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1.
Surg Case Rep ; 10(1): 137, 2024 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-38833185

RESUMO

BACKGROUND: Cardiac metastasis including the right ventricle from renal cell carcinoma is rare. No standard treatment for cardiac metastasis and recurrence in renal cell carcinoma has been established. CASE PRESENTATION: We present the case of a 61-year-old man who underwent the resection of recurrent right ventricular metastasis caused by renal cell carcinoma following molecular targeted therapy. The first cardiac operation was performed for right ventricular metastasis due to renal cell carcinoma. The patient had a good postoperative course. Two years after the first operation, however, follow-up computed tomography revealed the recurrence of the right ventricular tumor and metastases in both lungs. Molecular targeted therapy was carried out and effectively controlled the lung metastasis but the right ventricular lesion remained unchanged, leading to reoperation. The recurrent right ventricular tumor was completely resected through a redo median sternotomy assisted by cardiopulmonary bypass. The patient had an uneventful postoperative course and was discharged on the 13th postoperative day. Follow-ups at 2 years showed no cardiac recurrence. CONCLUSION: Surgical intervention was considered useful in managing the recurrence of right ventricular metastasis from renal cell carcinoma after molecular targeted therapy.

2.
Physiol Rep ; 12(6): e15957, 2024 03.
Artigo em Inglês | MEDLINE | ID: mdl-38546216

RESUMO

Epicardial adipose tissue (EAT) is an active endocrine organ that is closely associated with occurrence of atrial fibrillation (AF). However, the role of EAT in the development of postoperative AF (POAF) remains unclear. We aimed to investigate the association between EAT profile and POAF occurrence in patients who underwent cardiovascular surgery. We obtained EAT samples from 53 patients to evaluate gene expression, histological changes, mitochondrial oxidative phosphorylation (OXPHOS) capacity in the EAT, and protein secretion in EAT-conditioned medium. EAT volume was measured using computed tomography scan. Eighteen patients (34%) experienced POAF within 7 days after surgery. Although no significant difference was observed in EAT profile between patients with and without POAF, logistic regression analysis identified that the mRNA expression levels of tumor necrosis factor-alpha (TNF-α) were positively correlated and adipocyte size in the EAT was inversely correlated with onset of POAF, respectively. Mitochondrial OXPHOS capacity in the EAT was not associated with POAF occurrence; however, it showed an inverse correlation with adipocyte size and a positive correlation with adiponectin secretion. In conclusion, changes in the secretory profile and adipocyte morphology of the EAT, which represent qualitative aspects of the adipose tissue, were present before the onset of AF.


Assuntos
Fibrilação Atrial , Humanos , Fibrilação Atrial/metabolismo , Tecido Adiposo Epicárdico , Adipócitos/metabolismo , Tecido Adiposo/metabolismo , Inflamação/metabolismo , Pericárdio/metabolismo
3.
Surg Case Rep ; 9(1): 175, 2023 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-37789134

RESUMO

BACKGROUND: The prognosis of hepatocellular carcinoma (HCC) with vascular invasion is extremely poor, especially in patients with tumor thrombus (TT) of the inferior vena cava (IVC), which is an oncological emergency with a high risk of sudden death due to TT extension or migration. Herein, we describe a case of HCC with TT of the IVC that rapidly extended into the right atrium (RA), in which right hepatectomy was performed under cardiopulmonary bypass. CASE PRESENTATION: A 64-year-old man was diagnosed with HCC with IVC TT, and right hepatic lobectomy was scheduled. While awaiting surgery, he complained of respiratory distress and rushed to the emergency room. The TT had reached the RA, and the patient was in a state of oncologic emergency. We requested the cooperation of the cardiovascular surgery department, and under artificial cardiopulmonary support, the right atrium was incised, and a part of the TT was removed. The IVC was clamped to prevent tumor dispersal, and right hepatic lobectomy was performed. The remaining thrombus was excised along with the right lobe of the liver by incising the IVC. There were no serious postoperative complications, and the patient is alive 1 year and 5 months postoperatively. CONCLUSION: Hepatic resection with cardiopulmonary bypass could be an option for HCC with TT reaching the RA.

4.
J Artif Organs ; 25(2): 117-124, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34689296

RESUMO

Hematocrit (Hct) values after the initiation of cardiopulmonary bypass (CPB) must be maintained appropriately to avoid perioperative complications. Therefore, an accurate prediction is required. However, the standard prediction equation often results in actual values that are lower than the predicted values. This study aimed to clarify the limits of agreement (LOA) and bias of the prediction equations and investigate better the prediction equations. A retrospective study was performed on adult patients between April 2015 and December 2020. Study 1 included 158 patients, and Study 2 included 55 patients. The primary outcomes were the LOA and bias between the predicted and measured Hct values after the initiation of CPB, and two studies were conducted. In Study 1, total blood volume (TBV) was estimated, and the new blood volume index (BVI) was calculated. BVI was also evaluated for the overall value and gender differences. Therefore, the patient's background was compared by gender differences. In, Study 2 the conventional predicted equation (Eq. 1), the predicted equation using the new BVI (Eq. 2), and the predicted equation using the new BVI including physiological factors in the TBV equation (Eq. 3) were compared. In Study 1, BVI was 53 (44-67) mL/kg. In Study 2, bias ± LOA was - 2.5 ± 6.8% for Eq. 1, 0.1 ± 6.6% for Eq. 2, and 0.4 ± 6.2% for Eq. 3. The new equation is expected to predict the Hct value after the initiation of CPB with better LOA and bias than the conventional equation.


