Sei Morizumi

Adventitial Cystic Disease of the Femoral Vein

Adventitial cystic disease of the blood vessel wall is a rare disease. It occurs most commonly in arteries and very rarely in veins (Levien and Benn, J. Vasc. Surg. 1998;28:193-205). We report the case of a 28-year-old man with severe adventitial cystic disease of the femoral vein who underwent a resection of the cystic wall.

Conservative Therapy as a Primary Treatment for Spontaneous Isolated Dissection of the Superior Mesenteric Artery

BACKGROUND Spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) is a rare and potentially fatal disease. Several therapeutic options are available, including conservative therapy, endovascular repair, and open surgery. Herein, we report our experiences in the treatment of SIDSMA. METHODS Between February 2009 and June 2013, 17 patients were diagnosed as having SIDSMA. We retrospectively reviewed and analyzed their clinical characteristics, medical history, risk factors, symptoms, diagnostic imaging modality, treatment, and outcome. The lesions were categorized according to the modified Sakamotos classification. If no evidence of bowel necrosis or arterial rupture was present in the patients with symptomatic SIDSMA, we first performed conservative therapy, even if the patients had abdominal pain. RESULTS The subjects included 15 men and 2 women, with a median age of 62.8 years. Eight patients were symptomatic and 9 were asymptomatic. Conservative therapy included the use of antithrombotic agents in 3 patients but not in 5 patients. During the follow-up period (mean, 21.1 months), all the patients were discharged without any significant complications, and none of the patients showed the progression of the dissection on follow-up computed tomography angiography examinations. CONCLUSIONS Conservative therapy without antithrombotic agents should be the primary treatment for SIDSMA. Endovascular repair for SIDSMA is associated with several risks, thus the procedure might occasionally be useful and necessary.

A rare case of axillobifemoral bypass graft infection caused by Helicobacter cinaedi.

Helicobacter cinaedi infection is rarely encountered in nonimmunocompromised patients. We report the case of an 85-year-old man who presented with axillobifemoral bypass graft infection caused by Helicobacter cinaedi. The patient was not immunocompromised. We successfully treated him by iliac stenting of the native iliac artery, with near-total removal of the infected graft. At present, 48 months later, the patient is doing well at home, with no evidence of infection. To the best of our knowledge, this is the first report of infection of a prosthetic graft caused by Helicobacter cinaedi.

Inhibition of neointimal hyperplasia with a novel tacrolimus-eluting suture.

To the Editor: Intimal hyperplasia surrounding the suture line remains the leading cause of graft failure after coronary artery bypass graft surgery and peripheral vascular bypass surgery. Immunosuppressive drugs, such as tacrolimus, have been shown to inhibit the development of intimal hyperplasia

Off-pump coronary artery bypass grafting in a patient with neurofibromatosis I

Neurofibromatosis, otherwise known as von Recklinghausen disease, is a congenital hereditary disorder involving tissues of neuroectodermal or mesodermal origin. Involvement of the coronary arteries is, however, extremely rare. To the best of our knowledge, this represents the first report of off-pump coronary artery bypass grafting using the bilateral internal mammary arteries for coronary arterial vasculopathy in a patient with neurofibromatosis and of the longest reported follow-up of such a case after bypass surgery.

Effect of external counterpulsation on cardiac work following cardiac surgery: Implications of the mechanism responsible for clinical benefits

BACKGROUND External counterpulsation (ECP) has been recognized as a non-invasive treatment for chronic refractory angina or heart failure. However, the mechanisms responsible for the clinical benefits of ECP therapy remain elusive. Moreover, the clinical significance of ECP therapy for postoperative patients has not been established yet. METHODS Six adult patients received ECP therapy for 60 min under pulmonary artery catheter monitoring after cardiac surgery. Hemodynamic data were obtained before ECP therapy (pre-ECP), 20 min after ECP was commenced (20-min-ECP), 40 min after ECP was commenced (40-min-ECP), and after ECP therapy (post-ECP). RESULTS The mean right atrial pressure (pre-ECP: 9 ± 4 mmHg; 20-min-ECP: 12 ± 5 mmHg; 40-min-ECP: 12 ± 4 mmHg; and post-ECP: 9 ± 4 mmHg), pulmonary wedge pressure (16 ± 6 mmHg, 20 ± 7 mmHg, 20 ± 7 mmHg, and 17 ± 7 mmHg, respectively), cardiac index (2.4 ± 0.4 l/min/m(2), 2.8 ± 0.6 l/min/m(2), 2.7 ± 0.5 l/min/m(2), and 2.5 ± 0.4 l/min/m(2), respectively), cardiac work index (2.5 ± 0.4 kgm/m(2), 3.3 ± 0.8 kgm/m(2), 3.1 ± 0.8 kgm/m(2), and 2.6 ± 0.5 kgm/m(2), respectively), and left ventricular stroke work index (32 ± 7 gm/m(2), 41 ± 12 gm/m(2), 39 ± 12 gm/m(2), and 33 ± 8 gm/m(2), respectively) significantly (p<0.05) increased after ECP was commenced (pre-ECP vs. 20-min-ECP) and decreased after ECP was discontinued (40-min-ECP vs. post-ECP). Significant (p<0.001) diastolic augmentation (20-min-ECP: 24 ± 6%, 40-min-ECP: 23 ± 5%) and systolic unloading (3 ± 1%, and 3 ± 1%, respectively) were obtained. No clinical adverse effects were observed. CONCLUSIONS ECP increases venous return, cardiac output, and cardiac work in addition to diastolic augmentation and systolic unloading. These actions may play important roles in the clinical benefits of ECP therapy. Our data also suggest that ECP is beneficial for patients undergoing cardiac surgery.

