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: Reverse total shoulder arthroplasty has become a widely accepted surgical procedure in Japan since the time when the implants were approved for use in 2014. There is a doubt, however, as to whether the implants designed for Western people are suitable for Japanese people, particularly for females of relatively small stature. The purpose of this study was to investigate the glenoid dimension, with special focus on the length after glenoid reaming, in Japanese rotator cuff tear patients. METHODS: Fifty-six shoulders of 55 patients (35 males and 20 females; mean age, 63.8 years) were studied. Using the three-dimensional computed tomography images of the entire scapula before shoulder surgery, we measured the glenoid height and width, and calculated the correlation between these measurements and the patient's height. Further, we measured the anteroposterior length of the scapular neck at the subchondral bone and the length at 15 mm medial to the subchondral bone, to simulate both the glenoid width after reaming (width of the ‘virtual reamed surface’) and the space available for the end of the center post of a standard glenoid baseplate. RESULTS: The average glenoid height and width were 35.8 mm and 28.1 mm in males and 30.8 mm and 23.4 mm in females, respectively. There was a significant correlation between patient height and glenoid size (glenoid height, r = 0.69; width, r = 0.75; p < 0.01). The mean value of the width of the virtual reamed surface was 27.0 mm in males and 22.5 mm in females. The mean anteroposterior length at 15 mm medial to the subchondral bone was 12.4 mm in males and 9.5 mm in females; the length was shorter than 8 mm in 6 female shoulders. CONCLUSIONS: There was a significant correlation between patient height and glenoid size. Considering that the common diameter of the commercially available baseplates and their center posts is greater than 25 mm and 8 mm, respectively, these prosthetic parts would be too large, especially for the Japanese female glenoid. Given that the current results of Japanese shoulder dimensions are similar to those of Asian people, ‘Asian size implants’ should be developed.
Arthroplasty ; Asian Continental Ancestry Group* ; Female ; Glenoid Cavity ; Humans ; Japan ; Male ; Neck ; Rotator Cuff* ; Scapula* ; Shoulder ; Tears*