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1.
Kyobu Geka ; 76(5): 358-361, 2023 May.
Artículo en Japonés | MEDLINE | ID: mdl-37150914

RESUMEN

Case 1:A 73-year-old man was transported to our hospital for evaluation of sudden onset of chest pain, back pain, and dyspnea. We initially misdiagnosed him with advanced esophageal cancer accompanied by mediastinal metastasis;however, subsequent multi-detector row computed tomography (MDR-CT) confirmed the diagnosis. We performed coil embolization of a bronchial artery aneurysm and thoracic endovascular aortic repair( TEVAR) to seal the root of the bronchial artery. Case 2:An 81-year-old woman with a one-week history of fever and cervical pain was diagnosed with a ruptured infected thoracic aneurysm. She underwent the same treatment as described in Case 1. Physicians should consider it as a differential diagnosis of mediastinal hematoma.


Asunto(s)
Aneurisma Roto , Rotura de la Aorta , Arterias Bronquiales , Embolización Terapéutica , Procedimientos Endovasculares , Humanos , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Arterias Bronquiales/diagnóstico por imagen , Arterias Bronquiales/cirugía , Mediastino , Embolización Terapéutica/métodos , Procedimientos Endovasculares/métodos
2.
Kyobu Geka ; 76(3): 179-187, 2023 Mar.
Artículo en Japonés | MEDLINE | ID: mdl-36861272

RESUMEN

The optimal management of Stanford type A accute aortic dissection (TAAAD) with mesenteric malperfusion (TAAADwM) is controversial. Our strategy of TAAADwM is open superior mesenteric artery (SMA) bypass prior to aortic repair, if we suspect TAAADwM on computed tomography (CT) scan, whatever other findings might be or not. The need of treatment of mesenteric malperfusion prior to aortic repair is not always linked with digestive symptom, lactate, intraoperative finding. The mortality of 14 patients with TAAADwM was 21.4%, which was an allowable result. Our strategy might be proper at instances of, allowable time for management of open SMA bypass, unnecessarily of endovascular treatment, confirming an enteric property and ability to respond to a rapid hemodynamic change.


Asunto(s)
Disección Aórtica , Procedimientos de Cirugía Plástica , Humanos , Disección Aórtica/complicaciones , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/cirugía , Ácido Láctico , Arteria Mesentérica Superior/diagnóstico por imagen , Arteria Mesentérica Superior/cirugía , Tomografía Computarizada por Rayos X
3.
Kyobu Geka ; 74(2): 139-141, 2021 Feb.
Artículo en Japonés | MEDLINE | ID: mdl-33976021

RESUMEN

The patient was a 76-year-old man with myasthenia gravis (MG). He suffered from a sudden back pain, and was diagnosed with Stanford type A acute aortic dissection. We performed emergency graft replacement of the ascending aorta under cardiopulmonary bypass with hypothermic circulatory arrest. A neuromuscular blocking agent was administered only once at tracheal intubation. The operation was completed without incident. A neuromuscular antagonist was administered once just after the operation. Fifteen hours after the operation, the tracheal tube was extubated. His postoperative course was uneventful and he has been well for three years since the operation. This is a very rare surgical case report of acute aortic dissection with MG.


Asunto(s)
Disección Aórtica , Miastenia Gravis , Anciano , Disección Aórtica/complicaciones , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/cirugía , Aorta , Puente Cardiopulmonar , Urgencias Médicas , Humanos , Masculino , Miastenia Gravis/complicaciones
4.
Ann Thorac Surg ; 112(1): e9-e11, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-33421387

RESUMEN

Neurological disorders are the most unpredictable and feared complications after open surgery or endovascular aortic repair. Paraplegia because of spinal cord injury is well known after thoracoabdominal aortic surgery but not after valvular surgery. We herein present a case of paraplegia after mitral and tricuspid valve surgery in a patient with a history of surgery involving the thoracoabdominal and abdominal aorta. The paraplegia was likely caused by temporary postoperative hypotension as low as 40 mm Hg for more than 10 minutes with decreased spinal perfusion in the intensive care unit.


