Language：English  

A 59-year-old man with no prior neurological deficits developed a massive stroke during the repair of a double-barreled acute type A aortic dissection with major entry in the ascending aorta and an occluded brachiocephalic artery. As right cerebral ischemia was alleviated by the circle of Willis, the patient was alert and conscious preoperatively. Nevertheless, the thrombus in the right carotid artery induced a severe postoperative right cerebral embolism. In conclusion, occlusion of the carotid artery is a risk factor of postoperative severe stroke, even in patients without neurological symptoms preoperatively.

DOI： 10.1177/2050313X211025215

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本胸部外科学会  

researchmap

Language：Japanese   Publisher：日本胸部外科学会-関東甲信越地方会  

researchmap

Language：Japanese   Publisher：日本胸部外科学会-関東甲信越地方会  

researchmap

Language：Japanese   Publisher：日本胸部外科学会-関東甲信越地方会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: Excessive prostaglandin E2 production is a hallmark of abdominal aortic aneurysm (AAA). Enhanced expression of prostaglandin E2 receptor EP4 (prostaglandin E receptor 4) in vascular smooth muscle cells (VSMCs) has been demonstrated in human AAAs. Although moderate expression of EP4 contributes to vascular homeostasis, the roles of excessive EP4 in vascular pathology remain uncertain. We aimed to investigate whether EP4 overexpression in VSMCs exacerbates AAAs. Approach and Results: We constructed mice with EP4 overexpressed selectively in VSMCs under an SM22α promoter (EP4-Tg). Most EP4-Tg mice died within 2 weeks of Ang II (angiotensin II) infusion due to AAA, while nontransgenic mice given Ang II displayed no overt phenotype. EP4-Tg developed much larger AAAs than nontransgenic mice after periaortic CaCl2 application. In contrast, EP4fl/+;SM22-Cre;ApoE-/- and EP4fl/+;SM22-Cre mice, which are EP4 heterozygous knockout in VSMCs, rarely exhibited AAA after Ang II or CaCl2 treatment, respectively. In Ang II-infused EP4-Tg aorta, Ly6Chi inflammatory monocyte/macrophage infiltration and MMP-9 (matrix metalloprotease-9) activation were enhanced. An unbiased analysis revealed that EP4 stimulation positively regulated the genes binding cytokine receptors in VSMCs, in which IL (interleukin)-6 was the most strongly upregulated. In VSMCs of EP4-Tg and human AAAs, EP4 stimulation caused marked IL-6 production via TAK1 (transforming growth factor-β-activated kinase 1), NF-κB (nuclear factor-kappa B), JNK (c-Jun N-terminal kinase), and p38. Inhibition of IL-6 prevented Ang II-induced AAA formation in EP4-Tg. In addition, EP4 stimulation decreased elastin/collagen cross-linking protein LOX (lysyl oxidase) in both human and mouse VSMCs. CONCLUSIONS: Dysregulated EP4 overexpression in VSMCs promotes inflammatory monocyte/macrophage infiltration and attenuates elastin/collagen fiber formation, leading to AAA exacerbation.

DOI： 10.1161/ATVBAHA.120.314297

PubMed

researchmap

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

researchmap

Language：Japanese   Publisher：日本胸部外科学会-関東甲信越地方会  

researchmap

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

researchmap

Language：Japanese   Publisher：日本胸部外科学会-関東甲信越地方会  

researchmap

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

researchmap

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

researchmap

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：BioMed Central Ltd.  

Background: Tracheo-innominate artery fistula (TIF) is a rare but fatal complication occurring after tracheotomy. Brachiocephalic trunk transection, one of the surgical treatments for TIF, is mostly associated with a full or partial median sternotomy. We describe a case of TIF with continuous bleeding, which was successfully treated with brachiocephalic trunk transection through a collar incision without the need for median sternotomy. Case presentation: Case 1. An 18-year-old man was referred to our hospital with bleeding from a tracheal stoma, which had ceased prior to admission. TIF was suspected after examination. Innominate artery transection was performed through a collar incision. TIF was not revealed when we cut the innominate artery anterior wall open
therefore, we opted for preventive surgical intervention. The post-operative course was uneventful, and the patient was asymptomatic at the 3-year follow-up. Case 2. A 14-year-old male patient was admitted to our hospital with bleeding from a tracheal stoma, and TIF was suspected after examination. There was persistent bleeding when the cuff of the tracheotomy tube was deflated. Brachiocephalic trunk transection was performed through a collar incision using balloon occlusion. The post-operative course was uneventful, and rebleeding has not occurred 2 years later. Conclusions: Brachiocephalic trunk transection without any median sternotomy may offer the benefits of post-operative infection prevention. In patients with suspected continuous bleeding, using a balloon catheter may be a safe and effective method of treatment.

