Cardiac Magnetic Resonance Feature Tracking Analysis for Change in Right Ventricular Function After Cardioplegic Arrest.

BACKGROUND: Using echocardiography to assess right ventricular (RV) function after cardioplegic arrest is challenging. Cardiac magnetic resonance (CMR) imaging is a superior alternative, with the feature tracking technique enabling quantitative assessment of myocardial deformation. METHODS: This single-center, prospective study from 2020 to 2022 assessed RV function in 42 patients who underwent open heart surgery with cardioplegic arrest. CMR data were collected preoperatively, one week postoperatively, and at follow-up (6-12 months after surgery), and assessed using the CMR feature tracking technique. RESULTS: Postoperatively, there was no significant change in RV end-diastolic volume, but RV end-systolic volume significantly decreased, leading to a notable increase in RV ejection fraction. By follow-up, both RV end-diastolic and end-systolic volumes had significantly reduced compared with the preoperative values. Right ventricular longitudinal contractility decreased after surgery but recovered to the preoperative values by follow-up, while RV circumferential contractility improved postoperatively and remained superior to the preoperative levels at follow-up. CONCLUSION: On CMR imaging, significant changes in RV systolic motion were observed after cardioplegic arrest, with decreased longitudinal but increased circumferential contractility. At follow up, these changes had reverted to the preoperative patterns by the mid-term (6-12 months).

Aortic root replacement in a patient with unoperated tricuspid atresia.

A 42-year-old man was referred to our hospital with heart failure and unoperated tricuspid atresia with pulmonary valve stenosis. His condition was initially managed with medical therapy; however, he required repeat hospitalisations for congestive heart failure. We diagnosed the chief cause of his heart failure as aortic valve regurgitation secondary to aortic root dilatation. Aortic root replacement was performed and then his heart failure was controlled.

Left ventricular assist device implantation after plasma exchange for heparin-induced thrombocytopenia.

Treating a patient with heparin-induced thrombocytopenia can be challenging particularly when the patient requires urgent cardiac surgery that uses heparin for anticoagulation. We herein report a case of a 61-year-old man with idiopathic dilated cardiomyopathy associated with heparin-induced thrombocytopenia and who underwent plasma exchange to remove heparin-induced thrombocytopenia antibodies before undergoing left ventricular assist device implantation. The surgery was performed using cardiopulmonary bypass and unfractionated heparin.

False lumen embolization and false lumen stent-graft techniques for ruptured post-dissection thoracoabdominal aneurysm.

This report details the successful endovascular repair of a ruptured thoracoabdominal aortic aneurysm in a patient with chronic type B aortic dissection. The procedure consisted of thoracic endovascular aortic repair, abdominal endovascular aortic repair, false lumen (FL) embolization with Candy-Plug, and FL stent-graft technique. The approach effectively regulated FL inflow, achieving complete FL closure. The patient was discharged without major complications including spinal cord ischemia or renal failure, and the long-term outcome is also favorable with reduction of the aneurysm size. The follow-up results have shown a reduction in the aneurysm size. This less invasive method could be an option of treatments for post-dissection thoracoabdominal aortic aneurysms, especially in ruptured cases.

Endovascular aneurysm repair with mesenteric artery bypass for abdominal aortic aneurysm with occlusion of celiac and superior mesenteric arteries.

A 67-year-old male patient required surgical management of an abdominal aortic aneurysm. Contrast-enhanced computed tomography showed a saccular infrarenal abdominal aortic aneurysm and occlusion of the origins of the celiac artery, superior mesenteric artery, and inferior mesenteric artery. Aortography revealed large amounts of blood flow from capillaries around the abdominal aorta to the inferior mesenteric artery and retrograde blood flow to a meandering mesenteric artery through the superior rectal artery. Considering the risk of bowel ischemia, we performed endovascular aneurysm repair with mesenteric artery bypass. The operation was successful, and his postoperative course was uneventful. This procedure could be useful and less invasive.

Endovascular aneurysm repair with mesenteric artery bypass for an abdominal aortic aneurysm with occlusion of celiac and superior mesenteric arteries.

A 67-year-old male patient required surgical management of an abdominal aortic aneurysm. A contrast-enhanced computed tomography showed a saccular infrarenal abdominal aortic aneurysm, with occlusion of the origins of the celiac artery, superior mesenteric artery, and inferior mesenteric artery. An aortography revealed large amounts of blood flow from capillaries around the abdominal aorta to the inferior mesenteric artery and retrograde blood flow to the meandering mesenteric artery through the superior rectal artery. Considering the risk of bowel ischemia, we performed endovascular aneurysm repair with mesenteric artery bypass. The operation was successful, and the postoperative course was uneventful. This procedure may be useful and less invasive.

Endoscopy-assisted removal of multiple left ventricular thrombi through right mini-thoracotomy.

Left ventricular thrombus is life-threatening when it causes systemic embolization. In cases with a high risk of systemic embolization, left ventricular thrombectomy is recommended. However, the optimal surgical approach is unclear, especially for non-ischemic cardiomyopathy, because left ventriculotomy carries the risk of postoperative cardiac dysfunction. We herein report a male patient with multiple left ventricular thrombi due to acute myocarditis. Endoscopy-assisted left ventricular thrombectomy through right mini-thoracotomy was successfully performed. This method might be an efficient and less-invasive left ventricular thrombectomy for non-ischemic cardiomyopathy.

Successful hybrid management of a ruptured abdominal aortic aneurysm induced by type II and IIIB endoleaks after endovascular aortic repair.

Ruptured abdominal aortic aneurysm after endovascular abdominal aortic repair is a relatively rare condition. The management of this type of a rupture is challenging and controversial. We report here a case of ruptured abdominal aortic aneurysm 6 months after endovascular abdominal aortic repair. Although the main cause of this rupture was initially believed to be a type II endoleak, it was also a type IIIB endoleak practically. The patient was successfully treated via the hybrid approach. He recovered well, with no endoleaks for the next 6 months.

Low-gradient Structural Valve Deterioration in a Patient of Cardiac Sarcoidosis.

We report a case of structural valve deterioration, which occurred 7 years after aortic valve replacement in a 78-year-old male with cardiac sarcoidosis. His echocardiography showed low transprosthetic valve gradient and depressed left ventricular function. A dobutamine stress echocardiography was performed to identify his pathophysiology, and it revealed that his depressed left ventricular function was not due to cardiac sarcoidosis but to structural valve deterioration. Reoperation for structural valve deterioration was performed, and his left ventricular function recovered.