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Recently, organic polysulfides have been synthesized as cathode active materials exceeding the battery performance of sulfur. However, the conventional organic polysulfides have exhibited capacities lower than the theoretical capacity of sulfur because the π-organic moieties do not conjugate with the sulfur chains. In this work, the organopolysulfides, synthesized via inverse vulcanization using disulfide compounds, exhibited higher capacities equal to the theoretical capacity of sulfur because of enhanced electronic conductivity based on the conjugation between organic moieties and sulfur chains. Furthermore, the organopolysulfide including 1,3-dhitiol-2-thione moiety exhibited the highest capacity because of the enhanced electronic conductivity. This finding will pave the way to develop next-generation rechargeable batteries.
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Recently, polymer electrolytes have been developed for high-performance and eco-friendly fuel cells. Among the candidates, eggshell membrane (ESM) has been promising because of its abundance to assemble various energy devices with low cost and its absorption ability of organic materials. In this work, we investigated fuel cells that included ESM-absorbing xanthene-, triphenylmethane-, and azo-type tar dye, which contained abundant hydrophilic groups, as polymer electrolytes. We found out two points: (1) that the fuel cells that included ESM-absorbing xanthene-type dye generated the highest I-V performance, and (2) the basic molecular structures of the tar dyes determined the correlation of the maximum power and proton conductivities.
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We herein report a case in which we encountered complications when placing an Impella CP ventricular assist device (catheter-based ventricular assist device) in a patient with a Perceval bioprosthetic valve (sutureless valve). Specifically, the catheter-based ventricular assist device became anchored to the sutureless valve and needed to be removed under cardiopulmonary bypass. (Level of Difficulty: Advanced.).
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A 34-year-old woman was hospitalized with shortness of breath and chest tightness and pain. She had undergone aortic valve replacement for aortic stenosis at the age of 18 years. Transthoracic echocardiography showed left ventricular asynergy and a high aortic valve pressure gradient. Thus, structural valve deterioration was diagnosed. Coronary computed tomography and coronary angiography revealed left main trunk ostial stenosis that had caused acute anteroseptal myocardial infarction. Urgent surgery revealed pannus formation around the prosthetic valve and covering the ostium of the left main trunk. A Bentall procedure and coronary artery bypass grafting were performed. The postoperative course was uneventful.
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Valva Aórtica , Pannus , Adulto , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Constrição Patológica , Feminino , HumanosRESUMO
PURPOSE: Endovascular aneurysm repair (EVAR) for an isolated common iliac artery aneurysm (iCIAA) sometimes requires a bifurcated stent graft (SG). In EVAR, it is essential to preserve the renal artery (RA). However, this is challenging in cases of anatomical variation. The double D technique (DDT) can be used in anatomically inadequate cases with a commercially approved bifurcated SG. Here, we report the repair of iCIAA in the presence of a challenging RA anatomy, through EVAR using the DDT. CASE REPORT: An 84-year-old woman was diagnosed with a maximal 35-mm diameter left iCIAA and a nonaneurysmal aorta by computed tomography (CT), which also showed that the right RA arose 50-mm above the aortic bifurcation. The DDT was chosen because commercially approved bifurcated SGs typically require a distance of >70 mm from the proximal position to the aortic bifurcation. Postoperative CT showed excellent results with no endoleaks or SG kinking and occlusion, as well as preservation of robust blood flow to the right RA. CONCLUSION: Endovascular aneurysm repair using the DDT can be an alternative option for treatment of iCIAA with a challenging RA anatomy.
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Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/métodos , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/métodos , Aneurisma Ilíaco/cirurgia , Artéria Renal/anormalidades , Stents , Idoso de 80 Anos ou mais , Aortografia/métodos , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/fisiopatologia , Desenho de Prótese , Artéria Renal/diagnóstico por imagem , Artéria Renal/fisiopatologia , Resultado do TratamentoRESUMO
BACKGROUND: Open stent grafting is an alternative of graft replacement and thoracic endovascular aortic repair for aortic arch aneurysm. We have performed open stent grafting with half sternotomy (mini-OSG) to reduce in-hospital stay and recovery time of patients and herein report seven cases of mini-OSG for aortic aneurysm and dissection. CASE PRESENTATION: The patients' mean age was 66 years. Cardiopulmonary bypass was performed conventionally, and an open stent graft was inserted via an aortotomy on the aortic arch during circulatory arrest. No mortality occurred. The mean operation time was 387 min, and the mean blood loss was 587 ml. The patients were weaned from the ventilator 7.1 h postoperatively. No pseudoaneurysm or endoleakage was observed during the 2- to 20-month follow-up. CONCLUSIONS: Mini-OSG might be less invasive, although further studies and intensive follow-up are needed.
