Hisashi Satoh

Differential Color Imaging Technique of Helical CT Angiography in the Diagnosis of Total Anomalous Pulmonary Venous Drainage

Three-dimensional images obtained by helical CT are very informative for the diagnosis of various kinds of cardiovascular diseases. However, it is sometimes difficult to recognize spatial relationships of arteries, veins, tracheae, and bronchi in some complicated congenital heart diseases, such as total anomalous pulmonary venous drainage (TAPVD), major aortopulmonary collateral arteries, vascular rings, etc. Because the spatial information is essential for successful surgical intervention, we have developed a differential 3D color imaging technique that uses helical CT angiography. After arteries and veins had been determined by the shape, continuity, and CT density on sequential CT images, …

Spool-Like Stent for the Open Sternum After Cardiac Operations

Severe edematous heart after a cardiac operation is impossible to treat if there is compression of the heart due to the sternum. In these patients delayed sternal closure may be a useful procedure until the heart decreases in size. We devised a spool-like stent for the open sternum to maintain the optimal cardiac space for the severely edematous heart and to fix the chest wall to allow for management while the sternum is open.

Outcomes of single-stage total arch replacement via clamshell incision

BackgroundTreatment of complex aortic pathologies involving the transverse arch with extensive involvement of the descending aorta remains a surgical challenge. Since clamshell incision provides superior exposure of the entire thoracic aorta, we evaluated the use of this technique for single-stage total arch replacement by arch vessel reconstruction.MethodsThe arch-first technique combined with clamshell incision was used in 38 cases of aneurysm and aortic disease in 2008 and 2009. Extensive total arch replacement was used with clamshell incision for reconstruction of arch vessels under deep hypothermic circulatory arrest.ResultsOverall 30-day mortality was 13%. The mean operating time was approximately 8 hours. Deep hypothermia resulted in mean CPB time exceeding 4.5 hours and mean duration of circulatory arrest was 25 minutes. The overall postoperative temporary and permanent neurologic dysfunction rates were 3% and 3% for elective and 3% and 0% for emergency surgery, respectively. All patients except the five who died in hospital were discharged without nursing care after an average post-operative hospital stay of 35 days.ConclusionsThe arch-first technique, combined with clamshell incision, provides expeditious replacement of the thoracic aorta with an acceptable duration of hypothermic circulatory arrest and minimizes the risk of retrograde atheroembolism by using antegrade perfusion.

Surgical Repair of Aberrant Subclavian Artery Through Clamshell Approach

Aberrant subclavian artery is a rare abnormality that often occurs in association with Kommerells diverticulum. The optimal surgical treatment is exclusion and reconstruction of the dilated diverticulum or aberrant subclavian artery. To accomplish such a radical operation in a single stage, we have introduced total (or partial) arch replacement using deep hypothermic circulatory arrest and the arch-first technique through a bilateral submammary thoracotomy (the clamshell approach). This technique provides excellent exposure of the neck arteries and the entire thoracic aorta.

Preoperative Evaluation of the Right Gastroepiploic Artery on Multidetector Computed Tomography in Coronary Artery Bypass Graft Surgery

BACKGROUND The right gastroepiploic artery (GEA) is commonly used in coronary artery bypass grafting, but a method for preoperative assessment of the suitability of the GEA has not been established. Here, we assessed the efficacy of 64-slice multidetector computed tomography (MDCT) for this purpose. METHODS Multidetector computed tomography was performed for 32 patients (24 males, 8 females; mean age, 65.9 +/- 7.4 years) undergoing coronary artery bypass graft surgery. Preoperative MDCT criteria for GEA suitability were no significant stenosis or calcification and a diameter of 2.0 mm or more in the middle portion of the GEA. The skeletonized GEA was inspected in 30 patients to determine the accuracy of evaluation of arteriosclerosis by MDCT (2 patients were excluded owing to severe GEA stenosis). The internal diameter at the anastomotic site was compared with the diameters of the proximal, distal, and middle regions of the GEA on MDCT. RESULTS The GEA was used to bypass a target coronary artery in 30 patients. The diameter of the middle of the GEA on MDCT correlated strongly with the actual internal diameter at the anastomotic site (r = 0.72, p < 0.0001). The diameter at the anastomotic site calculated from MDCT using the distance from the GEA origin to the anastomotic site and the actual diameter did not differ significantly (2.76 +/- 0.6 versus 2.87 +/- 0.5 mm, p = 0.06). CONCLUSIONS Preoperative MDCT imaging of the GEA is reliable for diagnosis, and a middle diameter of 2.0 mm or greater can be used to indicate GEA suitability for coronary artery bypass grafting.

Open Surgical Repair Can Be One Option for the Treatment of Persistent Type II Endoleak after EVAR.