DOI： 10.1186/s13019-020-1080-y

Scopus

PubMed

researchmap

Language：English   Publisher：(NPO)日本血管外科学会  

researchmap

Language：Japanese   Publisher：(NPO)日本血管外科学会  

researchmap

Language：English   Publisher：(NPO)日本血管外科学会  

researchmap

Language：Japanese   Publisher：(NPO)日本血管外科学会  

researchmap

Language：Japanese   Publisher：(NPO)日本血管外科学会  

researchmap

Language：English   Publisher：(NPO)日本血管外科学会  

researchmap

Language：Japanese   Publisher：日本胸部外科学会-関東甲信越地方会  

researchmap

Language：Japanese   Publisher：日本胸部外科学会-関東甲信越地方会  

researchmap

Language：Japanese   Publisher：日本胸部外科学会-関東甲信越地方会  

researchmap

Language：English  

DOI： 10.1016/j.jvs.2018.11.040

PubMed

researchmap

Language：Japanese   Publisher：日本胸部外科学会-関東甲信越地方会  

researchmap

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

researchmap

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

researchmap

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

researchmap

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

researchmap

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

researchmap

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

researchmap

Language：Japanese   Publisher：(NPO)日本血管外科学会  

researchmap

Language：Japanese   Publisher：(NPO)日本血管外科学会  

researchmap

Language：Japanese   Publisher：(NPO)日本血管外科学会  

researchmap

Language：Japanese   Publisher：(NPO)日本血管外科学会  

researchmap

Language：Japanese   Publisher：(NPO)日本血管外科学会  

researchmap

Language：Japanese   Publisher：日本胸部外科学会-関東甲信越地方会  

researchmap

DOI： 10.1007/s11748-018-1014-y

PubMed

researchmap

Language：Japanese   Publisher：日本胸部外科学会-関東甲信越地方会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：BioMed Central Ltd.  

Background: It is well known that there are major differences between the Japanese and Western population regarding the incidence of ischemic heart disease and stroke. The purpose of this study was to evaluate differences of patients' characteristics between Belgian and Japanese cohort with acute type A aortic dissection. Methods: In 487 patients (297 male patients, mean age 61.9 ± 12.2 yrs) who underwent surgery for acute type A aortic dissection, baseline preoperative and intraoperative data were collected. Belgian patients (n = 237) were compared to Japanese patients (n = 250). Clinical data included patient demographics, history, status at presentation, imaging study results and intraoperative findings. Results: The Japanese cohort had significantly more women (48.8% vs. 28.7%, p &lt
0.0001), lower BMI (24.2 vs. 26.4, p &lt
0.0001) and lower prevalence of hypertension (49.2% vs. 65.8%, p = 0.0002). More DeBakey type I dissections and less type III dissections with retrograde extension were reported in Belgium than in Japan (77.2% vs. 48.4%, p &lt
0.0001, 3.4% vs. 38.7%, p &lt
0.0001, respectively). More entries were found in the ascending aorta (78.5% vs. 58.5%, p &lt
0.0001) and aortic arch (24.9% vs. 13.7%, p = 0.0018) in Belgian patients than in Japanese patients, who had more entries in the descending aorta or undetected entries. Conclusions: In acute type A aortic dissection, Belgian patients reveal striking differences from Japanese patients regarding gender distribution, entry tear location and type of dissection. Japanese women are more likely to develop acute type A aortic dissection than Belgian women. (234 words).