Coronary artery aneurysm occurring very late after drug-eluting stent implantation

An 82-year old woman presented with chest pain and was diagnosed as having acute myocardial infarction. Coronary angiography (CAG) showed 90% stenosis in the proximal left anterior descending artery (LAD). The patient underwent percutaneous coronary intervention using a sirolimus-eluting stent (SES). A repeat CAG performed 6 months after SES implantation revealed no problems. Eight years later, the patient presented with recurrent angina. CAG showed severe stenosis of the SES with a large aneurysm. We performed off-pump coronary artery bypass grafting without ligation or plication of the LAD, but with the application of fibrin glue to the coronary artery aneurysm. The postoperative course was uneventful. The mechanism responsible for the occurrence of coronary artery aneurysms occurring late after drug-eluting stent implantation remains unclear, and the treatment strategy remains controversial. Herein, we discuss a surgical treatment for this rare entity.

Analysis of the perioperative change in cognitive function of patients with risk factors for cognitive impairment in cardiovascular surgery

ObjectiveThe purpose of the present study is to assess the perioperative changes in the cognitive function of patients after cardiovascular surgery (CVS) and to find out risk factors for early postoperative cognitive decline.Materials and methodsFrom December 2013 to March 2017, 291 patients underwent elective or urgent CVS with cardiopulmonary bypass in our institution. One hundred and fifteen patients, who agreed to an evaluation of their cognitive function, were included in this study. The cognitive function was evaluated by the HDS-R and MMSE at three time points: before surgery, in the early postoperative period and at discharge. The patients’ characteristics, perioperative data, HDS-R and MMSE scores were obtained by reviewing their medical records retrospectively.ResultsThe patients were stratified into three age groups. In all of the age groups, the early postoperative cognitive functional scores were severely decreased in comparison to the preoperative values. However, by the time of discharge, the function had improved to the same level as before surgery in each of the groups. In addition, the similar tendency was observed in patients with preoperative cognitive dysfunction. Moreover, multiple regression analysis demonstrated that preoperative cognitive function and age were significant risk factors for early cognitive impairment.ConclusionAlthough preoperative cognitive decline and patients’ age were the risk factors for early postoperative cognitive impairment after CVS, a significant recovery can be expected even in elderly patients or patients with low preoperative cognitive function by the time of discharge.

A Case of Cardiogenic Stroke After Thoracoscopic Left Atrial Appendectomy

Thoracoscopic left atrial appendectomy is a minimally invasive procedure for left atrial appendage occlusion in patients with non-valvular atrial fibrillation, particularly those at a great risk for both stroke and bleeding despite appropriate oral anticoagulant therapy. It serves as an alternative strategy for stroke risk reduction. Moreover, the oral anticoagulant therapy can be discontinued after the operation. However, we encountered a 74-year old male patient who developed cardiogenic stroke after thoracoscopic left atrial appendectomy. We report this case to introduce how we evaluate the risk of postoperative cardiogenic stroke by means of contrast-enhanced cardiac computed tomography (CT), and how we formulate the postoperative patient management strategy including short-term oral anticoagulation therapy by using results of cardiac CT.

Thoracoscopic left atrial appendectomy and thoracic endovascular aortic repair (TEVAR) in a patient with cardiogenic stroke combined with acute aortic dissection

The simultaneous occurrence of cardiogenic stroke and acute aortic dissection is rare, and its treatment remains unclear. Although anticoagulation therapy is usually chosen for cardiogenic stroke due to atrial fibrillation, it is inappropriate for acute aortic dissection. Recently, thoracoscopic left atrial appendectomy (TLAA) has been suggested as an alternative for anticoagulation. We herein report a case of a 78-year-old man with combined cardiogenic stroke and acute aortic dissection in whom thoracic endovascular aortic repair (TEVAR) was performed after TLAA. Although anticoagulants were discontinued after TLAA, there was no recurrence of stroke, and he underwent TEVAR safely. This case indicates that TLAA followed by TEVAR is an ideal treatment for combined cardiogenic stroke and acute aortic dissection and also suggests a new indication of TLAA.