PURPOSES Endovascular abdominal aortic aneurysm repair (EVAR) is an increasingly used method of repairing abdominal aortic aneurysm (AAA). However, the treatment of persistent type II endoleak is still a controversial issue. Five cases are reported here in which we performed open surgical repair of growing aneurysm due to persistent type II endoleak. METHOD Totally 128 EVAR cases were retrospectively reviewed, which were operated in our hospital from April 2008 to October 2013. These cases were followed by periodical contrast-enhanced computed tomography (CT) after EVAR. When persistent type II endoleak caused aneurysm sac growth, we performed surgical repair method for the first line treatment. In the operation, we incised the aneurysm sac by abdominal small median incision approach and sutured lumber arteries from inside of aneurysm sac and tied inferior mesenteric artery (IMA) in addition to aneurysmorrhaphy. Contrast-enhanced CT scanning was performed in a week after open repair for the confirmation of complete treatment. RESULTS Five of 128 cases (3.9%) were needed to be surgically repaired because of aneurysm sac growth (>5 mm), including two ruptured AAA cases. All patients recovered uneventfully. Contrast-enhanced CT scanning performed a week after these operations showed no endoleak and intact stent grafts and reduction of the aneurysm size. CONCLUSION We believe open surgical repair method of persistent type II endoleak with aneurysm expansion is secure method, and can be one of the preferable options for this life threatening complication after EVAR.

Emergency rescue endovascular stent grafting of ascending aorta to relieve life-threatening coronary obstruction in a case of acute aortic dissection.

Myocardial ischemia associated with acute aortic dissection is frequently a fatal complication, and the emergent management still remains a challenge. We report a patient with life-threatening myocardial ischemia due to acute aortic dissection managed by rescue stent grafting of the ascending aorta. Coronary blood flow improved immediately with this endovascular procedure, hemodynamic status was ameliorated dramatically, followed by uneventful open repair.

Intraoperative implantation of percutaneous left ventricular assist system.

The percutaneous left ventricular assist system, using modified Dennis technique, has been used successfully to treat patients experiencing severe cardiogenic shock in a variety of nonsurgical situations. Fluoroscopy is generally essential for implantation. Our experience with the implantation of the percutaneous left ventricular assist system during operations is described here. The percutaneous left ventricular assist system was applied using transesophageal echocardiographic imaging and by leading with the index finger through the right atrium without fluoroscopy.

Analysis of Complications Affecting Survival After Employment of Ventricular Assist System (VAS) Using Pneumatic and Centrifugal Pumps

From August 1984 to July 1992, 34 patients at Osaka University Medical School and affiliated hospitals required left or biventricular assist following open heart surgery (28 patients) and other procedures (6 patients). Five children under the age of 3 years with complex cardiac lesions were supported by left ventricular assist (LVAS). Of the 29 adult patients, left ventricular assist was applied in 21 and biventricular assist in 8, for durations of 7–984 h (average: 154 h). A pneumatic diaphragm-type pump was used in 11 patients (group 1; gr. 1) and a centrifugal pump in 19 (group 2; gr. 2). Recently, four patients received a new percutaneous LVAS with a transseptal left atrial cannula and a centrifugal pump (group 3; gr. 3). Three patients (27%) in gr. 1, 13 (68%) in gr. 2, and 1 (25%) in gr. 3 were weaned from VAS. There were two survivors (18%) in gr. 1, seven (37%) in gr. 2, and none in gr. 3. Major complications in gr. 1 were bleeding (3; 27%) and right heart failure (3; 27%); in gr. 2, bleeding (6; 32%) and thromboembolism (4; 21%); and in gr. 3, bleeding (1; 25%) and low output syndrome (LOS) (1; 25%). Sixteen patients died while on VAS; eight (50%) of them had bleeding. In contrast, of the nine patients who died after being weaned from VAS only one had bleeding. Of the nine survivors, four had complications (three had thromboembolism and one had bleeding). Postoperative bleeding after the institution of VAS was the major factor affecting survival and should be avoided to achieve better results. The new percutaneous VAS, with its low incidence of complications, may be promising.

Total arch replacement for a subacute type A dissection in a patient with a terminal tracheostoma after total laryngectomy: report of a case

Standard full median sternotomy for total arch replacement in tracheostomy patients may lead to mediastinitis and graft infection. Several approaches for typical cardiac surgery, including a T-shaped sternotomy, have been used in patients with both terminal and transient tracheostomas; however, these procedures offer inadequate surgical exposure of the arch vessels. We herein report the case of a 67-year-old man with a subacute type A aortic dissection with a terminal tracheostoma after total laryngectomy, who successfully underwent total arch replacement by a fourth intercostal thoracotomy performed using an anterior bilateral approach and the arch-first technique. To our knowledge, this is the first report of a case of total arch replacement in a patient with subacute aortic dissection and a terminal tracheostoma.