Annals of Thoracic and Cardiovascular Surgery
Online ISSN : 2186-1005
Print ISSN : 1341-1098
ISSN-L : 1341-1098
Advance online publication
Showing 1-41 articles out of 41 articles from Advance online publication
  • Chika Nakashima, Hiroaki Harada, Satoshi Shibata
    Article ID: cr.19-00145
    Published: 2019
    [Advance publication] Released: September 20, 2019
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    Spontaneous hemothorax caused by the rupture of a benign schwannoma has rarely been reported. Herein, we present the successful excision of an extremely rare case of mediastinal ancient schwannoma causing intrathoracic bleeding. A 27-year-old man was admitted to our emergency department because of back pain and dyspnea. Computed tomography revealed massive pleural effusion with a posterior mediastinal tumor. We performed a resection of the tumor which had ruptured, and the tumor was diagnosed as an ancient schwannoma.

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  • Yang Gao, Shubin Li, Xijing Zhuang, Feng Gao, Lei Shi, Xu Meng
    Article ID: oa.19-00132
    Published: 2019
    [Advance publication] Released: September 06, 2019
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    Background: Function tricuspid regurgitation (TR) is frequently observed in patients undergoing mitral valve surgery. It is unclear that mitral valve repair (MVr) or mitral valve replacement (MVR) has influence on the likelihood of late TR progression.

    Methods: This study included 193 patients with degenerative mitral valve disease who underwent either MVr or MVR. Detailed preoperative materials, follow-up information, and echocardiographic data were collected and statistically analyzed.

    Results: At 6 and 12 months postoperatively, MVR patients were more likely to have New York Heart Association (NYHA) class III or IV symptoms than MVr patients (6 mo: 15.2% vs 5.0%, 12 mo: 13.0% vs 4.0%, both P <0.05). At 24 months, the incidence of Grade 1+ TR was significantly higher in MVR patients than MVr patients (25.0% vs 12.9%, P <0.05). In univariate analysis, age (odds ratio [OR] = 1.036, P = 0.036), MVR (OR = 2.256, P = 0.033), and preoperative TR area (TRA; OR = 1.541, P = 0.047) were significant predictors for TR progression. In multivariate logistics analysis, only MVR was independently risk factor (P = 0.006). Subsequently, patients were divided into tricuspid valve repair (TVr) group and untreated group. In both subgroups, MVR patients were associated with significantly larger TRA (P <0.01).

    Conclusion: MVR was an independent risk factor for TR progression, whether tricuspid valve was treated or not.

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  • Robert Tonks, Gurion Lantz, Jeremy Mahlow, Jeffrey Hirsh, Lawrence S. ...
    Article ID: oa.19-00164
    Published: 2019
    [Advance publication] Released: September 06, 2019
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    Purpose: The Convergent procedure is a hybrid, multidisciplinary treatment for symptomatic atrial fibrillation (AF) consisting of minimally invasive surgical epicardial ablation and percutaneous/catheter endocardial ablation. We investigated outcomes following introduction of the Convergent procedure at our institution.

    Methods: Retrospective study examining single-center outcomes. Demographic, procedural, and post-procedural variables were collected with follow-up data obtained at 3, 6, and 12 months.

    Results: In all, 36 patients with paroxysmal (11%) or persistent/long-standing persistent (89%) AF underwent the Convergent procedure. 36% also underwent concomitant left atrial appendage (LAA) exclusion by thoracoscopic placement of an epicardial clip. Mean age 60.6 ± 8.0 years with mean arrhythmia burden of 3.9 ± 2.7 years. All patients had failed prior attempts at medical management, 81% had failed prior cardioversion, and 17% had failed prior catheter ablation. Convergent was performed successfully in all patients with no peri-procedural deaths or major complications. At 3 and 12 months, 77.8% and 77.3% of patients, respectively, were free from symptomatic arrhythmia. 65.8% were off anti-arrhythmic medication at 12 months.

    Conclusions: The Convergent procedure is safe and has good short- and intermediate-term clinical success rates. This unique hybrid approach combines strengths of surgical and catheter ablation and should be part of any comprehensive AF treatment program.

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  • Masahide Komagamine, Tomohiro Nishinaka, Yuki Ichihara, Satoshi Saito, ...
    Article ID: oa.19-00192
    Published: 2019
    [Advance publication] Released: August 26, 2019
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    Purpose: Immunosuppressant and steroid are inevitable for graft survival after renal transplantation, and their usage is known to be a risk factor for mortality and morbidity after cardiac surgery. We evaluated the long-term clinical outcomes in patients who underwent cardiac surgery after renal transplantation.

    Methods: We retrospectively reviewed 23 patients who underwent cardiac surgery after renal transplantation with maintained grafts at the time of the cardiac surgery in our institution between June 2000 and June 2018 (19 males, 4 females; mean age, 55 (38–81) years).

    Results: The interval from renal transplantation to cardiac surgery was 80.0 ± 84.6 (0.25–298) months. The mean follow-up period after cardiac surgery was 78.3 (range: 1–216) months. Cumulative survival rates at 1, 5, 7, and 10 years were 95.7%, 95.7%, 87.7%, and 68.2%, respectively. Renal graft survival rates at 1 and 5 years were 86.1% and 79.9%, respectively.

    Conclusions: This retrospective review suggests that cardiac surgery in kidney transplant patients can result in good survival rates. Thanks to dedicated postoperative and long-term management, approximately 80% of the renal grafts still maintained their function 5 years after cardiac surgery.