Asunto(s)
Aneurisma de la Aorta Torácica/cirugía , Implantación de Prótesis Vascular/efectos adversos , Procedimientos Endovasculares/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/métodos , Paraplejía/etiología , Complicaciones Posoperatorias , Insuficiencia de la Válvula Tricúspide/cirugía , Anciano , Aneurisma de la Aorta Torácica/complicaciones , Aneurisma de la Aorta Torácica/diagnóstico , Humanos , Imagen por Resonancia Magnética , Masculino , Insuficiencia de la Válvula Tricúspide/complicaciones
5.
Interact Cardiovasc Thorac Surg ; 32(4): 661-663, 2021 04 19.
Artículo en Inglés | MEDLINE | ID: mdl-33221869

RESUMEN

Extravasation of prosthetic grafts is rare. Various anatomical problems after graft replacement might make standard endovascular treatment difficult. Use of a commercially available main body requires an adequate distance of the flow divider. An 86-year-old man developed extravasation of a graft that had been implanted in the infrarenal abdominal aorta 24 years previously. Endovascular repair with upside-down and kissing stent graft techniques using the contralateral leg was successfully performed.


Asunto(s)
Aorta Abdominal , Implantación de Prótesis Vascular , Anciano de 80 o más Años , Aorta Abdominal/diagnóstico por imagen , Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/cirugía , Prótesis Vascular , Implantación de Prótesis Vascular/efectos adversos , Procedimientos Endovasculares/efectos adversos , Humanos , Masculino , Diseño de Prótesis , Stents , Resultado del Tratamiento
8.
Eur J Cardiothorac Surg ; 45(3): e41-5, 2014 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-24335472

RESUMEN

OBJECTIVES: Transit-time flow measurement (TTFM) allows intraoperative functional assessment of grafts in coronary artery bypass grafting (CABG). The major limitation of this technique is a low positive predictive value (PPV) that could lead to unnecessary graft revisions. A combined approach with high-resolution epicardial ultrasonography (HR-ECUS) and TTFM was evaluated for the first time in terms of diagnostic accuracy. The aim of this study is to evaluate the added value of intraoperative HR-ECUS for an improved graft patency verification. METHODS: From November 2009 to September 2012, 333 patients underwent isolated CABG. A total number of 717 grafts were performed; all grafts were intraoperatively verified by means of both TTFM and HR-ECUS. RESULTS: Among 678 grafts considered functioning at TTFM, 3 (0.4%) were failing at HR-ECUS and promptly redone (2 bilateral internal mammary artery-Y-grafts and 1 left internal mammary artery to left anterior descending (LIMA-LAD)). These were confirmed as true positive at graft revision due to technical error. HR-ECUS confirmed the good functioning of the remaining 675 grafts already demonstrated by TTFM; among them, 8 showed high troponin I release (clinical false negative), whereas the remaining 667 had no high TnI release (clinical true negative). In 2 of 39 grafts malfunctioning at TTFM, HR-ECUS confirmed the graft failure; surgical inspection of the anastomosis during redo procedure (in both cases LIMA-to-LAD graft) showed a technical error leading to define those 2 grafts as 'true positive' on the basis of either direct vision and improved post-redo TTFM parameters. Finally, in 35 cases, HR-ECUS did not confirm TTFM diagnosis demonstrating a full patency of the anastomosis; these grafts had an uneventful clinical course (true negative). The main result of this study is the increase of PPV from 10% with TTFM to almost 100% of TTFM + HR-ECUS, avoiding many unnecessary graft revisions. CONCLUSIONS: HR-ECUS should be considered complimentary to TTFM. Simultaneous use of the two methods during CABG provides morphological and functional information improving considerably diagnostic accuracy of intraoperative graft verification procedure close to 100%.


