RESUMO
BACKGROUND: The ideal surgical technique for ischemic mitral regurgitation (MR) is controversial. We introduced an extended posterior mitral leaflet (PML) augmentation technique for functional MR with severe tethering, which detached the PML from the annulus almost completely and augmented it with a large 3×6-cm oval pericardial patch. MethodsâandâResults: A total of 17 mitral repairs using the new technique were performed for ischemic MR with no 30-day mortality and 2 hospital deaths. The NYHA class was III in 47% and IV in 13%. The EuroSCORE II was 9.7±4.9. The ring size was 32±1.4 mm. Concomitant coronary bypass was performed in 67% and left ventricular repair in 28%. The mechanism of leaflet closure was evaluated using transthoracic echocardiography in 15 survivors. MR decreased to none or trivial with a significant increase in coaptation length (Pre: 4.6±0.8 mm vs. Post: 9.8±2.5 mm; P<0.001). The PML flexibly moved forward and tightly contacted as if "snuggling up" to the anterior leaflet. There were no late deaths, heart failure readmissions or MR recurrences during follow-up (850±181 days). All patients remained in NYHA I or II. CONCLUSIONS: Extended PML augmentation for ischemic MR showed excellent early results with deep leaflet coaptation through a "snuggling up" phenomenon, which would help prevent late MR recurrence.
Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Isquemia/etiologia , Insuficiência da Valva Mitral/cirurgia , Idoso , Procedimentos Cirúrgicos Cardíacos/mortalidade , Procedimentos Cirúrgicos Cardíacos/normas , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/mortalidade , Insuficiência da Valva Mitral/patologia , Recidiva , Estudos Retrospectivos , Resultado do TratamentoRESUMO
A 78-year-old woman with liver cirrhosis due to chronic hepatitis C visited our department for treatment of a thoracic aortic aneurysm. Her Child-Pugh classification was class A, and her model for end-stage liver (MELD) disease score was 8. As she also had thrombocytopenia associated with splenomegaly and esophageal varices, endoscopic injection sclerotherapy and partial splenic embolization were performed before total arch replacement surgery for treating esophageal varices to reduce the bleeding risk during transesophageal echocardiography and for thrombocytopenia, respectively. After endoscopic injection sclerotherapy and partial splenic embolization, the platelet count increased; hence, total arch replacement surgery was performed. By combining partial splenic embolization and endoscopic injection sclerotherapy, we were able to safely perform transesophageal echocardiography and total arch replacement surgery in the perioperative period.
RESUMO
BACKGROUND: Morphologically, the risk of aortic aneurysm rupture is mainly evaluated based on its type (e.g., fusiform or saccular) and diameter. Based on the finite element analysis, peak wall stress has been identified as a more sensitive and specific predictor of rupture in recent years. Moreover, in finite analysis, the neck of aneurysm is the highest peak wall stress and is associated with the rupture point. CASE PRESENTATION: A saccular aortic aneurysm (84 mm) was incidentally detected during preoperative examination for chronic empyema in a 74-year-old male patient with a history of polycythemia. Aortic arch graft replacement using an open stent was performed. CONCLUSIONS: Morphologically, this case was associated with a very high risk of rupture; nevertheless, it did not rupture. In this case, a mural thrombus (likely formed due to polycythemia) covered the neck of aneurysm that is experiencing the highest peak wall stress and is associated with the rupture point. The mural thrombus decreased peak wall stress and could reduce the risk of rupture even for huge saccular aneurysms. Furthermore, the mural thrombus was fully occupied in aneurysms, such as during coil embolization. Thus, polycythemia could decrease the risk of rupture of huge saccular aneurysms.
Assuntos
Aneurisma da Aorta Abdominal , Aneurisma Aórtico , Ruptura Aórtica , Policitemia , Tromboembolia , Trombose , Masculino , Humanos , Idoso , Policitemia/complicações , Aneurisma Aórtico/complicações , Ruptura Aórtica/complicações , Trombose/complicações , Trombose/cirurgia , Tromboembolia/complicações , Aneurisma da Aorta Abdominal/complicaçõesRESUMO
Surgical reconstruction is one of the standard treatments for renal artery aneurysm. However, its intraoperative evaluation is sometimes difficult depending on the operative field, aneurysm morphology, and peripheral blood vessel distribution. This case demonstrated that after renal artery reconstruction, indocyanine green fluorescence angiography is used to evaluate the results of repairing. This method is useful in visceral aneurysm evaluation not only for assessing reconstructed blood flow but also for confirming tissue perfusion of the renal parenchyma.