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  • Daisuke Sato, Sohei Hayashi, Shozo Sakata, Riken Kawachi, Mie Shimamur ...
    Article ID: cr.19-00154
    Published: 2019
    [Advance publication] Released: August 23, 2019
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    Mediastinal ectopic goiter is a thyroid tumor that lies entirely below a plane extending from the superior surface of the first thoracic vertebra to the suprasternal notch, and commonly lies in the vicinity of the thymus. Intrapericardial ectopic goiter is extremely rare. We present an extremely rare case of a 63-year-old woman with an intrapericardial ectopic goiter and review the pertinent literature.

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  • Kohei Hachiro, Takeshi Kinoshita, Tohru Asai, Tomoaki Suzuki
    Article ID: oa.19-00141
    Published: 2019
    [Advance publication] Released: August 07, 2019
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    Background: There is no clear finding on the course of coexisting aortic regurgitation (AR) after treatment of mitral regurgitation (MR). We investigated the effect of mitral surgery for MR on coexisting AR.

    Methods: Between January 2008 and December 2016, 75 patients underwent mitral surgery for MR coexisting mild AR. Of these, 65 patients who were available to follow-up postoperative echocardiographic tests 1 year after surgery were included in the present study. Patients were divided into two groups according to the degree of postoperative AR. We investigated the predictive factors for continued AR and perioperative cardiac function.

    Results: In all, 22 patients’ AR improved and became less than mild and 43 patients’ persisted at mild or increased. The predictive factor for continued AR was left atrial diameter >50 mm (P = 0.021, odds ratio = 4.739, 95% confidence interval: 1.259–17.846) in multivariate logistic regression analysis. No patients underwent reoperation for continued AR in both groups. However, one patient was rehospitalized for heart failure in the continued AR group.

    Conclusion: Left atrial diameter may be an important prognostic factor for continued AR after mitral surgery for MR. MR with mild AR should be treated as soon as before the left atrium expands.

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  • Fei Li, Zeping Huang, Yuetang Wang, Xinshuang Ren, Minghui Tong, Jie Z ...
    Article ID: oa.18-00287
    Published: 2019
    [Advance publication] Released: August 02, 2019
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    Purpose: Our study aimed to investigate the potential pathogenetic theories of different phenotype prevalence in bicuspid aortopathy.

    Methods: A total of 407 bicuspid aortic valve (BAV) patients with aortic dilation were retrospectively reviewed. Association was determined between aortic valve lesion types and aortic configurations to confirm the homogeneous BAV subsets, and then, dominance analysis was used to evaluate the relative importance of two components of aortic valve lesion (BAV phenotype and valvular dysfunction) that associated with aortic configurations in each subgroup.

    Results: Dominance analysis showed that Type-1 LR was the dominant contributor (79.0% and 79.6%) associated with the higher prevalence of the dilation of aortic root (AoR) and ascending aorta (AAo) in BAV patients with Type-1 LR and aortic regurgitation (AR) or aortic stenosis (AS) + AR. However, AS was the main contributor (60.0%) associated with the raised incidence of the dilation of AAo and proximal aortic arch (PArc) in Type-0 LAT and AS.

    Conclusions: Different dominant pathogenetic theory determined the phenotype of BAV aortopathy. In patients of Type-1 LR with AR, inherent disposition is mainly responsible for the higher frequency of AoR dilation. Valve-related hemodynamics determined greater prevalence of the dilation of AAo and PArc in patients of Type-0 LAT with AS.

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  • Ryo Suzuki, Akihito Mikamo, Yuutaro Matsuno, Akira Fujita, Hiroshi Kur ...
    Article ID: oa.19-00106
    Published: 2019
    [Advance publication] Released: July 24, 2019
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    Background: Intraoperative predonated autologous blood transfusion is thought to replenish platelets and coagulation factors and ameliorate coagulopathy. This study aimed to evaluate whether intraoperative predonated autotransfusion improves coagulopathy during thoracic aortic surgery.

    Methods: Patients who underwent thoracic aortic surgery were randomized into two groups as follows: those who received intraoperative predonated blood (group A: n = 31) and those who did not receive (group N: n = 22). In group A, autologous blood was retransfused immediately after cessation of cardiopulmonary bypass (c-CPB).

    Results: The mean intraoperative allogenic blood or blood product transfusion requirements were significantly lesser in group A than in group N (packed red blood cells [RBCs]: 6.3 ± 5.1 vs. 9.1 ± 4.3 units, p = 0.04; fresh frozen plasma [FFP]: 3.0 ± 4.1 vs. 6.1 ± 5.7 units, p = 0.03). After c-CPB, hemoglobin (Hb) level, platelet count, and coagulopathy became significantly worse than those at the start of surgery in both the groups. However, the values significantly improved 30 min after c-CPB only in group A. Renal function was significantly worse in group N.

    Conclusions: Intraoperative predonated autotransfusion significantly improved coagulopathy, with reduced allogeneic blood transfusion volume during thoracic aortic surgery. Furthermore, reduction of allogeneic blood transfusion may reduce the adverse effects on renal function.

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  • Koji Kawago, Toshiya Nishibe, Shunya Shindo, Hidenori Inoue, Shinya Mo ...
    Article ID: oa.19-00128
    Published: 2019
    [Advance publication] Released: July 18, 2019
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    Purpose: This study aimed to assess whether hangekobokuto (HKT) can prevent aspiration pneumonia in patients undergoing cardiovascular surgery.

    Methods: We performed a single-center, double-blinded, randomized, placebo-controlled study of HKT in patients undergoing cardiovascular surgery. JPS HKT extract granule (JPS-16) was used as HKT. The primary endpoint was defined as the prevention of postoperative aspiration pneumonia. The secondary endpoints included complete recovery from swallowing and coughing disorders.

