Masatake Katsu

Coated prostheses are associated with prolonged inflammation in aortic surgery: a cost analysis.

This prospective study was conducted to compare inflammatory responses between patients receiving coated and uncoated vascular prostheses, and to examine their effect on length of stay and cost of patients undergoing abdominal aortic aneurysmectomy. Patients undergoing elective vascular reconstruction of an abdominal aortic aneurysm were assigned randomly to coated-graft or uncoated-graft groups (n = 20, for each group). Interleukin (IL)-6, granulocyte elastase, white blood cell count, C-reactive protein (CRP), and body temperature (BT) were prospectively recorded preoperatively and on postoperative days (PODs) 1, 3, 7, and 14. In-hospital stay and hospitalized costs were also analyzed. IL-6 and CRP concentrations in the coated-graft group were higher than those in the uncoated-graft group (P = 0.01 and 0.05). BT was more frequently elevated >37 degrees C at POD 14 in the coated-graft group than in the uncoated-graft group (P =0.03). Discharge was delayed, and overall hospitalization cost was higher in the coated-graft group than in the uncoated group (17.6 vs. 13.5 days, and 2 010 000 vs. 1 780 000 yen, P = 0.006 and P = 0.002, respectively). Coated vascular prosthesis demonstrated more profound inflammatory reaction than noncoated prosthesis, postoperatively.

Thoracic aortic aneurysm associated with pseudocoarctation of the aorta

Pseudocoarctation is a rare anomaly in the descending thoracic aorta. A 44-year-old man experienced sudden onset of back pain for 5 days prior to admission. Computed tomography showed kinking and stenosis in the distal aortic arch with a distal aneurysm. The patient underwent emergency surgery, with a diagnosis of impending rupture. The aneurysm was lobular with a very thin wall. Pseudocoarctation is rare and most often is asymptomatic. However, the aneurysm should be treated surgically, and the area of stenosis resected.

Treatment of Abdominal Malignancy Invading the Vena Cava: A Report of Seven Cases

Retroperitoneal tumors and other abdominal malignancies invading the inferior vena cava can be treated surgically when no metastases are present. We resected four retroperitoneal tumors, two renal cell carcinomas, and one gastrointestinal stromal tumor with a concomitant caval resection. Although meticulous care is required when manipulating the major vessels, long-term survival with an improvement in the quality of life was achieved. These cases are described, with particular focus on the management of the major vessels.

Two-staged treatment strategy in patients with severe carotid or cerebrovascular diseases undergoing coronary artery bypass grafting

PurposeThere is no clear consensus on how to treat patients undergoing coronary artery bypass grafting (CABG) who have severe concomitant carotidcerebral artery stenosis. The aim of this study was to evaluate our surgical results in patients with severe carotid and/or cerebrovascular disease undergoing CABG.MethodsBetween October 2003 and April 2009, a total of 47 such patients were treated at our institution with the following strategies: (1) protective carotid artery stenting for severe carotid stenosis performed either before (n = 20) or after (n = 5) CABG or (2) a superficial temporal artery-middle cerebral artery anastomosis procedure followed by CABG if indicated (n = 4). Off-pump CABG was performed in 75% of the patients. Results. There were no major perioperative strokes or in-hospital deaths; however, three patients had transient ischemic attacks and two had minor strokes during the early post-CABG period. All of the patients with postoperative cerebrovascular events had had unilateral carotid artery occlusion. There were no late deaths during the follow-up period (up to 6 years, with a mean of 27 months). However, major adverse cardiocerebrovascular events (MACCE) occurred in seven patients (14.9%). The rates of freedom from MACCE at 1 and 3 years were 92% and 74%, respectively.ConclusionIt appears that our two-staged approach is safe and may reduce the risk of postoperative cerebrovascular events.