Assuntos
Dermatite Herpetiforme/terapia , Retardo do Crescimento Fetal/terapia , Granulócitos/imunologia , Impetigo/terapia , Leucaférese/métodos , Monócitos/imunologia , Pele/imunologia , Biópsia , Dermatite Herpetiforme/sangue , Dermatite Herpetiforme/diagnóstico , Feminino , Retardo do Crescimento Fetal/sangue , Retardo do Crescimento Fetal/diagnóstico , Retardo do Crescimento Fetal/imunologia , Humanos , Impetigo/sangue , Impetigo/diagnóstico , Impetigo/imunologia , Gravidez , Fatores de Risco , Pele/patologia , Resultado do TratamentoRESUMO
The J Graft Open Stent Graft (JOSG) is used for the frozen elephant trunk procedure in Japan. We report a 70-year-old male who developed a rapidly progressing distal arch aneurysm caused by a distal stent graft-induced new entry (DSINE) 7 months after the procedure. The JOSG was originally implanted at the curved part of the distal arch. It created its initial DSINE on the greater curve and rapidly "sprang" back in 2 months. Urgent thoracic endovascular aortic repair fixed this serious complication. We should remember such rapid progression of DSINE by JOSG and treat its initial sign earlier.
RESUMO
BACKGROUND: New guidelines from The Society of Thoracic Surgeons recommend adding surgical ablation as a concomitant procedure for class I indications. We performed the maze procedure for all patients who experienced atrial fibrillation (AF) before cardiac surgery, without surgeon pre-exclusion. METHODS: We retrospectively analyzed 83 patients, aged 71 ± 11 years (22% >80 years), who underwent Cox maze IV for persistent AF between 2014 and 2017. The mean AF duration (AFD) was 6.9 ± 8.6 years and European System for Cardiac Operative Risk Evaluation II was 7.2 ± 6.8. RESULTS: The 30-day mortality was 2.4%. During follow-up (mean, 675 days), the 1-, 2-, and 3-year survival rates were 92%, 86%, and 82%, respectively. No strokes were observed despite a mean CHA2DS2-VASC (Congestive heart failure, Hypertension, Age [≥65 = 1 point, ≥75 = 2 points], Diabetes, and Stroke/transient ischemic attack [2 points], vascular disease, Sex [female = 1 point]) score of 4.1 (expected stroke rate, 4%/y). Twelve patients required a new pacemaker; 56 of 73 survivors (77%) remained AF free. Multivariate logistic regression identified preoperative AFD, f wave size, and mean heart rate per Holter as important risk factors for AF recurrence, with AFD as the most important: 98% of patients with AFD less than 5 years remained AF free. Although the AF-free rate with the AFD of 5 or more years was only 55%, their symptoms improved without heart failure readmission. Concomitant atrial plication was performed more frequently in the group with AFD for 5 or more years, with greater atrial volume reduction and appreciable increases in stroke volume. CONCLUSIONS: The Cox maze IV procedure performed without pre-exclusion showed reasonable survival rates. Although AF recurred in patients with longer AFD, they fared well with substantial increases in stroke volume. Concomitant atrial volume reduction may have contributed to these additional benefits.
Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Sistema de Condução Cardíaco/fisiopatologia , Complicações Pós-Operatórias/epidemiologia , Medição de Risco/métodos , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/mortalidade , Fibrilação Atrial/fisiopatologia , Ecocardiografia , Eletrocardiografia , Feminino , Seguimentos , Humanos , Incidência , Japão/epidemiologia , Masculino , Complicações Pós-Operatórias/diagnóstico , Radiografia Torácica , Recidiva , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendênciasRESUMO
The GORE EXCLUDER Iliac Branch Endoprosthesis (IBE) device is designed to seal off a common iliac artery (CIA) aneurysm, preserving the internal iliac artery during endovascular aortic repair. We report the case of an 84-year-old man with isolated saccular right CIA aneurysm (35 mm) and a relatively small terminal aorta (24 mm). The IBE device was successfully placed, and intraoperative angiography revealed no leakage or delay. However, postoperative computed tomography revealed marked compression of the contralateral leg by a bridging component. Although his ankle-brachial index was preserved, its acute occlusion was judged highly possible; we decided to perform preemptive angioplasty. The angiography revealed the stenosis only in the left anterior oblique view, and angioplasty was uneventfully performed. The leg was successfully patent at 1-year follow-up. When compression by IBE and bridging component in the terminal aorta is expected, caution should be preserved at intraoperative angiography following the device deployment.