DOI： 10.1186/s13019-018-0782-x

Scopus

PubMed

researchmap

Publishing type：Research paper (scientific journal)   Publisher：Wiley  

DOI： 10.14814/phy2.13878

researchmap

DOI： 10.1016/j.jtcvs.2018.02.007

PubMed

researchmap

DOI： 10.1152/ajpheart.00329.2018

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER  

To evaluate and compare the clinical outcomes and hospital costs of using sutureless aortic valves vs conventional stented aortic valves.
Between 2007 and 2011, 52 elderly patients undergoing aortic valve replacement for aortic stenosis in our center had a sutureless valve inserted. From among 180 patients who had a stented valve inserted during the same period, 52 patients were matched to the sutureless group, based on age, gender, and operation type. We compared clinical outcomes and hospital costs between the two groups.
The sutureless group had a higher Euroscore (logistic Euroscore I) risk (12.8 vs 9.7; p = 0.02), with significantly shorter aortic cross-clamp (ACC) time (p < 0.01), cardiopulmonary bypass (CPB) time (p < 0.01), intensive care unit stay (p < 0.01), intubation time (p < 0.01), and overall hospital stay (p = 0.05). The sutureless group also revealed a significant hospital cost saving of approximately 8200a,notsign (p = 0.01).
The clinical and hemodynamic outcomes of using the sutureless bioprosthesis were excellent. The reduced ACC and CPB times had a favorable effect on the duration of intubation and intensive care stay, resulting not only in faster recovery and discharge home, but also in a significant hospital cost reduction.

DOI： 10.1007/s00595-017-1516-8

Web of Science

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：JAPANESE CIRCULATION SOC  

Background: Stanford type A acute aortic dissection (A-AAD) extends to the brachiocephalic branches in some patients. After ascending aortic replacement, a remaining re-entry tear in the distal brachiocephalic branches may act as an entry and result in a patent false lumen in the aortic arch. However, the effect of brachiocephalic branch re-entry concomitant with A-AAD remains unknown.
Methods and Results: Eighty-five patients with A-AAD who underwent ascending aortic replacement in which both preoperative and postoperative multiple-detector computed tomography (MDCT) scans could be evaluated were retrospectively studied. The presence of a patent false lumen in at least one of the brachiocephalic branches on preoperative MDCT was defined as brachiocephalic branch re-entry, and 41 patients (48%) had this. Postoperatively, 47 of 85 (55%) patients had a patent false lumen in the aortic arch. False lumen remained patent after operation in 34 out of the 41 (83%) patients with brachiocephalic branch re-entry, as compared to that in 13 of the 44 (30%) patients without such re-entry (P<0.001). Brachiocephalic branch re-entry was a significant risk factor for a late increase in the aortic arch diameter greater than 10 mm (P=0.047).
Conclusions: Brachiocephalic branch re-entry in patients with A-AAD is related to a patent false lumen in the aortic arch early after ascending aortic replacement and is a risk factor for late aortic arch enlargement.

DOI： 10.1253/circj.CJ-16-0462

Web of Science

PubMed

researchmap

Language：Japanese   Publisher：Japan Surgical Association  

We describe the case of a patient who underwent surgery for mitral insufficiency caused by an extremely rare traumatic tear in the mitral-valve leaflet. The patient was a 42-year-old man who fell from the third floor and sustained facial bone fractures, pelvic fracture, cerebral contusion, pulmonary contusion, and traumatic aortic dissection. He was admitted to the hospital. Mitral valve regurgitation was mild immediately after injury, with no hemodynamic abnormalities. The patient received hospital treatment and was discharged on day 18 after injury because his general condition had improved. The patient was regularly followed-up, and exertional dyspnea developed 2 years after the accident. Transthoracic echocardiography showed aggravation of mitral insufficiency. Mitral annuloplasty was performed 3 years after the accident. Intraoperative examination revealed a tear in the leaflet near the anterior commissure of the mitral valve (A1), apparently causing the severe mitral insufficiency. Mitral regurgitation resolved after suturing the tear in the leaflet, and exertional dyspnea also resolved.

DOI： 10.3919/jjsa.77.535

researchmap

Language：Japanese   Publisher：Japan Surgical Association  

We describe our experience with a patient who underwent surgery for a bilateral coronary-pulmonary artery fistula and a coronary artery aneurysm associated with preoperative cardiopulmonary arrest. A 47-year old woman lost consciousness and was transported by ambulance to the hospital. The patient regained consciousness in the ambulance, and presented at the emergency & critical care medical center of our hospital, but cardiopulmonary arrest occurred during examination. Echocardiography showed cardiac tamponade. Pericardial drainage was immediately performed, and spontaneous circulation was restored. After the induction of brain hypothermia, a careful examination revealed an aneurysm, 5 mm in maximum diameter, in the right coronary artery and an aneurysm, 8 mm in maximum diameter, in the left coronary artery. Bilateral coronary-pulmonary artery fistulas had thus developed. Cardiopulmonary arrest was apparently caused by the rupture of a coronary artery aneurysm. Aneurysmectomy was performed, and the coronary-pulmonary artery fistulas were closed during cardiopulmonary bypass. Photodynamic eye was useful for the intraoperative detection of small coronary artery aneurysms. On postoperative day 12, the patient was discharged from the hospital uneventfully.

