Early bioprosthetic valve calcification with alfacalcidol supplementation

We report a case of early bioprosthetic valve calcification in a 76 year-old woman who had received supplementation with alfacalcidol, an analogue of vitamin D, for 3 years after her initial valve replacement. She underwent aortic valve replacement at the age of 71 and subsequently complained of shortness of breath. Ultrasonic cardiography revealed severe aortic stenosis and we performed a second aortic valve replacement with a bioprosthesis. Histopathologic and x-ray examination showed calcification on the explanted valve. She had not presented with any known risk for early bioprosthetic calcification, suggesting that vitamin D supplementation may accelerate calcification of bioprosthetic valves.ArticleJOURNAL OF CARDIOTHORACIC SURGERY. 8:11 (2013)journal articl

Prosthetic valve endocarditis caused by Staphylococcus capitis: report of 4 cases

Although Staphylococcus capitis is considered to be a rare causative organism for prosthetic valve endocarditis, we report 4 such cases that were encountered at our hospital over the past 2 years. Case 1 was a 79-year-old woman who underwent aortic valve replacement with a bioprosthetic valve and presented with fever 24 days later. Transesophageal echocardiography revealed an annular abscess in the aorto-mitral continuity and mild perivalvular regurgitation. We performed emergency surgery 5 days after the diagnosis of prosthetic valve endocarditis was made. Case 2 was a 79-year-old woman presenting with fever 40 days after aortic valve replacement with a bioprosthesis. Transesophageal echocardiography showed vegetation on the valve, and she underwent urgent surgery 2 days after prosthetic valve endocarditis was diagnosed. In case 3, a 76-year-old man presented with fever 53 days after aortic valve replacement with a bioprosthesis. Vegetation on the prosthetic leaflet could be seen by transesophageal echocardiography. He underwent emergency surgery 2 days after the diagnosis of prosthetic valve endocarditis was made. Case 4 was a 68-year-old woman who collapsed at her home 106 days after aortic and mitral valve replacement with bioprosthetic valves. Percutaneous cardiopulmonary support was started immediately after massive mitral regurgitation due to prosthetic valve detachment was revealed by transesophageal echocardiography. She was transferred to our hospital by helicopter and received surgery immediately on arrival. In all cases, we re-implanted another bioprosthesis after removal of the infected valve and annular debridement. All patients recovered without severe complications after 2 months of antibiotic treatment, and none experienced re-infection during 163 to 630 days of observation. Since the time interval between diagnosis of prosthetic valve endocarditis and valve re-replacement ranged from 0 to 5 days, early surgical removal of the infected prosthesis and an appropriate course of antibiotics were attributed to good clinical outcomes in our cases

Prosthetic Valve Endocarditis after Double Valve Replacement with the Manouguian Procedure

Prosthetic valve endocarditis is a rare but severe complication after double mitral and aortic valve replacement. It is debated whether or not all prostheses should be replaced simultaneously, because of high operative mortality with redo double valve replacement. We report a case of prosthetic valve endocarditis after double mitral and aortic valve replacement with the Manouguian procedure. A 56-year-old man had undergone double valve replacement 12 years prior and presented with high fever 2 months after dental treatment. Enterococcus faecalis was isolated from blood cultures twice. Transthoracic echocardiography showed perivalvular mitral regurgitation, but no vegetations or abscess. Transesophageal echocardiography revealed an abscess on the aortomitral continuity of the Manouguian patch. We removed all previous prostheses and performed redo aortic and mitral valve replacements with a repeat Manouguian procedure. The postoperative course was satisfactory. Precise preoperative evaluation by transesophageal echocardiography and radical removal of the infected prostheses resulted in successful treatment.ArticleANNALS OF THORACIC AND CARDIOVASCULAR SURGERY. 19(2):151-153 (2013)journal articl

Indicators of Survival after Open Repair of Ruptured Abdominal Aortic Aneurysms and an Index for Predicting Aneurysmal Rupture Potential

信州大学博士（医学）・学位論文・平成23年12月28日授与（乙第21139号）・髙橋耕平ArticleAnnals of Vascular Diseases. 4(3):209-217 (2011)journal articl

Open stent graft repair with upper-half Sternotomy for blunt thoracic aortic injury: a case report

Abstract Background Thoracic endovascular aortic repair is now widely applied to the treatment of blunt aortic injury. However, its long-term outcomes remain unclear. Endoleakage and migration might occur in the long term, especially when younger patients undergo endovascular aortic repair. In open stent grafting, the proximal end of the open stent graft is directly sutured to the native aorta, which may reduce the risk of endoleakage and migration. We applied open stent grafting to the treatment of blunt aortic injury in the subacute phase and herein report the patient’s clinical course. Case Presentation A 20-year-old man with a developmental disorder collided with a steel tower while skiing. He was transferred to our hospital by helicopter. X-ray examination and computed tomography revealed fractures of left humeral head and femoral neck and aortic isthmus dissection. We did not perform an acute-phase operation because of the presence of multiple trauma and instead performed open stent grafting with an upper-half sternotomy 42 days after the injury. He recovered uneventfully without psychological problems other than his preexisting developmental disorder. No endoleakage or aneurysm was observed during an 18-month follow-up period. Conclusions Open stent grafting might be an alternative to open surgery and thoracic endovascular aortic repair for blunt chest trauma, although intensive follow-up is needed

Indicators of Survival after Open Repair of Ruptured Abdominal Aortic Aneurysms and an Index for Predicting Aneurysmal Rupture Potential

Background: The aims of this study were to assess variables associated with survival in patients undergoing ruptured abdominal aortic aneurysm (RAAA) repair and to develop an index other than the aneurysmal diameter to predict rupture potential. Methods: This study included 43 consecutive patients who underwent open surgery for RAAAs. Results: The mortality rate was 18.6% (8/43). The ratio between the maximum aneurysmal diameter and the length (along the central axis) from the aneurysmal neck to the point at which the diameter was three-fourth of the maximum aneurysmal diameter was used as an index to predict aneurysmal rupture potential. The index score was 2.7 ± 1.2 in the RAAA and 1.9 ± 0.9 in the EAAA (p = 0.018). For aneurysms of ≤ 6-cm diameter, the index score was 3.0 ± 1.0 in the RAAA and 1.8 ± 0.9 in the EAAA (p = 0.03). All patients in the EAAA except one had an index score of < 2.3 and 6 of the 7 patients with RAAA had a score of > 3. Conclusions: The results suggest that patients with AAA having scores of > 3 are at high risk of rupture. This index would be useful for decision making regarding repair of AAA, especially in the borderline cases