No abstract

These findings clearly demonstrate that our RP method, especially when using a Thompson retractor, is a preferable alternative to TP for AAA surgery.

Background: A triangular resection (TR)/suture of the posterior leaflet lesion is the most common technique in mitral valve repair procedures. However, posterior leaflet motion is restricted after surgical resection in echocardiogram analyses. Although several reports have compared the resection/suture technique and the artificial chorda technique, few reports have compared TR with folding repair (FR). We compared the effectiveness and short-term impact of the TR and non-resection-based FR procedures on patients undergoing mitral valve repair.Methods: Mitral valve repair was conducted on 36 patients with moderate to severe mitral regurgitation (MR) through either TR (n=18) or FR (n=18). Echocardiographic data were collected pre-and postoperatively. Routine echocardiographic follow-ups were performed for each patient. Data were analyzed using t-test, Mann-Whitney U-test, chi-squared analysis, or Fisher's exact test. P values <0.05 were considered significant.Results: Operative time and length of stay within the intensive care unit and hospital did not significantly differ between the two techniques. Post-operative echocardiographic results showed a significantly larger mitral valve area after FR (P=0.029). The regurgitation regression rate was 94% under mild MR in the FR group (1 case; severe) and 88.8% in the TR group (2 cases; moderate) during the same duration.Conclusions: Both techniques showed comparable outcomes and durability. However, FR is relatively simple and it is possible to re-initiate FR procedures; thus, it may also provide an opportunity for lessexperienced surgeons to conduct valve repair surgeries. The study was registered with the University Hospital Medical Information Network (study ID: UMIN000039041).

An aneurysm of the left sinus of Valsalva producing aortic and mitral regurgitation with myocardial ischemia was treated successfully by reconstructing the left coronary sinus while preserving the aortic cusp combined with coronary artery bypass grafting. Aortic and mitral regurgitation occurred due to distortion of the left aortic cusp by a huge aneurysm that also compressed and obstructed the main trunk of the left coronary artery. The postoperative course was uneventful and follow-up showed aortic and mitral regurgitation to be absent and the coronary graft to be patent. Aortic valve-sparing surgery thus proved to be an appropriate procedure for this case.

Acute aortic dissection (AAD) continues to be associated with high mortality and morbidity. Pulmonary embolism is also a life-threatening disease. The treatment of these life-threatening diseases remains controversial in case complications arise. Thrombolytic therapy and intensive treatment would be needed to manage these fatal diseases. A 49-year-old man with progressive back pain was admitted to our hospital. Computed tomography (CT) scan revealed type A AAD. Emergency operation for hemiarch replacement was performed. Two weeks postoperatively, the patient’s oxygenation worsened and his d -dimer levels elevated. CT scan revealed a massive thrombus in the bilateral pulmonary arteries. Intensive anticoagulation therapy was started immediately. On postoperative day 27, the patient was weaned from mechanical ventilation, but the false lumen with thrombus was recanalized again. The patient was discharged on postoperative day 75 without resulting in major complications for aortic dissection. The diagnosis of pulmonary embolism concomitant with AAD is difficult. The treatment of pulmonary embolism after AAD is controversial. Our strategy seems to be suitable for acute pulmonary embolism that occurs during the treatment of AAD. ˂ Learning objective: The diagnosis of pulmonary embolism concomitant with acute aortic dissection (AAD) is difficult. The treatment of pulmonary embolism after AAD is controversial. Investigating factor XIII levels might help in the early detection of pulmonary embolism.>