Early results of modified aortic-valve sparing partial root replacement in acute type A aortic dissection with an intimal tear in the aortic sinuses.

We describe a modified aortic valve-sparing partial root replacement (AVSPRR) technique for acute type A aortic dissection with an intimal tear (IT) in the aortic sinus. This procedure consists of selective replacement of the sinus containing an IT with a rectangular patch. If an IT exists in any coronary sinus, the coronary button was reimplanted to the neo-sinus and an external wrapping of the noncoronary sinus was added. Modified AVSPRR may be considered a feasible short-term outcome, and may be considered as an option in selected patients.

Stanford type A aortic dissection secondary to infectious aortitis: a case report.

Nowadays, infectious aortitis has become a rare disease thanks to antibiotics, but remains life-threatening. We present a case of a patient with acupuncture-induced infectious aortitis leading to aortic dissection. Chest computed-tomogram scan revealed Stanford type A dissection with pericardial effusion. Under the impression of an impending rupture, emergent surgery was performed. During surgery, infectious aortitis was identified incidentally, so she underwent resection of the infected aorta including surrounding tissues. Then the ascending aorta and hemi-arch were replaced with a prosthetic graft as an in situ fashion. The resected tissue and blood cultures revealed Staphylococcus aureus, so prolonged antibiotherapy was prescribed.

Interrupted inferior vena cava combined with partial anomalous pulmonary venous return drainage to the IVC in a 67-year-old adult.

A 67-year-old woman presented with lower body edema and was found to have a suprarenal inferior vena cava (IVC) obstruction without hepatic vein obstruction and partial anomalous pulmonary venous return (PAPVR) draining the right pulmonary veins to the IVC below the obstructed IVC on CT angiography. The patient underwent retrohepatic cavoatrial bypass with a polytetrafluoroethylene (PTFE) 16-mm ringed graft via a posterolateral thoracotomy and retroperitoneal approach.

Late simultaneous presentation of left ventricular pseudoaneurysm and tricuspid regurgitation after blunt chest trauma.

A 32-yr-old man developed progressive exertional dyspnea 4 yr after blunt chest trauma due to an automobile accident. Two-dimensional echocardiography and computed-tomographic coronary angiography demonstrated a large pseudoaneurysm of the left ventricle and severe tricuspid regurgitation. The patient underwent successful surgical exclusion of the pseudoaneurysm by endoaneurysmal patch closure and repair of the tricuspid valve regurgitation. To the best of our knowledge, this is the first case of these 2 different pathologies presenting late simultaneously after blunt chest trauma and successful surgical repairs in the published literature.

Delayed left ventricular pseudo-aneurysm after postinfarction repair of ventricular septal defect.

Left ventricular pseudo-aneurysm is a rare complication that usually occurs after myocardial infarction or cardiac surgery. Sometimes it is related to cardiac rupture. We report on surgical management for a left ventricular pseudo-aneurysm that developed four years after surgery for ventricular septal defect in a patient with acute myocardial infarction.

Surgical Repair of Aortocaval Fistula Presenting with Cardiogenic Shock.

Aortocaval fistula (ACF) occurs in <1% of all abdominal aortic aneurysms (AAAs), and in 3% to 7% of all ruptured AAAs. The triad of clinical findings of AAA with ACF are abdominal pain, abdominal machinery bruit, and a pulsating abdominal mass. Other findings include pelvic venous hypertension (hematuria, oliguria, scrotal edema), lower-limb edema with or without arterial insufficiency or venous thrombus, shock, congestive heart failure, and cardiac arrest. Surgery is the main treatment modality. We report successful surgical treatment in a patient with a ruptured AAA with ACF who presented with cardiogenic shock.

Feasibility and Safety of Single-Port Video-Assisted Thoracic Surgery for Primary Lung Cancer.