    Results: Between August 2014 and August 2015, a total of 34 patients were registered in this study. The rate of subjects with postoperative aspiration pneumonia was significantly lower in the HKT group than in the placebo group (p = 0.017). In high-risk patients for aspiration pneumonia, the rate was significantly lower in the HKT group than in the placebo group (p = 0.015). The rate of subjects with swallowing disorders tended to be lower in the HKT group than in the placebo group (p = 0.091), and in high-risk patients, the rate was significantly lower in the HKT group than in the placebo group (p = 0.038).

    Conclusions: HKT can prevent aspiration pneumonia in patients undergoing cardiovascular surgery. In high-risk patients for aspiration pneumonia, HKT can prevent aspiration pneumonia and improve swallowing disorders.

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  • Hakan Saclı, Ibrahim Kara, Mevriye Serpil Diler, Bilal Percin, Ahmet I ...
    Article ID: oa.18-00293
    Published: 2019
    [Advance publication] Released: July 12, 2019
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    Purpose: In this study, we aimed to assess myocardial protection and ischemia–reperfusion injury in patients undergoing open heart surgery with isothermic blood cardioplegia (IBC) or hypothermic blood cardioplegia (HBC).

    Materials and Methods: A total of 48 patients who underwent isolated coronary artery bypass grafting or isolated mitral valve surgery between March 2017 and October 2017 were evaluated as randomized prospective study. Study groups (HBC: Group 1, IBC: Group 2) were compared in terms of interleukin 6 (IL-6), IL-8, IL-10, and complement factor 3a (C3a) levels, metabolic parameters, creatine kinase-muscle/brain (CK-MB) and high-sensitivity Troponin I (hsTn-I), and clinical outcomes.

    Results: Comparison of the markers of ischemia–reperfusion injury showed significantly higher levels of the proinflammatory cytokine IL-6 in the early postoperative period as well as IL-8, in Group 2 (p <0.001), whereas the anti-inflammatory cytokine IL-10 was significantly higher during the X1 time period (p = 0.11) in Group 2, and subsequently it was higher in Group 1. Using myocardial temperature probes, the target myocardial temperatures were measured in the patients undergoing open heart surgery with different routes of cardioplegia, and significant differences were noted (p = 0.000).

    Conclusion: HBC for open heart surgery is associated with less myocardial injury and intraoperative and postoperative morbidity, indicating superior myocardial protection versus IBC.

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  • Baburhan Ozbek, Nursen Tanrikulu
    Article ID: oa.18-00309
    Published: 2019
    [Advance publication] Released: July 12, 2019
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    Purpose: Different surgical procedures were defined due to degree of Ebstein anomaly. In this study, we are reporting our surgical experience of adult patients with Ebstein anomaly.

    Methods: We analyzed the patients, who had operated with the diagnosis of Ebstein anomaly from March 2011 through February 2018, retrospectively. We evaluated patients in two groups: patients with cone type surgical repair were in Group 1 and patients with other surgical (Danielson, Carpentier) procedures were in Group 2.

    Results: There were 23 patients in the study; 9 (39%) were in Group 1 and 14 (61%) were in Group 2. In the comparison of preoperative data, groups were statistically similar. Aortic cross clamp and cardiopulmonary bypass (CPB) times, need for inotropic agents, intubation time, postoperative >2 tricuspid regurgitation incidence, intensive care unit, and hospital staying times were statistically significantly higher in Group 2. There was one mortality (4.3%) in Group 2 due to sepsis.

    Conclusion: Cone type repair can safely be performed in the repair of Ebstein anomaly with acceptable results. Our results are encouraging to prefer this technique as one of the first-line treatment of Ebstein anomaly. However, further randomized controlled studies are recommended to evaluate the efficacy of this surgical procedure.

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  • Hai-Yan Guo, Xiao-Qing Pan, Ming Hu, Yong-Feng Liang, Xin-Cai Qiu, Zhe ...
    Article ID: oa.19-00017
    Published: 2019
    [Advance publication] Released: July 04, 2019
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    Purpose: This study aims to compare the effects and prognosis of medical thoracoscopy-assisted argon plasma coagulation (APC) combined with electrosurgical unit (ESU) surgery, video-assisted thoracic surgery (VATS), and pleurodesis surgery, in providing appropriate treatment for elderly refractory pneumothorax patients.

    Methods: Patients with refractory pneumothorax aged over 65 years were divided into three groups: APC combined with ESU (N = 20), VATS (N = 26), and pleurodesis (N = 24). Data on demographic characteristics, lung function evaluation, and short- and long-term prognoses were collected.

    Results: Following surgery, compared with the APC-ESU and pleurodesis groups, patients in the VATS group demonstrated poor short-term prognoses, with high pleural effusion drainage levels and high visual analog scores (VAS; P <0.05). After the surgery, St. George’s Respiratory Questionnaire (SGRQ) scores in the pleurodesis group were slightly elevated, whereas SGRQ scores in both the APC-ESU and VATS groups demonstrated a continual decrease. Finally, medical resource consumption analysis demonstrated a significant difference in hospitalization costs among the three groups; the VATS group being the most expensive.

    Conclusion: Medical thoracoscopy-assisted APC combined with ESU is a safe, effective, and affordable treatment for elderly patients with refractory pneumothorax.

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  • Katsunari Matsuoka, Tetsu Yamada, Takahisa Matsuoka, Shinjiro Nagai, M ...
    Article ID: oa.19-00080
    Published: 2019
    [Advance publication] Released: July 04, 2019
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    Purpose: Smoking is reported to be a risk factor for postoperative complications. However, there is no consensus regarding the length of time for which patients need to give up smoking. Therefore, we examined the relationship between preoperative smoking status and postoperative complications in patients who underwent lobectomy for treatment of lung cancer.