Asunto(s)
Puente de Arteria Coronaria/métodos , Ecocardiografía/métodos , Análisis de la Onda del Pulso/métodos , Anciano , Prótesis Vascular , Puente de Arteria Coronaria/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Revascularización Miocárdica/métodos , Estudios Retrospectivos
11.
J Heart Valve Dis ; 18(2): 142-6, 2009 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-19455886

RESUMEN

BACKGROUND AND AIM OF THE STUDY: Functional mitral regurgitation (FMR) with leaflet tethering is a serious complication related to dilated cardiomyopathy. Although FMR with mitral leaflet tethering can be improved by secondary chordal cutting, the technique may compromise valvular-ventricular interaction. The aim of chordal translocation (CT) is to maintain valvular-ventricular interaction. METHODS: An initial successful mitral valve repair with CT was performed on a 55-year-old patient with FMR. Following secondary chordal cutting, artificial chordae were sutured to the tip of each papillary muscle, from where the secondary chordae originated. The artificial chordae were passed through the mid-septal annulus and fixed on the side of the left atrium. The force direction generated by the artificial chordae was very similar to the natural stress line on the anterior mitral leaflet. In a subsequent clinical series, CT was performed on 13 FMR patients. RESULTS AND CONCLUSION: The study results indicated that CT, in conjunction with secondary chordal cutting, might represent a promising treatment for preserving valvular-ventricular interaction in FMR patients.


Asunto(s)
Cuerdas Tendinosas/cirugía , Insuficiencia de la Válvula Mitral/cirugía , Músculos Papilares/cirugía , Suturas , Materiales Biocompatibles , Puente de Arteria Coronaria , Humanos , Masculino , Persona de Mediana Edad , Politetrafluoroetileno
13.
J Thorac Cardiovasc Surg ; 136(4): 868-75, 2008 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-18954624

RESUMEN

OBJECTIVE: Treatment of ischemic mitral regurgitation accompanied by strong tethering remains a challenge. Undersized ring annuloplasty is frequently associated with residual/recurrent mitral regurgitation caused by mitral-leaflet tethering. Although chordal cutting is a simple procedure for repairing severe tethering of the anterior mitral leaflet, it often affects mitral valvular-ventricular continuity. In this study, using 3-dimensional echocardiography, we investigated the effects of "chordal translocation" on the geometry of the mitral components in a canine model of acute ischemic mitral regurgitation. METHODS: In 6 mongrel dogs, under cardiopulmonary bypass with cardiac arrest, artificial chordae were implanted to each papillary-muscle tip and passed through the midseptal annulus to an external tourniquet to control the tension of the stitch thereafter. Subsequently, secondary chordae were cut near their point of attachment to the anterior leaflet. After weaning from cardiopulmonary bypass, acute ischemic mitral regurgitation was induced by ligating the obtuse marginal branches. We obtained data in 2 states of the artificial chordae: relaxation (simulating chordal cutting) and gentle traction (simulating chordal translocation). RESULTS: In the chordal translocation state versus the chordal cutting state, the left ventricle ejection fraction (42.6% +/- 2.9% vs 33.2% +/- 2.3%, P < .0001), preload recruitable stroke work (54.8 +/- 2.7 mm Hg vs 34.1 +/- 2.2 mm Hg, P = .0002), and end-systolic elastance (6.7 +/- 0.5 mm Hg/mL vs 4.2 +/- 0.2 mm Hg/mL, P = .0013) improved markedly. The mitral-valve tethering volume, defined as the volume enclosed by the mitral annulus and 2 leaflets, was smaller in the chordal translocation state than in the chordal cutting state (812 +/- 88 mm(3) vs 1213 +/- 41 mm(3), P = .03). In the chordal translocation state (CT-1 and CT-2) versus the chordal cutting state, the posterior mitral-leaflet tethering area (15.7 +/- 0.7 mm(2) vs 25.1 +/- 1.2 mm(2), P < .0001 for CT-1 and 15.0 +/- 0.7 mm(2) vs 25.1 +/- 1.2 mm(2), P < .0001 for CT-2) showed a greater improvement than the anterior mitral-leaflet tethering area (41.0 +/- 0.7 mm(2) vs 46.1 +/- 1.3 mm(2) for CT-1, P = .01 and 812 +/- 88 mm(2) vs 1213 +/- 41 mm(2) for CT-2, P = .03). The mitral annular geometry did not differ between the states. CONCLUSION: Compared with chordal cutting alone, chordal translocation improved both the left ventricle function and mitral geometry in a canine model of acute ischemic mitral regurgitation. Chordal translocation may be beneficial because it ameliorates the tethering of both the anterior and posterior leaflets, which is aggravated by mitral annuloplasty alone.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos/métodos , Cuerdas Tendinosas/trasplante , Insuficiencia de la Válvula Mitral/cirugía , Válvula Mitral/patología , Válvula Mitral/cirugía , Remodelación Ventricular/fisiología , Animales , Puente Cardiopulmonar , Modelos Animales de Enfermedad , Perros , Ecocardiografía Tridimensional , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Isquemia Miocárdica/fisiopatología , Probabilidad , Distribución Aleatoria , Valores de Referencia , Sensibilidad y Especificidad , Volumen Sistólico , Función Ventricular Izquierda/fisiología
14.
Eur J Cardiothorac Surg ; 34(4): 755-9, 2008 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-18640048