BACKGROUND: The feasibility of single-port video-assisted thoracic surgery (SPVATS) for primary lung cancer is not well understood. In this study, we compared SP and multi-port (MP) VATS for the surgical treatment of patients with primary lung cancer. METHODS: Surgical treatment was performed in 181 patients with primary lung cancer at Inje University Haeundae Paik Hospital between June 2012 and December 2015. A propensity-matched analysis was used to compare the postoperative outcomes and to evaluate the comparative feasibility and safety of SPVATS and MPVATS. RESULTS: There were 37 patients in the SPVATS group and 67 patients in the MPVATS group. Propensity matching produced 32 pairs. The operation time (210 minutes versus 200 minutes, p=0.11), volume of the estimated blood loss (170 mL versus 160 mL, p=0.19), duration of chest tube drainage (5 days versus 6 days, p=0.66), and length of hospital stay (9 days versus 10 days, p=0.89) were similar between the 2 groups. CONCLUSION: In our study, SPVATS for primary lung cancer was safe and feasible in well selected patients. A prospective, randomized study with a large group and long-term follow-up is necessary to evaluate the clinical feasibility and the advantages of SPVATS for primary lung cancer.

A New Root-Strengthening Technique for Acute Aortic Dissection with a Weakened Aortic Root: The Neo-Adventitia Technique.

BACKGROUND: Dissection flaps in acute type A aortic dissection typically extend into the root, most frequently into the non-coronary sinus (NCS). The weakened root can be susceptible not only to surgical trauma, but also to future dilatation because of its thinner layers. Herein, we describe a new technique that we named the "neo-adventitia" technique to strengthen the weakened aortic root. METHODS: From 2012 to 2016, 27 patients with acute type A aortic dissection underwent supracommissural graft replacement using our neo-adventitia technique. After we applied biologic glue between the dissected layers, we wrapped the entire NCS and the partial left and right coronary sinuses on the outside using a rectangular Dacron tube graft that served as neo-adventitia to reinforce the dissected weakened wall. Then, fixation with subannular stitches stabilized the annulus of the NCS. RESULTS: There were 4 cases of operative mortality, but all survivors were discharged with aortic regurgitation (AR) classified as mild or less. Follow-up echocardiograms were performed in 10 patients. Of these, 9 showed mild or less AR, and 1 had moderate AR without root dilatation. There were no significant differences in the size of the aortic annulus (p=0.57) or root (p=0.10) between before discharge and the last follow-up echocardiograms, and no reoperations on the aortic roots were required during the follow-up period. CONCLUSION: This technique is easy and efficient for reinforcing and stabilizing weakened roots. Furthermore, this technique may be an alternative for restoring and maintaining the geometry of the aortic root. An externally reinforced NCS could be expected to resist future dilatation.

Acute Limb Ischemia and Coronary Artery Disease in a Case of Kimura's Disease.

Kimura disease (KD) is an immune-mediated chronic inflammatory disease of unknown etiology. KD has many complications associated with hypereosinophilia, including various forms of allergic reactions and eosinophilic lung disease. Additionally, hypereosinophilia is associated with hypercoagulability, which may lead to thromboembolic events. A 36-year-old man with KD presented with acute limb ischemia and coronary artery occlusion. He underwent thrombectomy, partial endarterectomy of both popliteal arteries, and coronary artery stent insertion. KD is a systemic disease that affects many organs and presents with thromboembolism and vasculitis. In a patient with KD, physicians should evaluate the vascular system, including the coronary arteries.

A New Surgical Repair Technique for Ischemic Total Papillary Muscle Rupture.

Papillary muscle (PM) rupture is an emergency surgical condition that may occur after acute myocardial infarction. In patients with compete rupture of the PM, mitral valve replacement is preferred or recommended generally because of unstable vital signs or technical difficulties with successful repair, as compared with patients with partial PM rupture. This case report describes the successful repair of a complete anterolateral PM rupture by using the single PM formation technique with subsequent ring annuloplasty.

Long Segmental Reconstruction of Diffusely Diseased Left Anterior Descending Coronary Artery Using Left Internal Thoracic Artery with Extensive Endarterectomy.

In coronary artery bypass grafting, a diffusely diseased left anterior descending coronary artery (LAD) is an obstacle to achieving complete revascularization, consequently leading to the possibility of a poor prognosis. Long segmental reconstruction with or without endarterectomy is a revascularization method for treating diffusely diseased coronary arteries. Herein, we report a successful case of long segmental reconstruction of a diffusely diseased LAD using a left internal thoracic artery onlay patch after endarterectomy.

