1.A Case of Prosthetic Valve Dysfunction Early after Surgery Using a Mosaic Bioprosthesis
Takahiro Shojima ; Hiroshi Yasunaga ; Naofumi Enomoto ; Hideki Sakashita ; Takeshi Oda ; Yukio Hosokawa ; Kageshige Todo
Japanese Journal of Cardiovascular Surgery 2010;39(3):118-121
An 81-year-old man underwent aortic valve replacement with a 21-mm Medtronic Mosaic porcine bioprosthesis for the treatment of bicuspid aortic valve stenosis. In addition to the appearance of chest discomfort on effort and a new diastolic murmur, echocardiography performed 2 years and 3 months after the surgery showed a high pressure gradient across the bioprosthetic valve and a reduction in the valve orifice area. Prosthetic valve dysfunction was diagnosed. During a repeat operation, 2 large tears on the left cusp and a subvalvular overgrown abundant pannus were observed, and the bioprosthetic valve was replaced with a 19-mm On-X mechanical heart valve. On analysis of the explant bioprosthesis, the right non-coronary stent post was bent outwards by approximately 9°, it compressed the left cusp by pulling the left right and left non-coronary stent posts closer together, thus altering the leaflet geometry and function. We speculated that pannus formation had resulted from turbulent blood flow caused by impaired or altered leaflet function. The 2 large tears appeared to be the result of contact with the bias cloth secondary to the stent distortion.
2.Relationship between the guide tube andsticking pain.
Kenji MIYAMURA ; Katsuyuki SAWADA ; Yukio TSUKUDA ; Hideki HAYASHI ; Mikio NAKAMURA ; Shinichi FUWA ; Tetsuo HOSOKAWA ; Yoshifumi YOMESHIMA ; Kazushi NISHIJO
Journal of the Japan Society of Acupuncture and Moxibustion 1985;35(3-4):208-214
Comparative trials were undertaken using 16 types of guide-tubes of different caliber and external diamter: small caliber (1.35mm) and large cliber (1.80mm) tubes of eight types of external diameter (i. e, 2.5, 3.0, 3.5, 4.0, 4.5, 5.0, 5.5 and 6.0mm). 540 tappings was performed with a hard needle (length: 58.0mm, diameter: 0.16mm, head diameter: 1.25mm).
The result can be summarized as follows:
1. Among the six small guide-tubes with 2.5-5.0mm external diameter, the larger external diameter was, the less sticking pain was experienced.
2. The four small caliber guide-tubes with 4.5-6.0mm external diameter caused significantly less sticking pain compared with the four small caliber guide-tubes of 2.5-4.0mm and the four large guide-tubes of 4.5-6.0mm.
3.Development of a Pseudoaneurysm of the Thoracic Aorta at the Cannulation Site : Our Experience with Three Cases
Yuichiro Hirata ; Satoru Tobinaga ; Hiroyuki Saisho ; Kumiko Wada ; Tomokazu Ohno ; Eiji Nakamura ; Yukio Hosokawa ; Shinichi Hiromatsu ; Hidetoshi Akashi ; Hiroyuki Tanaka
Japanese Journal of Cardiovascular Surgery 2013;42(4):320-323
A pseudoaneurysm of the thoracic aorta after cardiac surgery is a rare complication, but can be life-threatening when it is ruptured. The pseudoaneurysm itself presents no symptoms in many cases, or may be similar to an atherosclerotic aortic aneurysm. Therefore, it is usually found incidently during imaging studies. We encountered 3 cases of pseudoaneurysm of the thoracic aorta that developed during the long-term follow-up after congenital cardiac surgery. None of the patients experienced specific symptoms associated with the pseudoaneurysm, and were diagnosed by chest roentgenograms and computed tomography. Most patients who undergo surgery for congenital heart defects as adolescents are free from medical treatment, and do not regularly see a doctor after the surgery. It is important to consider the possibility of a pseudoaneurysm in patients having a history of cardiac surgery.
