RESUMO
Ironically, the hepatic vena cava is mostly involved in Budd-Chiari syndrome in the Asia-Pacific region, whereas living-donor liver transplantation is predominant, which cannot replace the hepatic cava. Hata and colleagues introduced a new surgical technique for venous reconstruction in living-donor liver transplantation, providing a novel solution to this longstanding dilemma.
Assuntos
Síndrome de Budd-Chiari , Transplante de Fígado , Doadores Vivos , Veia Cava Inferior , Síndrome de Budd-Chiari/cirurgia , Síndrome de Budd-Chiari/diagnóstico por imagem , Humanos , Transplante de Fígado/métodos , Veia Cava Inferior/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Veias Hepáticas/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Masculino , FemininoRESUMO
Although mortality and complication rates of cardiovascular surgery have been reduced, shaggy aorta, which is defined as an extensive severe atherosclerosis of the thoracic and abdominal aorta, is considered a risk factor for perioperative mortality and complications. The shaggy aorta often leads a poor prognosis, and a very high hospital mortality rate when embolization occurs in multiple organs. Therefore, it is important to prevent embolism through detailed evaluation of the disease with preoperative contrast-enhanced computed tomography (CT) scan and intraoperative transesophageal echocardiogram, appropriate individualized treatment decisions, and careful surgical manipulation.
Assuntos
Doenças da Aorta , Aterosclerose , Embolia , Humanos , Aterosclerose/complicações , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/cirurgia , Embolia/complicações , Tomografia Computadorizada por Raios X , Fatores de Risco , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/cirurgia , Doenças da Aorta/complicaçõesRESUMO
It is not uncommon for aortic regurgitation to occur after ascending aortic replacement. There are various causes of the aortic valve insufficiency after ascending aorta replacement. Among them, most common is a reoperation after open repair of Stanford type A acute aortic dissection. Although it is becoming safer to perform reoperative cardiac surgery, the risks of operative mortality and morbidity is still higher than those of non-reoperative cardiac surgeries. In order to improve the mortality and morbidity rate, we should select the best strategies with a thorough preoperative evaluation. Moreover, a careful observation after the operation is required to find the complications, especially the patients who have the risk of aortic valve insufficiency.
Assuntos
Aneurisma Aórtico , Dissecção Aórtica , Insuficiência da Valva Aórtica , Dissecção Aórtica/cirurgia , Aorta/cirurgia , Aneurisma Aórtico/cirurgia , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/cirurgia , Humanos , Complicações Pós-Operatórias , ReoperaçãoRESUMO
A 31-year-old woman was referred to our institution because of aortoesophageal fistula (AEF) six months after the descending aortic replacement for acute aortic dissection. We operated one-stage repair of the AEF. Thoracoscopic esophagectomy was firstly performed in prone position from right thoracic cavity, and then the esophagus was reconstructed with gastric conduit via posterior mediastinal route with omental flap. Secondly, graft replacement of the descending aorta using lateral oblique straight incision was performed and the graft was covered with omental flap simultaneously. The postoperative course was uneventful, and she started oral intake on the 13th day after surgery. Although the one-stage surgery for the AEF is highly invasive, it could be a good option for selected cases.
Assuntos
Aneurisma da Aorta Torácica , Doenças da Aorta , Implante de Prótese Vascular , Fístula Esofágica , Fístula Vascular , Adulto , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/cirurgia , Fístula Esofágica/diagnóstico por imagem , Fístula Esofágica/etiologia , Fístula Esofágica/cirurgia , Esofagectomia , Feminino , Humanos , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/etiologia , Fístula Vascular/cirurgiaRESUMO
A 76-year-old woman was admitted to our hospital complaining of dyspnea on effort. Echocardiography showed severe mitral regurgitation. Her medical history indicated that she was allergic to metal, and skin patch tests were positive for nickel, cobalt, platinum, manganese, iridium, chromium, and zinc. Valvuloplasty involved triangular resection of P2 and mitral valve annuloplasty with a metal-free, 29 mm Tailor Flexible Ring. The sternum was closed using polyester non-absorbable sutures instead of surgical steel wire. Her postoperative course was uneventful and she was discharged on postoperative day 21. Nine months later, she is well and free of allergic symptoms.