RESUMO
Taxonomy of mud crabs genus Scylla has been misidentified for several years due to their high morphological plasticity. Several reports concerning mud crab have been published with misleading identification in Bangladesh. In this study, partial fragments of nuclear and mitochondrial DNA of Scylla species obtained from four locations along the Bangladesh coast were used to resolve taxonomical ambiguity of mud crab species. A single PCR product from the nuclear first internal transcribed spacer (ITS-1) marker and phylogenetic trees constructed based on 16S rDNA sequences indicated that all Scylla species obtained in this study were S. olivacea. Both molecular data and morphological characters revealed that S. olivacea is the only major species in Bangladesh coastal waters. Further, the 16S rDNA haplotypes significantly differed with known S. serrata by 33%. From this study it is clear that 'S. serrata' commonly reported from Bangladesh should be S. olivacea.
Assuntos
Braquiúros/genética , Filogenia , Animais , Bangladesh , Braquiúros/classificação , Núcleo Celular/genética , Marcadores Genéticos , Mitocôndrias/genética , Reação em Cadeia da PolimeraseRESUMO
Pentacuspid pulmonary valve is an extremely rare congenital anomaly. A 71-year-old woman presented with dyspnea on exertion. The preoperative examination showed a large pulmonary artery aneurysm with severe pulmonary regurgitation. The pentacuspid pulmonary valve was an intraoperative finding with four equivalent leaflets and one hypoplastic leaflet. The valve was successfully repaired by use of a bicuspidization technique combined with annuloplasty, and pulmonary artery reduction was performed. Postoperatively, the patient remained asymptomatic with trivial pulmonary regurgitation 1 year later. To our knowledge, this is the first report of a pentacuspid pulmonary valve repair.
Assuntos
Aneurisma/cirurgia , Anuloplastia da Valva Cardíaca/métodos , Artéria Pulmonar/cirurgia , Insuficiência da Valva Pulmonar/cirurgia , Valva Pulmonar/anormalidades , Valva Pulmonar/cirurgia , Idoso , Aneurisma/complicações , Dilatação Patológica/cirurgia , Dispneia/etiologia , Ecocardiografia , Feminino , Humanos , Insuficiência da Valva Pulmonar/diagnóstico por imagem , Insuficiência da Valva Pulmonar/etiologiaRESUMO
BACKGROUND: Severe patient-prosthesis mismatch, defined as effective orifice area index ≤0.65 cm(2) m(-2), has demonstrated poor long-term survival after aortic valve replacement. Reported rates of severe mismatch involving the Perimount Magna aortic bioprosthesis range from 4% to 20% in patients with a small annulus. METHODS: Between June 2008 and August 2011, 251 patients (mean age 70.5 ± 10.2 years; mean body surface area 1.55 ± 0.19 m(2)) underwent aortic valve replacement with a Perimount Magna bioprosthesis, with or without concomitant procedures. We performed our procedure with rigorous patient-prosthesis matching to implant a valve appropriately sized to each patient, and carried out annular enlargement when a 19-mm valve did not fit. The bioprosthetic performance was evaluated by transthoracic echocardiography predischarge and at 1 and 2 years after surgery. RESULTS: Overall hospital mortality was 1.6%. Only 5 (2.0%) patients required annular enlargement. The mean follow-up period was 19.1 ± 10.7 months with a 98.4% completion rate. Predischarge data showed a mean effective orifice area index of 1.21 ± 0.20 cm(2) m(-2). Moderate mismatch, defined as effective orifice area index ≤0.85 cm(2) m(-2), developed in 4 (1.6%) patients. None developed severe mismatch. Data at 1 and 2 years showed only two cases of moderate mismatch; neither was severe. CONCLUSIONS: Rigorous patient-prosthesis matching maximized the performance of the Perimount Magna, and no severe mismatch resulted in this Japanese population of aortic valve replacement patients.
Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Bioprótese , Implante de Prótese de Valva Cardíaca/efeitos adversos , Próteses Valvulares Cardíacas/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/mortalidade , Ecocardiografia , Feminino , Seguimentos , Implante de Prótese de Valva Cardíaca/métodos , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese/métodos , Resultado do TratamentoRESUMO
A 33-year-old man presented with severe aortic insufficiency due to a prolapsed bicuspid aortic valve. The ventriculoaortic junction was dilated to 29 mm without root dilatation, and external ring annuloplasty was performed using a Gelweave (Terumo, Tokyo, Japan) graft to reduce the size to 22 mm. The leaflets were repaired by dividing and suturing a raphe between the right and left cusps. This combination provided adequate coaptation depth (8 mm) and showed excellent results, with trivial aortic insufficiency. This approach is suitable for repair of a bicuspid aortic valve with a dilated ventriculoaortic junction without root dilatation.
Assuntos
Valva Aórtica/anormalidades , Anuloplastia da Valva Cardíaca/métodos , Doenças das Valvas Cardíacas/cirurgia , Adulto , Valva Aórtica/cirurgia , Doença da Válvula Aórtica Bicúspide , Humanos , Masculino , Indução de RemissãoRESUMO
A 70-year-old woman was admitted to our institution with acute myocardial infarction. Coronary angiography demonstrated total occlusion of the left anterior descending artery, which was successfully revascularized. Four days later, the patient suddenly went into shock. The subsequent emergency operation revealed a blowout rupture of the left ventricular free wall. Several TachoComb® (CSL Behring, Tokyo, Japan) sheets were applied to control bleeding and avoid the need for a cardiopulmonary bypass. Horizontal mattress sutures were used in combination with a pair of Teflon felt strips for reinforcement. The combination of TachoComb® sheets and sutures is a novel hybrid method and an effective life-saving procedure for the treatment of left ventricular blowout ruptures. This approach avoids the need for a cardiopulmonary bypass. Sutureless repairs with TachoComb® sheet achieve rapid hemostasis without the need for cardiopulmonary bypass. This stabilizes patient hemodynamics immediately and preserves the fragile myocardium. This allows emergency room physicians to open the chest and apply the TachoComb® sheet to stabilize the patient before the cardiac surgeons arrive at the operating room. This technique will be very useful in emergency situations.
RESUMO
BACKGROUND: Acute respiratory failure is a serious issue that occasionally occurs after weaning from cardiopulmonary bypass (CPB) after heart surgery. This condition can be refractory to mechanical ventilation and the mortality rate is high. Venovenous extracorporeal membrane oxygenation (VV-ECMO) is applied to treat acute lung failure after CPB at our institution. This report describes the use of VV-ECMO after cardiac surgery at a single institution. METHODS: We analyzed the outcomes of 11 patients who developed severe acute respiratory failure requiring VV-ECMO after undergoing heart surgery with a cardiopulmonary bypass. RESULTS: Four (36.4%) patients died in hospital. One patient required conversion from VV- to venoarterial (VA-) ECMO because of circulatory instability. One patient each died of respiratory failure and heart failure and two died of ischemic colitis. Lung damage secondarily developed in these four patients to other disabled organs. Seven (63.6%) patients whose lungs were primarily disabled were weaned from VV-ECMO upon recovery from respiratory failure and were ambulatory at the time of discharge from hospital. The ratio of PaO2/FIO2 (P/F) at 24 h after starting VV-ECMO did not significantly differ between survivors and non-survivors (187.9 ± 57.7 vs. 135.5 ± 20.5, p = 0.10), but tended to be higher in survivors. Non-survivors were significantly older than survivors. CONCLUSION: Patients who develop severe acute respiratory failure after undergoing heart surgery using cardiopulmonary bypass derive a survival benefit from VV-ECMO.
