Koji Furukawa

Clinical Implications of Additional Pedal Artery Angioplasty in Critical Limb Ischemia Patients With Infrapopliteal and Pedal Artery Disease.

Purpose: To evaluate the clinical implications of additional pedal artery angioplasty (PAA) for patients with critical limb ischemia (CLI). Methods: Twenty-nine patients (mean age 77.8±8.6 years; 21 men) with CLI (32 limbs) presenting with de novo infrapopliteal and pedal artery (Kawarada type 2/3) disease were reviewed. The need for PAA was based on the existence of sufficient wound blush (WB) around the target wounds after conventional above-the-ankle revascularization. Fourteen patients with insufficient WB in 14 limbs received additional PAA, while 15 patients with sufficient WB in 18 limbs did not. The groups were compared for overall survival, limb salvage, and amputation-free survival within 1 year after the procedure. The wound healing rate, time to wound healing, and freedom from reintervention rate were also evaluated. Result: The success rate of additional PAA was 93% (13/14). All limbs with successful PAA achieved sufficient WB (13/13). Despite insufficient WB before the additional PAA, overall survival (86% vs 73%, p=0.350), limb salvage (93% vs 83%, p=0.400), amputation-free survival (79% vs 53%, p=0.102), and freedom from reintervention (64% vs 73%, p=0.668) rates were similar in both groups. Furthermore, the wound healing rate (93% vs 60%, p=0.05) was higher and time to wound healing (86.0±18.7 vs 152.0±60.2 days, p=0.05) was shorter in the patients who received PAA. Conclusion: Additional PAA might improve the WB and clinical outcomes (especially speed and extent of wound healing) in patients with CLI attributed to infrapopliteal and pedal artery disease.

Mycotic pseudoaneurysm of the ascending aorta caused by Escherichia coli

An 81-year old woman with high fever and a history of hospital admission because of pyelonephritis 3 months previously was transferred to our hospital. Contrast-enhanced computed tomography revealed a mycotic pseudoaneurysm in the ascending aorta and a massive pericardial effusion. We resected the ascending aorta and the proximal part of the brachiocephalic artery and performed in situ revascularization with a prosthetic vascular graft. Bacterial examination proved that the causative micro-organism was Escherichia coli. The prosthetic graft was wrapped with a pedicled omentum following completion of the aortic reconstruction. Her postoperative course was uneventful. She was discharged from the hospital 1 month postoperatively.

Aortic Pseudoaneurysm due to Simple Vertebral Compression Fracture Treated with Conservative Management

Blunt aortic injures are rarely associated with minimal trauma. We present a 78-year-old man with an aortic pseudoaneurysm resulting from a simple vertebral compression fracture, which was conservatively managed. He was diagnosed with a compression fracture from a minor fall 10 days previously, and fortuitously he visited the hospital after which follow-up computed tomography (CT) for previous multiple aortic surgeries was performed. The enhanced CT revealed a pseudoaneurysm on the abdominal aorta, which was bleeding from a pinhole perforation. He was conservatively treated and follow-up CT 9 months later revealed that the pseudoaneurysm had disappeared.

Predictor of neurologic dysfunction after elective thoracic aorta repair using selective cerebral perfusion.

Objectives This study was undertaken to determine the factors that influence postoperative neurological dysfunction after selective cerebral perfusion (SCP). Design From 1995 to August 2004, 60 patients were evaluated for the presence of cerebro-vascular disease (CVD), and then underwent thoracic aortic operations using SCP. Perioperative factors were evaluated by multivariate analyses. Results Hospital mortality rate was zero. Sixteen patients (26.7%) proved to have CVD. Permanent neurological dysfunction (PND) appeared in three patients (5.0%) and transient neurological dysfunction (TND) in two (3.3%). Univariate analysis revealed superficial temporal artery (STA) pressure during SCP (p=0.0410) to be a significant risk factor for PND. Variables that achieved values of p<0.2 (aortic cross-clamp time, presence of CVD, old cerebral infarction, presence of clots or atheroma) were examined with multivariate analysis and the presence of CVD (p=0.038) and STA pressure during SCP (p=0.032) were independent risk factors for PND. Multivariate analysis for TND did not show any risk factor. Conclusions The presence of CVD was indicated as an independent risk factor for PND after thoracic aortic operations using SCP.

