Toru Mizumoto

Aortic arch aneurysms: Treatment with extraanatomical bypass and endovascular stent-grafting

Endovascular repair of thoracic aortic aneurysms is emerging as an attractive alternative to surgical graft replacement. However, patients with aortic arch aneurysms are often excluded from the target of endovascular repair because of lack of suitable landing zones, especially at the proximal ones. In this paper we describe our method for treating patients with aortic arch aneurysms using a combination of extraanatomical bypass surgery and endovascular stent-grafting.

Aneurysm expansion after stent-graft placement in the absence of endoleak

Sixty-three patients with thoracic or abdominal aortic aneurysms were treated with endovascular stent-grafts. No endoleak was identified at any interval of follow-up in 58 patients. In four of them (7%), the aneurysms expanded by 10 mm or more during follow-up and additional interventions were required. Aneurysm expansion was caused by inappropriate sealing at the aneurysmal necks in two patients and transgraft seroma in the other two. Although some aneurysm expansion could be avoided by proper patient selection and accurate placement of stent-grafts, it seems difficult to predict aneurysm expansion in most cases.

Determinants of recurrent tricuspid regurgitation following tricuspid valve annuloplasty during mitral valve surgery

The purpose of this study was to determine risk predictors for recurrent tricuspid regurgitation (TR) following tricuspid valve annuloplasty during mitral valve surgery.

The impact of global left ventricular afterload on left ventricular reverse remodeling after aortic valve replacement

Conventional indices such as prosthetic valve effective orifice area (EOA) or transvalvular pressure gradients (TPG) may be unreliable in predicting left ventricular (LV) reverse remodeling after aortic valve replacement (AVR). We hypothesized that the global LV afterload, including valvular and arterial impedance, could influence LV reverse remodeling after AVR.

Verapamil reduced pulmonary hypertension in adult respiratory distress syndrome

Pulmonary hypertension is usually seen in adult respiratory distress syndrome (ARDS), which causes an acute increase in the work load on the right ventricle [1]. The management of pulmonary vascular resistance (PVR) is beneficial to right ventricular function because the PVR in survivors of ARDS tends to decrease during therapy [2]. In the present paper, we describe a patient in whom verapamil reduced PVR more effectively than prostaglandin E~ (PGE 0.

Neuroprotective effect of pressure-oriented flow regulation and pH-stat management in selective antegrade brain perfusion during total aortic arch repair

OBJECTIVES The aim of this study was to assess the safety and effectiveness of our selective antegrade brain perfusion (SABP) strategy, which is characterized by moderate hypothermic and low-pressure management under pH-stat using a completely closed cardiopulmonary bypass circuit with a single centrifugal pump. METHODS Forty-nine consecutive patients (median age, 74) underwent total aortic arch replacement using a 4-branched graft. SABP was conducted with individual cannulation in all arch vessels. The SABP flow rate was monitored, and the flow rates of each arch vessel were also measured in patients with available data. RESULTS One patient died of cerebral infarction, and 7 had transient neurological deficits without apparent findings on postoperative imaging studies and without residual sequels at hospital discharge. The operation, cardiopulmonary bypass, cardiac arrest, circulatory arrest and SABP times were 327 min (interquartile range, 292-381), 211 (184-247), 107 (84.8-138.3), 54.0 (48-68) and 137 (114-158), respectively. The total flow of the SABP was 18.1 ml/kg/min (15.7-20.9). The flow rates of the brachiocephalic, the left carotid and the left subclavian arteries were 9.5 ml/kg/min (7.7-11.5), 4.2 (2.8-5.7) and 4.5 (3.7-5.5), respectively. Only the flow rate of the brachiocephalic artery was significantly correlated with the total SABP flow rate (Spearman rank correlation coefficient, r = 0.58, P < 0.01). CONCLUSIONS The moderate hypothermic, high-flow, low-pressure SABP strategy with pH-stat management can be applied in adult aortic surgery; however, the feasibility and effectiveness of this concept need further evaluation in a prospective controlled study.