    Methods: Between January 2009 and December 2014, 1380 patients underwent lobectomy for lung cancer at our institution. After excluding patients who had undergone induction therapy, 1248 patients were enrolled in this study. We examined the relationship between postoperative complications and preoperative smoking habitation.

    Results: Among the enrolled patients, 1210 (97%) underwent video-assisted thoracoscopic lobectomy and 38 (3%) underwent lobectomy via open thoracotomy. The incidence of postoperative complications was higher in smokers than in nonsmokers, and the frequency of respiratory-related complications increased along with the number of pack-years. However, there was no relationship between the length of the preoperative smoking cessation period and the frequency of postoperative complications.

    Conclusion: The risk of postoperative complications does not increase even if smoking is continued within 2 weeks before surgery. It seems unnecessary to delay the timing of surgery to allow patients to cease smoking, especially those scheduled for thoracoscopic surgery.

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  • Eiji Nakajima, Hidenobu Takashi, Osamu Taira, Kentarou Fukuda, Kinya F ...
    Article ID: cr.19-00081
    Published: 2019
    [Advance publication] Released: June 12, 2019
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Glomus tumors originate from a neuroarterial structure called the glomus body, and grow mostly in soft tissue. It is rare for glomus tumors to develop in the respiratory system. The patient of the present case had an abnormal shadow in the right lung on chest X-ray, and computed tomography (CT) findings displayed a lung tumor in the right S6. Bronchoscopy was performed for the diagnosis of the lung tumor, and a polypoid bronchial tumor was unexpectedly found to occupy the right B3. The bronchial tumor was diagnosed as a glomus tumor, and the lung tumor was diagnosed as an adenocarcinoma. The bronchial glomus tumor was cauterized by argon plasma coagulation (APC). Three weeks after the cauterization by APC, the right lower lobectomy was performed for the treatment of the lung adenocarcinoma. The patient has remained disease free for 2 years.

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  • Hasan Ersoz
    Article ID: oa.19-00056
    Published: 2019
    [Advance publication] Released: June 12, 2019
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    Purpose: We performed an experimental study comparing different suture techniques in trachea anastomoses using the ex vivo sheep model, which deals with the parameters that suture tension, air leakage, intraluminal pressure, and tension at which the anastomosis will rupture. We aimed to find an answer to “Which suture technique should be used in tracheal anastomoses?”

    Methods: In all, 45 sheep tracheas were randomly divided into three groups (each n = 15) differing in suture technique for anastomoses: single stitches, mixed, and continuous suture. The anastomoses were evaluated for air leakage under normal (25 mbar) and high (70 mbar) intraluminal pressures without tension. Then, air leakage was followed under high intraluminal pressure with tensile stress. Tension levels of dehiscence were also recorded. Data were statistically evaluated.

    Results: No air leakage was observed at 25 mbar intraluminal pressure. At 70 mbar pressure without tension, no statistically significant difference was found among the groups (p >0.05). However, single-stitch technique was the best in terms of air leakage tension and rupture tension levels (p <0.05).

    Conclusion: The most reliable and advantageous is single-stitch technique for a tracheal anastomosis in short-term results. Further studies are needed to analyze longer ventilation periods in terms of other serious complications as ischemic dehiscence and stenosis.

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  • Hiroaki Komatsu, Nobuhiro Izumi, Takuma Tsukioka, Hidetoshi Inoue, Hik ...
    Article ID: oa.19-00075
    Published: 2019
    [Advance publication] Released: June 12, 2019
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    Purpose: To evaluate prognosis of patients with esophageal carcinoma undergoing pulmonary metastasectomy, and help determine appropriate therapeutic strategies.

    Methods: We retrospectively studied 16 patients (15 men and one woman; median age 66.5 years) with esophageal carcinoma, who underwent curative resection of pulmonary metastases. Clinical characteristics and surgical outcomes were analyzed.

    Results: In all, 11 patients underwent wedge resection, three segmentectomy, and two lobectomies. The average operating time and blood loss were 147 min and 103 mL, respectively. There were no perioperative deaths or severe complications. Five-year overall survival rate was 40.2% and 2-year disease-free survival rate was 35.2%. All recurrences occurred within 2 years. Univariate and multivariate analyses revealed that absence of adjuvant chemotherapy after therapy for esophageal carcinoma was a significant predictor of poor prognosis and recurrence, respectively (p <0.05). The prognosis of seven patients who underwent esophagectomy with adjuvant chemotherapy was better than that of the other nine patients (p = 0.0166).

    Conclusion: Pulmonary metastasectomy in patients with esophageal carcinoma was only one choice of multimodal treatment, and perioperative chemotherapy was important for long-term survival after pulmonary metastasectomy. Pulmonary metastasectomy was effective in patients undergoing esophagectomy with adjuvant chemotherapy.

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  • Shigeto Nishikawa, Toshi Menju, Koji Takahashi, Ryo Miyata, Makoto Son ...
    Article ID: oa.19-00078
    Published: 2019
    [Advance publication] Released: June 12, 2019
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Purpose: Src family tyrosine kinases, including Fyn, are non-receptor tyrosine kinases that drive malignancy in various kinds of cancers. Fyn has also been suggested to be an effector of epidermal growth factor receptor (EGFR) signaling, and is recognized as a potential therapeutic target. However, little is known about the clinical importance of phosphorylated Fyn (pFyn) in lung adenocarcinoma. The purpose of this study is to examine the prognostic significance of pFyn in this disease.