Mid-term results of mitral valve repair for ischemic mitral regurgitation adjusted according to the degree of remodeling progression

ObjectivesMitral annuloplasty (MAP) for ischemic mitral regurgitation (IMR) with advanced remodeling is often associated with recurrent mitral regurgitation (MR). We performed surgeries adjusted according to the degree of remodeling; i.e., for advanced remodeling cases, we added subvalvular repair (SVR) to MAP. This study aimed to evaluate our experience with patients with IMR.Methods and resultsThirty patients with IMR (MR grade ≥ 2) were retrospectively analyzed. We performed MAP with SVR for 13 patients (MAP + SVR group) and MAP alone for 17 patients (MAP group). The MAP + SVR group had significantly larger left ventricular dimension and tenting height than the MAP group. Four patients (two in each group) experienced recurrence of MR (MR grade ≥ 2), and the 3-year and 5-year freedom from recurrence of MR rates were 97% and 83%, respectively. Six patients (two in the MAP group and four in the MAP + SVR group) died of cardiac causes during follow-up, and the 3-year and 5-year freedom from cardiac-related death rates were 81% and 74%, respectively. There was no difference between the 2 groups regarding freedom from recurrent MR (p = 0.6) and freedom from cardiac-related death (p = 0.1). The preoperative left ventricular end-systolic dimension was a significant predictor of cardiac death in the multivariate analysis.ConclusionMitral valve repair adjusted according to the degree of remodeling progression provided durable mitral competence; however, it remains unclear if such a strategy is related to a high probability of freedom from cardiac-related death.

Adventitial cystic disease of the common femoral vein misdiagnosed as deep vein thrombosis

We report a case of venous adventitial cystic disease of the right common femoral vein, misdiagnosed as deep vein thrombosis before surgery in a 47-year-old woman who presented with swelling and heaviness in her right leg. Complete cyst wall resection and common femoral vein reconstruction via patch angioplasty were performed. The patients postoperative course was uneventful.

Selection of a Surgical Treatment Approach for Aortic Coarctation in Adolescents and Adults

PURPOSE Coarctation of the aorta (CoA) in adolescents and adults is relatively rare. Several operative techniques for CoA in adolescents and adults have been reported, but there is still no consensus. This study aims to highlight the use of individual patient characteristics to select optimal treatment strategies for CoA in adolescents and adults. METHODS Surgical repair of CoA was performed in five patients (mean age: 34 ± 14 years, range: 13-58 years). All patients had primary CoA, and one had aneurysm above the CoA. One patient had undergone previous aortic valve replacement (AVR) and graft replacement of the ascending aorta. One patient underwent resection of the coarctation without cardiopulmonary bypass (CPB) followed by direct end-to-end anastomosis. Three patients underwent CoA resection with an interposition graft through a lateral thoracotomy with partial CPB. One patient underwent AVR with extra-anatomical bypass (ascending-descending aorta). RESULTS No in-hospital deaths occurred, and there were no complications. During the follow-up period, there has been no recurrence of CoA. CONCLUSION CoA in adolescents and adults is associated with different issues from those encountered in infant patients, and comprehensive surgery should be performed in all cases.

A Giant Cardiac Cavernous Hemangioma Involving the Left Atrial Roof in an Elderly Woman

Cardiac tumors are relatively rare, with primary hemangiomas being a particularly rare benign neoplasm. Herein, we report a case of a symptomatic cardiac tumor detected via echocardiography in an 82-year-old woman. Although we performed advanced imaging examinations for her heart, we could not diagnose the tumor before surgery. Eventually, a tumor involving the left atrial roof was detected, and it was completely resected to relieve her symptoms and establish a precise diagnosis. Histopathological examination indicated a cardiac cavernous hemangioma. The patient exhibited an uneventful recovery without any complications.

Successful Embolization Therapy through Reentry Tear in the Right Subclavian Artery for Treating Patent False Lumen in the Aortic Arch Formed after Type A Dissection Repair

A 73-year-old woman had undergone hemiarch replacement with primary entry resection for treating acute type A dissection 6 years ago. Postoperative computed tomography (CT) showed a patent false lumen (FL) in the aortic arch and a reentry tear in the right subclavian artery. The remaining aortic arch enlarged, which resulted in formation of a 55-mm-diameter aneurysm. We performed reentry occlusion using embolization with glue and coil. The patient’s clinical course after the procedure was uneventful, and subsequent CT showed that FL was thrombosed and had decreased in size.