RESUMEN

OBJECTIVE: Saline injection test performed during mitral valvuloplasty is popular; however, discrepancies are sometimes noticed between the 'naked eye' findings of regurgitation during the saline injection test and the echocardiographic findings after surgery. These discrepancies may arise due to the geometric differences in the mitral valve-left ventricular complex between the saline-injected left ventricle (LV) and the beating LV. Therefore, to elucidate these differences, we compared the three-dimensional geometries between these two conditions. METHODS: Sonomicrometry crystal markers were implanted in seven mongrel dogs at the mitral annulus, edge of the mitral leaflets between scallops, tips of papillary muscles, and LV apex under cardiopulmonary bypass. Geometric data of the LV were acquired during the saline injection test and in the beating heart. RESULTS: The commissural width was greater and the annular height was lesser during the saline injection test than in the beating heart (20.5+/-5.1mm vs 17.2+/-2.2mm, p<0.01 and 5.5+/-1.8mm vs 7.3+/-2.2mm, p<0.05, respectively), indicating that the saddle-shaped mitral annulus was flattened during the test. Additionally, the middle scallop width and the distance between the papillary tips were greater during the test (14.0+/-4.2mm vs 11.3+/-3.6mm, p<0.05 and 22.9+/-5.9mm vs 11.6+/-5.0mm, p<0.01, respectively), implying that the middle scallop was stretched by the traction of the chordae. The distance between the papillary tips and the mitral annular plane remained constant in both the conditions (19.3+/-2.6mm vs 18.6+/-6.2mm, not significant). CONCLUSIONS: The saline injection test could aid in determining the length of the reconstructed chordae. However, the test may provide inaccurate data of the mitral-LV dimensions due to the flattened annulus and overstretched leaflets.


Asunto(s)
Válvula Mitral/anatomía & histología , Animales , Puente Cardiopulmonar , Perros , Paro Cardíaco Inducido , Ventrículos Cardíacos/anatomía & histología , Válvula Mitral/fisiología , Insuficiencia de la Válvula Mitral/diagnóstico , Insuficiencia de la Válvula Mitral/cirugía , Contracción Miocárdica , Músculos Papilares/anatomía & histología , Músculos Papilares/fisiología , Cloruro de Sodio , Función Ventricular Izquierda
15.
Kyobu Geka ; 60(6): 433-7; discussion 437-40, 2007 Jun.
Artículo en Japonés | MEDLINE | ID: mdl-17564056

