Narihiro Ishida

Preoperative Planning for Endovascular Aortic Repair of Abdominal Aortic Aneurysms: Feasibility of Nonenhanced MR Angiography versus Contrast-enhanced CT Angiography

PURPOSE To compare vascular measurements to determine stent types and configurations for abdominal endovascular aneurysm repair (EVAR) by comparing results of contrast material-enhanced computed tomographic (CT) angiography and nonenhanced magnetic resonance (MR) angiography. MATERIALS AND METHODS This prospective study was institutional review board approved, and all patients provided written informed consent. Fifty patients (45 men and five women; mean age, 76.0 years) admitted for elective abdominal EVAR underwent preoperative abdominal CT angiography (triplanar reformatted images; section thickness of 1-3 mm) and nonenhanced MR angiography (triplanar two-dimensional single-shot turbo field-echo images; section thickness of 6 mm). Two observers independently completed standard measurement and device selection forms for endovascular stent planning for CT and MR angiography. Pearson and intraclass correlation coefficients were calculated to evaluate intermodality and interobserver differences. RESULTS No significant difference was found in aortic neck diameter (observer 1: CT, 18.5 mm; MR, 19.0 mm; P = .43) (observer 2: CT, 19.6 mm; MR, 19.3 mm; P = .59), aortic neck diameter 15 mm distal to the lowest renal artery (observer 1: CT, 19.2 mm; MR, 19.2 mm; P = .38) (observer 2: CT, 19.6 mm; MR, 19.6 mm; P = .91), aortic neck length (observer 1: CT, 43.6 mm; MR, 43.6 mm; P = .85) (observer 2: CT, 44.4 mm; MR, 44.0 mm; P = .93), or other key vascular measurements (P = .23-.99) for preoperative planning. These included aneurysm diameter, lowest renal artery to aortic bifurcation length, aortic bifurcation diameter, common iliac artery diameters, external iliac artery diameters, length between orifices of lower renal and internal iliac arteries, and iliac artery sealing length. CT and MR angiography measurements showed very strong correlation (r = 0.92-0.99). Intraclass correlation coefficients between observers ranged from 0.90 to 0.98. Stent types and configurations determined with CT measurements remained unaltered when reassessed with MR measurements. CONCLUSION Measurements obtained with nonenhanced MR angiography appear equally accurate to those of CT angiography in the preoperative planning of abdominal EVAR.

Normothermic total arch replacement without hypothermic circulatory arrest to treat aortic distal arch aneurysm in a patient with cold agglutinin disease

Cold agglutinin disease although rare, can lead to serious complications for patients undergoing cardio-thoracic surgery, especially when cardiopulmonary bypass is applied under hypothermic circulatory arrest. We describe normothermic total arch replacement without hypothermic circulatory arrest in a patient with cold agglutinin disease. The patient tolerated all procedures well and did not develop cerebral ischemia due to surgical maneuvers or thrombotic or haemolytic complications due to cold agglutinin disease. Although endovascular aortic repair is the first choice under such complex conditions, this method could also serve as an alternative strategy when endovascular aortic repair is precluded.

Two-stage portal vein ligation facilitates liver regeneration in rats.

Background/Aims: Recent reports have demonstrated that some patients are unable to undergo scheduled liver resection after preoperative portal vein embolization due to insufficient hypertrophy of the future remnant liver. The present study examined whether two-stage portal vein ligation (PVL) increases hypertrophy of the future remnant liver compared to conventional PVL in rats. Methods: Rats were divided into 3 groups: group A, ligation of left primary branch; group B, ligation of right and left primary branches; group C, ligation of the left primary branch, followed by 2-stage PVL 7 days postoperatively. To evaluate liver regeneration, the proliferating cell nuclear antigen labeling index (LI), mitotic index (MI) in the caudate lobe and weight ratio of caudate lobe to body weight were measured. Results: The weight ratio of caudate lobe to body weight was significantly higher in group C than in groups A or B 14 days postoperatively. In groups A and B, LI and MI in the caudate lobe peaked 2 days postoperatively, then decreased to preoperative levels by 7–8 days postoperatively, but remained significantly elevated until 10–14 days postoperatively in group C. Conclusion: Two-stage PVL increases hypertrophy of the future remnant liver compared to conventional PVL in rats.

An unusual case of the right subclavian artery aneurysm resulting from long-term repetitive blunt chest trauma

This case report describes a right subclavian artery aneurysm secondary to long-term repetitive blunt trauma. A 62-year-old man with a right subclavian artery aneurysm had had a history of bird hunting using a shotgun that impacted substantially against his right clavicula and shoulder weekly for >20 years. The patient underwent open repair with partial sternotomy and distal balloon control. The aneurysmal sac was resected, and the right subclavian artery was reconstructed with a primary end-to-end anastomosis. Histopathologic examination of the resected aneurysmal wall revealed that all three layers of the arterial wall were comparatively intact, with fibrosis and lipid deposition in the intima and in various degrees of degeneration in the media, suggesting a true aneurysm.

