Tsuneo Ariyoshi

Effect of Etidronic Acid on Arterial Calcification in Dialysis Patients

AbstractBackground: Bisphosphonate drugs, including etidronic acid, are effective agents for the treatment of osteoporosis and may reduce arterial calcification. The aim of this randomised control trial was to characterise the effect of etidronic acid on arterial calcification in patients undergoing chronic haemodialysis. Methods: Patients undergoing chronic haemodialysis were assigned to one of two groups by a simple randomisation method: an etidronic acid group (n = 8; 400 mg/day for 24 weeks) and a control group (n = 6; no etidronic acid therapy). Serum calcium, phosphate, calcium-phosphate product, alkaline phosphatase, lactate dehydrogenase, activated colecalciferol and parathyroid hormone levels were measured at baseline and then at 4-weekly intervals thereafter. Results: Calcification scores of the coronary arteries and the thoracic and abdominal aorta were determined by volume-correcting data collected by a multidetector-row computerised tomographic scanner at baseline, at 6 months and at 1 year. Two patients in the etidronic acid group were excluded from the final analysis because of medical complications. The remainder of the patients (n = 6) showed no significant temporal changes in serum levels of assessed parameters. While no significant temporal changes in coronary calcification score were observed in either group, the mean aortic calcification score significantly decreased over time from 1000 ± 460mm3 at baseline to 970 ± 580mm3 at the completion of treatment and 350 ± 180mm3 at 1 year (p = 0.009), corresponding to a mean percentage decrease of −64.1% (range −86.5% to −50.1%). By contrast, in the control group, the mean aortic calcification score significantly increased with time from 1460 ± 1280mm3 to 1510 ± 1150mm3 at the completion of treatment and 2070 ± 1200mm3 at 1 year (p = 0.006), corresponding to a mean percentage change in the calcification score of +130.0% (range 2.1–414%). Conclusion: Etidronic acid markedly reduced aortic calcification in patients with end-stage renal disease undergoing chronic haemodialysis. The effect of this agent on aortic calcification may attenuate the increase in aortic stiffness and result in improved long-term outcomes in patients undergoing chronic haemodialysis.

Systolic anterior motion after mitral valve repair: predicting factors and management

PurposeThe aim of this study was to determine the mechanism of systolic anterior motion (SAM) after mitral valve (MV) repair by analyzing the clinical data of patients with MV repair.MethodsA total of 104 MV repairs were performed for patients with isolated degenerative posterior leaflet prolapse. Eight patients (7.7%) developed SAM with severe mitral regurgitation. We compared the preoperative and intraoperative findings of the two groups (8 patients in the SAM group, 96 in the non-SAM group) and reported the clinical courses of the SAM patients.ResultsPreoperative left ventricular end-diastolic and end-systolic diameters were significantly smaller and the preoperative left ventricular ejection fraction was significantly greater in the SAM group than in the non-SAM group. The number of patients with a sigmoid septum and the number with anterior leaflet-septal contact (LSC) during diastole were significantly larger in the SAM group. Incidence of billowing posterior leaflet, prolapsed segments, and operative techniques were comparable for the two groups. SAM improved with correction of hemodynamic status in four patients. In four other patients secondary cardiopulmonary bypass was required to resolve SAM. SAM resolved with additional repairs in two patients, whereas the other two required MV replacement. Of the six patients in whom conservative treatment or re-repair was successful, one had recurrent SAM 3 months after surgery.ConclusionThe sigmoid septum and LSC may predict SAM after MV repair. A strict follow-up is imperative for patients with persistent or recurrent SAM.

Primary cardiac osteosarcoma with imaging that revealed no calcification.

Osteosarcoma is a rare primary cardiac malignancy. Calcification on imaging is crucial to differentiating osteosarcoma, but we encountered a case that was difficult to diagnose because imaging revealed no calcification. A 67-year-old man was admitted for heart failure. Echocardiography demonstrated mitral regurgitation and a mass in the left atrium. A cardiac malignancy was suspected. Computed tomography revealed no calcification. Operation was performed, and histopathological examination identified the tumor as an osteosarcoma.

Arrhythmogenic Left Ventricular Cardiomyopathy Associated With Noncompaction

A 46-year-old woman was admitted to our hospital because of progressive exertional dyspnea and occasional premature ventricular contraction. An enhanced computed tomographic scan revealed partial defect of the left ventricular myocardium and prominent trabecular meshwork at the same thin-wall segment. She underwent resection and endoventricular patch plasty using cardiopulmonary bypass. Histopathologic examination showed transmural fibro-fatty replacement of the myocardium, with an extremely thickened endocardium. Here we report an extremely rare case of surgery in a patient with arrhythmogenic left ventricular cardiomyopathy associated with left ventricular noncompaction.

Circumaortic left renal vein associated with juxtarenal abdominal aortic aneurysm.

The patient was an 82-year-old man who was found to have a juxtarenal abdominal aortic aneurysm accompanied by a circumaortic left renal vein (CLRV). During dissection of the proximal anastomosis site the CLRV was injured, but was successfully repaired. A graft implantation was performed below the renal arteries. The incidence of CLRV is thought to be rare, however it is found in 7% of cadavers donated for anatomy. CLRV may cause unexpected bleeding by inadvertent dissection of the abdominal aorta. To prevent unexpected bleeding, surgeons should always keep in mind this potential risk when performing surgery.