Assuntos
Hipersensibilidade , Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral , Idoso , Ecocardiografia , Feminino , Humanos , Hipersensibilidade/etiologia , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/cirurgiaRESUMO
A 52-year-old woman with mitral valve insufficiency and congestive heart failure due to infective endocarditis was treated by mitral valve replacement with a mechanical valve. Warfarin was started on postoperative day (POD) 3, but sudden onset of anemia with left abdominal pain presented on POD 8. Abdominal apoplexy was diagnosed by computed tomography (CT) and ultrasonographic imaging, but active bleeding was not evident. She was hemodynamically stable and her prothrombin time-international normalized ratio(PT-INR) at that time was 1.70 (compared with 2.56 on POD 7). To avoid repeated bleeding, PT-INR was controlled at around 1.5. Other complications did not arise, and thereafter her postoperative course was favorable.
Assuntos
Endocardite Bacteriana , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral , Endocardite Bacteriana/complicações , Feminino , Humanos , Coeficiente Internacional Normatizado , Pessoa de Meia-Idade , Valva Mitral , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/cirurgia , Acidente Vascular CerebralRESUMO
This study investigated the safety and efficacy of a sustained release of basic fibroblast growth factor (bFGF) with biodegradable gelatin hydrogel sheets as therapeutic angiogenesis in canine chronic myocardial infarction (MI) models. Canine chronic MI model was induced by ligating the left anterior descending coronary artery and its diagonal branches. At 4 week post-induction, we applied either saline (Control group, n = 5) or 200 µg of bFGF (Treatment group, n = 6) soaked gelatin hydrogel sheets on the ischemic area of the left ventricular (LV) wall. At 6 weeks after the procedure, we evaluated the efficacy by echocardiography and immunohistochemical study. There were no procedure-related adverse events or deaths. The serum bFGF level was under detectable levels in all animals at any sampling points. In terms of efficacy, echocardiographic evaluation demonstrated that fractional shortening was significantly improved in the treatment group. In addition, immunohistochemical study showed that the capillary density in the border zone of the MI area, as well as the MI area, significantly increased in the treatment group. Therapeutic angiogenesis by bFGF using biodegradable gelatin hydrogel sheets was safe, increased the capillary density, and improved LV function in canine chronic MI models.
Assuntos
Vasos Coronários/diagnóstico por imagem , Fator 2 de Crescimento de Fibroblastos/administração & dosagem , Infarto do Miocárdio/tratamento farmacológico , Neovascularização Patológica/tratamento farmacológico , Animais , Doença Crônica , Vasos Coronários/efeitos dos fármacos , Preparações de Ação Retardada , Modelos Animais de Doenças , Cães , Implantes de Medicamento , Hidrogéis , Masculino , Microesferas , Infarto do Miocárdio/diagnóstico , Neovascularização Patológica/diagnóstico , Proteínas RecombinantesAssuntos
Fístula Artério-Arterial/diagnóstico por imagem , Fístula Artério-Arterial/cirurgia , Aneurisma Coronário/diagnóstico por imagem , Aneurisma Coronário/cirurgia , Vasos Coronários , Artéria Pulmonar , Idoso , Fístula Artério-Arterial/etiologia , Procedimentos Cirúrgicos Cardiovasculares/métodos , Aneurisma Coronário/complicações , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Feminino , Humanos , Tomografia Computadorizada Multidetectores , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Resultado do TratamentoRESUMO
A 55-year-old morbidly obese woman [body mass index (BMI) 51.2] developed acute type A aortic dissection, and she also presented with significant hypoxemia and hypercapnia. She underwent a successful emergency total arch replacement, but severe hypoxemia persisted and Pao2/Fio2 lowered to 71.9 mmHg. We therefore applied high frequency jet ventilation (HFJV), which soon improved the hypoxemia without hemodynamic compromise. HFJV was discontinued three days later, when her Pao2/Fio2 improved to 170.0 mmHg. Weaning from the respirator was initiated on postoperative day 13. The patient was extubated on postoperative day 19 and was discharged on postoperative day 74 free from disabilities. HFJV may be effective for severe hypoxemia after cardiovascular surgery.
