Akio Kawasaki

Progression of Abdominal Aortic Aneurysm After Endovascular Stent-Grafting in a Patient with Behçet's disease: Report of a Case

A 53-year-old man with Behçets disease was admitted to our hospital for investigation of back and lower abdominal pain. Computed tomography (CT) showed a projecting saccular aneurysm below the right renal artery. We placed a stent-graft just below the right renal artery, successfully excluding the abdominal aortic aneurysm (AAA). His C-reactive protein level and white blood cell count remained elevated after stent-grafting. About 5 months later, he was readmitted with recurrent back and lower abdominal pain and CT showed progression of the AAA. Thus, we performed straight grafting using a woven Dacron graft just below the right renal artery. The patient had an uneventful postoperative course. We discuss the controversial issue of treating AAA in patients with Behçets disease, focusing on the indications and timing of surgery.

Papillary muscle sandwich plasty for ischemic mitral regurgitation: a new simple technique.

Chronic ischemic mitral regurgitation (IMR) is recognized as functional regurgitation and a common cause of congestive heart failure caused by the myocardial infarction remodeling process. IMR is a strong predictor of poor outcomes in patients with ischemic cardiomyopathy. Various types of mitral valve repair (MVR) techniques, such as annuloplasty, 1 the edge-to-edge technique, 2 and chordal cutting, have been reported. However, these procedures have yet to result in clearly improved patient outcomes, and the best surgical intervention is still controversial. Therefore the development of new techniques is necessary for better results in patients with IMR. Conventional MVR procedures, such as edge-to-edge repair or repair with an artificial chordae with an undersized ring were original options; however, satisfactory results were not obtained because of recurrent mitral regurgitation and late death. In this article we introduce our new simple procedure, the so-called sandwich plasty.

SEPTAL‐SUPERIOR EXPOSURE IN MITRAL VALVE SURGERY WITH RADIOFREQUENCY ABLATION

Background:  We review the results of surgical radiofrequency ablation of both atria in patients of mitral valve disease approached by septal‐superior exposure and discuss the availability of this approach.

Combined surgery for ischemic cardiomyopathy : Report of a case

A 65-year-old female with catecholamine-dependent ischemic cardiomyopathy was admitted to our hospital. Preoperative examination revealed severe triple vessel coronary artery disease, severe mitral valve regurgitation and left ventricular (LV) dilatation associated with low ejection fraction. Coronary artery bypass grafting with four distal anastomoses, mitral valve plasty using original papillary muscle application method, LV volume reduction using overlapping method and biventricular pacing were performed. Postoperative course was uneventful and quality of life at 2 years after surgery was good. Active combined surgery has the possibility of improving the outcome of patients with severe ischemic cardiomyopathy.