Kazuyoshi Tanigawa

Thrombus removal with a temporary vena caval filter in patients with acute proximal deep vein thrombosis.

Between September 1999 and January 2001 we performed thrombus removal with the use of a temporary vena caval filter in 11 patients who had acute iliofemoral venous thrombosis. To facilitate thrombus removal, 5 patients initially received catheter-directed thrombolytic therapy (thrombolysis group), and the other 6 received surgical thrombectomy (thrombectomy group). Residual thrombus was confirmed after initial catheter-directed thrombolysis in all patients in the thrombolysis group, and thrombolysis was continued in the ward. Bleeding complications subsequently occurred in 2 patients. In the thrombectomy group, 1 patient had residual thrombus just below the temporary filter, and a permanent vena caval filter was deployed for removal. Another patient had a residual thrombus in the superficial femoral vein, and rethrombectomy was performed. One patient in the thrombectomy group died of pneumonia. All other patients were discharged. There were no deaths from pulmonary thromboembolism in this series. Post-thrombotic syndrome occurred in 2 of the 5 patients in the thrombolysis group (40%) and in 3 of the 6 patients (50%) in the thrombectomy group. We conclude that a temporary vena caval filter is useful for the management of acute proximal deep vein thrombosis, especially when aggressive treatment is required.

Mitral valve repair for degenerative disease with leaflet prolapse: to improve long-term outcomes

PurposeResidual mitral regurgitation (MR) is a risk factor of reoperation. Here we report the midterm results of mitral valve repair for degenerative disease with mitral valve prolapse and identify important factors for durable repair.MethodsFrom April 1999 to September 2007, 116 patients with leaflet prolapse (59 men; mean age 63 years) underwent mitral valve repair; they consisted of 19 anterior, 67 posterior, 23 bileaflet, and 7 isolated commissures. The mean clinical and echocardiographic follow-ups were at 4.1 ± 2.3 and 3.3 ± 2.4 years, respectively.ResultsAltogether, 12 patients showed recurrent moderate or severe MR during the follow-up period; and 10 of the 12 patients (83.8%) had recurrent moderate or severe MR within 1.5 years. Causes of early MR recurrence were dehiscence of sutured segments and ineffectiveness of the artificial chords. The rates of freedom from reoperation at 3 and 7 years were 95.3% ± 2.0% and 91.0% ± 4.7%, respectively. The rates of freedom from recurrent moderate or severe MR at 3 and 7 years were 90.5% ± 2.9% and 83.8% ± 5.9%, respectively.ConclusionsThe prevention of dehiscence of the sutured segment and reestablishment of coaptation using artifi- cial chords are imperative to maintain the durability of mitral valve repair for patients with degenerative disease.

Imaging-Based Predictors of Persistent Type II Endoleak After Endovascular Abdominal Aortic Aneurysm Repair

OBJECTIVE The purpose of this study is to determine the imaging-based parameters associated with the occurrence of persistent type II endoleaks after endovascular abdominal aortic aneurysm repair. MATERIALS AND METHODS We reviewed the imaging and clinical data for 47 patients with early-onset type II endoleak after endovascular repair. Various predictors of persistent type II endoleaks were analyzed on the basis of preoperative CT findings. In addition, the appearance time of endoleak cavity on the operative angiogram and the relative attenuation of the endoleak cavity in the arterial phase image from the first postoperative CT study were analyzed. RESULTS The early-onset type II endoleak resolved spontaneously in 22 patients (i.e., the transient group), whereas it was identified on CT studies of the remaining 25 patients 6 months after endovascular repair (i.e., the persistent group). The appearance time of the endoleak cavity on angiographic examination was significantly shorter in the persistent group than in the transient group (mean [± SD] appearance time, 4.7 ± 0.3 s vs 8.8 ± 0.3 s). The relative attenuation of the endoleak cavity on the first postoperative CT scan was also significantly higher in the persistent group than in the transient group (mean, 0.70 ± 0.03 vs 0.30 ± 0.04). For each parameter, ROC analysis revealed the following cutoff points for predicting persistent type II endoleak: 6 seconds for the appearance time of the endoleak cavity (sensitivity, 88%; specificity, 86%), and 0.5 for the relative attenuation of the endoleak cavity (sensitivity, 80%; specificity, 95%). Evaluation of other imaging-based parameters revealed no statistically significant differences between the groups. CONCLUSION The appearance time of the endoleak cavity on the final operative angiogram and the attenuation of the endoleak cavity on the first postoperative CT scan can be strong imaging-based predictors of persistent type II endoleak.

