A left intraventricular lipoma resected with the assistance of endoscopic camera

Cardiac lipomas are extremely rare benign neoplasms of the heart. Most of them do not cause clinical symptoms, so far they are found incidentally in the majority of cases. Here, we describe a case of left intraventricular lipoma in an asymptomatic 34-year-old man which found by transthoracic echocardiography at comprehensive medical examination. Echocardiography and magnetic resonance imaging demonstrated a 3 × 3-cm mass in apical wall of the left ventricle, which was diagnosed as lipoma or liposarcoma. Although he was asymptomatic, tumor resection was indicated to confirm a diagnosis of the tumor and to prevent of future fatal complications. Surgery was performed with endoscopic assistance, and the tumor was resected. Histological examination of the tumor specimens consistent of lipoma. The patient is currently asymptomatic, and no recurrence was seen after 4 years.

Zone 0 TEVAR with femoral artery inflow for an anastomotic pseudoaneurysm

We describe the case of an 89-year-old female with a distal anastomotic pseudoaneurysm of the ascending aorta after an ascending aorta replacement for an acute type A aortic dissection. Initially, we attempted endovascular repair using a semi-custom-made thoracic fenestrated stent graft. However, this treatment failed due to an endoleak. Two weeks later, we performed a total arch vessel debranching using femoral artery inflow and thoracic endovascular repair. Postoperative computed tomography revealed no signs of the endoleak. This hybrid approach could be an effective treatment option for anastomotic pseudoaneurysms of the ascending aorta.

OUP accepted manuscript

The best treatment for a right-sided aortic arch (RAA) and Kommerell diverticulum (KD) has not been determined due to the rarity of these conditions. The current trend in the treatment of this disease is to increase the endovascular approach without a sternotomy. We describe a rare condition with an association of an RAA with a KD of an aberrant left subclavian artery and an anomalous right vertebral artery originating from the aortic arch (AVA). The left vertebral artery was missing. Also, there was an incomplete circle of Willis due to the absence of the left and right posterior communication arteries. Therefore, the AVA was the only artery to supply the vertebral-basilar system. In our case, a simple thoracic endovascular aortic repair was not suitable because of the sharply curved arch and short landing zone. Also, a debranching thoracic endovascular aortic repair was not appropriate because that approach would not permit reconstruction of the AVA. The patient successfully underwent a total arch replacement with the frozen elephant trunk technique. This procedure could be an effective option for patients with RAAs with KDs associated with another arch vessel anomaly.

Aorto-left common carotid artery bypass with off-pump coronary artery bypass

BACKGROUND

Although carotid artery disease can occur in patients who have coronary artery disease (CAD), ostial stenosis of a left common carotid artery (CCA) along with CAD is a rarely reported condition.

CASE REPORT

We describe a rare case of severe stenosis of the left CCA ostium and CAD, which were successfully treated with an off-pump coronary artery bypass and aorto-left CCA bypass. This strategy minimizes the risk of perioperative strokes. Furthermore, an aorto-supra aortic trunk bypass provides a more physiological blood flow pattern than cerebral approaches. This approach would be a safe and effective treatment option.

Seven arterial aneurysms with an acute type A aortic dissection

BACKGROUND

Multiple arterial aneurysms are often seen in the elderly and are caused mainly by atherosclerosis.

Modified total arch replacement with the frozen elephant trunk technique for a right-sided aortic arch and aortic diverticulum in a teenager

BACKGROUND

A right sided aortic arch (RAA) and an aortic diverticulum (AD) are a rare congenital anomaly associated with an aortic rupture and dissection. Recently, various methods for the surgical management have been described to treat RAAs and ADs.

CASE REPORT

We describe a case of an RAA with a mirror image branching (RAMI) and AD in a teenager who complained of chest pain. We planned a total arch replacement with the frozen elephant trunk technique. Further, we needed to devise a way to reconnect the cerebral vessels because of his small arch anatomy and limited space in the mediastinum. We performed a right subclavian artery debranching, creating an anastomosis using one graft and diamond anastomosis, and performed the left innominate and right carotid anastomosis in an island fashion. This surgical approach could be a treatment option for young or small patients with RAMIs and ADs, whose arch anatomy is very small.

An octogenarian patient with double thoracic saccular aortic aneurysms in conjunction with a Kommerell diverticulum treated with a staged hybrid repair

BACKGROUND

A Kommerell diverticulum (KD) and aberrant subclavian artery (ASA) are an aortic vascular anomaly.

CASE REPORT

We describe a case of a KD with a right ASA and two asymptomatic thoracic saccular aortic aneurysms in an 83-year-old man, which were treated with a total arch replacement, frozen elephant trunk technique, and staged thoracic endovascular aortic repair.

CONCLUSIONS

Some reports on the treatment of a KD and ASA have been reported thus far in the literature. However, it is considered rare to find two asymptomatic thoracic saccular aortic aneurysms coexisting with a KD in a patient over 80 years old, as was discovered in this patient.

Reduction of respiratory motion artifacts in gadoxetate-enhanced MR with a deep learning-based filter using convolutional neural network

Objectives

To reveal the utility of motion artifact reduction with convolutional neural network (MARC) in gadoxetate disodium–enhanced multi-arterial phase MRI of the liver.

Methods

This retrospective study included 192 patients (131 men, 68.7 ± 10.3 years) receiving gadoxetate disodium–enhanced liver MRI in 2017. Datasets were submitted to a newly developed filter (MARC), consisting of 7 convolutional layers, and trained on 14,190 cropped images generated from abdominal MR images. Motion artifact for training was simulated by adding periodic k-space domain noise to the images. Original and filtered images of pre-contrast and 6 arterial phases (7 image sets per patient resulting in 1344 sets in total) were evaluated regarding motion artifacts on a 4-point scale. Lesion conspicuity in original and filtered images was ranked by side-by-side comparison.

