BackgroundAtherosclerotic abdominal aortic aneurysm (AAA) is a progressive, gradual aortic rupture that results in death in the absence of surgical intervention. Key factors that regulate initiation and progression of AAA are unknown, making targeted interventions difficult. MicroRNAs play a fundamental role in atherosclerosis, and atherosclerotic coronary artery disease is characterized by tissue- and plasma-specific microRNA signatures. However, little is known about microRNAs involved in AAA pathology. This study examined tissue and plasma microRNAs specifically associated with AAA.Methods and ResultsAAA and normal wall tissues were sampled from patients undergoing AAA repair (n=13; mean age, 68±6 years) and aortic valve replacement surgery (n=7; mean age, 66±4 years), respectively. MicroRNA expression was assessed by high-throughput microRNA arrays and validated by real-time polymerase chain reaction for individual microRNAs that showed significant expression differences in the initial screening. MicroRNAs related to fibrosis (miR-29b), inflammation (miR-124a, miR-146a, miR-155, and miR-223), and endothelium (miR-126, let-7 family members, and miR-21) were significantly upregulated in AAA tissue. Significant negative correlations were seen in expression levels of monocyte chemoattractant protein-1 and miR-124a, -146a, and -223; tumor necrosis factor-α and miR-126 and -223; and transforming growth factor-β and miR-146a. Expression of microRNAs, such as miR-29b, miR-124a, miR-155, and miR-223, that were upregulated in AAA tissue was significantly reduced in plasma of patients with AAA (n=23; mean age, 72±9 years) compared to healthy controls (n=12; mean age, 51±11 years) and patients with coronary artery disease (n=17; mean age, 71±9 years).ConclusionsThe expression of some microRNAs was specifically upregulated in AAA tissue, warranting further studies on the microRNA function in AAA pathogenesis and on the possibility of using a microRNA biomarker for AAA diagnosis.

Appropriate stent grafts need to be chosen carefully to prevent Type 1a endoleak and bird-beak configuration after landing Zone 1 and 2 TEVAR. Patients with bird-beak configuration on early postoperative multidetector computed tomography require closer follow-up to screen for Type 1a endoleak.

Esophageal duplication cysts are frequently encountered in the mediastinum and rarely in the abdomen. A case of laparoscopic resection of an intra-abdominal esophageal duplication cyst is reported. An incidental 4.5 x 4.0 x 3.5-cm, well-circumscribed, homogenous mass anterior to the intra-abdominal esophagus was detected on staging CT examinations for breast cancer in a 51-year-old woman. Laparoscopic resection of the lesion was performed after completion of breast-conserving surgery and whole breast irradiation. The defect of the muscular layer of the esophagus caused by the complete removal of the lesion required repair with muscular sutures. It was helpful to inspect the integrity of the esophageal wall repair by examining the exterior wall of the esophagus laparoscopically while insufflating air into the esophageal lumen through a fiberoptic esophagoscope. A laparoscopic approach utilizing intraoperative esophagoscopy is easy and safe for removal of intra-abdominal esophageal duplication cysts.

PurposeThis study aimed to examine the risk factors for severe postoperative tricuspid regurgitation (TR) in patients undergoing mitral valve surgery. We also studied the effects of prophylactic tricuspid valve repair (TVR) on severe postoperative TR.MethodsWe retrospectively studied 125 patients without severe TR who underwent mitral valve surgery from 1987 to 2006. Patients did not undergo TVR before 1998 (the early period, n = 54). In 1998 (the late period, n = 71), patients with a preoperative tricuspid annular diameter of ≥35 mm underwent TVR using an annuloplasty ring (n = 52).ResultsIn the analysis of the early period, the rates of freedom from severe TR at 10 and 20 years after surgery were 76 and 59 %, respectively. A multivariate analysis identified moderate preoperative TR as a significant risk factor for severe TR. In the late period, none of the 52 patients who underwent TVR developed severe TR. However, 4/19 patients who did not undergo TVR developed severe TR, and all of these four patients had a preoperative tricuspid annular diameter of ≤35 mm.ConclusionsModerate preoperative TR is a significant risk factor for severe postoperative TR in patients undergoing mitral valve surgery. The aggressive application of TVR can prevent severe postoperative TR; however, tricuspid annular dilatation might not be a good indicator for TVR.

The PET/PGA stent-graft demonstrated histologic and mechanical integration with the native aorta. This next-generation stent-graft might reduce the risk of migration and endoleaks, leading to preferable long-term results of endovascular aneurysm repair.

Elective TEVAR using the Gore TAG for degenerative descending thoracic aortic aneurysms without LSA coverage is effective and provides satisfactory early and mid-term outcomes. However, since the bird-beak configurations progressed, a conformable and flexible device for the next generation of procedures will be needed.

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RELAY NBS PLUS stent-grafts can be safely and effectively implanted with controlled deployment to satisfactorily repair aortic arch pathology, even in the cases considered to present with an unfavorable anatomy for the first generation commercially available stent-graft devices. These encouraging outcomes will need to be confirmed in a larger series with a longer follow-up.