Swinging Calcified Amorphous Tumors With Related Mitral Annular Calcification

Among cardiac calcified amorphous tumors, the mitral annular calcification-related calcified amorphous tumor is extremely rare. We herein describe 3 surgical cases of swinging calcified amorphous tumor with related mitral annular calcification. The clinical, echocardiographic, and pathophysiologic features are reported here together with a brief review of the literature.

Circumaortic left renal vein associated with juxtarenal abdominal aortic aneurysm.

The patient was an 82-year-old man who was found to have a juxtarenal abdominal aortic aneurysm accompanied by a circumaortic left renal vein (CLRV). During dissection of the proximal anastomosis site the CLRV was injured, but was successfully repaired. A graft implantation was performed below the renal arteries. The incidence of CLRV is thought to be rare, however it is found in 7% of cadavers donated for anatomy. CLRV may cause unexpected bleeding by inadvertent dissection of the abdominal aorta. To prevent unexpected bleeding, surgeons should always keep in mind this potential risk when performing surgery.

Spiral suspension, a novel repair technique for severe functional tricuspid regurgitation

From the Department of Cardiovascular Surgery, Nagasaki University Hospital, Nagasaki, Japan. Disclosures: Authors have nothing to disclose with regard to commercial support. Received for publication Sept 6, 2017; revisions received Dec 31, 2017; accepted for publication Jan 16, 2018; available ahead of print March 9, 2018. Address for reprints: Kikuko Obase, MD, Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan (E-mail: kobase@nagasaki-u.ac.jp). J Thorac Cardiovasc Surg 2018;156:649-52 0022-5223/

Liver Autotransplantation for an Inferior Vena Cava Tumor

36.00 Copyright 2018 by The American Association for Thoracic Surgery https://doi.org/10.1016/j.jtcvs.2018.01.082

Survival and quality of life of octogenarians who underwent mechanical valve replacement at a younger age

Title Liver Autotransplantation for an Inferior Vena Cava Tumor Author(s) Takatsuki, Mitsuhisa; Eguchi, Susumu; Hashizume, Koji; Soyama, Akihiko; Hidaka, Masaaki; Tanigawa, Kazuyoshi; Eishi, Kiyoyuki; Kuroki, Tamotsu Citation Transplantation, 98(12), pp.e91-e93; 2014 Issue Date 2014-12-27 URL http://hdl.handle.net/10069/35370 Right

Valve-sparing aortic root re-implantation for commissural detachment with fibrous strand

PurposeMechanical valve replacement is associated with complications, however, there is little information on the quality of life (QOL) of octogenarians who had undergone mechanical valve replacement at a relatively younger age. We examined survival, valve-related events, and the QOL of octogenarians who had undergone mechanical valve replacement.MethodsA total of 56 octogenarians who underwent mechanical valve replacement between 1969 and 1997 (age at the time of surgery, 65.6 ± 6.7 years), completed a questionnaire on survival, valve-related events, and QOL (basic activities of daily living, instrumental activities of daily living, mental health).ResultsThe mean follow-up was 12.4 ± 6.6 years, and the cumulative follow-up period was 642.4 patient-years. Six valve-related deaths (0.9%/patient-year) were registered during the follow-up. Furthermore, 11 valverelated events (1.8%/patient-year) were recorded. The mean age of the 21 survivors was 82.9 ± 1.8 years, and 19 of the survivors lived at home. Their QOL was excellent.ConclusionThe valve-related deaths and events in octogenarians who had previously undergone mechanical valve replacement at a younger age were within acceptable limits. The QOL was similar to that of octogenarians described in previous studies.

Single lung retrieval from a donor supported by a left ventricular assist device

Both aortic valve commissural detachment and commissural fenestration are rare causes of aortic regurgitation. In general, aortic valve replacement is the mainstay treatment for aortic regurgitation caused by commissural detachment or commissural fenestration. We herein describe valve-sparing aortic root re-implantation and aortic valve repair for aortic regurgitation and aortic root dilatation in an extremely rare case accompanied by both commissural detachment and commissural fibrous strand of fenestrated cusp.