Four patients with DeBakey type 1 aortic dissection underwent primary repair operations: resection of intimal tear with complete aortic transection, circumferential suture line reinforced with Teflon felt strips, and end-to-end anastomosis. There was one hospital death due to pneumonia, and the other three survived. Postoperative CT revealed excellent thrombogenesis in the residual false lumen in three patients. In one case with Marfan's syndrome thrombus formation was not identified in the false lumen.

Afferent loop syndrome (ALS) is a mechanical obstruction of the afferent limbs after gastrectomy with gastrojejunostomy reconstruction. Patients with cancer recurrence require immediate and less invasive treatment because of their poor condition. Percutaneous transhepatic/transluminal drainage (PTD) and endoscopic enteral stenting offer reasonable palliative treatment for malignant ALS but are not fully satisfactory in terms of patient quality of life (QoL) and stent patency. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) using a lumen-apposing metal stent may address these shortcomings. Clinical data from 11 reports showed that all patients who had undergone EUS-GE had positive technical and clinical outcomes. The adverse event rate was 11.4%, including only mild or moderate abdominal pain, with no severe adverse events. Indirect comparative studies indicated that patients who had undergone EUS-GE had a significantly superior QoL, a higher clinical success rate, and a lower reintervention rate than those who had undergone PTD or endoscopic enteral stenting. Although the evidence is limited, EUS-GE may be considered as a first-line treatment for malignant ALS because it has better clinical outcomes than other less invasive treatments, such as PTD or endoscopic enteral stenting. Further prospective randomized control trials are necessary to establish EUS-GE as a standard treatment for ALS.

In this study, we assessed a series of our cases in which endoscopic self-expandable metal stents (SEMSs) were used to treat malignant afferent loop obstruction (ALO) that arose after pancreaticoduodenectomy (PD). We retrospectively examined the records of 7 patients who underwent endoscopic SEMS placement for malignant ALO following PD. Clinical success was achieved in all cases. The median procedure time was 30 min (range, 15–50 min). There were no cases of stent occlusion, and no procedure-related adverse events were encountered. All patients died of their primary disease, and the median overall survival period was 155 days (range, 96–374 days). A re-intervention involving endoscopic ultrasound-guided hepaticogastrostomy combined with antegrade stenting was performed for obstructive jaundice and acute cholangitis in 1 case. In conclusion, endoscopic SEMS placement may be an effective and safe treatment for malignant ALO that arises after PD.

Background : Left atrial reverse remodeling occurs when the left atrial load is reduced after mitral valve repair for mitral valve regurgitation. However, several reports demonstrate mitral valve stenosis after mitral valve repair with a mitral ring, which leads to impaired left atrial reverse remodeling. Objective : To examine the effect of ring size and body size on left atrial reverse remodeling after mitral valve repair. Patients and Methods : Sixty patients underwent transthoracic echocardiography before and after mitral valve repair for mitral valve regurgitation in our hospital. The left atrial volume (LAV) was compared pre- and postoperatively. Ring-size/BSA (mm/m2) was defined as values to express the mismatch between ring-size and body size after mitral valve repair with a mitral ring. In addition, we examined which factors correlated with the left atrial volume reduction rate including ring-size/BSA. The mean ring size was 28 mm. The study interval was 17±6 months. Result : LAV changed from 82±37 ml to 47±20 ml postoperatively. The left atrial volume reduction rate was 39.8±18.6%. The peak pressure gradient measured from the transmitral flow (TMF p-PG) was 7.5±3.0 mmHg. Ring size showed a stronger correlation with body height than BSA. The ring-size/BSA was 17.7±2.1 mm/m2. Multivariate analysis shows that correlates of the LAV reduction rate were ring-size/BSA, pre LAV and age. Ring-size, TMF p-PG, ring annuloplasty only and postoperative TRPG did not show a strong correlation with the LAV reduction rate. Conclusion : A mismatch between body size and ring size is a negative factor for left atrial reverse remodeling after mitral valve repair with a mitral ring. The ring-size/BSA may be a useful factor to express grade of the mismatch.