    Methods: A total of 282 lung adenocarcinoma specimens were collected from patients who underwent surgery at our institute. A tissue microarray was assembled from paraffin-embedded tumor blocks. pFyn expression was analyzed through immunostaining of the tissue microarray and each case was classified as positive or negative. The association of clinical information with pFyn expression was analyzed statistically.

    Results: pFyn was positive in 107 cases. A pFyn-positive status was significantly associated with male gender, p53 mutant, pathological stage, tumor size, plural invasion, lymphatic invasion, vascular invasion, and differentiation. pFyn positivity was associated with poor relapse-free survival (RFS; hazard ratio [HR]: 2.11, 95% confidence interval [CI]: 1.32–3.42, p <0.01) and poor overall survival (OS; HR: 1.95, 95% CI: 1.17–3.33, p = 0.01).

    Conclusion: pFyn expression may affect the prognosis of patients with lung adenocarcinoma after lung resection.

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  • Yutaka Miyawaki, Hiroshi Sato, Hideki Yokogawa, Shinichi Sakuramoto, K ...
    Article ID: cr.19-00041
    Published: 2019
    [Advance publication] Released: May 14, 2019
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    The progress and popularization of microvascular surgical techniques may improve the outcomes of esophageal reconstruction using non-gastric tube (GT) grafts. A pedicled jejunum (PJ) with microvascular anastomoses is frequently selected as a reconstructed conduit for esophageal reconstruction when the GT is unavailable, and the internal thoracic (IT) vein is frequently selected as a recipient blood vessel for microvascular anastomosis. However, the IT vein may be inadequate for microvascular anastomosis because of its absence or underdevelopment. Since it is difficult to preoperatively predict such rare cases, it becomes necessary to urgently and rapidly prepare an alternative blood vessel. Herein, we present surgical procedures for superdrainage using the cephalic vein (CeV). Due the superficial nature of the CeV, it is both easy to identify and collect sufficient length. Thus, the CeV is very useful as an urgent substitute blood vessel when the IT vein is unavailable for microvascular anastomosis in esophageal reconstruction.

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  • Kenshi Yoshimura, Hideyuki Tanaka, Tomoyuki Wada, Takashi Shuto, Madok ...
    Article ID: cr.18-00081
    Published: 2019
    [Advance publication] Released: May 09, 2019
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    In 2002, a 37-year-old male with Marfan syndrome underwent the Bentall operation, total arch replacement, and aortobifemoral bypass for DeBakey type IIIb chronic aortic dissection, annuloaortic ectasia, and aortic regurgitation. In 2007, mild mitral regurgitation (MR) caused by mitral valve prolapse was identified. In April 2017, echocardiography revealed the worsening of MR and moderate tricuspid regurgitation (TR). Moreover, coronary angiography (CAG) revealed a coronary artery aneurysm in the left main trunk (LMT). In August 2017, the patient underwent mitral valve replacement (MVR), tricuspid annuloplasty (TAP), and coronary artery reconstruction. We reconstructed the LMT aneurysm using an artificial graft. True aneurysm of the coronary artery complicated with Marfan syndrome is a rare complication that has seldom been reported. This case highlights that it is essential to carefully follow-up patients with Marfan syndrome after the Bentall operation.

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  • Haruhiko Shiiya, Yasuhiro Suzuki, Shigeo Yamazaki, Kichizo Kaga
    Article ID: cr.18-00275
    Published: 2019
    [Advance publication] Released: March 11, 2019
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    We describe a 36-year-old asymptomatic female with multiple bronchial artery aneurysms (BAAs) and a bronchial artery (BA) to pulmonary artery (PA) fistula. She was treated with thoracoscopic BA resection without lobectomy in lieu of catheter embolization as first-line treatment. The configuration of the BA and the location of the BAAs were clearly visualized using three-dimensional computed tomography (3DCT); therefore, the segment of the BA to resect was assessed preoperatively and complete resection of all BAAs was performed. Preoperative BA angiography delineated the BA to PA fistula, and guided surgical decision-making.

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  • Yusuke Misumi, Toru Kuratani, Koichi Maeda, Koichi Toda, Shigeru Miyag ...
    Article ID: cr.18-00201
    Published: 2018
    [Advance publication] Released: December 18, 2018
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    Transcatheter aortic valve implantation (TAVI) through a peripheral arterial access is often complicated by concomitant arteriopathy. We describe here the first successful case of TAVI through the carotid artery in Japan. The patient was an 83-year-old woman with severe aortic stenosis (AS). Preoperative computed tomography (CT) revealed a shaggy distal aortic arch and left subclavian artery ostium, along with severely calcified bilateral iliofemoral arteries. Trans-apical and direct aortic approaches were abandoned because of frailty. Following the thorough cerebrovascular assessment, the left common carotid artery was selected for arterial access and a CoreValve transcatheter aortic valve was successfully implanted without neurologic complications.

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  • Andre Critsinelis, Chitaru Kurihara, Masashi Kawabori, Tadahisa Sugiur ...
    Article ID: cr.18-00082
    Published: 2018
    [Advance publication] Released: August 28, 2018
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    Mechanical circulatory support may result in sufficient myocardial recovery to allow for explantation of the left ventricular assist device (LVAD). The duration of support associated with left ventricular recovery has generally been 6–12 months. In this report, we present a patient in whom the left ventricle recovered after 5 years of support with a LVAD. Our report demonstrates that long-term monitoring for left ventricular recovery is prudent and may allow for late device explantation.

