Severe tricuspid regurgitation after mitral valve surgery: the risk factors and results of the aggressive application of prophylactic tricuspid valve repair.

PURPOSE: This study aimed to examine the risk factors for severe postoperative tricuspid regurgitation (TR) in patients undergoing mitral valve surgery. We also studied the effects of prophylactic tricuspid valve repair (TVR) on severe postoperative TR. METHODS: We retrospectively studied 125 patients without severe TR who underwent mitral valve surgery from 1987 to 2006. Patients did not undergo TVR before 1998 (the early period, n = 54). In 1998 (the late period, n = 71), patients with a preoperative tricuspid annular diameter of ≥35 mm underwent TVR using an annuloplasty ring (n = 52). RESULTS: In the analysis of the early period, the rates of freedom from severe TR at 10 and 20 years after surgery were 76 and 59 %, respectively. A multivariate analysis identified moderate preoperative TR as a significant risk factor for severe TR. In the late period, none of the 52 patients who underwent TVR developed severe TR. However, 4/19 patients who did not undergo TVR developed severe TR, and all of these four patients had a preoperative tricuspid annular diameter of ≤35 mm. CONCLUSIONS: Moderate preoperative TR is a significant risk factor for severe postoperative TR in patients undergoing mitral valve surgery. The aggressive application of TVR can prevent severe postoperative TR; however, tricuspid annular dilatation might not be a good indicator for TVR.

[Prosthetic Valve Endocarditis using Immunosuppressive Agent for Atopic Dermatitis;Report of a Case].

A 26-year-old man had a history of severe atopic dermatitis. He was taking immunosuppressive drug. Mitral valve replacement (MVR) had been performed for infective endocarditis March 2008. He came to our hospital in July 2012 complaining of fever of 39 degrees Celsius. According to computed tomography (CT) and transesophageal echocardiography (TEE), we diagnosed that he had cerebral embolism and bacterial infection of prosthetic valve. Antibiotic treatment was performed for 2 weeks after the onset of cerebral infarction. Then we conducted re-MVR. The postoperative course was satisfactory. He showed a gradual improvement in the level of consciousness and was discharged. In patients with atopic dermatitis, bacteria can penetrate into the blood from the skin easily. So they are often affected by bacteremia. There are some reports that infective endocarditis is likely to occur in immunosuppressed patients. It is suggested that immunosuppressive drug was involved in the development of prosthetic valve endocarditis (PVE) in addition to atopic dermatitis in this patient.

Predictive biomarkers of COVID-19 prognosis identified in Bangladesh patients and validated in Japanese cohorts.

Despite high vaccination rates globally, countries are still grappling with new COVID infections, and patients diagnosed as mild dying at home during outpatient treatment. Hence, this study aim to identify, then validate, biomarkers that could predict if newly infected COVID-19 patients would subsequently require hospitalization or could recover safely with medication as outpatients. Serum cytokine/chemokine data from 129 COVID-19 patients within 7 days after the onset of symptoms in Bangladesh were used as training data. The majority of patients were infected with the Omicron variant and over 88% were vaccinated. Patients were divided into those with mild symptoms who recovered, and those who deteriorated to moderate or severe illness. Using the Lasso method, 15 predictive markers were identified and used to classify patients into these two groups. The biomarkers were then validated in a cohort of 194 Covid patients in Japan with a predictive accuracy that exceeded 80% for patients infected with Delta and Omicron variants, and 70% for Wuhan and Alpha variants. In an environment of widespread vaccination, these biomarkers could help medical practitioners determine if newly infected COVID-19 patients will improve and can be managed on an out-patient basis, or if they will deteriorate and require hospitalization.

Anti-nucleocapsid antibodies enhance the production of IL-6 induced by SARS-CoV-2 N protein.

A cytokine storm induces acute respiratory distress syndrome, the main cause of death in coronavirus disease 2019 (COVID-19) patients. However, the detailed mechanisms of cytokine induction due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remain unclear. To examine the cytokine production in COVID-19, we mimicked the disease in SARS-CoV-2-infected alveoli by adding the lysate of SARS-CoV-2-infected cells to cultured macrophages or induced pluripotent stem cell-derived myeloid cells. The cells secreted interleukin (IL)-6 after the addition of SARS-CoV-2-infected cell lysate. Screening of 25 SARS-CoV-2 protein-expressing plasmids revealed that the N protein-coding plasmid alone induced IL-6 production. The addition of anti-N antibody further enhanced IL-6 production, but the F(ab')2 fragment did not. Sera from COVID-19 patients also enhanced IL-6 production, and sera from patients with severer disease induced higher levels of IL-6. These results suggest that anti-N antibody promotes IL-6 production in SARS-CoV-2-infected alveoli, leading to the cytokine storm of COVID-19.

