Matsuhisa Imaizumi

Prevention of arterial graft spasm by botulinum toxin: an in-vitro experiment

In coronary artery bypass surgery, arterial grafts result in improved patency rates. However, these grafts frequently fail due to spasm. Papaverine has been used to prevent graft spasm, but its effect is short-lived. Botulinum toxin inhibits muscle contraction for about three months. We investigated the usefulness of botulinum toxin in preventing arterial grafts spasm in vitro. Samples of abdominal aorta from male Wistar rats were cut into 2 mm rings and treated with various doses of botulinum toxin or papaverine for 30 min. All rings were stimulated with KCl and noradrenaline. Tension was recorded using myography. We compared constriction caused by noradrenaline or KCl in rings treated with botulinum toxin, or papaverine, or physiological salt solution (PSS) (control). In the presence of KCl and noradrenaline, almost all concentrations of botulinum toxin completely inhibited arterial contraction when compared with controls. Spasm prevention was lost after 60 min in rings with papaverine but persisted for 120 min in rings with botulinum toxin. In the histological examination, arterial wall structure was not destroyed by botulinum toxin. Botulinum toxin prevented arterial graft spasm in vitro and had a longer lasting effect than papaverine, with no toxic effect on the artery.

A Successful Case of Ascending Aorta—Abdominal Aorta Bypass for Middle Aortic Syndrome

The middle aortic syndrome (MAS) is a rare disease affecting children and young adults, and it occurs in about 0.5% to 2.0% of all aortic coarctation cases. Congenital, acquired, inflammatory, and infectious etiologies have been described. In the majority of cases, there is a short, isolated or diffuse tubular narrowing of the descending thoracic and abdominal aorta, often accompanied by ostial stenosis or occlusion of the renal and visceral branches, which leads to renovascular hypertension and visceral ischemia. Surgical treatment should be considered in cases of uncontrollable hypertension, evidence of end-organ damage such as cardiac failure, progressive renal insufficiency, or severe intermittent claudication. Several surgical treatments for this condition have been reported, including bypass grafting, graft replacement, or patch angioplasty. We report a successful case of ascending aorta—abdominal aorta bypass for MAS in a 11-year-old boy.

Surgical Repair of True Gastroduodenal Artery Aneurysm: A Case Report

Gastroduodenal artery aneurysms are uncommon. The majority of them are false or pseudoaneurysms, often seen in the setting of inflammation, specifically with pancreatitis. True aneurysms of gastroduodenal artery are extremely rare. As risk for rupture is unrelated to size, any gastroduodenal artery aneurysm should be considered for definitive treatment once the diagnosis has been made. A successful case of surgical repair of true gastroduodenal artery aneurysm in a patient with liver cirrhosis is reported in this study.

Bilateral Radial Artery Aneurysms in the Anatomical Snuff Box Seen in Marfan Syndrome Patient: Case Report and Literature Review

We describe the first Marfan syndrome case of non-traumatic bilateral radial artery aneurysms in the anatomical snuff box. A 74-year-old woman with Marfan syndrome had a pulsatile mass in her bilateral anatomical snuff box. The color Doppler ultrasonography showed an aneurysm of radial artery located in the bilateral anatomical snuff box. Resection of the right radial artery aneurysm was completed without complications. Histopathological analysis showed a true aneurysm with atherosclerotic changes in the arterial wall. We review the literature on non-traumatic or bilateral radial artery aneurysm in the anatomical snuff box, and discuss the clinical presentation and surgical management.

Surgical Repair of Localized Dissecting Aneurysm Originating from the Infrarenal Abdominal Aorta

Aortic dissection commonly affects the thoracic aorta and is associated with high morbidity and mortality rates. Localized dissections originating from the infrarenal abdominal aorta are extremely rare. We report a rare case of localized dissecting aneurysm originating from the infrarenal abdominal aorta in a 62-year-old man. Open surgical repair was successfully performed without any complications.

High-pressure irrigation and gentian-violet application for mediastinitis following replacement of ascending aorta and aortic valve

Mediastinitis following ascending aortic replacement is intractable and potentially fatal, and the feature is characterized as having both high mortality and morbidity when its causation pathology is methicillin-resistant Staphylococcus aureus (MRSA). Possible treatments for the condition, which include debridement, irrigation, and healthy tissue transposition, often result in failure. We report a case of MRSA mediastinitis after replacement of the ascending aorta and the aortic valve successfully treated by continuous saline lavage and drainage, debridement, high-pressure irrigation, and gentian-violet application, and delayed omental-flap transposition. The application of gentian violet and high-pressure irrigation may provide an additional option to the standard therapy for intractable mediastinitis after ascending aortic replacement.

Takotsubo cardiomyopathy after repair of ruptured abdominal aortic aneurysm

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Minimally invasive video-assisted thoracoscopic left ventricular epicardial lead implantation for biventricular pacing in a patient with persistent left superior vena cava

Cardiac resynchronization therapy (CRT) by biventricular pacing reduces symptoms and improves left ventricular function in many patients with heart failure due to left ventricular systolic dysfunction and cardiac dyssynchrony. Implantation of the biventricular pacing lead in association with persistent left superior vena cava is technically challenging. We report a successful case of minimally invasive video-assisted thoracoscopic left ventricular epicardial lead implantation for biventricular pacing in a patient with persistent left superior vena cava.

Severe Limb Ischemia Related to Previous Abdominal Aortic Aneurysm Repair Induced by Acute Aortic Dissection

We described the first case of limb ischemia induced by acute aortic dissection in the patient with previous abdominal aortic aneurysm (AAA) repair. A 56-year-old male was referred for severe limb ischemia. He underwent AAA repair one month before the referral. Computed tomography (CT) scan revealed Stanford type B aortic dissection extended to the proximal anastomosis site of the AAA repair. The false lumen made the complete interruption of antegrade blood flow at the proximal anastomosis site of the AAA repair.

Extralobar pulmonary sequestration infected with Mycobacterium gordonae

Pulmonary sequestration is a malformation composed of dysplastic lung tissue without normal communication with the tracheobronchial tree and with an anomalous systemic arterial supply. Few cases of pulmonary sequestration infected with tuberculous or nontuberculous mycobacterium have been reported. However, all of those reports were of intralobar pulmonary sequestrations. In the present article, we describe the first case of extralobar sequestration infected with Mycobacterium gordonae.