referred to our hospital because of a recent increase of dyspnea and facial edema. Computed tomography revealed severely thickened calcification, including a low-density area, presenting as a mediastinal tumor, compressing the right ventricular inflow tract. A complete resection was performed, and her symptoms dramatically improved. Idiopathic constrictive pericarditis was diagnosed pathologically.

Progression of left coronary artery dissection during and after aortic replacement in acute type A aortic dissection: a case report.

A 69-year-old man was transferred to our hospital with a diagnosis of acute type A aortic dissection. In the emergent operation, the dissection was found to extend to the orifice of the left coronary artery, but not to the coronary artery itself. The false lumen was closed using glue and sutures with felt strips, and graft replacement of the ascending aorta was performed. However, signs of myocardial ischemia were present after the operation, and the patient's condition continued to be unstable, even though intraaortic balloon pumping was initiated. A coronary angiogram and intravascular ultrasound performed three hours after the operation revealed a left main trunk stenosis due to pulsatile compression of the false lumen, which was caused by the extension of dissection. A coronary artery stent was subsequently deployed in the left main trunk. The patient was discharged four weeks later in a stable condition, although with segmental asynergy of wall motion, due to myocardial damage.