Assuntos
Aorta Torácica/cirurgia , Dissecção Aórtica/cirurgia , Ventilação em Jatos de Alta Frequência , Obesidade Mórbida/complicações , Insuficiência Respiratória/terapia , Dissecção Aórtica/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Insuficiência Respiratória/etiologiaAssuntos
Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Valva Aórtica/cirurgia , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Valva Mitral/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Idoso , Aorta/cirurgia , Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Implante de Prótese Vascular/métodos , Ecocardiografia Transesofagiana , Humanos , Masculino , Valva Mitral/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Fatores de TempoRESUMO
INTRODUCTION: A large number of clinical trials of therapeutic angiogenesis in patients with critical limb ischemia have been conducted in recent years. However, limb amputation, which is used as a primary endpoint in such studies, is not often required in Japan, which can make it difficult to carry out related clinical trials. Transcutaneous oxygen pressure (TcPO2) is widely used to evaluate the severity of limb ischemia, to decide the level of amputation, and to predict wound healing after limb amputation. The aim of the present study was to elucidate whether TcPO2 can be a surrogate index of limb ischemia, and to define an appropriate cutoff value for wound healing after limb amputation using meta-analysis. EVIDENCE ACQUISITION: A computer search was performed to identify studies describing the association between TcPO2 and limb ischemic events. From these, studies focused on wound healing after limb amputation were combined and analyzed. EVIDENCE SYNTHESIS: Eleven studies were identified for inclusion in this analysis. The analysis demonstrated that TcPO2 20 mmHg was a valid cutoff value for limb amputation and TcPO2 30 mmHg would be an appropriate value for wound healing after limb amputation. CONCLUSIONS: TcPO2 of 20 and 30 mmHg were considered appropriate cutoff values for limb amputation and wound healing after amputation, respectively.
Assuntos
Amputação Cirúrgica , Monitorização Transcutânea dos Gases Sanguíneos , Isquemia/diagnóstico , Isquemia/cirurgia , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/cirurgia , Oxigênio/sangue , Cicatrização , Amputação Cirúrgica/efeitos adversos , Biomarcadores/sangue , Humanos , Isquemia/sangue , Isquemia/fisiopatologia , Razão de Chances , Valor Preditivo dos Testes , Fatores de Risco , Resultado do TratamentoRESUMO
As a form of therapeutic angiogenesis, we sought to investigate the safety and efficacy of a sustained-release system of basic fibroblast growth factor (bFGF) using biodegradable gelatin hydrogel in patients with critical limb ischemia (CLI). We conducted a phase I-IIa study that analyzed 10 CLI patients following a 200-µg intramuscular injection of bFGF-incorporated gelatin hydrogel microspheres into the ischemic limb. Primary endpoints were safety and transcutaneous oxygen pressure (TcO2) at 4 and 24 weeks after treatment. During the follow-up, there was no death or serious procedure-related adverse event. After 24 weeks, TcO2 (28.4 ± 8.4 vs. 46.2 ± 13.0 mmHg for pretreatment vs after 24 weeks, p < 0.01) showed significant improvement. Regarding secondary endpoints, the distance walked in 6 min (255 ± 105 vs. 318 ± 127 m, p = 0.02), the Rutherford classification (4.4 ± 0.5 vs. 3.1 ± 1.4, p = 0.02), the rest pain scale (1.7 ± 1.0 vs. 1.2 ± 1.3, p = 0.03), and the cyanotic scale (2.0 ± 1.1 vs. 0.9 ± 0.9, p < 0.01) also showed improvement. The blood levels of bFGF were within the normal range in all patients. A subanalysis of patients with arteriosclerosis obliterans (n = 7) or thromboangiitis obliterans (Buerger's disease) (n = 3) revealed that TcO2 had significantly improved in both subgroups. TcO2 did not differ between patients with or without chronic kidney disease. The sustained release of bFGF from biodegradable gelatin hydrogel may offer a safe and effective form of angiogenesis for patients with CLI.