Experiences of Surgical Treatment for Juxtarenal Aortic Occlusion.

PURPOSE: To evaluate the outcomes of juxtarenal aortic occlusion (JRAO), a review of 15 patients who underwent aortic bypass replacement following aortorenal thrombectomy, especially focusing on the safety of suprarenal aortic clamping or transient aortic compression, was undertaken. MATERIALS AND METHODS: During the period of June 2001 to November 2012, 15 patients with JRAO (chronic 10, acute 5) were analyzed retrospectively. JRAO with combined stenosis of the renal artery was found in 2 patients, renal artery thrombus in 8 patients, and normal in 5 patients. RESULTS: All patients were males. Mean age was 61.7±11.2 years. There were 14 aortobifemoral bypass grafting and 1 aortobiiliac bypass grafting. Six Dacron and 9 PTFE artificial Y-grafts were implanted to the aorta with end-to-end anastomosis in the proximal aorta. Suprarenal aortic clamping was performed in 7 patients, supraceliac clamping in 2 patients, and transient aortic compression in 6 patients. There were 13 cases with aortic clamping time <10 minutes and 2 cases with >10 minutes. Thrombectomy of the aorta and renal artery was performed in 10 (66.7%) patients. There were no operative mortality cases. The perioperative morbidity rate was 26.7% (4/15). Preoperative renal function was impaired in four patients. The renal functions of these cases were recovered postoperatively. CONCLUSION: Aortic bypass replacement following aortorenal thrombectomy with suprarenal aortic clamping or transient aortic compression for JRAO is the optimal treatment. It is important to focus on short renal ischemic time during suprarenal aortic clamping for prevention of renal damage. It provides unmatched perioperative and long-term results.

Endovascular Revascularization for the Obstruction after Patch Angioplasty in Buerger's Disease.

Surgical revascularization for patients with Buerger's disease is possible only in a few cases, due to the diffuse segmental involvement and the lack of distal runoff vessels available for bypass surgery. We encountered a case of resting pain in the right foot, coldness with dysesthesia, and cyanosis on the right 1st toe. The patient was treated with an endovascular intervention after vein patch angioplasty failed due to an inflammatory reaction of Buerger's disease. We suggest that an endovascular procedure can be an effective treatment, even in addition to more conservative and surgical management, in patients with Buerger's disease and critical limb ischemia.

Successful Access Rate and Risk Factor of Vascular Access Surgery in Arm for Dialysis.

PURPOSE: Preservation of adequate vascular access is of vital importance for patients undergoing chronic dialysis in renal failure. The aim of this study is to evaluate the successful access rate and risk factors of arteriovenous fistula (AVF) in the arm for dialysis at a single center. MATERIALS AND METHODS: Patients undergoing vascular access operation between January 2006 and December 2011 were retrospectively identified. RESULTS: A total of 362 vascular access operations were performed. There were 338 autologous AVFs (93.4%) and 24 prosthetic grafts (6.6%). Men comprised 58.3% of all subjects. Mean age was 59.5±14.7 years. There were 187 diabetes mellitus patients (51.7%). There was a mean duration of 70.3±21.1 days between access creation to first cannulation. Overall successful access rate for dialysis was 95.9%. Of 338 autologous AVFs, 326 patients had patent AVFs for dialysis (96.4% surgical success rate), while 21 of 24 prosthetic grafts were patent (87.5% surgical success rate). A total of 141 patients (38.9%) came to surgery with preoperative central venous catheters (CVC) of which 130 (35.9%) AVFs had a patent fistula in the arm. The only risk factor related to successful access rate of AVF was preoperative CVC placement (P=0.012). CONCLUSION: Successful vascular access rate was 95.9%. The only risk factor related to patent access of AVF was preoperative CVC placement. At least 6 months prior to expected dialysis, AVF surgery is recommended, which may overcome the challenge of co-morbid conditions from having a preoperative CVC.

Early outcomes of single-port video-assisted thoracic surgery for primary spontaneous pneumothorax.

