Toru Ishizaka

Analysis of anatomical risk factors for persistent type II endoleaks following endovascular abdominal aortic aneurysm repair using CT angiography

PurposeTo predict persistent type II endoleaks (pT2Es) following endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms, we examined factors related to post-EVAR pT2Es.MethodsEighty-four cases of EVAR were analyzed. T2Es that persisted for ≥6xa0months were defined as pT2Es. pT2Es flowing from an inferior mesenteric artery (IMA) and lumbar artery (LA) were termed pIMA-T2Es and pLA-T2Es, respectively. The anatomical factors concerning the aneurysm, IMA and LAs were assessed in the preoperative CT angiography images. A statistical analysis was performed on the factors associated with pT2Es.ResultsThe incidence of pT2Es was 25xa0%. pT2Es were associated with postoperative changes in the aneurysm diameter. A univariate analysis showed that a sac thrombus and the number of patent side branches arising from an aneurysm were significant factors associated with pT2Es. The IMA diameters were significantly larger in cases of pIMA-T2Es. The significant factors associated with pLA-T2Es were a circumferential thrombus, the number of patent LAs and the mean LA diameter. Multivariate analyses indicated that a circumferential thrombus was a protective factor for pT2Es, whereas an IMA ≥2.6xa0mm and each additional LA branch ≥1.9xa0mm were powerful risk factors for a pT2E.ConclusionSignificant anatomical factors associated with pT2E were found in this study. These factors may be useful in selecting patients for perioperative intervention.

Assessment of functional tricuspid regurgitation using 320-detector-row multislice computed tomography: risk factor analysis for recurrent regurgitation after tricuspid annuloplasty.

OBJECTIVEnFunctional tricuspid regurgitation (TR) often develops secondary to left heart disease. Tricuspid annuloplasty (TAP) is usually the treatment of choice for significant TRs, but recurrence of TR after surgery can occur. Previous studies have not clearly demonstrated the cause of the recurrent TR after TAP. By using an electrocardiogram-gated 320-detector-row multislice computed tomography (CT), we sought to delineate the morphologic cause of the incompetent tricuspid valve and identify the risk factors for recurrent TR.nnnMETHODSnFrom August 2010 to September 2011, 35 patients underwent preoperative CT of the tricuspid valve. The distance between each commissure, the tethering angle of each leaflet, and the tethering height were measured. TAP using a rigid annuloplasty ring was performed in 22 patients. Risk factors for recurrent TRxa0were determined by multivariate analyses.nnnRESULTSnEnd-diastolic and end-systolic tricuspid valve annular diameters (TVAD) correlated significantly with preoperative TR severity (R(2), 0.2734-0.4287; Pxa0<xa0.05). However, compared with TVAD, tethering angles and height showed stronger correlation with preoperative TR severity (R(2): tethering angles, 0.5769-0.6810; tethering height, 0.6854). Multivariate analysis revealed that tethering height was an independent risk factor of postoperative recurrent TR (Pxa0=xa0.0069).nnnCONCLUSIONSnTVAD, tethering angles, and tethering height correlated significantly with preoperative TR severity. The tethering height of the tricuspid valve showed significant correlation with recurrent TR.

Identification of Left Atrial Ganglionated Plexi by Dense Epicardial Mapping as Ablation Targets for the Treatment of Concomitant Atrial Fibrillation

Autonomic ganglionated plexi (GPs) play a significant role in the initiation and maintenance of atrial fibrillation (AF). GPs are key targets for a maze procedure. The purpose of this study was to identify the location of the left atrial GPs based on dense epicardial mapping during a maze procedure in patients with concomitant AF.

