We performed aortic remodeling using a tailored Dacron graft (Yacoub's procedure) in two cases of root aneurysm combined with aortic regurgitation. The cases were 20-year-old and 45-year-old women. The leaflets did not coapt at a central portion, but the lack of coaptation did not produce significant prolapse. No organic change was found, so we attributed aortic regurgitation to sinotubular junction. Remodeling of the root was selected as the operative procedure because degeneration in the annulus was unlikely in these two cases. All three sinuses were excised, with 3mm of the arterial wall left above the aortic annulus and a small button of the aortic wall around the ostia of the coronary arteries. Then each commissure was pulled up and the height of the commissure was measured. The proximal end of the graft was then tailored to a scallop shape, so that the top of the scallop matched the commissure level. The graft was then sutured to the aortic rim with continuous 5-0 polypropylene sutures. Both coronary arteries were reimplanted utilizing the Carrel patch method and the distal graft anastomosis was completed. The aortic crossclamp times were 147 minutes and 163 minutes and the total pump times were 166 minutes and 189 minutes. One patient has mild or 1+ aortic regurgitation on postoperative echocardiogram and aortography, but she has no activity restrictions, and no evidence of congestive symptoms. Yacoub's remodeling procedure which spares the aortic valve, requires no anticoagulant therapy in the post-operative period. Aortic valve-sparing replacement of the aortic root is an excellent procedure for any patient with an ascending aneurysm and an anatomically salvageable valve. Although further long-term follow-up is required, we believe that preserving the native aortic valve is useful for preventing complications associated with mechanical valves.

During the past 7 years from January 1991 through October 1997, we treated 30 cases of aortic root reconstruction by the Carrel patch method. The cases included annulo-aortic ectasia (AAE), root aneurysm with aortic regurgitation (AR), aortic dissection with AR, and true aneurysm (ascending and arch) with AR. The surgical treatment consisted of 28 modified Bentall operations and 2 aortic root remodelings, similar to the Yacoub operation. The aortic root and valve were resected, the coronary arteries were dissected free, mobilized, and then implanted into the composite graft. Coronary anastomosis was performed by mattress suture reinforced by Teflon felt strips. In 5 cases it was necessary to undergo coronary artery bypass grafting for myocardial ischemia. Blood transfusion was unnecessary in 11 cases. Post operative death was seen in only one patient who underwent an emergency operation for cardiac tamponade due to aortic dissection on the 25th postoperative day. The operative mortality rate was 3.3%. The complications of anastomosis, for example leakage and dilatation of the coronary ostia, were not seen in our experience. Reoperation and late death were not observed during the follow-up period (average 23 months). Cerebral hemorrhage occurred in only one case, at 5 years after the operation, and all other patients had an uneventful postoperative course. The event-free rate is 75% (n=1) at 6 years. The operative procedure is considered feasible in any anatomic variation of aortic root diseases, even if dislocation of the coronary ostia is minimal, and this method holds hope for the prevention of anastomotic pseudoaneurysm formation and long-term survival. Although further long-term follow-up study is necessary, our experience suggests that the Carrel patch procedure has few late term complications.

Background: and Purpose Although numerous measures for stroke exist, stroke remains one of the leading causes of death in Japan. In this study, we aimed to determine the long-term survival rate after first-ever stroke using data from a large-scale population-based stroke registry study in Japan. Methods: Part of the Shiga Stroke and Heart Attack Registry, the Shiga Stroke Registry is an ongoing population-based registry study of stroke, which covers approximately 1.4 million residents of Shiga Prefecture in Japan. A total 1,880 patients with non-fatal first-ever stroke (among 29-day survivors after stroke onset) registered in 2011 were followed up until December 2016. Five-year cumulative survival rates were estimated using the Kaplan-Meier method, according to subtype of the index stroke. Cox proportional hazards models were used to assess predictors of subsequent all-cause death. Results: During an average 4.3-year follow-up period, 677 patients died. The 5-year cumulative survival rate after non-fatal first-ever stroke was 65.9%. Heterogeneity was present in 5-year cumulative survival according to stroke subtype: lacunar infarction, 75.1%; large-artery infarction, 61.5%; cardioembolic infarction, 44.9%; intracerebral hemorrhage, 69.1%; and subarachnoid hemorrhage, 77.9%. Age, male sex, Japan Coma Scale score on admission, and modified Rankin Scale score before stroke onset were associated with increased mortality during the chronic phase of ischemic and hemorrhagic stroke. Conclusions In this study conducted in a real-world setting of Japan, the 5-year survival rate after non-fatal first-ever stroke remained low, particularly among patients with cardioembolic infarction and large-artery infarction in the present population-based stroke registry.

BACKGROUND/AIMS: To confirm the feasibility of using newly developed endoscopic ultrasound (EUS) with Zone sonography(TM) technology (ZST; Fujifilm Corp.). METHODS: Seventy-five patients with pancreatic disorders were enrolled: 45 with intraductal papillary mucinous neoplasm; 15 with ductal carcinoma; five with neuroendocrine tumors; three with serous cystic neoplasms; and seven with simple cysts. The endoscopes used were EG-530UR2 and EG-530UT2 (Fujifilm Corp.). Two items were evaluated: visualization depth among four frequencies and image quality after automatic adjustment of sound speed (AASS), assessed using a 5-scale Likert scale by two endosonographers blinded to disease status. Because sound speed could be manually controlled, besides AASS, image quality at sound speeds of 1,440 and 1,600 m/sec were also assessed. RESULTS: In all cases, sufficient images were obtained in the range of 3 cm from the EUS probe. Judgments of image quality before AASS were 3.49+/-0.50, 3.65+/-0.48, respectively. After AASS, A and B scored 4.36+/-0.48 and 4.40+/-0.49 (p<0.0001). There were significant differences in the data before and after AASS and plus 60 m/sec, but no significant difference between the datasets were seen after AASS and at sound speeds manually set for minus 100 m/sec. CONCLUSIONS: EUS with ZST was shown to be feasible in this preliminary experiment. Further evaluation of this novel technology is necessary and awaited.
Endoscopes ; Endosonography ; Humans ; Judgment ; Mucins ; Pancreatic Diseases