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Aneurisma da Aorta Torácica/cirurgia , Stents , Esternotomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica , Implante de Prótese Vascular , Ponte Cardiopulmonar , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Adulto JovemRESUMO
Single-leaflet tilting-disc aortic valve prostheses are known to generate eccentric transvalvular flow jets. These prostheses are routinely inserted with the major valve opening directed toward the non-coronary sinus to achieve more favorable hemodynamic performance. From the viewpoint of blood flow dynamics, the structural and functional properties of tilting-disc aortic valves resemble those of congenital bicuspid aortic valves with right- and left-coronary leaflet fusion, which have been associated with aortopathy in the ascending aorta. Here we describe the case of a patient who had undergone aortic valve replacement in 1987 with a Björk-Shiley tilting-disc valve and required reoperation for ascending aortic aneurysm 29 years later. Eccentric flow jets through the tilting-disc valve directly impinged on the posterior wall of the ascending aorta including the aortotomy suture line, possibly contributing to the development of the saccular aneurysm in the ascending aorta.
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INTRODUCTION: Venous thromboembolism (VTE) of the lower extremities frequently occurs after surgery. It is unknown whether the complication of renal vein thrombosis (RVT) develops after an open repair (OR) for abdominal aortic aneurysm (AAA). Furthermore, anticoagulation therapy with apixaban, a direct oral anticoagulant (DOAC), has not been described as treatment for RVT in such cases. CASE: A 64-year-old man underwent OR for AAA. Postoperative computed tomography revealed RVT in the left renal vein. Apixaban (5 mg twice a day) therapy was initiated. Six months later, we discontinued anticoagulation therapy and observed no recurrence. Following OR, our patient developed RVT for which DOACs were very useful. CONCLUSION: Thus, RVT can manifest as VTE after OR and direct anticoagulants can be considered as a therapeutic option.
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Aneurisma da Aorta Abdominal/cirurgia , Inibidores do Fator Xa/administração & dosagem , Pirazóis/administração & dosagem , Piridonas/administração & dosagem , Veias Renais/efeitos dos fármacos , Grau de Desobstrução Vascular/efeitos dos fármacos , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Trombose Venosa/tratamento farmacológico , Administração Oral , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aortografia/métodos , Angiografia por Tomografia Computadorizada , Humanos , Masculino , Pessoa de Meia-Idade , Flebografia/métodos , Veias Renais/diagnóstico por imagem , Veias Renais/fisiopatologia , Resultado do Tratamento , Ultrassonografia Doppler em Cores , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologiaRESUMO
BACKGROUND: Atrioventricular groove hematomas during mitral valve surgery range from simple hematomas to complex atrioventricular disruptions that cause frank rupture with massive bleeding and subsequent mortality. A small or moderate-sized hematoma is reported to be present in the left atrioventricular groove in 10 to 30% of all patients immediately after mitral valve replacement. Despite the fact that atrioventricular groove hematomas are inherently unstable and unpredictable, conservative strategies are recommended due to the high mortality associated with additional surgical repair. Such conservative strategies, however, would not resolve the potential risk of rupture, and there also appears to be a certain degree of uncertainty to be overcome using the current advances in cardiac surgery. CASE PRESENTATION: We present a case of atrioventricular hematoma during double valve replacement which was treated with conservative management. A left ventricular pseudoaneurysm developed after surgery, but spontaneously resolved completely within six months. After reflecting on our case, we developed a check sheet, including the anesthesiologist's transesophageal echocardiography findings, for reasonable intraoperative decision-making regarding conservative management vs. additional surgical repair. Our check sheet helps organize the pathophysiological understanding of the injury and integrates partial findings from complementary viewpoints, and can be used to accurately assess intense situations and develop a common understanding among surgical team members. CONCLUSIONS: Our case involved an atrioventricular groove hematoma that occurred during mitral valve surgery and caused a left ventricular pseudoaneurysm. Conservative strategies yielded positive results. We hope our experience and original check sheet will be of value to surgical teams facing similar situations.
