Age-related enhanced degeneration of bioprosthetic valves due to leaflet calcification, tissue crosslinking, and structural changes.

AIMS: Bioprosthetic heart valves (BHVs), made from glutaraldehyde-fixed heterograft materials, are subject to more rapid structural valve degeneration (SVD) in paediatric and young adult patients. Differences in blood biochemistries and propensity for disease accelerate SVD in these patients, which results in multiple re-operations with compounding risks. The goal of this study is to investigate the mechanisms of BHV biomaterial degeneration and present models for studying SVD in young patients and juvenile animal models. METHODS AND RESULTS: We studied SVD in clinical BHV explants from paediatric and young adult patients, juvenile sheep implantation model, rat subcutaneous implants, and an ex vivo serum incubation model. BHV biomaterials were analysed for calcification, collagen microstructure (alignment and crimp), and crosslinking density. Serum markers of calcification and tissue crosslinking were compared between young and adult subjects. We demonstrated that immature subjects were more susceptible to calcification, microstructural changes, and advanced glycation end products formation. In vivo and ex vivo studies comparing immature and mature subjects mirrored SVD in clinical observations. The interaction between host serum and BHV biomaterials leads to significant structural and biochemical changes which impact their functions. CONCLUSIONS: There is an increased risk for accelerated SVD in younger subjects, both experimental animals and patients. Increased calcification, altered collagen microstructure with loss of alignment and increased crimp periods, and increased crosslinking are three main characteristics in BHV explants from young subjects leading to SVD. Together, our studies establish a basis for assessing the increased susceptibility of BHV biomaterials to accelerated SVD in young patients.

Gorget-like Cuddling Suture: An Anastomosis Reinforcement Technique to Reduce Suture Bleeding for Aortic Surgery.

We developed a new reinforcement technique, the Gorget-like Cuddling (GOCU) suture, to prevent suture line bleeding during aortic surgery. After continuous aortic anastomosis with thick outer felt, an additional 2-0 Ticron (Medtronic, Minneapolis, MN) suture is placed distal from the first suture line. This GOCU suture directly holds the needle holes. Wall tension on the anastomosis can also be reduced to prevent longitudinal dilatation of the aorta. This technique can contribute to hemostasis for a fragile aortic wall in cases like acute aortic dissection.

Infected thoracic aortic aneurysm caused by Clostridium ramosum: A case report.

A 73-year-old man undergoing conservative management of acute aortic dissection (Stanford type B) was diagnosed with infected aortic aneurysm based on clinical findings of aortic dilatation and recurrent laryngeal nerve paralysis. We performed total aortic arch replacement with a synthetic graft and omentopexy; and Clostridium ramosum was isolated from resection specimens. Infected aortic aneurysms are rare but may lead to death from aortic dissection or rupture. C. ramosum infection is rare and has seldom been reported, and thus no treatment guidelines, including antibiotic therapy, have been established. Therefore, it is necessary to accumulate a larger number of cases of aortic aneurysm infected by C. ramosum. To date, there has been no reported case of infected aortic aneurysm due to C. ramosum. Here, we report a case of infected aortic aneurysm due to C. ramosum. .

Rupture of the Remaining Renal Artery Aneurysm While Waiting for Stage 2 Surgery for a Patient with Bilateral Renal Artery Aneurysms and Multiple Aneurysms.

A 21-year-old man was referred to our department for treatment of multiple aneurysms, including bilateral renal artery aneurysms. He was clinically diagnosed with Loeys-Dietz syndrome. So, we developed a 2-stage surgical strategy. The first surgery involved reconstructing the right renal artery and replacing part of the abdominal aorta, bilateral common iliac artery, and bilateral internal and external iliac arteries with a synthetic graft. Although stent grafting of the left renal artery aneurysm had been scheduled for the second surgery, sudden rupture of the left renal artery aneurysm forced us to perform emergency renal artery reconstruction.

A case of dedifferentiated liposarcoma of the heart and stomach.

INTRODUCTION: Liposarcoma of the heart and stomach is rare. PRESENTAION OF CASE: We report a case of liposarcoma in both organs with dedifferentiated histology. A patient was referred to our hospital with anorexia and weight loss. Upper gastrointestinal tract endoscopy revealed 5-10-mm elevated lesions, and echocardiography and computed tomography showed tumorous lesions in the left atrium. Tumor resection and mitral valve replacement were performed, and biopsy was performed for the gastric tumor. Both the tumors were diagnosed as dedifferentiated liposarcoma. DISCUSSION: Liposarcoma - a mesenchymal malignant tumor that contains lipoblasts - is the second most common soft tissue sarcoma. The tumor occurs most frequently in the limbs and retroperitoneum and rarely originates in the heart and the stomach. CONCLUSION: Chemotherapy and radiotherapy are only adjunctive therapies but not es as standard treatment for cardiac tumors. Therefore, we believe that wide surgical resection was the best choice of treatment in the present case.

Difficult preoperative diagnosis in a case of rapidly progressive carcinomatous pericarditis.

A 54-year-old woman initially diagnosed with stage IIIb squamous cell carcinoma of the uterine cervix was treated with chemotherapy and radiation therapy. After 8 months, she developed dyspnea, leg edema, pleural effusion, pericardial effusion, and liver congestion. Her cardiac ejection fraction was normal and cardiomegaly was not evident. Metastatic carcinomatous pericarditis or pleurisy was suspected, but laboratory findings, including tumor markers, were normal. She was transferred to our hospital for the repair a cardiac injury caused by a pericardial drainage procedure. Emergency surgery was performed for the misplaced drainage catheter in the right atrium and for an abnormal mass in her right and left atria. The clinical diagnosis of carcinomatous pericarditis was made; however, her condition rapidly deteriorated, and she died 6 days postoperatively. At autopsy, metastasis was identified in a large area of the pericardium and myocardium.