A 46-year-old man had undergone aortic valve replacement for aortic regurgitation due to active infective endocarditis in 2006. He had been followed by transthoracic echocardiography revealing results within normal limits except for a subannular depressed scar. In 2010, a giant left ventricular pseudoaneurysm was detected on three-dimensional computed tomography. We performed surgery for patch closure of the pseudoaneurysm and redo aortic valve replacement.
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a heart muscle disorder characterized by right ventricular enlargement, right heart failure (HF), and ventricular arrhythmias which lead to sudden death especially in young adults. Current recommendations for management of patients with ARVC are antiarrhythmic medications, catheter ablation, and implantable cardioverter defibrillator therapy to prevent sudden cardiac death. However, despite these treatments, few patients suffer from recurrent ventricular arrhythmias or HF unresponsive to conventional management. Heart transplantation (HTx) is a preferred treatment for these cases, but because of a persistent donor heart shortage in Japan, ventricular assist device (VAD) support has become an important option for a management of the end‐stage ARVC. Previous articles reported 4 cases of a successful management by left ventricular assist device (LVAD), but the longest interval of LVAD support was only 333 days. We present 3 cases of ARVC patients who were successfully managed by LVAD implantation for more than a year. These 3 cases are unconventional examples of ARVC patients, considering the nature of the disease. The novelty of these cases should be taken in the context of the extremely long waiting period for HTx in Japan.
Background: The development of regenerative medicine in recent years has been remarkable as tissue engineering technology and stem cell research have advanced. The ultimate goal of regenerative medicine is to fabricate human organs artificially. If fabricated organs can be transplanted medically, it will be the innovative treatment of diseases for which only donor organ transplantation is the definitive therapeutic method at present. Summary: Our group has reported successful fabrication of thick functional myocardial tissue in vivo and in vitro by using cell sheet engineering technology which requires no scaffolds. Thick myocardial tissue can be fabricated by stacking cardiomyocyte sheets on the vascular bed every 24 h, so that a vascular network can be formed within the myocardial graft. We call this procedure a multi-step transplantation procedure. After human-induced pluripotent stem cells were discovered and human cardiomyocytes became available, a thick, macroscopically pulsate human myocardial tissue was successfully constructed by using a multi-step transplantation procedure. Furthermore, our group succeeded in fabricating functional human myocardial tissue which can generate pressure. Here, we present our way of fabricating human myocardial tissue by means of cell sheet engineering technology. Key Messages: Our group succeeded in fabricating thick, functional human myocardium which can generate pulse pressure. However, there are still a few problems to be solved until clinically functional human cardiac tissue or a whole heart can be fabricated. Research on myocardial regeneration progresses at such a pace that we believe the products of this research will save many lives in the near future.
A 69-year-old woman with invasive thymoma underwent chemoradiotherapy followed by surgical resection, including extended thymectomy, right upper lobectomy, and innominate vein and superior vena cava reconstruction with a polytetrafluoroethylene graft. Computed tomography on the 27th postoperative day revealed mediastinitis and right hemothorax; open debridement and evacuation were performed. Vacuum-assisted closure was initiated to heal the median incision. The wound gradually cleared, and the vacuum was terminated on the 150th postoperative day. On the 155th postoperative day, the patient suffered a sudden hemorrhage from the anterior thoracic wall. Computed tomography revealed a ruptured ascending aortic pseudoaneurysm surrounding the graft.
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