Transapical aortic perfusion using a deep hypothermic procedure to prevent dissecting lung injury during re-do thoracoabdominal aortic aneurysm surgery

Abstract Background Avoiding various complications is a challenge during re-do thoracoabdominal aneurysm surgery. Case presentation A 56-year-old man had undergone surgery for type I aortic dissection four times. The residual thoracoabdominal aortic aneurysm that had severe adhesions to lung parenchyma was resected. Since the proximal anastomotic site was buried in lung parenchyma, deep hypothermia was essential to avoid lung dissection and to protect the spinal cord during the proximal anastomosis. The deep hypothermia was induced with bilateral infusion of cardiopulmonary bypass by femoral artery cannulation for the lower body and by transapical cannulation for the upper body because of easy access. There was no hemorrhagic tendency after deep hypothermic bypass. The patient was discharged uneventfully. Conclusions For upper body perfusion, transapical aortic cannulation was a simple and effective procedure during left thoracotomy

Long-term Treatment of Teicoplanin for Methicillin-resistant Staphylococcus aureus Sternal Osteomyelitis with Renal Impairment : A Case of High Teicoplanin Trough Levels Maintained by Therapeutic Drug Monitoring

Teicoplanin, a glycopeptide antibiotic for methicillin-resistant Staphylococcus aureus, is recommended for therapeutic drug monitoring during treatment. Maintaining a high trough range of teicoplanin is also recommended for severe infectious disease. However, the optimal dose and interval of treatment for severe renal impairment is unknown. We report a 79-year-old man who received long-term teicoplanin treatment for methicillin-resistant Staphylococcus aureus bacteremia due to postoperative sternal osteomyelitis with renal impairment. Plasma teicoplanin trough levels were maintained at a high range (20-30 μg/mL). Although the patient required long-term teicoplanin treatment, a further decline in renal function was not observed, and blood culture remained negative after the start of treatment. Teicoplanin treatment that is maintained at a high trough level by therapeutic drug monitoring might be beneficial for severe methicillin-resistant Staphylococcus aureus infection accompanied by renal impairment

The influence of body fat percentage in the anthropometric prediction of cardiac structure size in infants

Predicting normal values of cardiovascular structure size are essential in managing congenital and pediatric heart diseases. Conventionally, normal values of cardiovascular structure size are predicted based on body surface area （BSA）, which is calculated from the infant’s weight and height. However, the predicted normal values may be more accurate if the actual body composition measurement is considered because there are large individual differences in lean body mass （LBM） and fat mass （FM）. The objective of this study was to evaluate the efficacy of measuring body fat percentage using the PEA POD Infant Body Composition System, a novel pediatric body composition measurement tool, in assessing cardiovascular structures focused on the diameters of the aortic valve （AVD） and mitral valve （MVD） and the left ventricular mass （LVM） in infants. We evaluated the associations between diameters of the AVD and MVD, LVM, and percent body fat （％BF） using the PEA POD system at term-equivalent age （37-42 weeks）. AVD and MVD were not significantly different between groups with high or low ％BF, whereas the differences between the predicted normal values and AVD and between the predicted normal values and MVD were significantly larger in the high ％BF group than those in the low ％BF group （p＜0.05 and p＜0.01, respectively）. The high ％BF group had significantly larger LVM/height2.16 than the low ％BF group （p＜0.05）, whereas no significant difference in LVM/BSA was found between the two groups. Body composition analysis is crucial for evaluating cardiovascular structure in infants because the existing methods for predicting normal values for valve diameter and LVM are significantly influenced by ％BF