An 80-year-old woman presented with dilatation of the distal aortic arch due to chronic type B aortic dissection. She underwent thoracic endovascular aortic repair (TEVAR) in zone 2 with GORE TAG thoracic endoprostheses (40 mm-15 cm and 34 mm-20 cm) for closure of the entry site at the proximal descending aorta. TEVAR was successfully performed and blood flow in the false lumen stopped. Two months after TEVAR, she was admitted to our hospital owing to syncope. A CT scan revealed type A aortic dissection, and emergency surgery was performed. The entry was proximal to the stent graft, and we performed total arch replacement with preservation of the stent graft. Retrograde type A aortic dissection is a rare but lethal complication of TEVAR. Careful consideration of the device selection is needed, and attention should be paid to the placement of the stent graft.

A 65-year-old man had received closure of the entry and false lumen Stanford type B acute aortic dissection via left thoratectomy 23 years previously. The patient underwent emergency graft replacement for a ruptured aneurysm of the thoraco-abdominal aorta 10 years previously. Enhanced computed tomography (ECT) revealed that the residual aortic dissection of the distal arch and the descending aorta were dilated. Reoperation via left thoracotomy usually requires a long cardiopulmonary bypass time and intraoperative bleeding. So we selected to perform open stent-grafting through median sternotomy alone, avoiding a left thoracotomy.

An 82-year-old woman fell into a state of shock during the treatment for a urinary tract infection. Computed tomography and transthoracic echocardiography revealed massive pericardial effusion. Pericardiectomy was performed in the operating room and hemorrhagic effusion was observed. Emergent sternotomy was performed, and the bleeding site was located at the posterior portion of the left ventricular outflow. We diagnosed a rupture of a left ventricular outflow tract pseudoaneurysm after infectious endocarditis. A pericardium patch closure of the pseudoaneurysm and an aortic valve replacement were performed. The patient was discharged 35 days after the operation without recurrence of infection. Left ventricular outflow tract pseudoaneurysms is an uncommon complication following infective endocarditis, aortic valve surgery or chest trauma. Transesophageal echocardiography and multidetector-row computed tomography (MDCT) is useful for identifying such lesions.

OBJECTIVE: A recent study suggested that rs6504340, a polymorphism within the homeobox B (HOXB) gene cluster, is associated with the susceptibility for malocclusions in Europeans. The resulting malocclusions require orthodontic treatment. The aim of this study was to investigate the association of rs6504340 and other dentition-implicated polymorphisms with dental and occlusal traits in Korean and Japanese populations. METHODS: The study participants included 223 unrelated Koreans from the Busan area and 256 unrelated Japanese individuals from the Tokyo metropolitan area. DNA samples were extracted from saliva specimens. Genotyping for rs6504340 and four single nucleotide polymorphisms (SNPs) that have been shown to be associated with the timing of first tooth eruption and the number of teeth at 1 year of age (rs10506525, rs1956529, rs9674544, and rs8079702) was performed using TaqMan assays. The Index of Orthodontic Treatment Need (IOTN), overjet, overbite, arch length discrepancy, crown sizes, and length and width of the dental arches were measured. Spearman's correlation coefficients were calculated to evaluate relationships between rs6504340 and these dental/occlusal traits. RESULTS: We evaluated the aesthetic components and dental health components of the IOTN in the Korean and Japanese populations and found that neither rs6504340 nor the other four SNPs showed any association with dental and occlusal traits in these East Asian populations. CONCLUSIONS: These negative results suggest that further research is needed to identify the genetic determinants of malocclusions in order to reach a consensus.
Asian Continental Ancestry Group* ; Busan ; Consensus ; Crowns ; Dental Arch ; DNA ; Genes, Homeobox ; Genetics ; Humans ; Index of Orthodontic Treatment Need ; Malocclusion ; Multigene Family ; Overbite ; Polymorphism, Single Nucleotide ; Saliva ; Tooth Eruption* ; Tooth*

Objectives: The aim of this study was to investigate the relationship between preoperative 10m gait speed and ADL disability in patients undergoing cardiovascular surgery. Methods: There were 131 patients who underwent scheduled cardiovascular surgery and pre and postoperative ADL evaluation from June 2014 to December 2017 in our hospital. A total of 19 patients, including 13 whose Barthel Index (BI) was lower than before surgery at discharge and 6 who had a long-term hospital stay of 6 weeks or more after surgery, was defined as the ADL disability group. The other 119 patients were defined as the control group. We retrospectively compared the two groups and searched for predictors of postoperative ADL disability. Results and Conclusions: An independent predictor of postoperative ADL disability was identified: more than 7.04seconds for walking 10m.

We report a successful case of aortic valve-sparing root replacement for dilated aortic root after a Ross procedure. A 29-year-old male underwent a Ross procedure when he was 11 years old for congenital aortic bicuspid valve. The right ventricular outflow tract was reconstructed using an autologous pericardium as a single leaflet valve. Aortic root dilatation and moderate aortic valve regurgitation were noted. Further investigation with enhanced computed tomography and ultrasonic cardiography revealed good quality of leaflets and sufficient geometric height, and aortic valve-sparing root replacement was performed. In addition, we performed pulmonary valve replacement with a biological valve. The post-operative course was uneventful and the patient was discharged after 8 days with a completely controlled aortic valve regurgitation. No recurrence of aortic valve regurgitation was observed 1 year later. Because surgical outcomes of congenital heart diseases have improved and more patients have an increasing life expectancy, several other problems were revealed, such as the occurrence of aortic root dilatation after a Ross procedure. Aortic roots may dilate due to arterial pressure; however, valve-sparing procedures may be performed if the volume of the leaflets is sufficient.

Cardiac metastasis from cervical cancer is rare. We herein present a case involving a 54-year-old woman with cervical cancer who was undergoing radiotherapy for left supraclavicular lymph node metastasis. The patient was admitted to the hospital because of shortness of breath. Transthoracic echocardiography showed a large mass in the right ventricle. To rescue the patient from circulatory collapse, we surgically resected the intracardiac mass via a right ventricular incision parallel to the posterior descending artery and left anterior descending artery. This approach prevented right ventricular outflow tract obstruction and perioperative pulmonary embolization, which could have led to death. The intracardiac mass was diagnosed as squamous cell carcinoma. After hospital discharge, the patient underwent chemotherapy. An echocardiography performed 3 months postoperatively showed recurrence of the cardiac metastasis, and the patient died 5 months later. Cardiac metastasis in the right ventricle can present as pulmonary embolization. Although rare, most cases of metastasis from cervical carcinoma to the heart have an extremely poor prognosis.