Unilateral Acute Lower Extremity Ischemia with Popliteal Artery Aneurysm as a Result of Vascular Type III Entrapment in an Elderly Patient

Popliteal artery entrapment syndrome (PAES) is a rare cause of acute limb ischemia in adult patients but commonly demonstrates as claudication in young patients. The most significant, although rare, complication associated with PAES is aneurysm formation. We present the case of an elderly patient with a unilateral popliteal artery aneurysm owing to symptomatic anatomic entrapment. This report presents the oldest patient ever reported with this syndrome and highlights the advantage of multimodal treatment. As multidetector computed tomography highly contributed to the rapid diagnostic confirmation and choice of treatment in the popliteal fossa, limb salvage was achieved in this patient.

Successful staged operation for acute aortic dissection and chronic thromboembolic pulmonary hypertension

We describe surgical treatment for a patient with chronic thromboembolic pulmonary hypertension who developed acute type A aortic dissection. Acute aortic dissection is a life-threatening disease and must be operated emergently, and chronic thromboembolic pulmonary hypertension can be treated only by pulmonary endarterectomy. We performed a staged procedure consisting of hemiarch replacement with antegrade cerebral perfusion first and pulmonary endareterectomy with periods of deep hypothermic circulatory arrest a week later. We used extracorporeal membrane oxygenation after aortic surgery as a bridge to pulmonary endarterectomy. Our strategy was useful for patients with chronic thromboembolic pulmonary hypertension who require complicated aortic surgery.

Change of luminal diameter of skeletonized and non-skeletonized radial artery graft at early and late postoperative period

AbstractThe radial artery is increasingly used as a second arterial conduit for myocardial revascularization. However, the radial artery is susceptible to vasospasm, which is thought to be the principal cause of graftn failure. The radial artery is harvested as a skeletonized or a non-skeletonized graft, but the effect of different harvesting technique remains unknown. In this study, we compared the early- and mid-term angiographic findings to elucidate its influence on the graft luminal diameter. We harvested 39 radial arteries either as a skeletonized (nxa0=xa018) or a non-skeletonized graft (nxa0=xa021) using an ultrasonic scalpel. We constructed a composite straight graft by combining a right internal thoracic artery and a radial artery. All the radial artery grafts were sequentially anastomosed to coronary arteries. We measured the diameters of the radial arteries before the operation, within 1xa0month and 1xa0year after the operation. At early postoperative period, graft diameter was significantly larger in skeletonized grafts. Graft diameter at the point before the first and the second anastomosis was similar in skeletonized grafts, although that was significantly smaller before the second anastomosis in non-skeletonized grafts. However, 1xa0year after the operation, the graft diameter was comparable and equally reduced after the first anastomosis in both groups. Skeletonization with an ultrasonic scalpel increases the luminal diameter of the radial artery graft at early postoperative period, which, however, reduces possibly as adaptation to graft flow 1xa0year after the operation.

IDENTIFICATION OF LEFT ATRIUM ACTIVE GANGLIONATED PLEXI BY DENSE EPICARDIAL MAPPING AS ABLATION TARGETS FOR THE TREATMENT OF ATRIAL FIBRILLATION

methods: Thirteen patients (age, 67±11 years; 9 males, 69%) with heart failure and concomitant atrial fibrillation (duration 67±105 months) underwent intraoperative epicardial electrophysiological mapping and GP ablation using the maze procedure at our institution. Twenty-four site, highfrequency stimulation (1000/min; output, 18 V; pulse width, 0.75 ms) was performed by placing tweezers directly onto the potential GP sites on the left atrial epicardium. The diagram of the epicardial mapping location is shown in the figure.

INTRAOPERATIVE EPICARDIAL ELECTROPHYSIOLOSIC MAPPING OF GANGLIONATED PLEXI FOR CONCOMITANT ATRIAL FIBRILLATION WITH A TEMPORARY PACEMAKER: INITIAL EXPERIENCE

Ganglionated plexi (GP) are hopeful optional targets for MAZE procedure. This study was aimed to reveal and identify activity of GP by epicardial location.nnTwelve patients with concomitant atrial fibrillation underwent intraoperative epicardial electrophysiologic mapping in our institution.