Treatment of prosthetic valve endocarditis complicated by destruction of the aortic annulus

PurposeIt has been reported that surgical treatment for prosthetic valve endocarditis complicated by destruction of the aortic annulus is associated with high mortality and morbidity. The aim of this study was to evaluate the efficacy of our surgical strategy for this situation.MethodsBetween October 2003 and April 2009, eight patients (mean age 68.6 years) with prosthetic valve endocarditis complicated by destruction of the aortic annulus were surgically treated at our hospital. We use a relatively simple procedure consisting of a patch plasty of the abscess cavity in addition to complete removal of the infected tissue of the abscess cavity followed by standard aortic valve replacement. All patients had active endocarditis and were in New York Heart Association functional class III or IV. Preoperative echocardiography revealed that four patients had moderate or severe aortic regurgitation, and two had mitral valve endocarditis as well.ResultsThere were no operative deaths (≤30 days). Cardiac complications included paroxysmal atrial fibrillation in three patients and transient atrioventricular block in one. One patient died of multiple organ failure 66 days after the surgery. The overall in-hospital mortality was 12.5%. Patients were followed-up for 6–49 months (mean 31 months). There was no recurrent prosthetic valve endocarditis. One patient required reoperation (mitral annuloplasty and redo aortic valve replacement). There were two late deaths: lung cancer in one and multiple organ failure related to pneumonia after the aforementioned redo operation in the other.ConclusionOur simple procedure for complicated prosthetic valve endocarditis yielded excellent early and midterm outcomes.

Predictors of success of the modified maze procedure using radiofrequency device.

The modified maze procedure using radiofrequency devices has become an increasingly common surgical option for patients with atrial fibrillation. Several lesion sets have been proposed and tested, but it remains unclear which yields the best results. We studied 61 patients who underwent the modified maze procedure using radiofrequency devices from March 2005. The pulmonary veins were isolated separately on both sides, and a connecting lesion was made inferiorly in the early series of 30 patients (group 1). In 31 patients (group 2) treated from May 2007, we added a superior connecting lesion between both pulmonary veins (completing a box lesion), and also performed coronary sinus ablation from the epicardial side, using a monopolar device. At 6 months postoperatively, maintenance of sinus rhythm with and without antiarrhythmic medications was 70% and 63%, respectively in group 1, and 94% and 90% in group 2 (both p < 0.05). Multivariate analysis indicated that the box lesion with coronary sinus ablation was an independent predictor of the maintenance of sinus rhythm at 6 months. These 2 lesions should not be eliminated from the modified maze procedure.

Splenic Artery Aneurysm of the Hepatosplenomesenteric Trunk

We herein report the case of a splenic artery aneurysm with a hepatosplenomesenteric trunk that presented in a pregnant woman. Catheter embolization was not performed due to the wide neck of the aneurysm and its close location to the trunk indicates a high risk of mesenteric trunk thrombosis. We instead performed surgical resection of the aneurysm after successful delivery of the infant by Caesarian section. The splenic artery was reconstructed by side-to-end anastomosis with the common hepatic artery.

Complete rupture of the anterolateral papillary muscle complicated with acute myocardial infarction due to diagonal branch occlusion

It is well known that post-infarction papillary muscle rupture of the anterolateral papillary muscle is less frequent than that of the posteromedial papillary muscle. This is thought to be due to a difference in blood supply (single vs dual) of the papillary muscles. Recently, we had two cases in which occlusion of the diagonal branch of the left anterior descending artery was found to be the culprit lesion of acute myocardial infarction leading to complete rupture of the anterolateral papillary muscle. Herein, we report on these two rare successful surgical cases with some review of the literature.

Aortic Regurgitation Due to Perforation of the Right Coronary Cusp 10 years After Implantation of a Freestyle Stentless Bioprosthesis

Abstract  Valve deterioration following aortic valve replacement using the Freestyle stentless bioprosthesis is related to cusp tear, operative injury, or infection. We report a patient with aortic regurgitation due to perforation of the right coronary cusp 10 years after implantation of a Freestyle stentless bioprosthesis in the absence of endocarditis. (J Card Surg 2011;26:613‐614)

Cardiac myxoma examined by 320-detector row computed tomography.

A 60-year-old woman was admitted for resection of a cardiac myxoma. Transesophageal echocardiography detected a large mass adhering to the interatrial septum (Figure 1). Electrocardiogram-gated 320-detector row computed tomography demonstrated no coronary artery stenosis and clearly revealed a spherical Figure 1. Transesophageal echocardiography detected a 40-mm oval mass with a pendulum-like movement, prolapsing into the left ventricle in diastole. A soft and high echoic tumor with heterogeneity of the internal echo is present in the left atrium (A, B, long axis view; C, short axis view). Asian Cardiovascular & Thoracic Annals 19(3/4) 285–286 The Author(s) 2011 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0218492311406556 aan.sagepub.com