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.

Background: A review committee for unapproved and off-label drugs with high medical needs determined that the indication of fibrinogen concentrate for cardiovascular surgery would be publicly acceptable in 2021. However, the Japanese Society of Cardiovascular Surgery is required the conduct of several surveys demonstrating that fibrinogen concentrate can be used properly in medical settings. A questionnaire concerning the use of fibrinogen concentrate in cardiovascular surgery was one such required survey. Methods: A questionnaire concerning the use of fibrinogen concentrate was conducted in December 2021 at 551 certified training facilities of the Japanese Board of Cardiovascular Surgery, and responses were received from 375 facilities (68%). Results: Fibrinogen concentrate was used in 98 centers (26%). Aortic surgery (thoracic/thoracoabdominal) (50%) and cardiac redo surgery (24%) were eligible common surgeries requiring fibrinogen concentrate, and the intraoperative measurement of fibrinogen levels was performed in 77% of centers. The triggers for the use of fibrinogen concentrate were a fibrinogen level <150 mg/dl in 30%, <100 mg/dl in 20% and massive bleeding tendency in 40%. Of note, only 39 facilities (10%) were able to prepare cryoprecipitate in-hospital, and 34 centers (9%) used it for cardiovascular surgery. One hundred and seven centers (29%) planned to apply for facility accreditation for the use of fibrinogen concentrate, and 40 facilities (10%) answered that they would decide based on the situation. The expected number of annual cases in which fibrinogen concentrate would be used for cardiovascular surgery reached 4,860 cases: <10 cases in 52 centers, 10-19 cases in 50 centers, 20-49 cases in 31 centers, 50-99 cases in 12 centers and ≥100 cases in 2 centers. Conclusion: We conducted a questionnaire on the use of fibrinogen concentrate. Intraoperative fibrinogen level measurement was performed at approximately 80% of institutions, and the annual number of cases likely to use fibrinogen concentrate was predicted to reach about 5,000 cases. However, only 10% of centers used cryoprecipitates prepared in-hospital.

A 52-year old woman was referred to our hospital because of abdominal pain and restlessness. A chest contrast-enhanced CT showed huge pericardial effusion and intraluminal defects in the main pulmonary artery. We could not make a diagnosis based on the cytology of the pericardial effusion and histopathology of the mass with a sample taken by a catheter. Therefore, we undertook biopsies of the mass by median sternotomy, which led to the diagnosis of pulmonary intimal sarcoma. The tumor resection was performed to release the right ventricular outflow stenosis. We tried to resect the tumor as much as possible, and reconstructed the pulmonary artery and aortic root. She was discharged to home and survived 5 months after surgery.

Among 62 patients who underwent hybrid arch TEVAR, which is a combination of supra-aortic bypass and TEVAR to treat arch aneurysm, 5 patients encountered postoperative cerebral infarction. In 2 patients, whose thoracic aorta were extremely shaggy, cerebral infarction were multiple and fatal. Other 3 patients, whose aorta were not shaggy, developed visual disturbance after TEVAR and minor cerebral infarction were detected in the area of vertebral artery. To prevent cerebral infarction after hybrid arch TEVAR, the blood flow from the left subclavian to vertebral artery is considered to be significant.

