記述言語：英語   掲載種別：研究論文（学術雑誌）  

Surgical repair of thoracoabdominal aortic aneurysms (TAAA) is a complex procedure that is associated with marked morbidity and mortality. Endovascular TAAA repair, initially reserved for patients at high risk, has yielded promising results and is performed on an increasing range of patients. This case report describes a hybrid approach-a combination of endovascular and open repair-for a patient with high-risk TAAA after aortic dissection. A 79-year-old man had undergone aortic replacement for chronic aortic dissection 20 years previously. His saccular TAAA, extending from the Th12 level to the renal artery origin, demonstrated progressive enlargement (56-60 mm) on computed tomography (CT) scans and compressed the celiac artery. In light of the patient's age and thoracotomy history, a hybrid repair strategy involving total debranching thoracic endovascular aortic repair (TEVAR) with four-branch abdominal reconstruction was selected to minimize surgical risk. The surgery was performed via a midline abdominal incision. Bypass surgery was first performed using a quadrant artificial graft to restore left renal, right renal, superior mesenteric, and common hepatic artery blood flow. The celiac artery was coiled, and TEVAR was completed. Intraoperative contrast and postoperative CT showed no endoleak and a patent debranching graft. The patient recovered without complications and was discharged 10 days postoperatively. The findings for the present hybrid procedure indicate that debranching TEVAR is less invasive and yields better outcomes than open aortic replacement, particularly for patients at high risk.

DOI： 10.1272/jnms.JNMS.2026_93-401

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Cardiac hemangiomas located in the right heart can lead to serious complications, including right ventricular outflow tract (RVOT) obstruction, arrhythmias, and sudden cardiac death. Although surgical resection remains the primary treatment, complete excision of intramural tumors poses risk of impairing cardiac function. This case report describes the successful resection of a large right ventricular hemangioma using intraoperative voltage mapping, which enable maximal tumor removal while preserving myocardial integrity and preventing postoperative heart failure. CASE PRESENTATION: A 76-year-old female underwent a routine health examination in July 2024, during which cardiomegaly and nonspecific ST-segment changes were detected on electrocardiography. Contrast enhanced computed tomography revealed a well-defined 60 mm mass within the right ventricle, causing significant ROVT stenosis. No evidence of distant metastasis or elevated tumor markers was detected. The patient underwent tumor resection via median sternotomy. Intraoperative voltage mapping was utilized to delineate viable myocardium at the tumor margins. The tumor was excised while preserving functional myocardial tissue. Cryoablation was performed at the resection margins, and resultant defect in the right ventricular wall was reconstructed using a bovine pericardial patch. Histopathological analysis confirmed the diagnosis of cardiac hemangioma. The patient experienced an uneventful postoperative course had no postoperative complications and was discharged on postoperative day 16. Preoperative and postoperative cardiac magnetic resonance imaging demonstrated preserved right ventricular function. CONCLUSIONS: Intraoperative voltage mapping proved to be a valuable adjunct in the surgical management of right ventricular tumors, enabling effective tumor resection while preserving myocardial tissue and maintaining postoperative cardiac function.

DOI： 10.1186/s44215-025-00239-w

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

This case report presents a case of lower extremity peripheral arterial disease (PAD) with severe calcified lesions extending from the external iliac artery to the bifurcation of the superficial femoral artery, involving the groin region. Owing to the complexity and risk of complications, such as infections and delayed wound healing, revascularization was performed with extensive endarterectomy. The inguinal-lifting technique (ILT) was used to provide safe surgical access and minimize complications. The procedure resulted in successful revascularization with no major wound-related issues. The ILT proved to be an effective approach for safe, extensive endarterectomy in complex PAD cases.

DOI： 10.3400/avd.cr.25-00122

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Primary cardiac angiosarcoma is an extremely rare and aggressive malignancy with a poor prognosis. Herein, we describe a case of left atrial angiosarcoma presenting with acute respiratory failure that required emergency surgical intervention, highlighting the condition's diagnostic and therapeutic challenges. CASE PRESENTATION: On routine chest radiography, a mass shadow in the right lower lung field was detected in a 75-year-old male, initially suspected to be lung cancer or a pulmonary abscess. During hospitalization for diagnostic workup, the patient's respiratory function suddenly deteriorated upon mobilization. In addition, contrast-enhanced CT revealed a large intracardiac mass occupying the left atrium. Following emergent intubation for severe hypoxemia, he was transferred to our institution for surgical intervention. Laboratory findings showed elevated inflammatory markers (white blood cells, 22850/μL; C-reactive protein, 15.9 mg/dL), coagulopathy (D-dimer, 18.67 μg/mL), and severe metabolic acidosis (pH 7.15; lactate, 31 mmol/L). Transesophageal echocardiography confirmed a large mass filling the left atrium, nearly incarcerated in the mitral valve orifice. Subsequently, emergency surgery was performed under cardiopulmonary bypass. Through a right atrial and transseptal approach, the friable tumor filling the left atrium was removed. However, the right lower pulmonary vein inlet showed extensive tumor involvement with residual attachment. Despite extensive resection and thorough cavity irrigation, complete resection could not be definitively confirmed. Initially, the patient regained consciousness without neurological deficits and was successfully weaned from mechanical ventilation on POD 6. However, severe tachypnea and copious bloody sputum production developed on POD 7, necessitating reintubation and tracheostomy. Despite hemodynamic stability, he experienced progressive type II respiratory failure, which caused his death on POD 14. Histopathological analysis revealed positivity for vascular endothelial markers (CD31, ERG, factor VIII) and absence of MDM2 expression, confirming the diagnosis of angiosarcoma. Pulmonary hemorrhagic necrosis from tumor infiltration or pulmonary tumor thrombotic microangiopathy might have caused his rapid respiratory deterioration. CONCLUSIONS: Left atrial angiosarcoma can present with acute life-threatening complications requiring emergency surgery. Despite successful tumor debulking, the prognosis remains poor because of aggressive tumor biology and potential pulmonary metastases. This case emphasizes that management of primary cardiac angiosarcoma remains challenging despite prompt surgical intervention.

DOI： 10.70352/scrj.cr.25-0759

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objectives: The venous cuff technique has been used primarily for arterial bypass using artificial grafts to the lower extremities. The boat-form vein cuff was designed to allow adjustment of the size and angle of the anastomosis at any anatomic site. We report our experience and outcomes of the original vein cuff technique in various peripheral artery bypass grafting procedures. Methods: A total of 10 patients underwent arterial bypass grafting using a polytetrafluoroethylene (PTFE) graft with a boat-form venous cuff. The indications for the surgery consisted of peripheral artery disease (n = 4), acute limb ischemia (n = 4), chronic mesenteric ischemia (n = 1), and traumatic upper limb ischemia (n = 1). Five patients required emergency surgery. Surgical outcomes, such as mortality and morbidity, limb salvage rate, and graft patency, were examined using perioperative and postoperative follow-up data. Results: There were no operative deaths or serious complications, including amputation of the lower extremity. During the follow-up period (44 ± 36.9 months), the PTFE graft remained patent in 9 patients (90%). In 1 patient, occlusion of the femoropopliteal bypass graft was observed 3 months after surgery. Conclusions: The simple design and creation of the boat-form vein cuff are useful at any anatomical site in peripheral artery bypass grafting with a PTFE graft.

DOI： 10.3400/avd.oa.24-00134

PubMed

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap