A man in his fifties was diagnosed with retrograde type A acute aortic dissection. He underwent total arch replacement using the Gelweave Lupiae graft and staged thoracic endovascular aortic repair. Five days after discharge from the hospital, he was referred to our institution because of severe hemolytic anemia. Electrocardiography-gated computed tomography angiography demonstrated significant kinking of the graft adjacent to the proximal anastomotic site. Cine cardiac magnetic resonance imaging showed that graft kinking deteriorated during systole. We concluded that his hemolytic anemia was caused by graft kinking and surgical repair was required. The graft was transected at the kinking site and then reconstructed. After surgical repair, the hemolytic anemia improved immediately.

A 35-year-old man was followed up for systemic lupus erythematous with antiphospholipid antibody-positive. He underwent an echocardiogram for a closer examination of his heart murmur. Transthoracic echocardiography revealed a calcified mass of 30 mm in diameter in the right ventricular outflow tract. Surgery was performed through an upper hemi-sternotomy. After establishment of beating-heart cardiopulmonary bypass, the pulmonary trunk was opened with a longitudinal incision. The highly calcified mass was located immediately below the pulmonary valve. We exfoliated the mass from the right ventricle, and resected it en bloc during short-term cardiac arrest. The postoperative pathological diagnosis was a calcified amorphous tumor. The patient was discharged from our hospital on postoperative day 12．No tumor recurrence was observed 9 months after the surgery.

OBJECTIVE: To investigate the clinical feasibility of dual energy subtraction (DES) imaging to improve the delineation of the vocal cord and diagnostic accuracy of vocal cord paralysis as compared with the anterior-posterior view of flat panel detector (FPD) neck radiography. MATERIALS AND METHODS: For 122 consecutive patients who underwent both a flexible laryngoscopy and conventional/DES FPD radiography, three blinded readers retrospectively graded the radiographs during phonation and inspiration on a scale of 1 (poor) to 5 (excellent) for the delineation of the vocal cord, and in consensus, reviewed the diagnostic accuracy of vocal cord paralysis employing the laryngoscopy as the reference. We compared vocal cord delineation scores and accuracy of vocal cord paralysis diagnosis by both conventional and DES techniques using kappa statistics and assessing the area under the receiver operating characteristic curve (AUC). RESULTS: Vocal cord delineation scores by DES (mean, 4.2 +/- 0.4) were significantly higher than those by conventional imaging (mean, 3.3 +/- 0.5) (p < 0.0001). Sensitivity for diagnosing vocal cord paralysis by the conventional technique was 25%, whereas the specificity was 94%. Sensitivity by DES was 75%, whereas the specificity was 96%. The diagnostic accuracy by DES was significantly superior (kappa = 0.60, AUC = 0.909) to that by conventional technique (kappa = 0.18, AUC = 0.852) (p = 0.038). CONCLUSION: Dual energy subtraction is a superior method compared to the conventional FPD radiography for delineating the vocal cord and accurately diagnosing vocal cord paralysis.
Absorptiometry, Photon/*instrumentation/*methods ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Feasibility Studies ; Female ; Humans ; Male ; Middle Aged ; Observer Variation ; Reproducibility of Results ; Sensitivity and Specificity ; Subtraction Technique ; Vocal Cord Paralysis/*radiography ; Vocal Cords/radiography ; *X-Ray Intensifying Screens ; Young Adult