Characteristics and treatment strategies of mitral regurgitation associated with undifferentiated papillary muscle

PurposeIn this report we review our experience of operations on mitral regurgitation associated with abnormal papillary muscles/chordae tendineae of the mitral valves and discussed the clinical characteristics, operative findings, and treatment strategies.MethodsUndifferentiated papillary muscle was defined as a hypoplastic chordae tendineae with anomalous formation of papillary muscles attached to the mitral valves directly. Consecutive 87 patients undergoing surgery for mitral regurgitation at our institution were reviewed and 6 of them had undifferentiated papillary muscle.ResultsThe underlying mechanism of regurgitation was prolapse at the center of the anterior leaflet in 3 cases and tethering, a wide area of myxomatous degeneration, and annular dilatation in one case, respectively. Five patients underwent mitral valve plasty and 1 patient received replacement. Anomalous formation of chordae tendineae was corrected by resection and suture with transplantation at the tip of the leaflet to which abnormal chordae were attached in 2 cases, while resection and suture with chordal shortening was performed in 1 case, and chordal reconstruction using artificial chordae was employed in 2 cases. There was no operative death, and postoperative echocardiography showed no residual regurgitation in any of the cases.ConclusionsMitral regurgitation associated with undifferentiated papillary muscle resulted from prolapse or tethering and impaired flexibility of leaflets. It was possible to successfully treat the patients by mitral valve plasty unless complex congenital cardiac malformation coexisted. Detailed examinations of attached papillary muscle by echocardiography and intraoperative inspection are necessary and surgical techniques should be selected appropriately in each case.

Surgical treatment for chronic type A aortic dissection and aortic regurgitation in a patient with a tracheostoma

We successfully performed aortic root replacement and partial aortic arch replacement by a T-shaped sternotomy at the second intercostal space in a patient who had undergone tracheotomy for respiratory insufficiency and cardiac failure caused by methicillinresistant Staphylococcus aureus pneumonia during preservation treatment of chronic type A aortic dissection and aortic regurgitation.

Triple-Barreled Aortic Dissection Developing Into Quadruple-Barreled Dissection

A78-year-old previously healthy woman was admitted to our hospital with acute and oppressive chest pain. She had no history of Marfan syndrome. The patient had intubation and deep sedation at another emergency unit because of pain and severe agitation. Physical examination showed no murmur, desaturation, signs of pulmonary edema, or ST-segment depression. Contrast-enhanced computed tomography images showed type B acute aortic dissection. Computed tomography images also revealed a triple-barreled dissection in the descending aorta (Fig 1; T true lumen; 1 and 2 false lumens.). She had been treated with medical therapy, and the course had been uneventful. Six years later, she was admitted to the emergency unit of our hospital with syncope and acute chest pain. All peripheral pulses were present except in the right arm. Physical examination showed a mild reactive isochoric mydriasis, loud continuous murmur, severe systemic desaturation (arterial oxygen saturation, 50%), and myocardial ischemia with ST-segment depression. Contrastenhanced computed tomography images showed that an

A case of pulmonary infective endarteritis associated with patent ductus arteriosus : surgical closure under circulatory arrest

A 35-year-old man was admitted to the hospital with prolonged high-grade fever. Chest computed tomography revealed multiple pulmonary infiltrations in both lungs, suggesting septic emboli. Echocardiography revealed patent ductus arteriosus and mobile large vegetations in the pulmonary artery. Because of uncontrollable infection and the imminent possibility of massive pulmonary embolism, he underwent transpulmonary surgical closure of the ductus and resection of the vegetations under hypothermic circulatory arrest using cardiopulmonary bypass. We report a rare case of open heart surgery in a patient with pulmonary infective endarteritis associated with patent ductus arteriosus.

Ten Years Experience of Aortic Root Replacement Using a Modified Bentall Procedure with a Carrel Patch and Inclusion Technique

OBJECTIVE A modified Bentall procedure with a Carrel patch and inclusion technique (Modified Bentall Procedure) has been used to treat combined disease of the aortic valve and aortic root. The current study examined the outcomes of this surgical technique. MATERIALS AND METHODS Between April 1999 and March 2009, 16 patients (10 males, 6 females; 63.3 ± 9.4 years) underwent elective surgery involving the Modified Bentall Procedure and no additional surgery, so they were included in the study. RESULTS The mean cardiopulmonary bypass time was 140.2 ± 34.4 min (range: 97-232 min), and aortic cross-clamp time was 97.3 ± 16.6 min (range: 76-132 min). There were no hospital deaths. No patients required additional surgery to correct excessive bleeding. The follow-up rate was 100% (16/16). The mean follow-up period was 5.6 ± 2.8 years (range: 0.7-9.9 years). One of the 16 patients died (6.3%) due to lung cancer, and 1 of the 15 surviving patients required additional surgery (6.7%) for a thoracic aortic aneurysm. Kaplan-Meier analysis found that 1-year and 5-year survival and event-free survival rates were all 100%. CONCLUSIONS The Modified Bentall Procedure provided satisfactory results over both the short term and long term.