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  • Tadahisa Sugiura, Chitaru Kurihara, Masashi Kawabori, Andre C. Critsin ...
    Article ID: cr.18-00021
    Published: 2018
    [Advance publication] Released: August 10, 2018
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    An increasing number of children with congenital heart disease are surviving into adulthood and subsequently developing end-stage heart failure. Two example populations are adults who have been previously operated on for congenitally corrected transposition of the great arteries (CCTGA) and transposition of the great arteries (TGA). Implantation of a continuous flow left ventricular assist device (CF-LVAD) in these patients can present unusual anatomical and physiologic challenges. In this report, we describe outcomes of CF-LVAD implantation in three such patients. These cases demonstrate the feasibility of implanting a CF-LVAD in patients who have undergone surgery for CCTGA and/or TGA.

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  • Yoshimori Araki, Chikao Teramoto, Yasunobu Konishi, Takafumi Terada, O ...
    Article ID: cr.18-00094
    Published: 2018
    [Advance publication] Released: August 09, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    We present a case of left ventricular outflow tract (LVOT) obstruction after double valve re-replacement with bioprostheses. A 72-year-old man, who had undergone double valve replacement (DVR) with bioprosthetic valves 9 years previously, underwent re-replacement of valves because of structural valve deterioration. However, owing to LVOT obstruction related to the bioprosthesis in the mitral position, acute pulmonary edema occurred immediately after surgery. LVOT obstruction was diagnosed by emergent cardiac catheterization. So prompt re-replacement surgery using a mechanical prosthesis was performed.

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  • Masahide Enomoto, Takeshi Kinoshita, Yasuo Kondo, Tomoaki Suzuki, Tohr ...
    Article ID: cr.17-00241
    Published: 2018
    [Advance publication] Released: June 21, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    We present the case of a 61-year-old patient with a history of essential thrombocythemia (ET) who was diagnosed as having aortic valve stenosis and dilatation of his ascending aorta. His aortic valve and ascending aorta were replaced under hypothermic circulatory arrest (HCA). No clear guideline exists for preoperative, perioperative, and postoperative management of cardiac surgery using HCA for ET patients. After performing risk assessment, we prescribed preoperative aspirin therapy and postoperative care was planned as usual for cardiovascular surgery in our establishment. Unexpectedly, activated clotting time did not exceed 400 seconds, but the course of treatment was otherwise uneventful.

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  • Hirofumi Kasahara, Takashi Hachiya, Atsuo Mori
    Article ID: cr.18-00020
    Published: 2018
    [Advance publication] Released: June 12, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Spontaneous rupture of the thoracic aorta is rare. We present a 76-year-old man who developed spontaneous rupture of the aortic arch associated with massive periaortic hematoma and hypovolemic shock. Because the site of rupture could not be identified, emergency hybrid endovascular aortic repair to shield a long segment of the aorta was performed according to the extent and density of periaortic hematoma on axial CT scans. His blood pressure improved just after deployment of the endograft. Rapid diagnosis by CT and prompt control of aortic hemorrhage by endografting salvaged this patient. Three-dimensional (3D) volume-rendered CT images are useful for identifying the site of aortic rupture, but may not be available in an emergency.

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  • Takahiro Yanagihara, Hideo Ichimura, Keisuke Kobayashi, Yukio Sato
    Article ID: cr.18-00077
    Published: 2018
    [Advance publication] Released: June 01, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Esophagobronchial fistula (EBF) caused by an esophageal foreign body is rare in adults. All surgical interventions in the reported cases were performed via right thoracotomy. We have successfully treated an 88-year-old woman with EBF caused by a thick 2 × 2 cm piece of cake decorating paper that was swallowed accidentally. There was a 2-month interval between ingestion of the foreign body and correct diagnosis. The bronchial opening of the EBF was on the cephalic wall of the proximal left main bronchus (LMB), so we planned a primary repair of the bronchial wall with sutures via left thoracotomy. We performed a division of the fistula and primary closure of the openings on the esophageal and bronchial walls and covered the suture sites with an intercostal muscle flap and pericardial fat, respectively. The patient resumed oral intake on postoperative day 11 and was subsequently transferred to other hospital for rehabilitation.

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  • Hazem El Beyrouti, Angela Kornberger, Nancy Halloum, Andres Beiras-Fer ...
    Article ID: cr.17-00236
    Published: 2018
    [Advance publication] Released: May 21, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Background: Coronary involvement in aortic dissection heralds a poor outcome. Involvement of the left main stem may lead to left ventricular (LV) failure requiring mechanical circulatory support.

    Case Report: A staged approach was applied in a 24-year-old female who suffered extensive infarction due to aortic dissection with left main stem involvement. After replacement of the ascending aorta and grafting of the left internal thoracic artery to the left anterior descending artery following a failed attempt at reconstruction of the left coronary ostium, she failed to wean from cardiopulmonary bypass (CPB) and underwent implantation of an extracorporeal life support (ECLS) system as a bridge to decision. Subsequent implantation of a left ventricular assist device (LVAD) as a bridge to recovery/transplantation was followed by an uneventful further course.

    Conclusions: Our experience suggests that early implantation of a ventricular assist device (VAD) as bridge to recovery/transplantation is an alternative to prolonged ECLS in patients who suffered extensive myocardial infarction in the course of aortic dissection.