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Falso Aneurisma/terapia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Hematoma/terapia , Insuficiência da Valva Mitral/cirurgia , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Insuficiência da Valva Aórtica/cirurgia , Tratamento Conservador , Cardiopatias/etiologia , Implante de Prótese de Valva Cardíaca/métodos , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
We report a case of bronchial artery aneurysm (BAA) successfully treated with a combination of transcatheter embolization and stent graft. A 50-year-old woman was referred to our hospital for further examination of a hemispherical bulging lesion on the middle esophagus detected by gastroscopy. Computed tomography (CT) revealed BAA with a 15 mm-diameter arising from the descending aorta on the left side of the esophagus. We performed transcatheter embolization combined with a stent graft because of a short neck. Postoperative course was uneventful. Follow-up CT showed complete isolation of the blood flow into the BAA. BAA is rare and often found incidentally by diagnostic imaging as shown in our case. Prompt treatment with complete isolation of blood inflow is required because the rupture of BAA is life-threatening.
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Aneurisma/terapia , Artérias Brônquicas , Embolização Terapêutica/métodos , Stents , Aneurisma/diagnóstico por imagem , Artérias Brônquicas/diagnóstico por imagem , Feminino , Gastroscopia , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XAssuntos
Falso Aneurisma/microbiologia , Aneurisma Infectado/microbiologia , Artéria Mesentérica Superior/microbiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus lugdunensis/isolamento & purificação , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/terapia , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/terapia , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Angiografia por Tomografia Computadorizada , Tratamento Conservador , Humanos , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/terapia , Trombomodulina/uso terapêutico , Resultado do TratamentoRESUMO
The partient was 76-year-old male. He had acute empyema due to lung abscess and open-window thoracotomy was performed to control infection. 3 years and 9 months later, the bronchial fistula was closed with abdominal rectus muscle and greater omentum. These are very useful when other muscles such as latissimus dorsi muscle, serratus anterior muscle and pectoralis major muscle are not available.
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Empiema Pleural/cirurgia , Músculo Esquelético/cirurgia , Omento/cirurgia , Idoso , Empiema Pleural/diagnóstico por imagem , Humanos , Masculino , Retalhos Cirúrgicos , Toracostomia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Endovascular therapy (ET) for chronic mesenteric ischemia (CMI) is a effective treatment to relieve the symptoms, such as postprandial abdominal pain, food fear, and progressive weight loss. CMI is not known to be caused by rare anatomical variation of severe stenosis of the superior mesenteric artery (SMA), with replaced the common hepatic artery to the SMA. The treatment of such a rare anatomical variation using ET technique has not been discribed. ET with kissing stent technique can be applied to the CMI accompanied with a rare anatomical variation. CASE PRESENTATION: An 80-year-old woman presented with a history of intermittent, severe epigastric pain. Over the preceding 5 months, she had less severe and self-resolving epigastric pain 15-30 min after every meal. Abdominal computed tomography (CT) showed severe calcification of the SMA origin and bubble-like intramural gas of the small bowel with the contrasted wall pneumoperitoneum. As the patient did not have peritonitis, a conservative approach was used. Angiography performed after symptom resolution showed severe stenosis of the SMA origin with calcification, and the SMA had replaced the common hepatic artery. ET with the kissing stent technique, namely stenting to the SMA and common hepatic artery, was successfully performed and relieved the patient's symptoms. CONCLUSIONS: CMI cause the symptoms of Pneumatosis intestinalis (PI) and pneumoperitoneum. Severe stenosis of the SMA origin replacing the common hepatic artery is a rare anatomic variation, which can cause CMI symptoms. ET with a kissing stent is the effective treatment option for the mesenteric artery stenosis accompanied with such rare anatomical variation.
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We report the case of a 28-year-old man with a rare angiosarcoma complicated by acute myocardial infarction secondary to tumor embolism. He was transported to our emergency unit because of sudden onset of chest pain. The echocardiography showed a 42×60 mm mass in the left ventricle, and the coronary angiography showed embolic occlusion of the proximal left anterior descending and circumflex arteries. Emergent surgical removal of the mass was attempted under cardiopulmonary bypass, concomitant with double coronary artery bypass grafting and mitral valve replacement with a mechanical prosthesis. However, complete tumor excision was impossible. The postoperative pathological examination revealed undifferentiated angiosarcoma. Twenty days after the operation, the patient suffered acute cerebral hemorrhage from a metastatic tumor in the brain. He died at 37 days after the initial cardiac surgery.