RESUMO
Studies suggest the internal thoracic artery as a shunt option due to its growth potential. However, long-term data are lacking. Here, a patient with a failing single ventricle shunt had an enlarged internal thoracic artery. We followed the patient for 12 years after converting this artery into a Blalock-Taussig shunt, analysing its growth to assess its effectiveness.
RESUMO
Hereditary connective tissue disease is known to cause aortic lesions at an early age. Familial aortic aneurysm/dissection is caused due to an ACTA2 mutation that affects smooth muscle structure. We present a case of a 15-year-old boy with a mild developmental disorder in whom no abnormalities were identified on previous physical examinations. The patient presented with severe left heart failure, extensive dissection from the ascending aorta to the common iliac artery, and myocardial and cerebral infarctions. He underwent an urgent Bentall surgery. Six months later, the patient underwent surgical reconstruction of the abdominal aorta from the aortic arch and returned to normal daily activities. Pathological examination demonstrated the absence of elastic fibers but presence of abundant reticular fibers and mucopolysaccharides from the tunica intima to the media. Genetic testing revealed a heterozygous missense variant of the ACTA2 gene. To the best of our knowledge, this is the first sporadic case of structurally abnormal smooth muscle organization resulting in clinical symptoms with no previously reported pathogenicity.
Assuntos
Aneurisma da Aorta Torácica , Dissecção Aórtica , Masculino , Humanos , Adolescente , Dissecção Aórtica/genética , Dissecção Aórtica/cirurgia , Mutação , Mutação de Sentido Incorreto , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/genética , Aneurisma da Aorta Torácica/cirurgia , Actinas/genéticaRESUMO
Background and Aims: The processes and mechanisms underlying lineage diversification are major topics in evolutionary biology. Eurasian goldenrod species of the Solidago virgaurea complex show remarkable morphological and ecological diversity in the Japanese Archipelago, with ecotypic taxa well adapted to specific environments (climate, edaphic conditions and disturbance regimes). The species complex is a suitable model to investigate the evolutionary processes of actively speciating plant groups, due to its ability to evolve in relation to environmental adaptation and its historical population dynamics. Methods: Two chloroplast markers, 18 nuclear microsatellite markers and ddRAD-sequencing were used to infer population genetic demography of S. virgaurea complex with its related species/genera. Key Results: Our analysis showed that populations in Japan form an evolutionary unit, which was genetically diverged from adjacent continental populations. The phylogenetic structure within the archipelago strongly corresponds to the geography, but interestingly there is no concordance between genetic structure and ecotypic boundaries; neighbouring populations of distinct ecotypes share a genetic background. Conclusions: We propose that the traits specific to the ecotypic entities are maintained by natural selection or are very recently generated and have little effect on the genomes, making genome-wide genetic markers unsuitable for detecting ecotypic differentiation. Furthermore, some sporadically distributed taxa (found as rheophytes and alpine plants) were repeatedly generated from a more widespread taxon in geographically distant areas by means of selection. Overall, this study showed that the goldenrod complex has a high ability to evolve, enabling rapid ecological diversification over a recent timeframe.
Assuntos
Solidago/genética , DNA de Cloroplastos/genética , Ecologia , Variação Genética/genética , Genética Populacional , Japão , Repetições de Microssatélites/genética , Filogenia , Filogeografia , Análise de Sequência de DNARESUMO
The case is reported of mitral valve repair with cusp-level chordal shortening for non-rheumatic mitral anterior leaflet prolapse. The simple and easily reproducible cusp-level shortening procedure consists of plication of the redundant chorda underneath the leaflet. Provided the chorda is thick enough, this procedure is more likely to be applied to regional mitral anterior prolapse due to elongation of the chorda, even in patients with non-rheumatic heart disease. The present patient underwent perioperative adaptive servo-ventilation (ASV) therapy. ASV might help to prevent atrial fibrillation recurrence after the Maze procedure by reducing sympathetic overactivity, contributing to the durability and outcome of mitral valve repair with cusp-level chordal shortening.
Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter , Cordas Tendinosas/cirurgia , Implante de Prótese de Valva Cardíaca , Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral/cirurgia , Prolapso da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Cordas Tendinosas/fisiopatologia , Ecocardiografia Doppler em Cores , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/fisiopatologia , Prolapso da Valva Mitral/diagnóstico , Prolapso da Valva Mitral/fisiopatologia , Recuperação de Função Fisiológica , Respiração Artificial , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do TratamentoRESUMO
Taraxacum albidum, a perennial herb of the Asteraceae family, exhibits both tetraploid and pentaploid in Japan. This study sequenced and characterized the complete chloroplast genome of T. albidum, revealing a 151,451 bp sequence with a typical quadripartite structure, comprising one large single-copy (LSC) region of 84,052 bp, one small single-copy (SSC) region of 18,541 bp, and two inverted repeat (IR) regions, IRa and IRb, each 24,429 bp in length. The chloroplast genome, excluding duplicates, contained 113 unique genes, including 79 protein-coding genes, 30 transfer RNA genes, and four ribosomal RNA genes. The GC content of this genome was 37.7%. Phylogenetic analysis revealed that T. albidum is most closely related to T. mongolicum, with the chloroplast genome sequences being nearly identical, differing by only one nucleotide. These findings suggest that the maternal lineage of T. albidum likely originates from T. mongolicum or its closely related species.