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  • Yu-San Chien, Yen-Chun Chao, Kuo-Sheng Lee, Kung-Hong Hsu
    Article ID: cr.18-00022
    Published: 2018
    [Advance publication] Released: May 18, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    We reported a case of ruptured tracheoinnominate fistula in a 14-year-old boy with history of repeated sternotomy. Tracheostomy was performed at age 2 years. Slide tracheoplasty was done at age 13 years. He presented to outpatient clinic with episodic hemosputum. Massive blood emanated from stoma during bronchoscopy evaluation. Venous-arterial extracorporeal membrane oxygenation was installed for resuscitation. A contrast-enhanced computed tomography (CT) and angiography confirmed the diagnosis. Immediate control of bleeding was achieved by an endovascular stent graft deployed at innominate artery. Massive hemorrhage recurred on day 7. An aortic arch stent was inserted and all arch vessels debranching via supraclavicular collar excision was performed. A covered stent was used to fenestrate the aortic stent and establish antegrade blood flow to all neck vessels via left common carotid artery. The patient remained stable at 10-month follow-up. Combination of extracorporeal membrane oxygenation, endovascular intervention, and surgical bypass could be effective in treating critical patients.

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  • Takashi Murakami, Yosuke Takahashi, Shinsuke Nishimura, Shinichi Iwata ...
    Article ID: cr.17-00204
    Published: 2018
    [Advance publication] Released: May 15, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Access challenges are sometimes encountered in patients who require transcatheter aortic valve implantation (TAVI). Transapical (TA) access is a well-established alternative, but it is more invasive than the standard transfemoral (TF) access techniques. We adopted the iliac endoconduit technique to perform TF TAVI in a patient with small-caliber, heavily calcified iliac arteries. This technique could provide an adequate access route for TAVI that is minimally invasive, even for patients with prohibitory iliac anatomy.

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  • Shinsuke Nishimura, Takashi Murakami, Hiromichi Fujii, Yosuke Takahash ...
    Article ID: cr.17-00245
    Published: 2018
    [Advance publication] Released: May 02, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    An arteriovenous fistula is a rare complication of ruptured abdominal aortic or iliac artery aneurysms (IAAs). Its clinical symptoms depend on its size, with signs of heart failure dominating if the fistula is large. Herein, we present a case of arteriovenous fistula with an unusual presentation. An 86-year-old male patient presented with extreme lower extremity edema, skin erosion, and continuous lymphorrhea (starting 3 months prior). Despite the large fistula between the right common IAA and the left common iliac vein after the rupture of the aneurysm, he did not develop heart failure symptoms, as the large shunt was predominantly directed toward the left lower extremity due to iliac vein compression. Careful physical examination and a high index of suspicion could have contributed to an earlier diagnosis and management.

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  • Taijiro Sueda, Shinya Takahashi, Keijiro Katayama
    Article ID: cr.18-00001
    Published: 2018
    [Advance publication] Released: April 26, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    We present the case of an 86-year-old male with an aortic arch saccular aneurysm who underwent zone 1 thoracic endovascular aortic repair (TEVAR) with debranching from the right subclavian artery to the left carotid and left subclavian arteries. The patient developed a type Ia endoleak 1 month later. Postoperative contrast computed tomography (CT) showed a hematoma around the aneurysm, concerning for impending rupture. He thus underwent emergency endograft removal and replacement with a one-branched graft using selective cerebral perfusion via the left subclavian artery perfusion. The left subclavian artery was used for systemic and cerebral perfusion without need for cannulation of the cervical arteries. The patient was successfully discharged 6 months after surgery.

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  • Hiroaki Komatsu, Nobuhiro Izumi, Takuma Tsukioka, Kyukwang Chung, Mich ...
    Article ID: cr.18-00028
    Published: 2018
    [Advance publication] Released: April 26, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    An 82-year-old woman was referred to our hospital because of dyspnea on effort. Echocardiography revealed severe aortic valve stenosis (AS). Simultaneously, chest computed tomography (CT) revealed a 19-mm nodule in the lower lobe of the right lung, and bronchoscopic biopsy revealed adenocarcinoma. She underwent transcatheter aortic valve implantation (TAVI) for severe AS. Three weeks later, she underwent lower lobectomy of the right lung and mediastinal dissection for the lung cancer. Her postoperative course was good, and she was discharged 8 days postoperatively. In conclusion, we encountered a patient who successfully underwent pulmonary resection for lung cancer following TAVI for severe AS. We suggest that pulmonary resection following TAVI is an acceptable choice for lung cancer in patients with severe AS because of the lack of a need for cardiopulmonary bypass, the high safety and efficacy of two-stage therapy, and the short period between the two therapies.

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  • Takanori Kono, Takeshi Oda, Keiichi Akaiwa, Katsuhiko Nakamura, Kenya ...
    Article ID: cr.18-00031
    Published: 2018
    [Advance publication] Released: April 20, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Metal allergy is an uncommon problem during surgery. Among them, titanium allergy is said to be rare, but can lead to serious complications, such as palmoplantar pustulosis (PPP). A 69-year-old woman was admitted to our hospital with a chief complaint of chest pain. Coronary angiography showed severe coronary artery disease that required coronary artery bypass grafting (CABG). The patient had a history of orthopedic surgery for left distal radius fracture 2 years previously, which resulted in inflammation on the left arm and PPP. We suspected titanium allergy based on results of skin patch tests and use of titanium alloy in the previous orthopedic operation. The patient underwent CABG without use of permanent metallic material. As a result, her PPP disappeared. In this rare case, it is difficult to identify the exact cause of the improvement in PPP; thus, further studies are required to clarify the mechanism of remission.

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  • Yoshihito Iijima, Hirohiko Akiyama, Yuki Nakajima, Hiroyasu Kinoshita, ...
    Article ID: cr.18-00041
    Published: 2018
    [Advance publication] Released: March 30, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Introduction: Primary leiomyosarcomas (LMS) of the mediastinum are extremely rare malignant mesenchymal tumors developing from soft tissues or great vessels. We present a case of a primary leiomyosarcoma of the middle mediastinum in which long-term survival was achieved.

