Significant anatomical factors associated with pT2E were found in this study. These factors may be useful in selecting patients for perioperative intervention.

OBJECTIVES Our goal was to determine the early and midterm outcomes after total arch replacement with the frozen elephant trunk (FET) technique compared to those of the conventional elephant trunk (ET) technique for acute retrograde type A aortic dissection. METHODS Between 2012 and 2019, a total of 49 patients had total arch replacement for acute retrograde type A aortic dissection. Patients were divided into the conventional ET (n = 17) and FET (n = 32) groups. The false lumen status was evaluated using enhanced computed tomography (CT) 1 week postoperatively. The diameter of the downstream aorta was evaluated annually using CT. The median follow-up period was 29 months. RESULTS Preoperative data and neurological complications were not significantly different in the 2 groups. The diameter and length of the ET prosthesis were significantly larger and longer in the FET group. The overall early mortality rate was 10.2% (5/49) with no differences between the 2 groups. The mean follow-up period was significantly longer in the conventional ET group. The rates of freedom from aortic events at 3 years were significantly lower in the FET group. At the level of the distal arch, postoperative false lumen patency was significantly lower and the follow-up aortic diameter was significantly smaller in the FET group. CONCLUSIONS The FET technique facilitates false lumen thrombosis and aortic remodelling at the distal arch level, with fewer adverse aortic events during the follow-up period with acceptable early outcomes; however, these findings are exploratory and require investigation.

No abstract

Disseminated intravascular coagulation (DIC) is an infrequent aortic dissection complication, and its optimal treatment remains controversial. A 55-year-old woman developed DIC associated with Stanford type B aortic dissection, which improved by administration of low-molecular-weight heparin combined with tranexamic acid, but the dissecting aneurysm of the descending aorta was dilated. After thoracic endovascular aortic repair for occlusion of entry tears detected by transesophageal echocardiography, DIC improved without anticoagulant therapy. Three months after treatment, the patient is doing well without complications. Endovascular repair is effective for DIC due to aortic dissection that requires anticoagulant therapy.

Purpose Restricted kinematic alignment (rKA) is a modified technique of kinematic alignment (KA) total knee arthroplasty (TKA) for patients with an outlier or atypical knee anatomy, striving to preserve the native knee joint line parallel to the ground in a bipedal stance. This study aimed to evaluate the accuracy of rKA TKA with a computed tomography (CT)-based patient-specific instrument (PSI) to achieve the preoperative plan with the joint line parallel to the ground level. Methods Using a CT-based PSI, 74 closed-leg standing long-leg radiographs were obtained before and after rKA TKA. The hip-knee-ankle angle (HKA), joint line orientation angle (JLOA), lateral distal femoral angle (LDFA), and medial proximal tibial angle (MPTA) were measured. Bone resection accuracy was evaluated by postoperative HKA deviations from the planned alignment and joint line by postoperative JLOA deviations from the ground level. Results The mean postoperative JLOA and HKA were 2.1° valgus (range, standard deviation: 6.0° valgus to 3.0° varus, 2.0) and 2.6° varus (3.5° valgus to 12.5° varus, 3.2), respectively. Postoperative JLOA and HKA were within ± 3° of the planned alignment for 69% and 86% of cases, respectively. Conclusions Despite a static verification, we clarified how the joint line after rKA TKA was reproduced in the closed-leg long leg radiographs to mimic the limb position during gait. However, this imaging method is not well-established, and lack of long-term survivorship and the relationship between joint line inclination and clinical outcomes represented limitations of this study. Level of evidence Level IV.

No abstract

P apillary fibroelastoma (PFE), a benign endocardial papilloma, is the second most prevalent primary cardiac tumor and the most prevalent cardiac valvular tumor. 1 A PFE contains many papillary fragments, has frond-like projections, and is attached to the endocardium. It can resemble myxoma, making it difficult to distinguish one from the other intraoperatively. We report our experience with an aortic valve PFE that was diagnosed as myxoma intraoperatively. After excision, aortic valve repair was performed. We discuss lessons for surgeons and pathologists that can be learned from this case. Case ReportIn March 2014, a 50-year-old asymptomatic man with no relevant medical history was referred to our hospital after inverted T waves were seen on his routine electrocardiogram. Echocardiograms and coronary computed tomograms (CT) revealed a 9-mm-diameter mobile mass on the underside of the aortic valve, apparently on the right coronary cusp. A coronary CT revealed no stenosis. We could not determine whether the mass was thrombus or tumor; in either case, there was risk of embolization. Therefore, surgical treatment was planned. Transthoracic echocardiograms showed no asynergy, morphologic abnormalities, or valvular disease, including aortic regurgitation. Laboratory data revealed no abnormalities.To perform mass resection, we established cardiopulmonary bypass between ascending aorta cannulation and right atrial drainage. After aortic cross-clamping, cardiac arrest was obtained with use of antegrade cardioplegia. The aortic valve tumor was stalkless and attached to the underside of the right coronary cusp. Its surface was smooth, indicative of myxoma (Fig. 1). Intraoperative frozen-section examination yielded spindle cells in edematous interstitial tissue, also consistent with myxoma.We decided to resect the tumor and its attachment, with sufficient margins. Resection created a large trapezoidal defect, including the free margin of the aortic valve leaflet. We repaired the defect with use of a glutaraldehyde-treated autologous pericardial patch and 6-0 Prolene running sutures (Fig. 2). To test for regurgitation, we filled the aortic root with water and confirmed that the water level did not drop. In-

A 78-year-old woman underwent surgical intervention for severe atrial functional mitral regurgitation and left ventricular apical aneurysm secondary to apical hypertrophic cardiomyopathy. Apical hypertrophic cardiomyopathy can cause atrial fibrillation and atrial functional mitral regurgitation. Left ventricular apical aneurysms can cause fatal arrhythmias, which may require surgical intervention.