Assuntos
Anormalidades Múltiplas/diagnóstico , Aorta Torácica/anormalidades , Dupla Via de Saída do Ventrículo Direito/diagnóstico , Permeabilidade do Canal Arterial/diagnóstico , Anormalidades Múltiplas/embriologia , Aorta Torácica/embriologia , Dupla Via de Saída do Ventrículo Direito/embriologia , Permeabilidade do Canal Arterial/embriologia , Feminino , Humanos , LactenteRESUMO
BACKGROUND: Ventricular septal rupture (VSR) is an infrequent but life-threatening situation. Although outcomes have improved with the introduction of infarction exclusion, we have experienced difficulty in determining the optimal patch size and shape for obtaining good outcomes. Therefore, we modified the infarction exclusion technique. Herein, we review our experience on the basis of early closure of VSR with and without use of the infarction exclusion technique. METHODS: We retrospectively analyzed the hospital records of 33 patients who underwent surgical treatment for VSR. We employed Dagget's method from 1982 to 1995, and then introduced the infarction exclusion technique in 1995. We have developed two modifications: the two-sheet single-patch technique and the three-sheet double-patch technique. RESULTS: Overall hospital mortality was 41.9% and that of the infarction exclusion group was significantly lower than the hospital mortality rate of the noninfarction exclusion group (21% and 63%, respectively, p = 0.0266). Late mortality of survivors was low in all groups during the observation period. The three-sheet double-patch group showed no residual shunt. This difference in outcomes between the single-patch and double-patch groups was statistically significant (p = 0.0174). CONCLUSIONS: The two-sheet method facilitates the restoration of ventricular geometry. A double-patch using the three-sheet method may be useful for reducing residual shunt.
Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Técnicas de Sutura , Ruptura do Septo Ventricular/cirurgia , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Cardíacos/instrumentação , Procedimentos Cirúrgicos Cardíacos/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Ruptura do Septo Ventricular/mortalidadeRESUMO
A 38-year-old man was diagnosed with acute type A aortic dissection and severe aortic regurgitation, and taken immediately to the operating room for repair of the ascending aorta using the Bentall procedure. The presence of the anomalous right coronary artery was revealed at the time of the procedure, and was repaired with single coronary button technique. Some case reports have described anomalous coronary artery in association with acute myocardiac infarction or angina pectoris. This report describes a case of anomalous coronary artery diagnosed during an emergency operation for aortic dissection.
Assuntos
Aneurisma Aórtico/cirurgia , Dissecção Aórtica/cirurgia , Anomalias dos Vasos Coronários/complicações , Adulto , Dissecção Aórtica/complicações , Aneurisma Aórtico/complicações , Emergências , Humanos , MasculinoRESUMO
We report the case of a 4-year-old boy with coarctation of the aorta resulting from persistent fifth aortic arch, a rare abnormality, along with an interrupted fourth aortic arch. When he visited a general practitioner with an upper respiratory infection, a heart murmur was noted. Computed tomography findings led to the diagnosis of persistent fifth aortic arch with an interrupted fourth aortic arch. He underwent aortic arch repair, excision of the fifth aortic arch, and anastomosis of the original arch with the descending aorta. Pathologically, the tissue of the fifth aortic arch was different from that of the normal aortic arch.
Assuntos
Coartação Aórtica , Anastomose Cirúrgica , Aorta/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Coartação Aórtica/diagnóstico por imagem , Coartação Aórtica/cirurgia , Pré-Escolar , Humanos , Masculino , Tomografia Computadorizada por Raios XRESUMO
Median full-sternotomy carries a risk of sternal infection and lethal mediastinitis in cardiac surgery. We performed open-heart surgery through partial median sternotomy in 5 patients with tracheostomy. Coronary artery bypass grafting (CABG) was performed in 3 patients, aortic valve replacement in 1, and mitral valve replacement in 1. No operative deaths or complications related to wound infection occurred. Partial sternotomy represents a safe alternative in cardiac surgery in patients with tracheostoma.
Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Esternotomia/métodos , Traqueostomia , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
PURPOSE: We performed antegrade thoracic endovascular aneurysm repair via the ascending aorta in selected high-risk patients scheduled for open surgery, in whom an iliofemoral or abdominal aortic approach was not feasible. We present our initial experience with this approach. METHODS: Of 16 consecutive patients who underwent antegrade endovascular aneurysm repair via the ascending aorta at our institution, 3 had an emergency intervention for rupture and 3 had an urgent intervention for impending rupture or complicated aortic dissection. The procedure was scheduled in 10 patients. The median patient age was 77 years. In 13 patients, one or more concomitant procedures were performed. In 6 patients, vascular access for endovascular aneurysm repair was obtained via a branch of the replacement graft. In 10 patients, direct cannulation of the ascending aorta was carried out using 2 pursestring sutures. RESULTS: The initial success rate was 100%. Early mortality occurred in 2 (12.5%) patients because of multiple organ failure in one and heart failure in the other. No patient required a second intervention during follow-up. The mean duration of follow-up was 19 months. CONCLUSION: The antegrade approach is a useful alternative in patients with no access suitable for endovascular aneurysm repair and who are not appropriate candidates for open conventional thoracic aortic surgery. This approach is applicable to selected patients.
Assuntos
Aneurisma da Aorta Torácica/cirurgia , Dissecção Aórtica/cirurgia , Ruptura Aórtica/cirurgia , Implante de Prótese Vascular/métodos , Procedimentos Endovasculares/métodos , Idoso , Idoso de 80 Anos ou mais , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/mortalidade , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/mortalidade , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/mortalidade , Aortografia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
One of the factors determing the postoperative results of arterial switch operation (ASO) for complete transposition of great arteries (TGA) is coronary event (CE). We analyzed the risk factors of CE after ASO in patients whose coronary patterns excluding Shaher type 1. The subjects were 44 patients operated from 1994 to 2007. As for the coronary reconstructive technique, procedures by Mee or Aubert were conducted on patients with Shaher 5A intramural type. The conventional technique was conducted on other patients, with or without trapdoor technique. In all patients, the pulmonary artery was reconstructed mainly with autopericardium using Lecompt maneuver. The mean observation period was 4.0 +/- 3.1 years, and the number of patients showing CE was 14 (32%) at 1.6 years after surgery on the average. The risk factors of CE and the operative procedures were discussed.
Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Doença das Coronárias/etiologia , Vasos Coronários/cirurgia , Transposição dos Grandes Vasos/cirurgia , Humanos , Lactente , Recém-Nascido , Complicações Pós-OperatóriasRESUMO
A 70-year-old man with severe multivalvular disease, atrial fibrillation, and kyphoscoliosis, had Cheyne-Stokes respiration with central sleep apnea. After triple-valve surgery with the maze procedure, adjunctive adaptive servo-ventilation therapy was initiated on the first postoperative day and continued seamlessly in the postoperative period. Seamless adaptive servo-ventilation therapy as an adjunct to triple-valve surgery is more likely to prevent heart failure remodeling without worsening of pulmonary hypertension and recurrence of atrial fibrillation.
Assuntos
Valva Aórtica/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca , Anuloplastia da Valva Mitral , Valva Mitral/cirurgia , Respiração Artificial/métodos , Apneia do Sono Tipo Central/terapia , Valva Tricúspide/cirurgia , Idoso , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Fibrilação Atrial/complicações , Fibrilação Atrial/cirurgia , Ablação por Cateter , Ecocardiografia Doppler , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/diagnóstico , Doenças das Valvas Cardíacas/fisiopatologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Masculino , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Anuloplastia da Valva Mitral/efeitos adversos , Polissonografia , Apneia do Sono Tipo Central/complicações , Apneia do Sono Tipo Central/diagnóstico , Apneia do Sono Tipo Central/fisiopatologia , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/fisiopatologiaRESUMO
Port-access cardiac surgery has been developed to minimize skin incision and improve cosmetic outcomes. Using this method, a skin incision is generally made just above where the thoracotomy will be placed, horizontally along the intercostal space at the anterolateral submammary position. However, this type of incision can affect the frontal view and shape of the breast. Here, we report our experience with minimally invasive cardiac surgery using a port-access approach via a small vertical right infra-axillary incision and a moving window method. Twenty patients underwent surgical procedures with this approach from December 2010 to January 2012. Thirteen patients underwent mitral valvuloplasty, four mitral valve replacement, one mitral and tricuspid valve replacement and atrial septal defect closure and two atrial septal defect closure. All surgical procedures were completed using this minimally invasive method. All patients had an uneventful recovery and indicated that they were satisfied with the cosmetic results during the follow-up. Our experience suggests that this technique can effectively minimize skin incision and improve cosmetic outcomes.
