One-stage hybrid procedure for aberrant right subclavian artery and thoracic aneurysm

A 60-year-old man without any symptoms was referred to our department because computed tomography revealed an aberrant right subclavian artery (ARSA) and a saccular aortic aneurysm arising opposite to the ARSA. We performed the following procedures through a median sternotomy: total arch replacement, insertion of a frozen elephant trunk to exclude the aneurysm and ARSA, placement of a vascular plug under transesophageal ultrasonography to occlude the dilated ARSA, and right axillary artery bypass. Postoperative computed tomography showed complete occlusion of the ARSA and exclusion of the aneurysm. This procedure should be considered an alternative strategy for treatment of patients with an ARSA

Abdominal aortic calcification as a potential predictor for postoperative atrial fibrillation in patients with aortic valve stenosis undergoing aortic valve replacement

Background: Postoperative atrial fibrillation (AF) is a common complication of cardiac surgery that has negative implications on patient outcomes. This study aimed to evaluate the effect of abdominal aortic calcification, measured using the Agatston Score, on patients undergoing aortic valve replacement for aortic valve stenosis. Methods and Results: This study included 183 patients who underwent aortic valve replacement. Preoperative characteristics and Agatston scores for abdominal aortic calcification were compared between patients with (n = 108) and without (n = 75) postoperative atrial fibrillation. Multivariate analysis showed that a high Agatston Score (derived by a cutoff point of 2767.65; odds ratio, 2.314; 95% confidence intervals (CI) , 1.063–5.041; P = 0.035), left atrial volumes (LAV) (derived by a cutoff point of 69.95; odds ratio, 3.176; 95% CI, 1.459–6.914; P = 0.004), and age (derived by a cutoff point of 75.5 years old, odds ratio, 3.465; 95% CI, 1.588–7.557; P = 0.003) were significant predictors of postoperative atrial fibrillation in the second week after surgery. Conclusions: Age and left atrial volume could be independent predictors of postoperative atrial fibrillation in patients with aortic valve stenosis, while the severity of abdominal aortic calcification, as measured using the Agatston Score, independently predicted postoperative atrial fibrillation during the second week following aortic valve stenosis. Patients with an Agatston Score exceeding 2767.65 should be considered at high risk and should receive appropriate management to improve outcomes

Epicardial Atrial Mapping Can Predict Elimination of Chronic Atrial Fibrillation After the Box Pulmonary Vein Isolation During Mitral Valve Surgery

Background: The pulmonary veins (PV) and posterior left atrium (LA) may contribute to the occurrence and maintenance of atrial fibrillation (AF). We evaluated whether simple epicardial electrophysiological mapping can predict elimination of chronic AF after the box PV isolation procedure. Methods and Results: Using a computerized 48-channel mapping system, we performed intraoperative atrial mapping in 16 patients with chronic AF associated with mitral valve (MV) disease. Patients' ages ranged from 48 to 76 years (mean, 61.4 years). AF duration ranged from 1 to 16 years (mean, 7.5 +/- 5.4 years). Simple box PV isolation was performed during the MV operation. Regular and repetitive activation was found in the LA of 12 of 16 patients, and irregular and chaotic activation was found in both atria in 4 of 16 patients; 12 patients with regular and repetitive activation of the LA were treated by box PV isolation and the other 4 patients with irregular and chaotic activation in both atria did not recover sinus rhythm after this procedure. AF-free rate was significantly higher in patients with regular and repetitive activation of the LA (P < 0.01). Conclusions: Box PV isolation was effective in the treatment of chronic AF associated with MV disease. Epicardial atrial mapping may predict elimination of AF after the box PV isolation. (Circ J 2012; 76: 852-859

Successful repair of recurrent ventricular septal perforation after myocardial infarction using double patch technique via right ventriculotomy: a case report

Abstract Background Post-myocardial infarction (MI) ventricular septal perforation (VSP) is a rare but life-threatening complication. Surgical repair is challenging and carries significant risks, particularly in the context of recurrent VSPs. This case study presents a patient with recurrent VSP after initial surgical repair following myocardial infarction. Case presentation A 65-year-old male were re-administered to our hospital due to recurrent VSP. He was during follow up after undergone emergency VSP closure surgery 2 months earlier, utilizing the bovine double patch technique via left ventriculostomy. The initial VSP was located in the apical part of the interventricular septum, while the recurrent VSP appeared in the upper middle portion of the interventricular septum (Fig. 1). As the previous patch remained intact, the second surgery employed the bovine double patch technique via right ventriculostomy. The patient’s condition remained stable without the development of heart failure symptoms. Conclusion Repairing recurrent VSPs remains a challenge, necessitating the mastery of appropriate approaches to achieve optimal outcomes. Further research and guidelines are required to refine management strategies for recurrent VSPs

Three-dimensional Echo-guided Suture of Atrial Septal Defect with Maniceps in an Experimental Model

Toward the establishment of suture closure procedures for atrial septal defect or patent foramen ovale under guidance of three-dimensional (3D) echocardiography but without use of cardiopulmonary bypass (off-pump surgery), an experimental study was conducted using a laparoscopic suture instrument, Maniceps. First, the panel setting of the 3D echo system which was optimal for precisely visualizing the surgical instruments on the image display with the least time delay was determined. The optimal setting was: 1) harmonic imaging, 2) no smoothing, 3) low scanning line density, and 4) a scanning range around 55°. Using an ex vivo model of atrial septal defect, 3D echo-guided surgical procedures were attempted in three steps. First, grasping of the edge of the defect with a forceps was attempted. It was feasible in every direction. Reverberation artifact occasionally disturbed imaging of the defect edge. Second, transfixion suture of the facing edges was attempted. Guided by 3D echo, serial sutures were feasible, but interlocking of the thread was a pitfall. Third, continuous suture of the defect was attempted under 3D echo guidance. Following the initial suture bite on one side, continuous suture could be performed under echo guidance. Deformity of the Maniceps needle after repeated sutures was a limitation. In conclusion, suture closure of the defect under 3D echo guidance using the Maniceps system is feasible in an ex viva ASD model as visualization is optimized by panel setting for guiding surgical procedures