Assuntos
Lesão Pulmonar Aguda/terapia , Ponte Cardiopulmonar/efeitos adversos , Oxigenação por Membrana Extracorpórea , Insuficiência Respiratória/terapia , Lesão Pulmonar Aguda/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Doenças Cardiovasculares/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência Respiratória/etiologiaRESUMO
Pulmonary artery aneurysms are rare and often arise in the left main trunk. Because they are uncommon, standardized treatment and clinical management are not clearly established. We present the case of a pulmonary artery aneurysm arising intraparenchymally and its surgical reconstruction using autologous pericardium. In terms of preserving pulmonary function, this procedure is effective compared with surgical procedures such as removal of part of the lungs.
Assuntos
Aneurisma/cirurgia , Pericárdio/transplante , Procedimentos de Cirurgia Plástica , Artéria Pulmonar/cirurgia , Procedimentos Cirúrgicos Vasculares , Aneurisma/diagnóstico por imagem , Aneurisma/patologia , Biópsia , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/patologia , Tomografia Computadorizada por Raios X , Transplante Autólogo , Resultado do TratamentoRESUMO
The aortic root of a 30-year-old man was replaced with a Freestyle stentless aortic bioprosthesis for aortic regurgitation associated with annuloaortic ectasia. His clinical course was uneventful, and he was discharged without complications. Three years and six months after surgery, he presented with a high fever. Four years after surgery, transthoracic echocardiography revealed severe aortic regurgitation. We performed exploratory surgery and discovered a torn left coronary cusp of the Freestyle bioprosthesis. Organized vegetation was adherent to the left coronary cusp leaflet. The non-coronary cusp and the right coronary cusp were normal. The diagnosis was aortic regurgitation due to valve failure related to infective endocarditis. Consequently, we reconstructed the aortic root with a composite graft (26-mm Valsalva graft and a 21-mm ON-X mechanical valve).
Assuntos
Insuficiência da Valva Aórtica/cirurgia , Bioprótese/efeitos adversos , Endocardite/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Próteses Valvulares Cardíacas/efeitos adversos , Falha de Prótese , Infecções Relacionadas à Prótese/cirurgia , Adulto , Insuficiência da Valva Aórtica/diagnóstico por imagem , Ecocardiografia Transesofagiana , Endocardite/diagnóstico por imagem , Endocardite/microbiologia , Implante de Prótese de Valva Cardíaca/instrumentação , Humanos , Masculino , Desenho de Prótese , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/microbiologia , Reoperação , Streptococcus/isolamento & purificação , Fatores de Tempo , Resultado do TratamentoAssuntos
Aneurisma Cardíaco/diagnóstico por imagem , Comunicação Interventricular/diagnóstico por imagem , Septos Cardíacos/patologia , Pericárdio/transplante , Acidente Vascular Cerebral/etiologia , Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Ecocardiografia Doppler em Cores/métodos , Feminino , Seguimentos , Sobrevivência de Enxerto , Aneurisma Cardíaco/complicações , Aneurisma Cardíaco/cirurgia , Comunicação Interventricular/complicações , Comunicação Interventricular/cirurgia , Septos Cardíacos/cirurgia , Humanos , Pessoa de Meia-Idade , Pericárdio/cirurgia , Índice de Gravidade de Doença , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/métodosRESUMO
We assessed the hypotheses that extension of aortic replacement would reduce the patency of the false lumen of the descending aorta and that postoperative patency of the false lumen would result in poor prognosis. One hundred and twenty-four consecutive patients underwent surgical repair for acute type A acute dissection on an emergency basis. Among the 124 patients, 89 patients had De Bakey type I dissection. Among the patients with De Bakey type I dissection, the false lumen of the descending aorta was preoperatively patent in 52 patients. Distal extent of aortic replacement was ascending aorta in 16 patients, hemiarch in 15 patients, partial arch in seven patients, and total arch in 11 patients. Patency of the false lumen was not influenced by distal extent of the aortic replacement. In a one-year follow-up, the maximum diameter of the descending aorta with patent false lumen had increased significantly than that with closed false lumen. Survival rates were 96% at one year and 67% at five years in the patients with patent false lumen and no mortality in the patients with closed false lumen. Patency of the false lumen was not influenced by extension of aortic replacement and associated with poor prognosis.