Assuntos
Valvuloplastia com Balão/métodos , Comunicação Interatrial/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Valva Mitral/cirurgia , Toracotomia , Valva Tricúspide/cirurgia , Valvuloplastia com Balão/efeitos adversos , Cicatriz/etiologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Satisfação do Paciente , Toracotomia/efeitos adversos , Resultado do TratamentoRESUMO
Closure of patent ductus arteriosus (PDA) in the elderly is a high-risk procedure due to the fragility of the aorta and aneurysmal changes in the ductus. Stent grafting has emerged as a method for treating aortic disease. We describe a case in which this endovascular technique was successfully performed for closure of a PDA with aneurismal change in a high-risk patient. This approach may comprise the armamentarium for treating this pathology in adults.
Assuntos
Implante de Prótese Vascular/métodos , Prótese Vascular , Permeabilidade do Canal Arterial/cirurgia , Stents , Idoso , Meios de Contraste , Permeabilidade do Canal Arterial/diagnóstico por imagem , Ecocardiografia , Feminino , Humanos , Politetrafluoretileno , Tomografia Computadorizada por Raios XRESUMO
Infectious endocarditis patients occasionally need emergency cardiac surgery even if they have a tracheostoma. However, a median full-sternotomy approach carries increased risk for sternal infection and lethal mediastinitis in cardiac surgery for patients with tracheostomas. We successfully performed valve replacement procedures using a lower partial median sternotomy approach in 6 infectious endocarditis patients with tracheostomas. There were neither operative deaths nor complications related to wound infection in these cases. The partial sternotomy approach represents a safe alternative in cardiac surgery for acute infectious endocarditis patients with tracheostomas who need emergent surgery.
Assuntos
Valva Aórtica/cirurgia , Endocardite/cirurgia , Implante de Prótese de Valva Cardíaca , Valva Mitral/cirurgia , Esternotomia , Traqueostomia , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Esternotomia/efeitos adversos , Fatores de Tempo , Traqueostomia/efeitos adversos , Resultado do TratamentoRESUMO
Aortoesophageal fistula secondary to thoracic aneurysm is rare, but is usually lethal, and few survivors have been reported. We report successful surgery for aortoesophageal fistula in a one-stage operation. Repair involved in situ replacement of the thoracic aneurysm using a rifampicin-soaked graft, primary repair of the esophagus, omental wrap and tube jejunostomy. This is the original report of the surgical repair of aortoesophageal fistula using a rifampicin-soaked graft.
Assuntos
Anti-Infecciosos/administração & dosagem , Aneurisma da Aorta Torácica/complicações , Doenças da Aorta/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Fístula Esofágica/cirurgia , Rifampina/administração & dosagem , Fístula Vascular/cirurgia , Aneurisma da Aorta Torácica/tratamento farmacológico , Aneurisma da Aorta Torácica/patologia , Aneurisma da Aorta Torácica/cirurgia , Doenças da Aorta/tratamento farmacológico , Doenças da Aorta/etiologia , Doenças da Aorta/patologia , Nutrição Enteral , Fístula Esofágica/tratamento farmacológico , Fístula Esofágica/etiologia , Fístula Esofágica/patologia , Esofagoscopia , Esôfago/cirurgia , Humanos , Jejunostomia , Omento/cirurgia , Desenho de Prótese , Infecções Relacionadas à Prótese/prevenção & controle , Retalhos Cirúrgicos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Fístula Vascular/tratamento farmacológico , Fístula Vascular/etiologia , Fístula Vascular/patologiaRESUMO
OBJECTIVE: Antegrade selective cerebral perfusion (ASCP) and retrograde cerebral perfusion (RCP) have proven to be reliable methods of brain protection during aortic surgery. These techniques are usually accompanied by systemic circulatory arrest with moderate hypothermia (24-28 degrees C) or deep hypothermia (18-24 degrees C). However, hypothermia can lead to various problems. The present study therefore reports results for thoracic aorta replacement using ASCP with mild hypothermic systemic arrest (28-32 degrees C). DESIGN: Between 1995 and 2003, 68 consecutive patients underwent repair of the ascending aorta and/or aortic arch. Mild hypothermic ASCP was utilized in 31 cases, moderate hypothermic ASCP in 20, and deep hypothermic RCP in 17. Various parameters were compared between the mild hypothermic ASCP, moderate hypothermic ASCP, and RCP. RESULTS: Hospital mortality was 10.3%, with no significant differences observed between any groups. Permanent neurological dysfunction was 8.8%, and no significant differences were observed between any groups. Mild hypothermic ASCP displayed significantly decreased transfusion volume, intubation time, and ICU stay. CONCLUSIONS: Use of ASCP with mild hypothermic systemic circulatory arrest during aortic surgery resulted in acceptable hospital mortality and neurological outcomes. ASCP with mild hypothermic arrest allows decreased transfusion volume and reduced duration of intubation and ICU stay.