Inferior Vena Cava Filter-Induced Thrombosis: Filter Insertion Prior to Catheter-Directed Thrombolysis and Successful Double-Filter Retrieval after Prolonged Indwelling Time.

Extended inferior vena cava (IVC) filter implantation time increases the risk of complications in patients. Here we present the case of a 72-year-old woman with IVC filter-induced thrombosis who underwent catheter-directed thrombolysis with prophylactic IVC filter placement. Two IVC filters were successfully retrieved 70 and 1858 days post placement. The decision to insert an IVC filter should be carefully considered with appropriate indications and all filters should be removed after the risk of deep vein thrombosis has resolved.

An Infected Popliteal Aneurysm Simultaneously Treated with Resection and Revascularization.

Infected popliteal aneurysm is a high-risk condition that may present as an emergency requiring an urgent attention with acute rupture and sepsis. The management of acute ischemia in the presence of local and systemic sepsis is challenging, and infection control and perioperative management during surgery are important. Here we report successful case of treating a patient with an infected popliteal aneurysm. The infection seemed to arise from the soft tissue surrounding the aneurysm, following cellulitis. Our report also includes a review of the related literature and suggests that devising methods for infection control is critical in achieving acceptable outcomes in such cases.

Emergency valve surgery for infective endocarditis complicated by acute intracranial hemorrhage: A case report.

INTRODUCTION: Optimal timing of surgical treatment for infective endocarditis (IE) complicated by intracranial hemorrhage remains controversial. PRESENTATION OF CASE: A 43-year-old man with IE received appropriate antibiotic therapy but had recurrence of cerebral infarction and intracranial hemorrhage (ICH). Emergency valve surgery was performed 2days after ICH onset because of heart failure and recurrence of cerebral complications. Postoperatively, he showed no neurologic symptoms; neuroimaging showed no enlargement of ICH. DISCUSSION: Postoperative risk of neurologic deterioration may be relatively lower than previously thought in patients with IE who undergo surgery within 1 month after ICH onset. CONCLUSIONS: Emergency surgery in patients with ICH is justified in cases of multiple indications for such small ICH. Further evaluation regarding the risk of subsequent hemorrhage in patients with ICH who require emergency valve surgery is warranted.

The results of total arch graft implantation with open stent-graft placement for type A aortic dissection.

BACKGROUND: One problem that conventional ascending treatment for type A aortic dissection has not satisfactorily resolved is chronic enlargement of residual dissection in the aortic arch and descending aorta. To address this problem, we have developed a new method for type A aortic dissection: total arch graft implantation with open-style stent-graft placement. METHODS: From October 1994 through October 1999, 19 patients with type A aortic dissection (13 acute and 6 chronic dissections) underwent total arch graft implantation with open-style stent-graft placement. After achievement of general anesthesia and hypothermic extracorporeal circulation, we replaced the dissected ascending aorta and neck vessels with a 4-branched graft and repaired the descending aorta with a stent graft to close the entry site completely and to obtain better peripheral perfusion. We then examined the acute-phase and chronic-phase results and the outcomes of the false lumen and dissected aorta. RESULTS: There were 1 (5.3%) hospital death and 2 late deaths. The survivals at 1 and 3 years were 89.5% and 82.6%, respectively. The following complications occurred in the perioperative period: 1 stroke, 2 cases of temporary paraparesis, 2 cases of temporary hemodialysis, and 3 cases of mediastinitis. No pulmonary complications were observed. Six months postoperatively, the targeted entry sites were completely closed in all cases, 80% (8/10) of preoperatively patent false lumina were clotted at the level of the end of the stent graft, and 60% (9/15) of the false lumina and 40% (6/15) of the dissected aorta had shrunk significantly. Two (13.3%) of 15 cases of postoperative dilatation in the dissected aorta were observed, and reoperation related to residual dissected aorta was performed in only 1 (1/17 [5.9%]) patient during the mean follow-up period of 2.4 +/- 1.6 years. CONCLUSION: Our preliminary review of the total arch graft implantation with a stent graft suggests that this new procedure for type A aortic dissection might provide better results in both the acute and the chronic phase, especially with regard to the outcome for the false lumen and dissected aorta.

Successful treatment of massive pulmonary embolism in the 38th week of pregnancy.

In 1998, a 32-year-old woman in week 38 of pregnancy was referred to our hospital because of swelling of the lower extremities and dyspnea at rest. A massive pulmonary embolism and thrombi in the right and left atria were detected. After a successful cesarean section, emergent pulmonary embolectomy was performed with the use of cardiopulmonary bypass. Both the mother and the fetus recovered without severe complications. Postoperatively, activated protein S deficiency was detected.

BioGlue® coronary embolism during open heart surgery.