BACKGROUND: Studies on tissue-engineered vascular scaffold construction mostly focus on biodegradable scaffold and acellular allogenic or xenogenlc vascular scaffold. However, there are some problems to be urgently solved, such as control of degradable speed of biodegradable scaffold, and donor-sourced bacterial virus infecting recipients during the implantation of acellular natural vascular scaffold.OBJECTIVE: This study was designed to treat allogenic blood vessels by ultrahigh pressure in conjunction with nuclease washing (decellularization) to observe the decellularization effects and porcine endogenous retroviras (PERV) removal.DESIGN: A controlled observation.SETTING: National Cardiovascular Center, Japan.MATERIALS: This study was performed at the National Cardiovascular Center, Japan from April 2004 to April 2005.Young healthy male 1-3-month-old minipigs, weighing 3-5 kg, were provided by Japanese Farm. The protocol was performed in accordance with ethical guidelines for the use and care of animals. The main reagents and equipments used in the present study were as follows: Hoechst 33258 (Dojindo Laboratories, Kumamoto, Japan), ultrahigh pressure device (KOBELCO, Kobe Steel, Ltd, Japan), and PCR (GENEAMP PCR SYSTEM 9700).METHODS: Porcine descending aorta vessels were isolated under a sterile condition and treated by cold isostatic pressing (981 MPa, 4 ℃) for disruption of donor cells. The cell debris was digested by nuclease and washed out by phosphate buffered saline for vascular scaffold.MAIN OUTCOME MEASURES: After processing of decellularization by ultrahigh pressure treatment, vascular DNA levels were quantitatively determined by a fluorescent probe (Hoechst 33258); Removal of cell components from vascular tissue and retention of scaffold fibers were observed by a transmission electron microscope (JEM 100 cx); Scaffold ultrastructure was observed via a scanning electron microscope (JBM 5200); The morphological structure of vascular wall was observed via an optical microscope (100 augmentation) . All these were performed to evaluate the antigen-removal effects of decellularization by ultrahigh pressure treatment from histological, molecular biological, and immunohistochemical standpoints. Proviral DNA levels of acellular PERV were measured by PCR to evaluate the effects of decellularization by ultrahigh pressure treatment on killing PERV, a typical pathogenic microorganism.RESULTS: After decellularization by ultrahigh pressure treatment, the wavy structure of fibers was completely retained, and tissues were thoroughly cell free. Transmission electron microscope results demonstrated that collagen fibers and elastic fibers, but not cell components were detectable. Scanning electron microscope results demonstrated that only acellular scaffold was found. There was no PERV detected in the treated tissues. However, the PERV could not be inactivated in the tissues treated by surface active agent. Intravascular DNA levels significantly altered from (31.7±3.5 ) mg/L pre-decelhilarization by ultrahigh pressure treatment to (1.16±0.23) mg/L post- decellularization by ultrahigh pressure treatment(P＜0.01). Results demonstrated that decellularization by ultrahigh pressure treatment ridded of cellular nucleus and contents mostly.CONCLUSION: The study demonstrated that decellularization by ultrahigh pressure treatment could fundamentally rid cell components of scaffold, and concomitantly inactivate PERV successfully.

A 61-year-old man fell into out-of hospital cardiopulmonary arrest due to rupture of an abdominal aortic aneurysm, and was resuscitated onsite. On arrival at the emergency room, a fusiform type abdominal aortic aneurysm and massive hematoma in the retro-peritoneal space were detected by ultrasonography. Quickly, an aortic occlusion balloon catheter was placed at the proximal site of abdominal aorta through the left brachial artery, and then graft replacement of the aneurysm was carried out. The inferior mesenteric artery was occluded, and was not reconstructed. Five hours after the operation, left hemi-colectomy was carried out for ischemic necrosis of the descending to sigmoid colon. Although he was complicated by multiple organ failure; renal failure, liver dysfunction, severe infection, and brain infarction, he survived without a fatal disability. A rare case with ruptured abdominal aortic aneurysm who fell into cardiopulmonary arrest outside the hospital but survived after bowel necrosis and multiple organ failure is reported.

A 71-year-old woman who had Takayasu's disease underwent Y-grafting, bypass grafting between the abdominal aorta and left renal artery with 8mm ePTFE graft and right nephrectomy for infrarenal abdominal aortic aneurysm and renovascular hypertension (RVH). Four years after the first operation, the bypass graft became occluded and hypertension was exacerbated. Magnetic resonance angiography revealed that the left renal artery was supplied by the collateral arteries. We performed replacement of the thoracoabdominal aorta and reconstruction of the left renal artery using the saphenous vein. Postoperatively serum creatinine level decreased and hypertension was controllable. She was discharged from the hospital and has been well for three years.