Fulminant myocarditis is known as a disastrous disease that requires intensive care with mechanical cardiopulmonary support. Percutaneous cardiopulmonary bypass (PCPS), which is referred to as extracorporeal membrane oxygenation, is usually used for fulminant myocarditis. However, in some cases, PCPS may be ineffective because of circulatory insufficiency and could be associated with various severe complications such as multiple organ failure or leg ischemia. In such cases, placement of a ventricular assist device (VAD) is required. A 46-year-old man with fever and severe fatigue was admitted to a local hospital and diagnosed as having fulminant myocarditis. Although an intra-aortic balloon pump and PCPS were introduced, cardiac function was not recovered, causing multiple organ failure and leg ischemia. Hence, he was transferred to our hospital for further mechanical support. Transesophageal echocardiography (TEE) revealed severe biventricular cardiac dysfunction, and radiography showed pulmonary edema. His total bilirubin level was 6.9 mg/dl and platelet level was 3,300/μl. Thus, we implanted a biventricular assist device (BiVAD). At 12 days after the implantation, TEE revealed improvement of cardiac function, and blood biochemical examination revealed recovery of multiple organ function. Thereafter, the patient was weaned from the BiVAD successfully. After the operation, the patient underwent a long rehabilitation. He was discharged 51 days after the operation, without any neurological or cardiac complication.

In emergency surgery for acute type A aortic dissection, the creation of needle holes can cause various issues and complications. One persistent challenge is the prevention of distal anastomotic new entry tears, which frequently necessitate additional intervention.Modification of the distal reinforcement technique offers a straightforward solution by combining existing hemostatic agents with tools such as occlusion balloons. We describe a modified distal reinforcement procedure employing a balloon-and-glue technique to help prevent new entry tears at the distal anastomosis and avoid total arch replacement.Ten patients with acute type A aortic dissection were treated using this technique. Postoperative computed tomography indicated no evidence of distal anastomotic entry tears. In conclusion, this modified distal reinforcement technique represents not only a method to prevent distal anastomotic new entry tears but also a palliative approach that may obviate the need for total arch replacement in patients in poor condition or of advanced age.

In emergency surgery for acute type A aortic dissection, the creation of needle holes can cause various issues and complications. One persistent challenge is the prevention of distal anastomotic new entry tears, which frequently necessitate additional intervention.Modification of the distal reinforcement technique offers a straightforward solution by combining existing hemostatic agents with tools such as occlusion balloons. We describe a modified distal reinforcement procedure employing a balloon-and-glue technique to help prevent new entry tears at the distal anastomosis and avoid total arch replacement.Ten patients with acute type A aortic dissection were treated using this technique. Postoperative computed tomography indicated no evidence of distal anastomotic entry tears. In conclusion, this modified distal reinforcement technique represents not only a method to prevent distal anastomotic new entry tears but also a palliative approach that may obviate the need for total arch replacement in patients in poor condition or of advanced age.

In emergency surgery for acute type A aortic dissection, the creation of needle holes can cause various issues and complications. One persistent challenge is the prevention of distal anastomotic new entry tears, which frequently necessitate additional intervention.Modification of the distal reinforcement technique offers a straightforward solution by combining existing hemostatic agents with tools such as occlusion balloons. We describe a modified distal reinforcement procedure employing a balloon-and-glue technique to help prevent new entry tears at the distal anastomosis and avoid total arch replacement.Ten patients with acute type A aortic dissection were treated using this technique. Postoperative computed tomography indicated no evidence of distal anastomotic entry tears. In conclusion, this modified distal reinforcement technique represents not only a method to prevent distal anastomotic new entry tears but also a palliative approach that may obviate the need for total arch replacement in patients in poor condition or of advanced age.