In cases of iatrogenic coronary embolism during cardiac surgery or percutaneous coronary intervention, small air bubbles or foreign bodies are directly injected, which usually result in serious adverse events if not treated promptly. We herein describe the case of a patient who developed acute myocardial infarction resulting in shock due to BioGlue® (CryoLife, Atlanta, GA, USA)-induced coronary embolism during the surgical repair of aortic dissection and was treated for retrieval of the material using a thrombectomy catheter. .

Surgical strategy for advanced gastric cancer with a concomitant thoracoabdominal aortic aneurysm requiring arterial reconstruction of the visceral branches.

A 70-year-old man who presented with hematemesis was found to have advanced gastric cancer concomitant with a thoracoabdominal aortic aneurysm (TAAA), which involved all branches of the visceral arteries. The patient underwent the following staged operations: first, radical resection of the advanced gastric cancer with simultaneous reconstruction of the visceral branches, followed 1 month later by endovascular aortic replacement of the TAAA. He recovered uneventfully and was discharged without any paralytic complications or sign of graft infection.

Vocal cord paralysis after aortic arch surgery: predictors and clinical outcome.

OBJECTIVE: This study is retrospective cohort study of data on vocal cord paralysis after aortic arch surgery collected during 14 years at a general hospital. We investigated factors in the development of vocal cord paralysis after aortic arch surgery and the effect of vocal cord paralysis on clinical course and outcome. METHODS: We reviewed data for 182 patients who underwent aortic arch surgery for aortic arch aneurysm and aortic dissection between 1989 and 2003, of whom 58 patients had proximal aortic repair, 62 had distal arch repair, and 62 had total arch repair. We assessed factors associated with the development of vocal cord paralysis and examined in detail the clinical outcome of patients with vocal cord paralysis. RESULTS: Postoperative vocal cord paralysis occurred in 40 patients. Multiple logistic regression analysis revealed the following risk factors with odds ratios (OR) for vocal cord paralysis: extension of procedures into distal arch (OR, 17.0), chronic dilatation of the aorta at the left subclavian artery (OR, 9.14), and total arch repair (OR, 4.24). Adoption of open-style stent-grafts reduced the incidence of vocal cord paralysis (OR, 0.031). The postoperative occurrence of vocal cord paralysis itself emerges as an independent predictor of pulmonary complications (OR, 4.12) and leads to a longer duration of hospital stay. CONCLUSIONS: The risk of vocal cord paralysis after aortic arch surgery depends on surgical factors, such as aneurysmal involvement of the distal arch, or the application of newer, less invasive surgical procedures. Vocal cord paralysis after aortic arch surgery itself, under aggressive postoperative respiratory management, did not increase aspiration pneumonia but was associated with postoperative complications leading to higher hospital mortality and prolonged hospitalization.

Using the EuroSCORE to assess changes in the risk profiles of the patients undergoing coronary artery bypass grafting before and after the introduction of less invasive coronary surgery.

BACKGROUND: Patients undergoing coronary artery bypass grafting seem to be older and have more comorbidity than patients in prior decades. We retrospectively assessed changes in the predicted mortality risk of patients who underwent coronary artery bypass surgery before and after the introduction of minimally invasive surgical techniques. METHODS: Between 1993 and 2002, 345 consecutive patients underwent coronary bypass surgery at Osaka Prefectural General Hospital. Minimally invasive direct coronary artery bypass was introduced in 1997 and off-pump bypass in 1999. Patients were divided into two groups, based on the year of surgery (1993 to 1996 and 1997 to 2002), and mortality risk was assessed with the European System for Cardiac Operative Risk Evaluation (EuroSCORE). RESULTS: The in-hospital mortality was 3% overall (11 of 345), 8% during the early period (6 of 106), and 2% during the later period (5 of 239). Multiple regression analysis identified an emergent operation to be an independent predictor of in-hospital mortality (p = 0.035). Factors associated with higher scores were recent myocardial infarction (p = 0. 028), preoperative intraaortic balloon pumping (p = 0.026) and preoperative ventilation (p = 0.026), but not age. Scores were higher in the minimally invasive (6.5 +/- 3.6, p = 0.004) and off-pump (5.0 +/- 3.7, p = 0.04) groups than in the conventional bypass group (4.1 +/- 3.3). The arterial graft in coronary artery bypass graft group was significantly less than in off-pump coronary artery bypass group (0.8 +/- 0.8 vs 1.2 +/- 0.8, p = 0.0001). Despite the increasing risk scores, overall in-hospital mortality decreased. CONCLUSIONS: The EuroSCORE was useful for assessing changes in the risk profile of patients undergoing bypass surgery over the past decade. The decrease in in-hospital mortality despite the increased risk might reflect the introduction of less invasive coronary surgery in high-risk patients.