RESUMEN

Case 1. Forty nine years woman was given a diagnosis of acute myocardial infarction. Coronary angiography and trans-esophageal echocardiography showed left main trunk dissection due to local aortic root dissection. We operated surgical repair at left main trunk by pericardium after percutaneous coronary intervention. Case 2. Forty nine years man was given a diagnosis of acute myocardial infarction caused by left main trunk dissection due to traumatic local aortic root dissection. We operated coronary artery bypass grafting after insertion of perfusion catheter to left main trunk for maintain coronary perfusion. Although local dissection of aortic aorta is relatively rare, it is potentially complicated with coronary malperfusion. We describe 2 success a cases of surgical treatment for local acute type A aortic dissection complicated with coronary malperfusion.


Asunto(s)
Angioplastia Coronaria con Balón , Aneurisma de la Aorta/cirugía , Disección Aórtica/cirugía , Enfermedad Coronaria/cirugía , Infarto del Miocardio/terapia , Disección Aórtica/complicaciones , Disección Aórtica/diagnóstico por imagen , Aorta/cirugía , Aneurisma de la Aorta/complicaciones , Aneurisma de la Aorta/diagnóstico por imagen , Angiografía Coronaria , Puente de Arteria Coronaria , Enfermedad Coronaria/etiología , Ecocardiografía Transesofágica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/etiología , Procedimientos Quirúrgicos Vasculares/métodos
16.
J Thorac Cardiovasc Surg ; 133(4): 1004-11, 2007 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-17382642

RESUMEN

OBJECTIVE: The chordal cutting method is performed for mitral valve tenting in functional mitral regurgitation, such as ischemic mitral regurgitation. However, the method may interfere with the mitral valvular-ventricular continuity. To maintain the continuity and the natural force direction between the papillary muscles and the mitral annulus after chordal cutting, we developed "translocation" of the secondary chordae tendineae. METHODS: Six mongrel dogs had sonomicrometry crystal markers implanted in the left ventricle, mitral annulus, and papillary muscle tips. After the secondary chordae tendineae of the anterior mitral leaflet from each papillary muscle were resected, each papillary muscle tip was connected to the mid-anterior mitral annulus with 4-0 polypropylene sutures, and then the sutures were taken out of the left atrium to control the chordal tension. The condition under which the artificial chordae were released was defined as "redundant." The chordal tension of 15 g of weight was defined as "taut," whereas the tension for 2-mm chordal shortening after "taut" was defined as "tight." After the dogs were weaned from cardiopulmonary bypass, hemodynamic and 3-dimensional data were acquired under the condition of "redundant," and then "taut," "tight," and "redundant." RESULTS: End-systolic elastance increased from 1.81 +/- 0.24 mm Hg/mL to 2.69 +/- 0.89 mm Hg/mL (P = .015) between "redundant" and "taut," and this was maintained between "taut" and "tight." However, preload recruitable stroke work increased from 41.3 +/- 12.0 mm Hg to 58.1 +/- 19.7 mm Hg (P = .005) between "redundant" and "taut," and was reduced to 51.7 +/- 22.9 mm Hg (P = .037) between "taut" and "tight." CONCLUSION: "Translocation" of the secondary chordae tendineae after chordal cutting improved left ventricular systolic function compared with simple chordal cutting.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos/métodos , Cuerdas Tendinosas/trasplante , Insuficiencia de la Válvula Mitral/cirugía , Función Ventricular Izquierda/fisiología , Animales , Perros , Válvula Mitral/cirugía
20.
Jpn J Thorac Cardiovasc Surg ; 50(10): 443-4, 2002 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-12428386

RESUMEN

We report a patient with a fractured J wire protruding through the outer polyurethane sheath of an Accufix electrode in the subclavian vein and right atrium. The wire within the subclavian vein was removed transvenously, while the tip of the lead within the right atrium was removed surgically via a median sternotomy.


Asunto(s)
Electrodos Implantados , Marcapaso Artificial , Falla de Equipo , Femenino , Humanos , Persona de Mediana Edad , Vena Subclavia/cirugía
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