Assuntos
Indutores da Angiogênese/administração & dosagem , Portadores de Fármacos , Tolerância ao Exercício/efeitos dos fármacos , Fator 2 de Crescimento de Fibroblastos/administração & dosagem , Gelatina/química , Isquemia/tratamento farmacológico , Extremidade Inferior/irrigação sanguínea , Neovascularização Fisiológica/efeitos dos fármacos , Doença Arterial Periférica/tratamento farmacológico , Idoso , Indutores da Angiogênese/efeitos adversos , Indutores da Angiogênese/química , Índice Tornozelo-Braço , Monitorização Transcutânea dos Gases Sanguíneos , Estado Terminal , Preparações de Ação Retardada , Composição de Medicamentos , Teste de Esforço , Feminino , Fator 2 de Crescimento de Fibroblastos/efeitos adversos , Fator 2 de Crescimento de Fibroblastos/química , Humanos , Hidrogéis , Injeções Intramusculares , Isquemia/diagnóstico , Isquemia/fisiopatologia , Japão , Masculino , Microesferas , Pessoa de Meia-Idade , Medição da Dor , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/fisiopatologia , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do TratamentoRESUMO
A 67-year-old woman suffered from severe aortic stenosis and atrial fibrillation, and underwent aortic valve replacement with a St. Jude Medical Regent 23-mm valve and pulmonary vein isolation using an AtriCure Isolator Synergy.At 6 days after the operation, she experienced sudden onset of atrial fibrillation, left side paralysis, and dysarthria. Right internal carotid artery embolism was diagnosed via magnetic resonance imaging, and we promptly performed neuroendovascular therapy with a Solitaire FR. Neuroendovascular treatment succeeded, and her neurological function was restored to near-normal. Her post-treatment course was uneventful, and she is currently well without neurological dysfunction.
Assuntos
Estenose da Valva Aórtica/cirurgia , Embolia Intracraniana/cirurgia , Complicações Pós-Operatórias , Idoso , Feminino , Próteses Valvulares Cardíacas , Humanos , Embolia Intracraniana/etiologia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/cirurgia , Fatores de TempoRESUMO
OBJECTIVE: Because microRNA-145 (miR-145) is a specific mediator in the regulation of the proliferation and differentiation of smooth muscle cells, we investigated the effect of miR-145 on the intimal hyperplasia in the rabbit model of vein graft disease using electroporation-mediated gene transfer. METHODS: The right jugular vein of male Japanese white rabbits was harvested and transduced with miR-145-encoding plasmids using an electroporator and then interposed in the carotid artery. At 2 or 4 weeks postoperatively, the venous graft was explanted, and the intimal thickness and intima/media area ratio were evaluated. Furthermore, 3 days after implantation, the myocardin and serum response factors were measured using real-time polymerase chain reaction. At 2 weeks after implantation, immunohistochemical investigations using mature smooth muscle markers, myosin heavy chain smooth muscle-1 and -2, and proliferation marker Ki-67 were performed. RESULTS: MiR-145 transduction significantly reduced the neointimal thickness at both 2 and 4 weeks (2 weeks, 52.1 ± 15.7 vs 113.2 ± 26.9 µm, P < .05, n = 6; 4 weeks, 42.4 ± 4.8 vs 136.5 ± 38.3 µm, P < .05, n = 8), and it also significantly reduced the intima/media area ratio at 4 weeks (0.22 ± 0.04 vs 1.13 ± 0.23, P < .01, n = 8). Additionally, it upregulated the mRNA expression level of myocardin compared with that in the grafts that did not receive gene transfer. Smooth muscle-2 and Ki-67 expression revealed that miR-145 transduced grafts contained more smooth muscle-2-positive mature smooth muscle cells and fewer Ki-67-positive proliferating cells. CONCLUSIONS: Nonviral transduction of miR-145 into the bypass graft could be a novel option for preventing intimal hyperplasia in vein graft disease.