Results

Of the 1344 original image sets, motion artifact score was 2 in 597, 3 in 165, and 4 in 54 sets. MARC significantly improved image quality over all phases showing an average motion artifact score of 1.97 ± 0.72 compared to 2.53 ± 0.71 in original MR images (p < 0.001). MARC improved motion scores from 2 to 1 in 177/596 (29.65%), from 3 to 2 in 119/165 (72.12%), and from 4 to 3 in 34/54 sets (62.96%). Lesion conspicuity was significantly improved (p < 0.001) without removing anatomical details.

Conclusions

Motion artifacts and lesion conspicuity of gadoxetate disodium–enhanced arterial phase liver MRI were significantly improved by the MARC filter, especially in cases with substantial artifacts. This method can be of high clinical value in subjects with failing breath-hold in the scan.

Key Points

• This study presents a newly developed deep learning–based filter for artifact reduction using convolutional neural network (motion artifact reduction with convolutional neural network, MARC).

• MARC significantly improved MR image quality after gadoxetate disodium administration by reducing motion artifacts, especially in cases with severely degraded images.

• Postprocessing with MARC led to better lesion conspicuity without removing anatomical details.

Natural internal thoracic-to-coronary artery collateral network

We describe a rare case of three-vessel coronary disease in a 67-year-old man who had spontaneous communication between the left internal mammary artery and the left anterior descending artery. We decided to perform elective coronary artery bypass grafting. However, he died from sudden cardiac arrest before surgery.

Black aortic valve: Minocycline pigmentation complicating treatment of pyoderma gangrenosum

We describe the case of a 75-year-old male with pyoderma gangrenosum (PG) who had severe aortic insufficiency and moderate mitral regurgitation. He had been taking minocycline for 15 years to treat PG. He underwent aortic valve replacement and mitral valve repair. Aortotomy revealed a black discoloration of the aortic valve and sinus of Valsalve.

Repair of a recurrent pseudoaneurysm of the ascending aorta in an atomic bomb survivor with myelodysplastic syndrome

The occurrence of infective aortic pseudoaneurysms tends to be intractable and difficult to treat. We experienced a very rare case of a recurrent infective pseudoaneurysm in the ascending aorta that occurred after cardiac surgery in an atomic bomb survivor with myelodysplastic syndrome. The pseudoaneurysm was successfully repaired using a femoral artery autograft with an omentopexy and the patient recovered well without any recurrence.

Early and midterm patency of the proximal anastomoses of saphenous vein grafts made with a Symmetry Aortic Connector System

OBJECTIVE

The purpose of this study was to investigate (1) the early and midterm patency rates in saphenous vein grafts that were anastomosed with the Symmetry Aortic Connector System (St Jude Medical, Inc, St Paul, Minn) and (2) risk factors for graft occlusion.

METHODS

Thirty-one patients underwent off-pump coronary artery bypass grafting for proximal saphenous vein graft anastomoses with the aortic connector system. Intraoperative graft flow was studied with transit time flowmetry, and angiography was performed before discharge in 29 cases. Midterm (at least 1 year after the operation) saphenous vein graft patency was assessed by coronary angiography or 3-dimensional coronary computed tomography in 27 cases.

RESULTS

Postoperative angiography demonstrated a 100% patency rate and no significant stenosis at the connector-anastomosed sites. The 1-year patency rate of the saphenous vein grafts with the aortic connector system was 92.6%, with 2 cases of saphenous vein graft occlusion. Both of these cases had low graft flow and poor left ventricular function documented during the operation.

CONCLUSION

Once surgical errors had been ruled out, the 1-year patency rate of proximal saphenous vein grafts anastomosed with the aortic connector system was favorable. Poor left ventricular function and low graft flow during the operation were risk factors for midterm graft occlusion. Selection of the target vessel and its runoff may also be an important determinant of long-term patency.

Early results and problems with St. Jude Medical Symmetry bypass system in Japan

The early results of coronary artery grafting with an aortic connector system were assessed in Japanese patients. From May 2002 through April 2003, 24 consecutive patients underwent off-pump coronary artery bypass using an aortic connector system. Another patient was excluded because the saphenous vein was insufficient for the smallest available aortic connector system. Saphenous veins were harvested from the thigh in 17 (70.8%) patients, and from the lower leg in 7. The size of the aortic connector system was 4.5-5.0 mm in 19 (79.2%) patients. Intraoperative epiaortic echo indicated that a side-clamp was contraindicated in 15 cases. Hemostasis was instantaneous in all patients. There were no hospital deaths and no neurologic morbidity. Pre-discharge angiography revealed 100% patency of the anastomoses. Use of the aortic connector system demonstrated excellent early results with low neurologic morbidity even when employed in the context of an atheromatous ascending aorta. However, smaller sizes of the device are required for some Japanese patients.

Venous aneurysms of the upper extremity--a case report

Venous aneurysms are a rare clinical entity, especially in upper extremities. A 35-year-old Japanese woman was diagnosed as having venous aneurysms in her left arm. The lesions were excised, and microscopic examination revealed a lack of smooth muscle, media, and elastic fibers in the aneurysmal wall, with partial hyperplasia of smooth muscle.

Pseudoaneurysm of a septal perforator in beating heart coronary bypass grafting

A 46-year-old man with unstable angina underwent beating heart coronary bypass grafting for a left anterior descending coronary artery. Postoperative angiography showed intramuscular extravasation (6 x 8 mm) distal to the anastomosis, which was most likely the result of a needle injury caused by a snare during the operation. Follow-up angiography 2 weeks later revealed no extravasation.