Naotaka Motoyoshi

Safety and efficacy of epidural cooling for regional spinal cord hypothermia during thoracoabdominal aneurysm repair

Twenty-four consecutive patients underwent epidural cooling as an adjunct to elective thoracoabdominal aortic repair under moderate systemic hypothermia. One patient suffered from postoperative paraplegia (4%), and another died from subarachnoidal hemorrhage (4%). Details of the technique, the associated care, and the pitfalls will be discussed.

Spontaneous rupture of coronary artery

We report a case of spontaneous coronary artery rupture (SCAR) 3 months after descending aortic replacement. Cardiac tamponade was confirmed at first by using echocardiography following emergency pericardial centesis. The patient was denied aortic dissection by computed tomography, thereafter diagnosed as SCAR with selective angiography, which revealed a leakage from the left circumflex branch. The patient underwent successful rupture site isolation by bilateral ligation and distal revascularization with aortocoronary bypass with saphenous vein graft.

Cleft on tricuspid anterior leaflet

We report a case of isolated congenital tricuspid regurgitation caused by a cleft in the anterior tricuspid leaflet associated with a patent foramen ovale. Preoperative echocardiography revealed severe tricuspid regurgitation resulting from anterior tricuspid leaflet prolapse. The patient underwent successful tricuspid valve repair with simple cleft suture and annuloplasty and direct closure of the patent foramen ovale.

Epidural cooling for regional spinal cord hypothermia during most or all of descending thoracic or thoracoabdominal aneurysm repair

Abstract Purpose: Hypothermia has some protective effect against ischemia of the spinal cord in thoracoabdominal aneurysm repair. Its method is divided into systemic or regional cooling. Several experimental studies of the regional cooling of the spinal cord have been performed, however, clinical reports are few. The purpose of this study is to evaluate the effect and safety of perfusion cooling of the epidural space during thoracic or thoracoabdominal aortic replacement. Methods: Between January 1998 to June 2001 37 patients (True aneurysm: 18 patients, type B aortic dissection: 19 patients) underwent thoracic or thoracoabdominal aortic replacement with an aid of epidural perfusion cooling. The age ranged from 23 to 78 years old with a mean age of 61 years old. Separate perfusion of upper and lower body was used in all cases. Temperature was lowered to around a 31°C or 32°C. In cases where proximal cross-clamping was danger, deep hypothermic circulatory arrest was used. Results: Ten patients underwent most or all of descending thoracic aneurysm repair with no spinal cord injury and hospital death. Number of patients of the Crawford type I, type II, and type III were 14, 8 and 5 patients, respectively. One Crawford type II patient was complicated with postoperative spinal cord injury (2.7%). There was one hospital death (2.7%) in Crawford type III. The mean epidural cooling time was 150 minutes, and mean infusion volume of cold saline was 981 cc. The mean lowest cerebrospinal fluid (CSF) temperature was 24.3°C, and mean temperature differences between nasopharynx and CSF was 6.3°C. Conclusion: Perfusion cooling of the epidural space during most or all of the descending thoracic or thoracoabdominal aneurysm repair was effective in reducing postoperative spinal cord injury and a safe method in clinical situations.

Completely resected superior sulcus tumor and vascular reconstruction of vertebral and subclavian arteries.

A 62-year-old man was pointed out the superior sulcus tumor of the left lung invading to the subclavian artery and the vertebral artery. Bronchoscopic brushing cytology of the tumor showed Class V large cell carcinoma. The patient was diagnosed as clinical stage IIIA(cT4N0M0). After concurrent chemoradiotherapy, we performed left-upper lobectomy and reconstructions of left subclavian and vertebral arteries through modified transmanubrial approach. Surgeons of three different departments took part in the operation. Cooperative works were the key for the complete resection of such an advanced superior sulcus tumor.

Ascending aortic replacement through right thoracotomy.

A 62-year-old woman with a history of esophageal resection and colon interposition with anterosternal subcutaneous tunnel required replacement of the ascending aorta due to dissecting aortic aneurysm. Preoperative three-dimensional computed tomography enabled us to reveal that right thoracotomy could offer an ascending aortic operation. The patient underwent successful operation under hypothermic circulatory arrest and the right anterolateral thoracotomy provided safe exposure of the diseased ascending aorta even when the suprasternal tunnel precluded conventional median sternotomy.

Modified cuffed anastomosis technique to treat pseudoaneurysms following thoracic endovascular aortic repair

Pseudoaneurysm after thoracic endovascular aortic repair (TEVAR) is very rare. We report a case of thoracic aortic pseudoaneurysms due to flares at the proximal end of a stent graft after TEVAR for ductal aneurysm. We describe a total aortic arch replacement in this case using a modified cuffed anastomosis technique with an elephant trunk procedure leaving the partial stent graft in situ.

Pulmonary venous obstruction in a patient with Marfan syndrome: Rare presentation of an expanding dissecting descending thoracic aortic aneurysm with annuloaortic ectasia

may have been promoted. In this case, endocarditis was initially suspected because of vegetation-like mobile masses that were found in the aortic valve on the transesophageal echocardiogram, but infection was negative in all other examination findings. We determined before surgery that these masses were most likely cardiac tumors. Mild exertional dyspnea was the only clinical symptom, but it is known that mobile tumors attached to an aortic valve can cause serious complications such as thromboembolism and myocardial ischemia, and we decided that a surgical excision was necessary. QAV with a narrow aortic annulus presenting with the development of multiple CPFs is a rare complication. There have been no similar cases reported in the literature. However, according to the characteristics of each pathologic condition, there is a possibility that CPF may develop with QAV.