The use of bioprosthetic valves in aortic valve replacement surgery is increasing due to the aging of patients, dietary restrictions associated with anticoagulation therapy, and avoidance of bleeding ...risks. However, some reports have raised concerns about the durability of the Mitroflow valve, and we investigated the remote results of the Mitroflow valve in our department. The subjects were 15 patients who underwent aortic valve eplacement using the Mitroflow valve from December 2013 to August 2022. The mean age was 77.5±5.6 years, all were female, the mean body surface area was 1.3±0.1m2, and all valve sizes were 19mm. One patient was lost to mediastinitis in the early postoperative period, but the others were discharged from the hospital without any complications. One patient underwent aortic valve replacement due to structural valve deterioration at 2.7 years postoperatively. Another patient had rapidly progressive stenosis of the Mitroflow valve（SVD）at 5.6 years postoperatively. There were 3 remote deaths（heart failure at 7.5 years postoperatively, acute myocardial infarction at 4 years postoperatively, and senility at 3.8years postoperatively）. By the Kaplan-Meier method, the cardiac associated mortality free rates were 100% at 1 and 3 years, 88% at 5 and 7 years, and the all-cause mortality free rates were 93% at 1 and 3 years, and 72% at 5 and 7 years. Reoperation and SVD free rates were 100% at 1 year, 90% at 3 and 5 years, and 77% at 7 years. Two of 15 patients with 19mm Mitroflow valves in our department had early SVD, suggesting the need for stricter indication and postoperative follow-up for Mitroflow valves.
The aryl hydrocarbon receptor (AHR) mediates the toxic effects of planar halogenated aromatic hydrocarbons (PHAHs). Bony fishes exposed to PHAHs exhibit a wide range of developmental defects. ...However, functional roles of fish AHR are not yet fully understood, compared with those of mammalian AHRs. To investigate the potential sensitivity to PHAHs toxic effects, an AHR cDNA was initially cloned and sequenced from red seabream (
Pagrus major), an important fishery resource in Japan. The present study succeeded in identifying two highly divergent red seabream AHR cDNA clones, which shared only 32% identity in full-length amino acid sequence. The phylogenetic analysis revealed that one belonged to AHR1 clade (rsAHR1) and another to AHR2 clade (rsAHR2). The rsAHR1 encoded a 846-residue protein with a predicted molecular mass of 93.2 kDa, and 990 amino acids and 108.9 kDa encoded rsAHR2. In the N-terminal half, both rsAHR genes included bHLH and PAS domains, which participate in ligand binding, AHR/ARNT dimerization and DNA binding. The C-terminal half, which is responsible for transactivation, was poorly conserved between rsAHRs. Quantitative analyses of both rsAHRs mRNAs revealed that their tissue expression profiles were isoform-specific; rsAHR1 mRNA expressed primarily in brain, heart, ovary and spleen, while rsAHR2 mRNA was observed in all tissues examined, indicating distinct roles of each rsAHR. Furthermore, there appeared to be species-differences in the tissue expression profiles of AHR isoforms between red seabream and other fish. These results suggest that there are isoform- and species-specific functions in piscine AHRs.
A 75-year-old woman presented with chronic cough and hemoptysis. Chest computed tomography (CT) and aortography revealed a small, contrast-filled outpouching in the wall of the descending aorta, ...which was thought to be the source of bleeding. At thoracotomy, there were firm adhesions between the descending aorta and the left S6. The aorta was clamped and the adhesions were removed revealing a defect in the aortic wall with thrombus. The defect was sutured. A penetrating atherosclerotic ulcer and intramural hematoma were diagnosed based on the radiological and operative findings.
Case: A 77-year-old dialysis patient. Debranching TEVAR (Thoracic endovascular aortic repair, fenestrated stent grafting 42 mm, 38 mm) of the left common carotid artery and left subclavian artery was ...performed for an approximately 7×8.5 cm saccular aneurysm. After surgery, due to enlargement of the aortic aneurysm by a type III endoleakage, dissection of the ascending aorta and a bypass occlusion of the left common carotid artery, reoperation was performed. The proximal stent graft was removed and the distal stent graft was left in place because no type Ib endoleakage was found and therefore, a total replacement of the aortic arch and reconstruction of the left common carotid artery were done. TEVAR was less invasive and dramatically improved surgical mortality. However, due to additional treatments for endoleakages, semipermanent imaging monitoring is necessary. Thus, it seems to be important to think that treatment must be performed with consideration of the fact that mortality increases once a reoperation is decided.
Abstract
Background
Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF) after infective endocarditis and/or valve replacement is rarely reported, and transesophageal echocardiography ...and cardiac multidetector computed tomography are useful for diagnosis. Surgery is mostly recommended to prevent fatal complications.
Case presentation
A 61-year-old man underwent repeat aortic valve replacement (AVR) with repair of a P-MAIVF due to hemolytic anemia 6 years after AVR, and 4 months after treatment of sepsis and an infected abdominal aortic aneurysm. Two years after the surgery, the patient is alive and well with no recurrence.
Conclusions
The present case was considered to be a very rare case in which surgery was performed because the blood flow entering and leaving the P-MAIVF contacted the prosthetic valve ring, resulting in hemolysis, severe anemia, and heart failure.
Late open conversion after EVAR YAMAUCHI, Masanobu; KAMIHIRA, Satoshi; KANETSUKI, Kazuma ...