Emergency Off-Pump Coronary Artery Bypass Graft Surgery for Patients on Preoperative Intraaortic Balloon Pump

BACKGROUND The aim of this study was to investigate early and long-term outcomes of patients with acute coronary syndrome preoperatively requiring intraaortic balloon pump support who underwent emergency off-pump coronary artery bypass graft surgery. METHODS One hundred and fifteen patients on preoperative intraaortic balloon pump receiving emergency off-pump coronary artery bypass graft surgery over an 11-year period were evaluated. The median age was 71 years (range, 33 to 87). Acute myocardial infarction and unstable angina were present in 54 patients (47.0%) and 61 patients (53.0%), respectively. Left main disease and triple-vessel disease without left main involvement were present in 74 patients (64.3%) and 33 patients (28.7%), respectively. RESULTS There were 3 perioperative deaths. Complete surgical revascularization was accomplished in 82 patients (71.3%), and in situ internal thoracic artery graft was used in 96 (83.5%). Late survival, freedom from major adverse cardiac and cerebrovascular events, and freedom from repeat revascularization rates at 5 years were 83.3%, 73.5%, and 84.2%, respectively. The Cox multivariate prognostic predictors of total mortality were preoperative renal impairment (hazard ratio [HR] 7.90; 95% confidence interval [CI]: 3.06 to 20.4) and low ejection fraction (HR 0.94, 95% CI: 0.88 to 0.99). The multivariate risk predictors of major adverse cardiac and cerebrovascular events were preoperative renal impairment (HR 2.68, 95% CI: 1.00 to 7.19) and peripheral vascular disease (HR 2.81, 95% CI: 1.05 to 7.51), and complete revascularization was protective (HR 0.39, 95% CI: 0.19 to 0.81). The multivariate risk factor of repeat revascularization was previous percutaneous coronary intervention (HR 3.26, 95% CI: 1.14 to 9.33), and complete surgical revascularization was also protective (HR 0.30, 95% CI: 0.11 to 0.85). CONCLUSIONS Off-pump coronary artery bypass graft surgery is a feasible option for patients requiring preoperative intraaortic balloon pump support.

A Case of Endovascular Stent Graft Repair for Traumatic Thoracic Aortic Aneurysm in a Young Patient with Multiple Injuries

症例は16歳,男性.1999年11月12日,スクーター運転中,車と衝突.当院救急外来へ搬送された.多発外傷(左上腕骨骨折,左大腿骨開放骨折,骨盤骨折,尿道断裂,外傷性小腸狭窄)を伴った外傷性胸部大動脈瘤と診断された.敗血症,DIC,肝機能障害が認められたため手術は困難と判断し,外傷性胸部大動脈瘤に対しては血圧コントロールしつつ慢性期にステントグラフト内挿術を行った.術後32ヵ月現在,瘤再発などなく良好に経過している.

One-Stage Operation for Ruptured Abdominal Aortic Aneurysm and Acute Myocardial Infarction.

症例は65歳男性. 腹痛を主訴に来院. また来院直後より胸痛が出現しECG所見では, V1-3誘導でST上昇が認められた. 緊急CTおよびCAG施行した結果, 急性心筋梗塞を合併した腹部大動脈瘤 (AAA) 破裂と診断し緊急手術を施行した. 手術は体外循環下に冠状動脈バイパス術 (CABG) を行った後, 補助循環中にAAA切除, 人工血管 (Yグラフト) 置換を行った. また慢性腎不全患者であったため術中透析を行った. 本術式は体外循環中にAAA手術を行うため大動脈周囲の操作は極めて容易であり, また心配された出血のコントロールも容易であったため本症例のように心機能低下を伴う虚血性心疾患 (IHD) とAAA合併例には有用な術式と考えられた.

One-Stage Repair of Salmonella enteritidis-Infected Infrarenal Aortic Aneurysm A Case Report

A sixty-three-year-old man was admitted with systemic sepsis, but he was in a hemody namically stable situation and found to have a contained rupture of an infrarenal aortic aneurysm, which was infected with Salmonella enteritidis. An abdominal plain film revealed a gas shadow forming a ring in the midabdomen. Computed tomography (CT) showed a contained rupture of an infrarenal aortic aneurysm with a gas formation in the retroperitoneum. An emergent extra-anatomic bypass from the ascending aorta to (continued on next page) (Abstract continued) the femoral arteries was performed. The retroperitoneal phlegmon and hematoma that contained a large pseudoaneurysm were removed through a separate incision. A CT obtained after surgery showed gas-containing fluid collections in the retroperitoneum and these were followed up by means of CT. Eight months after surgery, the fluid collec tions had resolved. Aggressive surgical treatment and antibiotic therapy have resulted in a successful outcome.