DOI： 10.3919/jjsa.77.303

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-BLACKWELL  

Coronary subclavian steal syndrome associated with upper extremity arteriovenous fistula is an uncommon but potentially life-threatening condition. We present a case of a 65-year-old male on hemodialysis with a left upper extremity arteriovenous fistula who underwent coronary revascularization involving bypass with the left internal thoracic artery to the left anterior descending artery. Intraoperative transit-time graft flow measurements and fluorescence imaging showed a reversed flow in the left internal thoracic artery, and the left internal thoracic artery was successfully converted as a free graft from the ascending aorta to the left anterior descending artery. doi: 10.1111/jocs.12444 (J Card Surg 2015;30:154-156)

DOI： 10.1111/jocs.12444

Web of Science

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-BLACKWELL  

BackgroundWe evaluated clinical outcomes of thoracic endovascular aortic repair (TEVAR) for ruptured descending thoracic aortic aneurysm (rDTAA).
MethodsTwenty-three patients with rDTAA (mean age, 76.88.8 years) underwent TEVAR at our center between January 2008 and April 2013.
ResultsIn twenty-three patients, five patients (21.7%) were in shock before surgery. Technical success was achieved in 21 patients. After TEVAR, retrograde Type A aortic dissection occurred in one patient, Type I endoleak in one patient, and Type II endoleak in three patients. The 30-day mortality rate was 4.3% (n=1), and there were five in-hospital deaths (21.7%). Six patients (26.1%) developed cerebral complications and two patients suffered from paraplegia. In the late phase, four patients died because of the following aortic events: re-rupture in one patient, rupture of another untreated aneurysm in two patients, and esophageal perforation in one patient.
ConclusionsTEVAR is associated with relatively low early morbidity and mortality and can be performed in older and high-risk patients. However, because aortic events during follow-up after TEVAR are not rare, we recommend close follow-up and application of early and aggressive reintervention. doi: 10.1111/jocs.12499(J Card Surg 2015;30:163-169)

DOI： 10.1111/jocs.12499

Web of Science

PubMed

researchmap

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：OXFORD UNIV PRESS INC  

OBJECTIVES: Intramural haematoma is defined pathologically as aortic dissection without an intimal tear. We therefore believe that this term is inappropriate as an acute clinical diagnosis, and instead, use the term 'thrombosed-type acute aortic dissection'. We compared the features of thrombosed-type acute aortic dissection with those of classic dissection.
METHODS: Thrombosed type was defined as aortic dissection without flow in the false lumen of the aorta on contrast-enhanced computed tomography. Surgery was indicated for all cases of type A acute aortic dissection, and central repair operations were performed in 509 patients. We retrospectively studied these patients' surgical records.
RESULTS: Three hundred and forty-four patients (68%) had classic dissection, and 165 (32%) had thrombosed type. Thrombosed type was associated with a significantly higher mean age (69 vs 60 years, P < 0.01), a higher incidence of cardiac tamponade (45 vs 28%, P < 0.01) and a lower incidence of malperfusion (6 vs 35%, P < 0.01) than classic dissection. Entry tears were located in the ascending aorta and the arch in 74 patients (45%) with thrombosed type. Since 2007, an intimal tear has been confirmed intraoperatively or on computed tomography in 39 (78%) of 50 patients with thrombosed-type aortic dissection. Mortality was significantly lower in patients with thrombosed-type dissection (6%) than in those with classic dissection (13%, P = 0.02).
CONCLUSIONS: Most cases of intramural haematoma are acute aortic dissections with an intimal tear without re-entry. Intramural haematoma should be referred to as thrombosed-type acute aortic dissection. Thrombosed type can be easily diagnosed on contrast-enhanced computed tomography and has features distinct from those of classic dissection. Our classification may be useful for the diagnosis of these types of aortic dissection.