Medical Journal of Shimane Prefectural Central Hospital,
2022, Volume:
46
Journal Article
Open access
From April 2010 to April 2021, we examined 12 patients（including 2 patients from other hospitals）who underwent LOC after EVAR at our hospital. During this period, the number of EVARs in our hospital ...was 234, and the LOC rate in our hospital was 4.3%（10/234 cases）. The stent grafts（SG）used were Endurant in 6 cases, Excluder in 4 cases, Zenith and AFX in 1 case each. The aortic diameter before EVAR was 57.5 ± 8.9 mm, the period from EVAR to LOC was 35.5 ± 21.6 months, and the aortic diameter before LOC was 65.3 ± 13.5 mm. The reasons for LOC were 1 case of enlargement of aneurysm due to migration, 10cases of enlargement of aneurysm due to endoleak（EL）, and 2 cases of infection（1 case was aorto-duodenal fistula）. Nine patients underwent aneurysmorrhaphy and aneurysmal neck banding. In one case of migration, the SG trunk was cut below the renal artery, the native aorta and the SG trunk were anastomosed bifurcated vascular prosthesis, and the distal vascular prosthesis was fixed with a bare stent in the SG leg. In infected cases, aneurysmorrhaphy, aneurysmal neck banding and omentopexy were performed in one case, and in aorto-duodenal fistula case, complete debridement and omentopexy around aorto-duodenal fistula and SG were performed. Of the 9 cases caused by EL, 7 cases showed aneurysm shrinkage, but 1 case remained unchanged and 1 case showed a slight enlargement. In our department, we basically performed aneurysmorrhaphy and aneurysmal neck banding with preserving SG, but it was considered that strict follow-up was required even after surgery.
Concentrations of anthropogenic radionuclides were measured in the muscle of marine mammals collected from various locations all over the world, and the global distribution of 137Cs in marine mammals ...was investigated. 40K was detected in all the specimens of marine mammals with no apparent difference between regions. An anthropogenic radionuclide, 137Cs, was detected in most of the species of marine mammals. With regard to the worldwide distribution of 137Cs, the highest concentration was noticed in the U.K. coast, followed by Lake Baikal, and decreases toward the southern sampling points. A strong positive correlation was observed between 137Cs levels in the muscle of marine mammals and the ambient seawater. Marine mammals feeding on fishes showed a higher concentration factor (CF) for 137Cs than those feeding on cephalopods. To our knowledge, this is the first report on the global distribution of 137Cs and the effect of feeding habits on the CF values of 137Cs in marine mammals.
The effectiveness of maintaining rhythm by Maze and pulmonary vein isolation（PVI） procedures, which are surgical operations for atrial fibrillation（AF）, is clear, and in addition, it has been shown to ...improve survival rate and prevent the onset of cerebral infarction. This time, we examined the late results after maze and PVI procedures at our hospital. The subjects were 77 cases from 1999 to June 2019, with 54 cases of chronic AF, 23 cases of paroxysmal atrial fibrillation, average age of 70 years, and 62％（48 cases） were male. The surgical procedure was 50 cases of biatrial maze, 19 cases of PVI, 7 cases of left atrial maze, and one case of right atrial maze. With 3 hospital deaths and 18 remote deaths, the survival rate was 96％ for 1 year, 88％ for 5 years, 71％ for 10 years, and 56％ for 15 years, which is the same as the life expectancy of 70 years old. The AF free rate at discharge was 85％, and the late AF free rate at an average observation period of 5.9 years was 63％. The AF free rate by Kaplan-Meier method decreased over time to 97％ for 1 year, 82％ for 5 years, 57％ for 10 years, and 37％ for 15 years. We compared 47 cases of remote sinus rhythm （SR） with 28 cases of AF. Univariate analysis revealed significant differences in postoperative left atrial（LA）diameter, SR at discharge, and late mortality. In multivariate analysis, the factors of remote SR were Maze procedure, postoperative LA diameter, and discharge at SR. In the ROC curve, the postoperative LA diameter of 47.5 mm was the cut-off value for maintaining SR in the remote period, and 77％ of the postoperative LA diameter of less than 47.5 mm was SR, but that of 47.5 mm or more was 44％. Anticoagulant therapy was continued in 73％ of patients after surgery, and cerebral infarction occurred in 5.5％ of 4 patients, all of whom were on anticoagulant therapy. Left atrial appendage occlusion was performed in 18 of the 20 patients who discontinued anticoagulant therapy, and no cerebral infarction occurred. Catheter ablation was performed in 4 postoperative cases, and all cases recovered to SR and were effective.
We performed thoracic endovascular aortic repair（TEVAR）for 33 type B aortic dissection at our institution from April 2011 to August 2019. The average age was 71 years old, and there were 21 men and ...12 women. The average interval of aortic dissection onset to TEVAR was 1,500 days（0-7,944 days） . We divided them into two groups of the E group within six months（17 cases）and the L group more than six months（16 cases）as for an interval of aortic dissection onset to TEVAR. There were two hospital death, three cerebral infarction and one paraparesis. There was no aorta-related death of the E group at remote period, and aorta-related death free rate of the L group was good with 94% at five years. Reintervention free rate at five years was 68% in the E group and 31% in the L group. The pre- and postoperative aortic maximum diameter（average）reduced from 49.7mm to 42.6mm in the E group, but enlarged it from 58.9mm to 61.7mm in the L group. The shrinkage and disappearance of false lumen was significantly provided in the E group than in the L group. The strict follow-up and various kinds of additional procedures were necessary in the cases that false lumen was not thrombosed completely and dilated after the closure of primary entry with TEVAR for double barrel type of chronic aortic dissection.
