Essential Thrombocytosis-Associated Thromboembolism in the Abdominal Aorta.

Essential thrombocytosis (ET) is a myeloproliferative disorder characterized by an anomalous increase in platelet production. Many patients with ET are asymptomatic. Few studies have reported ET-associated thromboembolism in large vessels such as the aorta. We report a patient with ET who presented with peripheral embolism from an abdominal aortic thrombus and developed acute limb ischemia. The patient underwent aortic replacement successfully. The patient's platelet count was controlled with hydroxyurea, and no recurrence was noted over 2 years of follow-up.

Multiple Ascending Aortic Mural Thrombi and Acute Necrotizing Mediastinitis Secondary to Acute Pancreatitis.

The formation of aortic thrombi is an extremely rare complication of acute pancreatitis. Here we report a case of acute pancreatitis complicated by a paraesophageal pseudocyst, necrotizing mediastinitis, and the formation of multiple thrombi in the ascending aorta. The patient was successfully treated by surgical therapy, which included extensive debridement of the mediastinum and removal of the aortic thrombi under cardiopulmonary bypass. Although esophageal resection was not carried out concomitantly, the lesions were resolved and the patient remained free of complications over 2 years of follow-up care.

Systemic-Pulmonary Shunt Facilitates the Growth of the Pulmonary Valve Annulus in Patients With Tetralogy of Fallot.

BACKGROUND: Transannular patching (TAP) frequently accompanies primary repairs (PRs) in symptomatic neonates with tetralogy of Fallot (TOF). If a systemic-pulmonary shunt (SPS) facilitates the growth of the pulmonary valve annulus (PVA), patients with a marginally small PVA could benefit from a staged repair in terms of lowering the risk of TAP. METHODS: Among 216 infants with TOF who underwent surgical intervention between January 2004 and December 2013, 29 infants underwent SPS with a subsequent repair (SPS group), whereas 187 infants received a PR (PR group). Median age and the Z-score of the PVA (PVA [Z]) at SPS were 32 days and -3.5, respectively. There was one late death and one follow-up loss after SPS, and preservation of the PVA was achieved on repair in 16 patients (16 of 29; 55%). RESULTS: Multiple regression analysis showed that performance of SPS was the only indicator of the increase in the PVA (Z) in the entire cohort (n = 216). On mixed linear regression, the PVA (Z) increased significantly after the placement of an SPS (-3.6 + 0.2*duration in months, p = 0.001), whereas the prerepair changes in the PVA (Z) were not statistically significant in the PR group (p = 0.7), with a significant intergroup difference (p < 0.001). Receiver operating characteristic curve analysis showed that placement of TAP is expected when the preshunt PVA (Z) is smaller than -4.2 (area under the curve: 0.82; 95% confidence interval: 0.62 to 1.00; sensitivity, 100%; specificity, 73%). CONCLUSIONS: SPS facilitates outgrowth of the PVA over somatic growth in patients with TOF. However, preservation of the PVA may not be achieved on staged repair if the initial PVA is too small.

Reoperative Aortic Root Replacement in Patients with Previous Aortic Root or Aortic Valve Procedures.

BACKGROUND: Generalization of standardized surgical techniques to treat aortic valve (AV) and aortic root diseases has benefited large numbers of patients. As a consequence of the proliferation of patients receiving aortic root surgeries, surgeons are more frequently challenged by reoperative aortic root procedures. The aim of this study was to evaluate the outcomes of redo-aortic root replacement (ARR). METHODS: We retrospectively reviewed 66 patients (36 male; mean age, 44.5±9.5 years) who underwent redo-ARR following AV or aortic root procedures between April 1995 and June 2015. RESULTS: Emergency surgeries comprised 43.9% (n=29). Indications for the redo-ARR were aneurysm (n=12), pseudoaneurysm (n=1), or dissection (n=6) of the residual native aortic sinus in 19 patients (28.8%), native AV dysfunction in 8 patients (12.1%), structural dysfunction of an implanted bioprosthetic AV in 19 patients (28.8%), and infection of previously replaced AV or proximal aortic grafts in 30 patients (45.5%). There were 3 early deaths (4.5%). During follow-up (median, 54.65 months; quartile 1-3, 17.93 to 95.71 months), there were 14 late deaths (21.2%), and 9 valve-related complications including reoperation of the aortic root in 1 patient, infective endocarditis in 3 patients, and hemorrhagic events in 5 patients. Overall survival and event-free survival rates at 5 years were 81.5%±5.1% and 76.4%±5.4%, respectively. CONCLUSION: Despite technical challenges and a high rate of emergency conditions in patients requiring redo-ARR, early and late outcomes were acceptable in these patients.

Successful surgical treatment for thoracoabdominal aortic aneurysm with leriche syndrome.

Thoracoabdominal aortic aneurysm accompanied by Leriche syndrome is an extremely rare combination of aortic diseases, the surgical management of which has not been described to date. We report the successful treatment of one such case through open surgical repair of the thoracoabdominal aorta.

Maze procedure in patients with left ventricular dysfunction.

BACKGROUND: The risks and benefits of a concomitant Maze procedure for patients with LV dysfunction undergoing major cardiac surgery have not yet been elucidated. This study aimed to evaluate the clinical impacts of the Maze procedure in patients with atrial fibrillation and left ventricular (LV) dysfunction. METHODS: Between January 1999 and March 2011, a total of 139 patients (mean age 52.7±12.3 years, 54 females) with valvular atrial fibrillation (AF) and an LV ejection fraction (EF) of 40% or less underwent open heart surgery with (n=77) or without (n=62) a concomitant Maze procedure. We compared adverse outcomes (death and composite of death, thromboembolic events and congestive heart failure [CHF]) during a median follow-up period of 66.0 months (inter-quartile range, 27.5-106.9 months). RESULTS: Adverse events occurred in 41 patients, including 36 deaths, seven thromboembolic events and eight hospitalizations due to CHF. After adjustment for baseline profiles with the use of propensity scores and inverse probability weighting, patients who had the Maze procedure were at lower risks of death (hazard ratio, 0.39; 95% confidence interval, 0.16-0.93; P=0.033) and composite adverse outcomes (hazard ratio, 0.28; 95% confidence interval, 0.14-0.57; P=0.017) than those not undergoing the Maze procedure. Furthermore, the Maze procedure resulted in superior functional status (P<0.001) and reduced the need for long-term anticoagulation therapy (67.1% vs. 91.2%, P=0.001). CONCLUSION: Performing the Maze procedure on patients with valvular AF and LV dysfunction reduced serious adverse outcomes and the need for long-term anticoagulation therapy when compared to cardiac surgery alone without the Maze procedure.