DOI： 10.1093/ejcts/ezt040

Web of Science

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：OXFORD UNIV PRESS INC  

OBJECTIVES: The purpose of this study was to evaluate the clinical outcomes of emergency surgery for acute type B aortic dissection with rupture and to compare results between open surgery and thoracic endovascular aortic repair (TEVAR).
METHODS: Two hundred and ninety-four patients with acute type B aortic dissection were admitted to our hospital between January 2000 and March 2012. At presentation, 30 (10%) patients had rupture (20 men, 10 women; mean age, 71 +/- 15 years), among whom 23 underwent emergency surgery: 9 underwent TEVAR and 14 underwent open surgery. The objective of TEVAR was closure of the primary entry site and the secondary tear site in the descending thoracic aorta.
RESULTS: In the TEVAR group, technical success was achieved: the primary entry site was closed, and bleeding was controlled in all 9 patients. There was no operative death, and 1 (13%) patient had cerebral infarction. In the open surgery group, 2 (14%) patients died during hospitalization, and 4 (29%) had cerebral infarction in the acute phase. Hospitalization tended to be longer in the open surgery group than in the TEVAR group. The overall survival rate at 1 year was 71 +/- 17% in the TEVAR group and 86 +/- 9% in the open surgery group (P = 0.89).
CONCLUSIONS: TEVAR for acute type B aortic dissection with rupture could be performed with relatively low morbidity and mortality, with no significant difference when compared with open surgery. The main objective of TEVAR for acute type B aortic dissection with rupture is control of bleeding, which can be achieved by closing the primary entry site and the secondary tear site in the descending thoracic aorta. If anatomically feasible and performed immediately, TEVAR is the treatment of choice for acute type B aortic dissection with rupture because it is less invasive than open surgery.

DOI： 10.1093/ejcts/ezs703

Web of Science

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：MEDICAL TRIBUNE INC  

Purpose: To study mid-term outcomes in patients admitted to receive treatment for acute type B aortic dissection.
Methods: The study group comprised 229 patients with acute type B aortic dissection treated between January 2000 and July 2010. 128 patients had a thrombosed false lumen, and 101 had a patent false lumen.
Results: In the thrombosed group, 6 had rupture, 4 had malperfusion, and 118 had no complications. There were 5 early deaths (3.9%). In the patent group, 12 had rupture, 19 had malperfusion, and 70 had no complications. There were 6 early deaths (5.9%). Overall survival rates in the thrombosed group and the patent group were 94.7 +/- 2.2% and 90.2 +/- 3.2% at 1 year, and 84.3 +/- 4.6% and 85.9 +/- 4.3% at 5 years (p = 0.892), respectively. Aorta-related event-free rates were 85.6 +/- 3.4% and 48.3 +/- 5.5% at 1 year, and 76.0 +/- 5.1% and 35.2 +/- 7.2% at 5 years (p <0.001), respectively.
Conclusions: The incidences of rupture and malperfusion during the acute phase were higher in the patent group compared with the thrombosed group. At the late period, although the aorta-related event rate was higher in the patent group, the survival rate did not differ between two groups. Close follow-up and aggressive intervention strategy of the patent group may result comparable outcomes with the thrombosed group.

DOI： 10.5761/atcs.oa.12.02077

Web of Science

PubMed

researchmap

Language：Japanese   Publisher：Japan Surgical Association  

An 81-year-old man was scheduled to undergo surgery for an aortic arch aneurysm. The patient was admitted to a local hospital because of congestive heart failure. Computed tomography showed an aortopulmonary fistula due to an aortic arch aneurysm. The patient was therefore transferred to our hospital for undergoing total arch replacement with closure of the fistula and coronary artery bypass grafting (AO-SVG-#4PD). It was difficult to maintain circulation during the cardiopulmonary bypass because of an aortopulmonary shunt. The patient required percutaneous cardiopulmonary support for 2 days and was discharged 49 days after the operation. Aortopulmonary fistula is a rare, potentially fatal condition that can lead to death because of right heart failure.

