Background: Heterotaxy syndrome associated with functional single ventricle and extracardiac total anomalous pulmonary venous connection (TAPVC) is characterized by high operative risks and has high ...mortality rate. Treatment strategies to address these risks remain uncertain.Methods: This retrospective study included 16 patients with heterotaxy syndrome and functional single ventricle and TAPVC who underwent TAPVC repair between 2003 and 2023. The patients were divided into two groups according to the time of TAPVC repair and the type of repair technique Used. The actuarial survival and freedom from reoperation for pulmonary venous obstruction were compared.Results: Actuarial survival differed significantly between the two groups (early group: 38.5% vs. late group: 100% at 1 year, p < 0.05). A comparison of TAPVC repair techniques revealed higher freedom from reoperation for pulmonary venous obstruction in the primary sutureless technique group (n = 6) than in the conventional repair technique group (100% vs. 63 % at 1 year, p = 0.15).Conclusion: Improved surgical outcomes by delaying surgical TAPVC repair and using primary sutureless technique for initial TAPVC repair, if possible.
Bioprosthetic aortic valves have limited durability. We herein report sudden progression of structural valve deterioration (SVD) and a successful case of emergency transcatheter aortic valve (TAV) ...implantation for acute decompensated heart failure (ADHF) caused by SVD. A 79-year-old man who had undergone a Bentall operation 11 years prior was diagnosed with ADHF due to suddenly progressive SVD. Emergency TAV implantation in the surgical bioprosthetic valve was selected based on the surgical risk. Ours and previous case reports suggest that SVD can progress suddenly, even after months of stability, and that emergency TAV implantation is effective.
Key Clinical Message
Acute valve thrombosis after bioprosthetic aortic valve replacement even under anticoagulation therapy is extremely rare. Cardiac computed tomography is a powerful imaging tool ...to detect valve thrombosis, and surgery is necessary in case of unstable hemodynamics.
Key Clinical Message
Deep femoral artery aneurysms (DFAA) are extremely rare. We treated four DFAAs with different procedures including surgical, endovascular, and hybrid surgery. The best treatment ...should be selected for each individual case.
We report three cases of deep femoral artery aneurysms treated with different techniques. Case 1: A 69‐year‐old man with a huge deep femoral artery aneurysm underwent open reconstruction using a 6 mm expanded polytetrafluoroethylen graft. Case 2: A 67‐year‐old man presented with bilateral deep femoral artery aneurysms. The right‐sided rupture was treated with hybrid embolization, while the left aneurysm was treated by endovascular stent‐grafts deployment. Case 3: A 87‐year‐old man with a large deep femoral artery aneurysm underwent simply surgical aneurysmectomy. As there are many treatment options for deep femoral artery aneurysms, a comprehensive preoperative assessment is essential, encompassing an evaluation of symptoms, anatomy, and comorbidities.
The Rastelli procedure is indicated for repair of tetralogy of Fallot (TOF) with pulmonary atresia. However, currently, there are no criteria available for concomitant surgical ...intervention for an enlarged ascending aorta in infancy. We report a rare case of TOF with pulmonary atresia complicated by severe enlargement of the ascending aorta in a girl aged 2 years and 5 months. We performed the Rastelli procedure with ascending aorta replacement. Pathological findings of the ascending aorta included fragmentation of elastic fibers and loss of smooth muscle cells. Postoperatively, the patient remained healthy and asymptomatic. This case indicates that ascending aortic enlargement in conotruncal anomalies may be associated with pathological lesion even in early childhood. Replacement of the diseased aorta could be considered as a concomitant procedure with definitive repair for conotruncal anomalies presenting with severe ascending aortic enlargement.
Abstract Background End-diastolic forward flow (EDFF) is recognized as restrictive right ventricular physiology (r-RVP), but conflicting results have been reported about effects on the clinical ...outcome in repaired tetralogy of Fallot (r-TOF). Objectives We hypothesized that the EDFF by Doppler was not specific for diagnosing r-RVP. Methods Sixty-two consecutive patients aged 15.7 ± 11.6 years who underwent cardiac catheterization were studied. Patients were divided according to the presence of EDFF (group 1: EDFF +, group 2: EDFF −) and RV size (group A: small RV, group B: large RV > 150 ml/m2 ). Results Group 1 ( n = 23) had higher a right atrial pressure (RAP), pressure gradient between the RAP and pulmonary diastolic pressure (PDP), and atrial natriuretic peptide (ANP) levels than group 2. Four patients (17.4%) in group 1 and 89.7% of patients in group 2 had a normal RAP range (a wave < 10 mm Hg). There were no differences in the RV volume, ejection fraction (EF), B-type natriuretic peptide levels, and severity of pulmonary regurgitation (PR) between groups 1 and 2. Group A had better RV and LVEF than group B, as well as a smaller LV size. The RAP in subgroup 1A was higher than that of the other 3 subgroups. Subgroup 1B had a similar RAP to group 2, and a lower PDP and a more severe PR than subgroup 1A. Conclusions Patients with EDFF are associated with increased ANP levels. The presence of EDFF may not be specific for r-RVP, since it is observed in some TOF patients with low PDP (severe PR) and normal RAP.
Recently, several centers have performed total arch replacement using the fenestrated frozen elephant trunk technique for acute Stanford type‐A aortic dissection. However, the long‐term results and ...need for additional treatment following this procedure are unclear. We report a case of a 54‐year‐old man who underwent endovascular therapy for endoleaks after total arch replacement using the fenestrated frozen elephant trunk technique for acute type‐A aortic dissection with an isolated left vertebral artery. After the surgery, the endoleak was resolved, and the patient was asymptomatic with no neurological deficits. This strategy might be effective in similar cases.
When endoleak occur after TAR using the fenestrated frozen elephant trunk technique in patients with rare anatomical subtypes, collaboration with other experts facilitates additional treatment.
Cor triatriatum is a rare cardiac anomaly sometimes associated with tetralogy of Fallot (TOF) and persistent left superior vena cava (PLSVC). We present the case of a 2-year-old girl who was ...diagnosed with a unique form of cor triatriatum that was associated with TOF and PLSVC. In this case, the abnormal membrane that arose from the posterior wall of the left atrium encircled the left superior vena cava (LSVC) in the left atrial cavity. Here, we discuss this rare case as well as the imaging studies and surgical strategy adopted.
We report a case in which the common trunk of the left pulmonary vein was injured incidentally due to a misunderstanding of the anatomy. After cutting the trunk, we recognized that the vessel ...included not only the superior but also the inferior component of the pulmonary vein. The cut end of the trunk and the left atrium were successfully anastomosed without any surgical morbidity. Although we retrospectively determined that the common trunk was visualized on preoperative computed tomography, we missed this finding during the preoperative evaluation. Furthermore, because we used the endostapler to cut the vessel, exposure of the pulmonary hilum was too short to identify the anomaly correctly. In the era of the endoscopic devices, exposure of the anatomical structures at surgery has become more limited, resulting in a tendency to misunderstand the anatomy during surgery. Because the common trunk of the left pulmonary vein occurs in 14% of patients demonstrating anatomical variations, thoracic surgeons should be aware of this type of anomaly not only before but also during surgery, and meticulous intraoperative confirmation of the vascular anatomy is required when using endoscopic devices.
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