    Case Report: A 77-year-old man presented to us for examination with an extrapleural sign in his upper mediastinum on chest X-ray. Computed tomography (CT) revealed a well- circumscribed mass in the middle mediastinum. Thoracoscopic resection of the mediastinal tumor and immunohistological findings, which were positive for smooth muscle actin (SMA), HHF-35, vimentin, and desmin confirmed primary leiomyosarcoma. It recurred twice with solid right pulmonary metastases, which were resected. He was followed-up for a total of 9 years and 6 months from the first surgery with no signs of recurrence after his last surgery.

    Conclusion: Surgical resection of both the primary tumor and pulmonary metastases remains the mainstay of treatment of primary leiomyosarcomas.

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  • Ryuichi Waseda, Isao Matsumoto, Yasuhiko Tatsuzawa, Akinori Iwasaki
    Article ID: cr.17-00223
    Published: 2018
    [Advance publication] Released: March 22, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    We present a case of a severe osteoporotic octogenarian who sustained serious flail chest from a traffic accident. The 3rd–9th ribs of the right chest wall were fractured. Non-operative management was unsuccessful. We performed a surgical fixation using a bio-absorbable and bio-active mini-plating set. This plating set is unsintered hydroxyapatite (u-HA) particles/poly-L-lactide (PLLA) composite osteosynthesis device commonly used for cranial, oral, and maxillofacial surgeries. The use of the u-HA/PLLA device for chest wall reconstruction has previously been reported, but no long-term results have been included. This case showed several advantages of the procedure with 4-year follow-up over other reported methods, especially in an osteoporotic elderly patient.

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  • Yohsuke Yanase, Akihito Ohkawa, Satomi Inoue, Yukihiro Niida
    Article ID: cr.18-00015
    Published: 2018
    [Advance publication] Released: March 17, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    In case of complete circumferential dissection of the ascending aorta, the dissected flap has the potential to fold backwards, causing several complications. We report two cases of Stanford type A acute aortic dissection (AAD) whose intimal flaps intussuscepted into the left ventricular outflow tract.

    Case 1: A 41-year-old man with AAD in whom transthoracic echocardiography (TTE) showed the dissected flap as folded back into the left ventricular outflow tract, causing severe aortic regurgitation (AR) with rapidly progressing acute pulmonary edema. Despite performing salvage surgery, the patient could not be rescued.

    Case 2: An 81-year-old man with annuloaortic ectasia developed Stanford type A AAD. TTE showed an extremely mobile intimal flap intussuscepting into the left ventricular outflow tract. However, AR was not severe as it was prevented by the flap itself. The patient was rescued by performance of the modified Bentall procedure.

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  • Susumu Isoda, Ichiya Yamazaki, Yusuke Matsuki, Hiroto Tomita, Yoshimi ...
    Article ID: cr.17-00222
    Published: 2018
    [Advance publication] Released: March 16, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    We report the use of glutaraldehyde (GA) in a case of valve repair for mitral valve prolapse associated with active infective endocarditis. GA scrubbed at the site of infection decontaminates and reinforces infected fragile tissue, avoids excessive debridement, and strengthens the edges of valve leaflets to facilitate suturing.

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  • Hiroo Kinami, Kiyozo Morita, Yoshihiro Ko, Gen Shinohara, Kazuhiro Has ...
    Article ID: cr.17-00085
    Published: 2018
    [Advance publication] Released: March 07, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Neonatal primary repair of tetralogy of Fallot (TOF) with absent pulmonary valve (APV) syndrome is associated with high mortality rates. Our plan involves a staged repair that avoids one-stage intracardiac repair (ICR), with a first palliation that closes the main pulmonary orifice using an expanded polytetrafluoroethylene (ePTFE) patch, pulmonary arterioplication, and an adjustable Blalock-Taussig (BT) shunt. This strategy was used for a neonatal case with TOF/APV syndrome with hypoplastic left ventricle (LV). There was evidence of subsequent progressive increase in the LV size, and bronchial compression was relieved and an ICR was performed successfully at 9 months of age.

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  • Takahiko Masuda, Masaki Hata, Kazuhiro Yamaya, Tomoyuki Suzuki, Naoya ...
    Article ID: cr.17-00200
    Published: 2018
    [Advance publication] Released: March 03, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Thoracic endovascular aortic repair (TEVAR) is used to treat retrograde type A acute aortic dissection (RTAAD). In case 1, a 52-year-old man, who was conservatively managed, reported worsening back pain. Emergency TEVAR was performed 7 days after onset. After deploying two GORE Conformable TAG (CTAG) in the descending aorta, his symptoms disappeared. In case 2, a 52-year-old man with progressive worsening resistant hypertension, renal dysfunction, and respiratory failure despite maximal medical therapy underwent TEVAR 8 days after onset. A CTAG was deployed from the left subclavian artery under rapid pacing, and two Zenith Dissection stents were placed, which resolved complications. In both cases, after 6 months, computed tomography (CT) scan showed complete resorption of the false lumen in the ascending aorta. TEVAR for RTAAD with complete thrombosis of false lumen in the ascending aorta can be an alternative to surgery when the primary tear is located in descending aorta.

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  • Hideki Ujiie, Daisuke Okada, Yuki Nakajima, Naoyuki Yoshino, Hirohiko ...
    Article ID: cr.11.01745
    Published: November 30, 2011
    [Advance publication] Released: November 30, 2011
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION
    The article was withdrawn because of the authors' decison.
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