BACKGROUND: Recently, single-port video-assisted thoracic surgery (VATS) has been proposed as an alternative to the conventional three-port VATS for primary spontaneous pneumothorax (PSP). The aim of this study is to evaluate the early outcomes of the single-port VATS for PSP. METHODS: VATS was performed for PSP in 52 patients from March 2012 to March 2013. We reviewed the medical records of these 52 patients, retrospectively. Nineteen patients underwent the conventional three-port VATS (three-port group) and 33 patients underwent the single-port VATS (single-port group). Both groups were compared according to the operation time, number of wedge resections, amount of chest tube drainage during the first 24 hours after surgery, length of chest tube drainage, length of hospital stay, postoperative pain score, and postoperative paresthesia. RESULTS: There was no difference in patient characteristics between the two groups. There was no difference in the number of wedge resections, operation time, or amount of drainage between the two groups. The mean lengths of chest tube drainage and hospital stay were shorter in the single-port group than in the three-port group. Further, there was less postoperative pain and paresthesia in the single-port group than in the three-port group. These differences were statistically significant. The mean size of the surgical wound was 2.10 cm (range, 1.6 to 3.0 cm) in the single-port group. CONCLUSION: Single-port VATS for PSP had many advantages in terms of the lengths of chest tube drainage and hospital stay, postoperative pain, and paresthesia. Single-port VATS is a feasible technique for PSP as an alternative to the conventional three-port VATS in well-selected patients.

Three different situations and approaches in the management for anomalous origin of the right coronary artery from the left coronary sinus: case report.

Anomalous origin of the right coronary artery from the left coronary sinus is rare but potentially dangerous if any ischemic signs are present. Multiple therapeutic options were advocated so far. We experienced three different situations and surgical approaches to these anomalies, and reviewed retrospectively. For the first case, we made a neo-ostium on the right sinus of Valsalva and anastomosed with the right coronary artery after arteriotomy. For the second and third cases, we applied coronary artery bypasses emergently: patient 2 the gastroepiploic artery during off-pump coronary artery bypass and patient 3 the left internal thoracic artery during surgery for acute aortic dissection. For the better outcomes, it is important to understand anatomic and hemodynamic characteristics of each patient and select the surgical options considering each characteristic.

Right ventricle inflow obstructing mass proven to be a synovial sarcoma.

Soft tissue sarcoma is the most common malignant cardiac tumor. The chief modes of presentation are embolization, obstruction, and arrhythmogenesis. We describe an unusual case of a 27-year-old man who presented with nausea and dyspnea on exertion. Transthoracic echocardiography and computed tomography revealed a huge mass in the right heart that extended through the inferior vena cava and right renal vein to the right kidney. The cardiac mass was resected, and an immunohistochemical analysis revealed it to be a TLE1-positive synovial sarcoma. After surgery, the patient received serial adjuvant chemotherapy. We herein describe the case with a brief review.

Isolated bypass to the superior mesenteric artery for chronic mesenteric ischemia.

Mesenteric ischemic symptoms appear only when two of the three major splanchnic arteries from the abdominal aorta are involved. Recently, we encountered a case of chronic mesenteric ischemia in a 50-year-old female patient caused by atherosclerotic obstruction of the celiac trunk and superior mesenteric artery. She was treated with a retrograde bypass graft from the right common iliac artery to the superior mesenteric artery (SMA) in a C-loop configuration. Complete revascularization is recommended for treatment of intestinal ischemia. When the celiac trunk is a not suitable recipient vessel, bypass grafting to the SMA alone appears to be both an effective and durable procedure for treating intestinal ischemia.

Single-port Video-Assisted Thoracic Surgery for Lung Cancer.

Video-assisted thoracic surgery (VATS) is a minimally invasive technique that has many advantages in postoperative pain and recovery time. Because of its advantages, VATS is one of the surgical techniques widely used in patients with lung cancer. Most surgeons perform VATS for lung cancer with three or more incisions. As the technique of VATS has evolved, single-port VATS for lung cancer has been attempted and its advantages have been reported. We describe our experiences of VATS for lung cancer with a single incision in this report.