Complete resection of asymptomatic solitary right atrial metastasis from renal cell carcinoma without inferior vena cava involvement

pump speed to approach the lower operating limit of 1800 rpm. Implications include (1) lower accuracy of estimated flow at lower speeds, (2) less ability to correct suction conditions by lowering pump speed, and (3) increased potential for pump thrombosis or rotor instability. Second, the HeartWare HVAD inflow cannula length was designed for placement through the left ventricular apex and is not optimized for the right ventricle. Shortening the length of the inflow cannula to accommodate the shallower right ventricular cavity in the right ventricular outflow tract is achieved by placing additional felt rings under the fixation ring (Figure 2, B). Other locations that may potentially allow normalchestclosure includeplacementintotherightatrium or the diaphragmatic surface of the right ventricle. For this patient, the goals for pump flows were 3 to 4 L/min through the RVAD and 5 to 6 L/min through the LVAD. Anticoagulation strategy consisted of aspirin and warfarin sodium, with an international normalized ratio goal of 2 to 3. We were successful in this case; however, this is the first report of HeartWare HVAD use in the role of RAVD after HeartMate II implantation. Firm recommendations regarding the potential widespread applicability of this therapy are therefore limited.

Single coronary artery with bicuspid aortic valve stenosis and aneurysm of the ascending aorta: report of a case

A 73-year-old man with a severely stenosed bicuspid valve and an aneurysm of the ascending aorta underwent valve and aortic surgery. Preoperative imaging revealed a single coronary artery arising from the right side of the sinus of Valsalva and a branch that perfused into the left side of the heart to pass through the front of the pulmonary artery. We replaced the aortic valve and ascending aorta, painstakingly avoiding damage to the coronary artery and obstruction of the sole coronary ostium.

Off-pump complete pericardiectomy for an unusual case of annular constrictive pericarditis.

We describe a case of a 64-year-old man with constrictive pericarditis of unusual anatomy. Preoperative investigations revealed the thickened and calcified pericardial ring encircling the right and left ventricular cavity at the level of the atrioventricular (AV) groove and crossing the left anterior descending coronary artery, leading to strangulation of the heart. Off-pump complete pericardiectomy was performed successfully. The patients postoperative course was uneventful.

Staged Hybrid Debranching and Thoracic Endovascular Aneurysm Repair for Multiple Aortic Aneurysms after Conventional Open Repair of the Descending Aorta: A Case Report

Endovascular repairs of thoracic and thoracoabdominal aortic aneurysm have recently been proposed as a less invasive alternative to conventional open surgical repair. In selective cases, adjunctive bypass surgery may be required to provide an adequate landing zone. We describe a case of staged hybrid debranching and thoracic endovascular aneurysm repair for distal aortic arch and thoracoabdominal aortic aneurysms after conventional open repair of the descending aorta.

Effects of omentopexy combined with granulocyte colony-stimulating factor in a rabbit heart model

OBJECTIVE We investigated whether omentopexy combined with subcutaneously administered granulocyte colony-stimulating factor (G-CSF) reduces infarction areas and improves left ventricular dysfunction in a rabbit model of coronary occlusion and reperfusion. METHODS A coronary artery of a male Japanese white rabbit was ligated for 30 min and then reperfused. An omental pedicle graft was fixed onto the myocardial ischemic area after abrading the epicardium. G-CSF (10 μg kg(-1)day(-1)) was subcutaneously administered for 5 days postoperatively. Animals were assigned to groups (n = 7 per group) as follows: group N, saline; group O, omentopexy and saline; group G, G-CSF; and group OG, omentopexy and G-CSF. At 4 weeks postoperatively, left ventricular ejection fraction and left ventricular end-diastolic diameter were evaluated by echocardiography. Harvested left ventricles were stained with Evans blue and triphenyltetrazolium chloride to measure necrotic and fibrotic areas. The arteriolar density in ischemic and nonischemic areas was evaluated. At 7 days postoperatively, the intrathoracic omentum was evaluated (n = 6 per group). RESULTS Echocardiography at 4 weeks postoperatively revealed significant improvement in the left ventricular dysfunction of group OG. Necrosis and fibrosis in ischemic areas were significantly reduced in groups G and OG. Arteriolar density in the ischemic area and intrathoracic omentum weight were increased largely in group OG than in the other groups. CONCLUSIONS Omentopexy with G-CSF offers more potential benefits for the ischemic heart than G-CSF alone.

Coronary Artery Bypass Grafting for an Anomalous Left Coronary Artery from the Pulmonary Artery in a 73-Year-Old Female.

Anomalous left coronary artery from the pulmonary artery (ALCAPA) in adults is a rare congenital coronary abnormality. We report a case of ALCAPA in a 73‐year‐old female managed by total arterial revascularization. doi: 10.1111/jocs.12755 (J Card Surg 2016;31:380–382)