We assessed the hypotheses that extension of aortic replacement would reduce the patency of the false lumen of the descending aorta and that postoperative patency of the false lumen would result in poor prognosis. One hundred and twenty-four consecutive patients underwent surgical repair for acute type A acute dissection on an emergency basis. Among the 124 patients, 89 patients had De Bakey type I dissection. Among the patients with De Bakey type I dissection, the false lumen of the descending aorta was preoperatively patent in 52 patients. Distal extent of aortic replacement was ascending aorta in 16 patients, hemiarch in 15 patients, partial arch in seven patients, and total arch in 11 patients. Patency of the false lumen was not influenced by distal extent of the aortic replacement. In a one-year follow-up, the maximum diameter of the descending aorta with patent false lumen had increased significantly than that with closed false lumen. Survival rates were 96% at one year and 67% at five years in the patients with patent false lumen and no mortality in the patients with closed false lumen. Patency of the false lumen was not influenced by extension of aortic replacement and associated with poor prognosis.
with a liposarcoma are symptomatic and that 15% have an asymptomatic liposarcoma discovered on a routine chest radiograph. Liposarcomas are usually large. The cases reported by Klimstra and associates 3 ranged from 6 to 40 cm, with a mean weight of 1500 g. Enzinger and Weiss 4 divided liposarcomas into the following 5 major morphologic subtypes: well differentiated, myxoid, round cell, dedifferentiated, and pleomorphic. Myxoid liposarcomas account for 40% to 50% of these tumors. Welldifferentiated liposarcomas are a less-aggressive neoplasm and can produce metastases. Complete surgical excision is the preferred therapeutic choice. Recurrence can occur in a subtotal resection despite adjuvant therapy. The pseudoencapsulated lesions that can be completely removed have a better prognosis than the noncapsulated and less well-differentiated tumors; however, most primary chest wall soft tissue sarcomas (70%) are low grade. Local recurrence was reported in 33% of patients in the study by Greager and colleagues. 5 The presence of local recurrence has no significant effect on the overall survival. 1 Radiotherapy may be effective in the control of local recurrence, but its role is unclear.
Background: Ischemic mitral regurgitation (IMR) with ischemic cardiomyopathy (ICM) was treated with surgical procedures, and mitral leaflet tethering was assessed. Twenty-two patients with both ICM (left ventricular ejection fraction <0.35) and IMR (>2) underwent coronary artery bypass grafting (CABG), mitral annuloplasty (MAP) with or without surgical ventricular restoration (SVR) and procedures targeting the subvalvular apparatus.
Methods and Results:Fourteen patients (group 1) underwent CABG and MAP, and the remaining 8 (group 2) underwent CABG, MAP, SVR, papillary muscle approximation (PMA), and papillary muscle suspension (PMS). PMA joined the entire papillary muscles with 3 mattress sutures. For PMS, 2 ePTFE sutures were placed between papillary muscle tips and fibrous annuli. Anterior and posterior mitral leaflet tethering angles (ALA and PLA) relative to the line connecting annuli, posterior and apical displacement of coaptation, and IMR grade were measured on echocardiography. Although preoperative ALA and PLA in group 2 were significantly larger than in group 1, there was no significant difference between groups at 1 month after surgery. At 1 year after surgery, however, the situation reversed: ALA and PLA in group 1 were significantly larger than in group 2.Conclusions: In addition to MAP, procedures targeting the subvalvular apparatus including PMA and PMS achieved persistent reduction of mitral valve leaflet tethering, which might lead to the improvement of long-term outcome. (Circ J 2013; 77: 1461 -1465
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