Assuntos
Volume Sanguíneo , Ponte Cardiopulmonar , Adulto , Volume Sanguíneo/fisiologia , Ponte Cardiopulmonar/efeitos adversos , Hematócrito , Humanos , Estudos Retrospectivos
5.
Kyobu Geka ; 74(7): 543-546, 2021 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-34193791

RESUMO

Penetrating heart injury is rare in Japan. A 35-year-old man stabbed himself with a fruit knife that was about 10 cm in length on the left precordium in an attempt to commit suicide and was transferred to our hospital. His vital signs were stable, and the knife remained stabbed in the left precordium. Cardiac injury and cardiac tamponade were suspected on computed tomography, and emergency surgery was performed. A large amount of red hematoma was found in the mediastinum and the pericardial space after median sternotomy. The knife had created a fissure of about 15 mm in the free wall of the right ventricle, and the injury was repairable. The knife passed through the sixth costal cartilage and the left internal thoracic artery, and hemostasis was easy. The patient's postoperative course was uneventful, but due to the suicide attempt and adjustment disorder, the patient was transferred to a psychiatric hospital on postoperative day 10.


Assuntos
Traumatismos Cardíacos , Ferimentos Penetrantes , Adulto , Traumatismos Cardíacos/diagnóstico por imagem , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/lesões , Ventrículos do Coração/cirurgia , Humanos , Japão , Masculino , Tentativa de Suicídio
6.
Front Cardiovasc Med ; 8: 683216, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34150873

RESUMO

Background: Takayasu arteritis (TA) is a large vessel vasculitis of unknown etiology characterized by chronic inflammatory changes of the aorta and its major branches. Complications such as anastomotic aneurysm and valve detachment have been reported in active TA patients who received aortic valve replacement and graft replacement of aorta. Case Summary:A 61-year-old man with a history of emergency aortic valve replacement and patch closure of the noncoronary sinus of Valsalva due to acute heart failure induced by acute aortic regurgitation and ruptured sinus of Valsalva 4 years ago was referred for exertional dyspnea. Dilatation of the sinus of Valsalva together with protrusion of the right sinus of Valsalva and ostial stenosis of the left coronary artery were newly found by computed tomography (CT). A Bentall operation with concomitant coronary artery bypass grafting was successfully performed with a composite graft. Diagnosis of TA was made on the basis of histological analyses of the resected sinus of Valsalva, though other arterial manifestations were not detected by 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography. Three months later, a follow-up study revealed left coronary ostial pseudoaneurysm at the anastomotic site together with strong 18F-FDG uptake, leading to commencement of steroid therapy. Eight months later, disappearance of left coronary ostial pseudoaneurysm was found by a follow-up CT scan. Conclusion: This is a rare TA case in whom spontaneous resolution of coronary anastomotic aneurysm by steroid therapy was found without reconstructive surgery.

7.
Eur J Cardiothorac Surg ; 60(1): 164-174, 2021 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-33517384

RESUMO

OBJECTIVES: Ischaemic spinal cord injury (SCI) is one of the most serious complications of aortic surgery. Ischaemic SCIs occur due to various aetiologies, and prediction of the risk is difficult. Magnetic resonance imaging (MRI) is useful to detect the details of spinal cord infarction. There are few studies about MRI for evaluating ischaemic SCI after cardiovascular surgery and aortic events. We report 9 cases of postoperative ischaemic SCI and analyse their MRI features. METHODS: T2-weighted MRI scans of 9 patients who developed ischaemic SCI due to cardiovascular surgery and aortic events between 2012 and 2017 were evaluated. RESULTS: In all patients, high-intensity areas were observed on T2-weighted magnetic resonance images. The site of infarction was the thoracic spinal cord level (9 cases) and additionally at the lumbar spinal cord level (5 cases). The area of infarction area was categorized based on the arterial territory: anterior spinal artery territory (3 cases), posterior spinal artery territory (2 cases), spinal sulcal artery territory (1 case) and artery of Adamkiewicz territory (3 cases). CONCLUSIONS: MRI revealed the infarction sites in all cases and the differences in the infarction patterns in each case. MRI could thus be useful for investigating the aetiology of ischaemic SCI following aortic surgeries and events.


Assuntos
Traumatismos da Medula Espinal , Isquemia do Cordão Espinal , Humanos , Infarto , Imageamento por Ressonância Magnética , Medula Espinal/diagnóstico por imagem , Isquemia do Cordão Espinal/diagnóstico por imagem , Isquemia do Cordão Espinal/etiologia
8.
Gen Thorac Cardiovasc Surg ; 62(9): 547-52, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24791925

RESUMO

BACKGROUND: We examined the effectiveness of right axillary arterial perfusion through an interposed Dacron graft in the prevention of cerebral embolism or complications related to ascending aortic cannulation in open proximal anastomosis technique of descending thoracic aortic aneurysm (TAA) or thoracoabdominal aortic aneurysm (TAAA) repair under deep hypothermic circulatory arrest through left thoracotomy. METHODS: Between May 2000 and August 2012, 44 patients underwent TAA or TAAA repair using open proximal technique under DHCA. These patients were divided into two groups for evaluation of the effectiveness of right axillary arterial perfusion. Group A included patients who underwent TAA or TAAA repair with ascending aortic cannulation (n=15). Group B was composed of patients who had TAA or TAAA repair with right axillary arterial perfusion through the interposed Dacron graft (n=29). RESULTS: Mortality in this series was 4.5% (2 of 44 patients; 1 in each group); wherein, the causes were sepsis due to graft infection and aortic dissection (Stanford type A). The incidence rates of cerebral embolism were 27 % (4 of 15 patients in group A) and 3.4% (1 of 29 patients in group B) (p=0.0392, Fisher's exact test). The rates of complications in relation to the aortic cannulation site (dissection or bleeding) were 13% (2 of 15 patients in group A) and 0% (0 of 25 patients in group B). CONCLUSIONS: Right axillary perfusion facilitates easy evacuation of air and allows prompt recommencement of upper body circulation. Consequently, it minimizes the risk of cerebral embolism or complications in relation to aortic cannulation through left thoracotomy.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Axila/irrigação sanguínea , Implante de Prótese Vascular/métodos , Adulto , Idoso , Anastomose Cirúrgica/métodos , Dissecção Aórtica/cirurgia , Aorta/cirurgia , Aneurisma da Aorta Torácica/mortalidade , Cateterismo , Parada Circulatória Induzida por Hipotermia Profunda , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Perfusão/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Toracotomia/métodos , Adulto Jovem
9.
Kyobu Geka ; 66(13): 1178-81, 2013 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-24322361

RESUMO

An 83-year-old man had undergone aortic valve replacement (AVR)[CEP Magna 21 mm] and coronary aortic bypass grafting (CABG)[left internal thoracic artery (LITA)-left anterier descending artery( LAD)] 2 years ago in our hospital. He was admitted for fever of unknown origin and developed a stroke to another hospital. The echocardiography and computerized tomography showed an abscessaround the aortic prosthetic valve. Prosthetic valve endocarditis (PVE) was diagnosed, and he was transferred to our hospital for surgical treatment. Three days after admission, acute heart failure developed that led to an emergency operation. When the ascending aorta was dissected, an aorto-left atrium fistula and vegetation were recognized. Aortic valve replacement and patch plasty of the aorto-left atrium fistula were performed successfully. This case was diagnosed as PVE with aorto-left atrium fistula, which is quite a rare complication of PVE.


Assuntos
Doenças da Aorta/complicações , Valva Aórtica/cirurgia , Endocardite/etiologia , Fístula/complicações , Cardiopatias/complicações , Próteses Valvulares Cardíacas/efeitos adversos , Infecções Relacionadas à Prótese , Fístula Vascular/complicações , Idoso de 80 Anos ou mais , Átrios do Coração , Humanos , Masculino
10.
Kyobu Geka ; 63(13): 1164-7, 2010 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-21174668

RESUMO

We performed surgical therapy to the rare case of the perforation of an aneurysm of the aortic cusp which had caused the congestive heart failure. 71-year-old man having developed coughing was diagnosed as a severe aortic regurgitation and came to our hospital for surgery. The non coronary cusp was dilated and perforated. The aortic valves were removed and replaced with a bioprosthetic valve. The pathological examination of the valves showed healed infective endocarditis. The patient discharged home uneventfully.


Assuntos
Aneurisma Aórtico/complicações , Insuficiência da Valva Aórtica/etiologia , Doenças das Valvas Cardíacas/complicações , Idoso , Aneurisma Aórtico/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Humanos , Masculino
11.
Jpn J Thorac Cardiovasc Surg ; 51(9): 475-7, 2003 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-14529172

RESUMO

There has been a decline in the number of medical students applying for thoracic surgery training programs. We obtained knowledge of medical students' views on thoracic surgery residency programs. After completion of thoracic surgery clerkship, 17 students were asked to fill out questionnaires on first-year thoracic surgery residency programs. The majority of students considered thoracic surgery to be held in high regard by the general public, and felt that the salary was sufficient. However, only one student chose a thoracic surgery training program. The main reason for not applying for thoracic surgery residency was lifestyle issues. The factors in determining career choice included quality of education and work hours. Medical students are likely to select specialties other than thoracic surgery. Since the main factor influencing medical students' career is the quality of education in a residency program, efforts should be made to improve the quality of education.


Assuntos
Internato e Residência , Estudantes de Medicina/psicologia , Cirurgia Torácica/educação , Adulto , Escolha da Profissão , Feminino , Humanos , Japão , Masculino , Inquéritos e Questionários
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