DOI： 10.3919/jjsa.73.3086

CiNii Books

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Objectives Postoperative disorders of the central nervous system remain a major problem in thoracic aortic surgery. Both retrograde cerebral perfusion and selective antegrade cerebral perfusion have become established techniques for cerebral circulatory management. In this study, we compared neurologic outcomes and mortality between retrograde cerebral perfusion and antegrade selective cerebral perfusion in patients with acute type A aortic dissection who underwent emergency ascending aorta replacement. Methods Between January 2003 and April 2011, a total of 203 patients with acute type A aortic dissection underwent emergency ascending aorta replacement in our hospital. We performed retrograde cerebral perfusion in 109 patients before 2006, and then mainly performed antegrade selective cerebral perfusion in 94 patients from 2006 onward. Results Cardiopulmonary bypass time and systemic circulatory arrest time were significantly longer in the antegrade selective cerebral perfusion group (p = 0.04, p\\0.001, respectively). The incidences of transient brain dysfunction and permanent brain dysfunction after surgery did not differ significantly between the groups. There were also no differences between the groups in other intraoperative variables, such as aortic cross-clamp time and the lowest rectal temperature, or in operative outcomes, including postoperative intensive-care-unit stay, mean peak amylase, and lipase levels until postoperative day 7, and 30-day mortality. Conclusion Both retrograde cerebral perfusion and antegrade selective cerebral perfusion were associated with acceptable levels of postoperative neurologic deficits, mortality, and morbidity. Either of these techniques for brain protection can be used selectively, based on a comprehensive assessment of general condition, in patients undergoing surgery for acute type A aortic dissection. © The Japanese Association for Thoracic Surgery 2012.

DOI： 10.1007/s11748-012-0142-z

Scopus

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

An infected thoracoabdominal aneurysm is a rare, life-threatening condition with high mortality. We performed an in situ graft replacement and applied a rectus abdominis muscle flap transfer technique in a case of infected thoracoabdominal aortic aneurysm after distal gastrectomy. A rectus abdominis muscle flap transfer might be a good alternative when the omental flap technique is not feasible. © 2011 The Japanese Association for Thoracic Surgery.

DOI： 10.1007/s11748-010-0718-4

Scopus

PubMed

researchmap

Language：English   Publisher：WILEY-BLACKWELL  

P>The patient was a 34-year-old man with corrected transposition of the great arteries and situs inversus who was admitted with dyspnea. He had undergone ventricular septal defect closure and pulmonary valve commissurotomy at the age of 15. Preoperative examinations revealed severe tricuspid (systemic atrioventricular valve) insufficiency associated with dysfunction of the systemic (anatomical right) ventricle. The tricuspid valve orifice was shown to open dorsally by computed tomography. Because of 90 degrees clockwise rotation of the heart, surgery was performed through right side thoracotomy. Tricuspid valve replacement with preservation of all leaflets and chordae tendineae was performed successfully, and the patient had an uneventful recovery after surgery. (J Card Surg 2010;25:740-742).

DOI： 10.1111/j.1540-8191.2010.01103.x

Web of Science

PubMed

researchmap

Language：Japanese  

PubMed

CiNii Books

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2010332097

Language：Japanese  

PubMed

CiNii Books

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2009346693

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：The Japanese Society for Cardiovascular Surgery  

A 74-year-old woman presented with shortness of breath. Cardiac ultrasonography showed that left-ventricular-wall motion was good (left ventricular ejection fraction, 70.2%). The left atrium and ventricle were enlarged (left anterior dimension, 53.4mm; left ventricular enddiastolic dimension, 58.5mm). The posterior cusp of the mitral valve was thickened; the flexibility was decreased. Color Doppler ultrasonography revealed a regurgitant jet toward the posterior cusp of the left atrium. However, there was no deviation of the anterior cusp. Severe mitral-valve insufficiency was diagnosed, and surgery was performed. The second heart sound (P2) of the posterior cusp was shortened because of localized calcification of the posterior mitral annulus. This site may have caused the regurgitation. Mitral annuloplasty with rectangular resection of the valve cusps and annulorrhaphy was performed. The patient had an uneventful recovery after surgery. Postoperative cardiac ultrasonography showed that mitral-valve insufficiency had improved and was regarded as trivial. Mitral annuloplasty is generally considered unsuitable for mitral-valve insufficiency with calcification of the valve annulus. In patients such as the present case who have localized calcification, however, mitral annuloplasty can be performed by resection of the valve cusps with annulorrhaphy.

DOI： 10.4326/jjcvs.36.333

researchmap