2 JCS/JSCVS/JCC/CVIT 2023 Guideline Focused Update on Indication and Operation of PCPS/ECMO/IMPELLA individual facilities.Therefore, in this Focus Update, specific classes or levels of evidence are not strictly mandatory, but rather they are presented as expert consensus.However, we strongly hope that this Focus Update will (1) serve as a guideline for the standardization of PCPS, ECMO, and IMPELLA therapy within Japan, (2) be widely used by various healthcare professionals including physicians, nurses, clinical engineers, and other professionals involved in this treatment, and (3) be continuously revised in the future.I. Indications for PCPS, ECMO, and IMPELLA Indicated Diseases and ConditionsIMPELLA and veno-arterial extracorporeal membrane oxygenation (V-A ECMO) have different support mechanisms and approaches to their application, and their use alone or in combination should be considered according to the patient's condition.For device selection, please refer to Section 8 (Device Selection for Temporary MCS) later in this chapter.Regarding the clinical results of V-A ECMO in Japan, an analysis of diagnosis-procedure combination (DPC) data of 5,263 patients, showed that 64.4% were weaned, but the subsequent in-hospital mortality rate was as high as 37.9%. 5J-PVAD (Japanese registry for Percutaneous Ventricular Assist Device), a registry of IMPELLA in Japan, reported the initial results of 823 patients: 30-day survival rates for patients treated with IMPELLA alone and ECPELLA (V-A ECMO plus IMPELLA) were 81.1% and 49.6%, respectively. 1
A 75-year-old man presented to our hospital 1 year after partial renal resection for clear cell carcinoma. A right lower lobe lung nodule noted at the time of surgery had increased to 3.0 cm in diameter and was confirmed as squamous cell lung carcinoma by bronchoscopic cytology. Computed tomography had also revealed paratracheal lymph node swelling. He underwent right lower lobectomy with lymph node dissection by video-assisted thoracic surgery. Pathological examination confirmed squamous cell carcinoma of the lung but diagnosed the right hilar and mediastinal lymph node metastases as clear cell carcinoma.
Objectives: The objective of this study was to assess changes in left ventricular (LV) volume, function and regional myocardial wall stress in non-infarcted segments following restrictive mitral annuloplasty (RMA) in patients with ischaemic cardiomyopathy (ICM) and severe functional mitral regurgitation (MR). Patients and methods: Twenty-two patients with ICM (ejection fraction ≪35%) and severe MR were investigated before and 3 months after RMA using cine-angiographic multidetector row computed tomography (cine-MDCT). For comparative purposes, 38 normal subjects were also studied. Cine-MDCT LV images were reconstructed in a cardiac cycle and regional circumferential wall stress (end-systolic stress (ESS)) was evaluated from the LV end-systolic image using Janz's method. The ESS was determined in six basal and six mid-LV segments of the ventricle based on AHA/ASE criteria. Five apical infarcted segments were not analysed. Mean circumferential fibre shortening (CFS) in both basal and mid-LV regions was determined as a parameter of regional systolic performance. Results: Left ventricular end-diastolic volume (index) (LVEDVI) and left ventricular end-systolic volume (index) (LVESVI) decreased significantly and left ventricular ejection fraction (LVEF) increased after surgery. Neither end-systolic nor end-diastolic sphericity index changed significantly after surgery. Regional ESS significantly decreased in both basal and mid-LV regions after surgery. There was a significant inverse correlation between the change in average value of regional ESS and magnitude of increase in mean CFS of the mid-LV region (r = −0.67, p = 0.0018). Postoperative reduction in ESS in the mid-LV region was also correlated with improvement in global EF (r = −0.72, p ≪ 0.01). Conclusion: The present cine-MDCT may be useful for assessing regional myocardial stress in patients with ICM. We found that RMA could reduce both end-diastolic and end-systolic volume leading to reduction in regional systolic wall stress, which resulted in improved ejection performance of non-infarcted myocardium in patients with functional MR and ICM.
We report a very rare case of survival after a ruptured thoracic aortic aneurysm (TAA). An 84-year-old man was transferred to a local hospital because of unconsciousness. Computed tomography showed a ruptured TAA and he was referred to our hospital for management. Although emergency surgery was recommended, the patient rejected it and remained hospitalized for conservative management. One week later, the patient decided to proceed with the surgery and graft replacement was successfully performed. His recovery was uneventful.
A bicuspid aortic valve (BAV) is associated with premature valve dysfunction and abnormalities of the ascending aorta. The aim of our study was to assess the degree of ascending aortic dilatation by measuring the ratio of the dimension of the AAo to that of the descending aorta (DAo) using preoperative computerized tomography (CT).A review of our institutional clinical database identified 76 patients undergoing aortic valve replacement (AVR) and 73 control patients undergoing off-pump coronary artery bypass (OPCAB group) between September 2009 and April 2012.There were 17 patients diagnosed with BAV (BAV group), and the remaining 59 patients had a tricuspid aortic valve (TAV group). The ratios of the dimensions of the AAo to that of the DAo (AAo/DAo) for each group were: BAV, 1.58 ± 0.25; TAV, 1.32 ± 0.11; and OPCAB, 1.29 ± 0.12. Interestingly, the AAo/DAo of the BAV group was significantly larger than that of the other groups.Although progressive AAo dilatation for BAV is well documented, the diameter of the AAo is currently the only estimate of aortic dilatation. In this study, we report that the ratio of the AAo and DAo diameters in patients with BAV can be a new index for assessing the dilatation of the AAo and differentiating the patients with BAV from those with TAV.
