Keiji Uchida

Decreased Tissue Inhibitor of Metalloproteinase-2/Matrix Metalloproteinase Ratio in the Acute Phase of Aortic Dissection

PurposeAortic dissection is characterized by fragility of the tunica media, and matrix metalloproteinases (MMPs) are enzymes that degrade the extracellular matrix of the aorta. This study examines MMPs in patients with acute aortic dissection (AAD) in an attempt to elucidate the mechanisms of their actions.MethodsEnzyme-linked immunosorbent assays were used to measure the quantification of MMP-2, MMP-9, and the tissue inhibitor of metalloproteinase (TIMP)-2 in 30 patients with AAD, 12 patients with abdominal aortic aneurysm (AAA), and 16 control (CON) patients who underwent coronary artery bypass grafting.ResultsMMP-2 and TIMP-2 were significantly lower in the AAD group than in the CON group, at 36 ± 19 vs 58 ± 30 (P ≪ 0.01) and at 21 ± 25 vs 216 ± 130 (P ≪ 0.001), respectively. The TIMP-2/MMP-2 ratio was 3.7 ± 1.7 in the CON group and 0.9 ± 0.8 in the AAD group (P ≪ 0.001 vs CON), and the TIMP-2/MMP-9 ratio was 200 ± 170 in the CON group and 37 ± 80 in the AAD group (P ≪ 0.001 vs CON).ConclusionLow TIMP-2/MMP-2 and TIMP-2/MMP-9 ratios might play an important role in the onset of aortic dissection, when the tunica media becomes fragile with chronic breakage and degradation of the extracellular matrix.

Distal Aortic Perfusion and Cerebrospinal Fluid Drainage for Thoracoabdominal Aortic Repair

Objective: The purpose of this study was to evaluate the short-term results of thoracoabdominal repair using distal aortic perfusion and cerebrospinal fluid (CSF) drainage.

A case of emergency surgery for acute mitral regurgitation due to complete papillary muscle rupture as complication of acute inferior myocardial infarction

We experienced a case with acute mitral regurgitation caused by complete posterior papillary muscle rupture as complication of acute inferior myocardial infarction, who underwent successfully emergency operation of mital valve replacement and coronary revascularization in acute stage. A 64-year-old woman developed sudden cardiogenic shock shortly after the onset of acute inferior myocardial infarction. The diagnosis of acute inferior myocardial infarction was based on the electrocardiographic findings. Under IABP support, preoperative coronary angiography visualized total occlusion of segment 3 of the right coronary artery, and preoperative left ventriculography showed akinesis of inferior wall and severe mitral regurgitation. At 6 hours after onset of papillary muscle rupture, emergency operation was performed. At operation, posterior papillary muscle was found to be totally ruptured. Coronary artery revascularization and mitral valve replacement were performed. Postoperative course was uneventful, with 4 days of IABP and 5 days of ventilatory support. She was discharged on the twentieth postoperative day in NYHA class I. Reports of successful emergency operation for total papillary muscle rupture following acute myocardial infarction are rare. Early diagnosis and surgical treatment are mandatory to save this group of patients.