4.Hybrid Treatment of the Intrathoracic Right Subclavian Artery Aneurysm
Yukio Hosokawa ; Seiji Onitsuka ; Satoru Tobinaga ; Shinichi Hiromatsu ; Kentaro Sawada ; Eiji Nakamura ; Tomokazu Ohno ; Hayato Fukuda ; Hidetoshi Akashi ; Hiroyuki Tanaka
Japanese Journal of Cardiovascular Surgery 2014;43(5):270-273
Subclavian artery aneurysm (SCAA), a peripheral arterial aneurysm, is a rare entity. The surgical procedure and approach depend on the location of the aneurysm. We present a case of the endovascular therapy combined with cross axillary bypass. The patient was a 75-year-old man with a small abdominal aortic aneurysm. Multi-detector computed tomography (MDCT) revealed an intrathoracic right SCAA 38 mm in diameter. The operation was performed successfully under general anesthesia. After cross bypass of bilateral axillary artery, the orifice of the right subclavian artery was covered with a stent-graft inserted into the right common carotid artery-brachiocephalic artery and the right subclavian artery was occluded with coils distal to the aneurysm. Post operation angiogram showed complete exclusion of the SCAA and patency of the right common carotid and right vertebral artery. We thought this hybrid treatment for the intrathoracic SCAA could be a useful surgical strategy.
5.Chronic Aortic Dissection with Aorta-Right Atrium Fistula
Mau Amako ; Satoru Tobinaga ; Yusuke Shintani ; Yukio Hosokawa ; Eiji Nakamura ; Hiroyuki Ohtsuka ; Koji Akasu ; Seiji Onitsuka ; Shinichi Hiromatsu ; Hidetoshi Akashi
Japanese Journal of Cardiovascular Surgery 2014;43(5):296-299
Aortic dissection with rupture into the right atrium is an extremely rare and rapidly fatal condition. We report the case of a 59-year-old man with a history of double valve replacement 2 years earlier at another hospital. Although the previous postoperative course had been uneventful, the patient had experienced facial edema and general fatigue for 10 days before admission to our hospital because of heart failure. The diagnosis of chronic aortic dissection with rupture into the right atrium was confirmed by intraoperative transesophageal echocardiography. At operation, we observed an aortic dissection that originated from a tear in the original aortic incision line. The fistula extended from the false lumen to the right atrium. The aortic adventitia were partially defective. The aortic dissection had ruptured and a pseudo-aneurysm had formed. We performed ascending aortic replacement and closure of the aorta-right atrium fistula under hypothermic arrest on cardiopulmonary bypass. The postoperative course was uneventful and the patient was discharged on the 17th postoperative day.
6.A Surgical Case of Residual Axillary Artery Aneurysm Associated with Kawasaki Disease
Kentaro Sawada ; Yukio Hosokawa ; Hinako Sakurai ; Ryo Kanamoto ; Shinichi Imai ; Yusuke Shintani ; Shinichi Nata ; Shinichi Hiromatsu ; Hidetoshi Akashi ; Hiroyuki Tanaka
Japanese Journal of Cardiovascular Surgery 2017;46(6):320-324
We herein report on a case in which we conducted bypass surgery for occlusion of a left axillary artery aneurysm with ischemic symptoms 21 years after the contraction of Kawasaki disease and achieved symptomatic improvement. The case involved a 22-year-old man who had been suffering from Kawasaki disease since the age of one. He had been undergoing antiplatelet therapy for bilateral axillary artery aneurysms by orally taking aspirin for 20 years. He suffered from symptoms of upper limb ischemia 21 years after receiving a diagnosis of peripheral aneurysms and occlusion of a left axillary artery aneurysm upon 3DCTA. We conducted aneurysmotomy, plication, and bypass surgery between the axillary and brachial arteries via the autologous vein. Pathological examination revealed due to the formation of atheroma in the tunica intima and disarrangement of the layer structure in the tunica media : thickening of the tunica media was partially observed. His fatigue upon exertion of his left upper extremity remarkably improved following surgery. Although peripheral aneurysms associated with Kawasaki disease are rare, as seen in this case, peripheral arterial disease remains and progresses even after long periods of time. It is believed necessary to carry out long term follow-up and examine the approaches to therapy including surgery in accordance with the site and degree of the disease.