The usefulness of super-selective arterial spin labeling for postoperative evaluation of pediatric moyamoya disease: technical note.

Moyamoya disease is characterized by progressive internal carotid artery (ICA) occlusion. Extracranial-intracranial bypass surgery is effective, particularly in pediatric patients; imaging plays a crucial role in evaluating intracranial perfusion pre- and post-surgery. Arterial spin labeling (ASL) is a magnetic resonance technique employed for noninvasive, whole-brain perfusion assessment by magnetically labeling inflowing blood. However, ASL cannot evaluate the territories and development of each vessel perfusion compared with digital subtraction angiography (DSA). Recently, super-selective ASL (SS-ASL) has been developed, performing pinpoint labeling on a specific artery at a time, and offering a tomographic view that distinctly displays blood supply areas for each vessel. Unlike DSA, SS-ASL is noninvasive and can be repeatedly performed in pediatric patients. In conclusion, SS-ASL is useful for evaluating bypass development over time and understanding the pathophysiology of pediatric moyamoya disease.

[Effect of Landiolol for Atrial Fibrillation after Open Heart Surgery].

PURPOSE: Postoperative atrial fibrillation (POAF) after open heart surgery is common complication. POAF is reported to prolong hospital stay and increase long-term mortality, therefore prevention of POAF is important. It is widely known that beta blocker decrease POAF, and we had used oral beta blocker after open heart surgery. We examined the effect of intraoperative and postoperative administration of intravenous beta blocker( landiolol) for POAF. METHOD: We evaluated 291 consecutive patients who underwent open heart surgery from November 2016 to November 2018. Those who underwent open heart surgery after November 2017 were 145, and 100 of the patients( group A) had intraoperative and postoperative landiolol administration. Those who underwent open heart surgery before November 2017 were 146, and 100 of the patients (group B) did not have landiolol administration. The primary endpoint was incidence of POAF within 7 days after surgery. RESULT: There was no significant difference in preoperative character between the groups, other than the ratio of males to females( group A:54 males, 46 females;group B:68 males, 32 females;p<0.05). The incidences of POAF were 20% and 36% in group A and group B, respectively( p<0.05). CONCLUSION: Intraoperative and postoperative administration of landiolol is effective for preventing POAF after open heart surgery.

[Suspected Left Ventricular Pseudo-false Aneurysm of a Huge Size Combined with Sustained Ventricular Tachycardia;Report of a Case].

A 74-year-old man was transferred to our hospital for heart failure and ventricular tachycardia. Left ventricular aneurysm of a huge size( 6×9 cm) was found on the imaging test, and was suspected to be a pseudo-false aneurysm because of its thick wall with small orifice. Occulusion of the right coronary artery (#1) was revealed by coronary arteriography and the diskinetic aneurysm in the inferior wall was revealed by left ventriculography. The surgical treatment was needed, because of the high risk of rupture. He successfully underwent Dor operation with endocardial cryoablation and left ventricular ejection fraction (LVEF) was found to be improved by postoperative left ventriculography. He discharged on 56 days after operation. Ventricular pseudo-false aneurysm is rare and the treatment is controversial.

[Modified David-Komeda Repair for Ventricular Septal Perforation Complicated with Severe Postoperative Acute Respiratory Distress Syndrome;Report of a Case].

A 61-year-old man presented by ambulance with dyspnea. He was diagnosed with myocardial infarction complicated with ventricular septal perforation (VSP), and intraaortic balloon pumping support and intensive care were started. Because of instability of hemodynamic status, modified David-Komeda operation with double patch was performed in the subacute phase of VSP. Although he developed acute respiratory distress syndrome( ARDS) on the 21st day after operation, he was successfully treated with corticosteroid pulse therapy and artificial ventilation. He was transferred to a rehabilitation hospital on the 141st postoperative day.

[Marfan-like aortic aneurysm syndrome; A surgical experience with Loeys-Dietz syndrome].

A 17-year-old female patient complaining of chest pain was transferred to our hospital to treat annuloaortic ectasia associated with severe aortic valve insufficiency. She underwent a valve sparing operation with graft replacement of the ascending aorta and the proximal portion of the aortic arch. After the 1st operation, she was diagnosed with Loeys-Dietz syndrome (LDS), which is recently described as an autosomal dominant aortic aneurysm syndrome caused by heterozygous mutations in the transforming growth factor-beta receptor type 1 and 2 genes. Only 2 months after the 1st operation, she developed heart failure due to recurrence of aortic regurgitation. Computed tomography (CT) scan showed an expansion of the aortic arch. Total arch replacement using the elephant trunk technique and aortic valve replacement were performed successfully 4 months after the 1st operation. The rapidly progressive nature of the aortic disease in patients with LDS underscores the importance of meticulous surveillance of the entire aorta and the need for early surgical management.