The purpose of this study was to examine whether KAATSU training improves femoris quadriceps muscle brightness in postoperative patients with valvular heart disease. The subjects were five patients (65.2 ± 10.1 years old; three males and two females; two with aortic stenosis, one with aortic regurgitation, and two with mitral regurgitation) after valvular heart surgery. KAATSU training was performed twice a week for 3 months after cardiac operation, and the patients were evaluated before and 3 months after the start of training. Grip strength and knee extension strength were measured. The mid-thigh was imaged in the resting supine position using an ultrasound imaging system, and the femoris quadriceps muscle brightness was calculated using image analysis software (ImageJ). The anterior thigh muscle thickness was defined as the thickness of the rectus femoris and anterior vastus intermedius muscles in the resting supine position at the center and anterior surface of the femur. The results showed a significant increase in knee extension strength and anterior thigh muscle thickness and a significant decrease in femoris quadriceps muscle brightness (61.0 ± 14.9 vs. 55.2 ± 14.8 a.u., p = 0.049) after 3 months of training compared to before training. The results suggest that KAATSU training is effective not only for improving skeletal muscle mass but also muscle quality index.
We evaluated the blood flow within the downstream aortic false lumen after frozen elephant trunk repair for acute aortic dissection and identified hemodynamic predictors of false lumen expansion and negative false lumen remodeling using four-dimensional flow magnetic resonance imaging.
Rationale: Hemolytic anemia is a rare postoperative complication of aortic surgery, which may be caused by an excessively kinked graft that causes abnormal blood flow. It has been reported that 4-dimensional flow magnetic resonance imaging (4D flow MRI) can identify abnormal flow. Herein, we report the guidance of 4D flow MRI in performing the revision procedure for a patient with hemolytic anemia by evaluating abnormal blood flow based on this method. Patient concerns: A 70-year-old woman presented with dizziness and fatigue. She had undergone total arch replacement with a frozen elephant trunk 5 years prior. We diagnosed hemolytic anemia caused by a kinked graft after total arch replacement. Diagnosis: Although computed tomography findings revealed 3 lesions of the kinked graft at the ascending portion and cervical branches, 4D flow MRI findings showed that only the kinked graft at the ascending portion caused hemolytic anemia due to an elevated viscous energy loss around it. Intervention: We performed surgery to remove the kinked section instead of revision surgery consisting of total arch replacement. Outcomes: The patient’s postoperative course was uneventful and there were no complications. Postoperative enhanced computed tomography findings showed that the repaired graft had an adequate length and smoothly curved shape. The 4D flow MRI findings revealed smooth flow in the ascending portion and decreased viscous energy loss. Lessons: Based on the 4D flow MRI findings, we adopted a less invasive approach, repairing only the ascending portion of the graft, instead of performing revision surgery comprising total arch replacement.
Introduction: Surgery for cardiovascular disease is often accompanied by sarcopenia and physical frailty, and improvement of muscle mass, muscle strength, and ADL, is often difficult only with cardiac rehabilitation using aerobic exercise. The resistance training under moderately restricted muscle blood flow, named as KAATSU, induces muscle hypertrophy and strengthens muscle through low intensity exercise. However, it remains uninvestigated whether KAATSU resistance training using low intensity load (KAATSU-RE) increases muscle strength, and induces hypertrophy in patients early after cardiovascular surgery. Hypothesis: To investigate the effects of KAATSU-RE on skeletal muscle strength, hypertrophy and its safety in patients early after cardiovascular surgery. Methods: Nine patients early after cardiac surgery were included in this study (seven males, age 54 ± 18 years, BMI 23.0 ± 3.7 kg/m 2 , AVR 5 cases, MVP 3, Bentall operation 1). The patients performed leg extension exercise (20~30% 1RM) under KAATSU condition two times/week for three months. Training started after 200 m walking early after the operation. Skeletal muscle mass index (SMI) was evaluated using bioelectrical impedance analysis (BIA). The anterior mid-thigh thickness (MTH) was measured using B mode transverse ultrasound images. Physical functions (isometric knee extension peak torque, handgrip strength, and walking speed) were also measured at three points, i.e. baseline (before operation), ~7 days early after operation, and ~3 months after the training. Results: SMI and MTH decreased significantly from 7 ± 1.1, and 2.5 ± 0.4 cm preoperatively to 6.7 ± 1.0, and 2.2 ± 0.3 cm approximately 1 week after surgery. Approximately 3 months after the training, they increased significantly to 7.6 ± 0.8 and 3 ± 0.4 cm. During the rehabilitation period, hemodynamic deterioration and side effects including subcutaneous hemorrhage were not observed, and all the patients completely finished the study. Conclusions: These results suggest that KAATSU training safely increased muscle mass in patients in the early perioperative period of cardiovascular surgery. KAATSU training appears to be a promising and effective method for cardiac rehabilitation in patients with cardiovascular surgery.
A 76-year-old woman with unstable angina underwent coronary stent implantation. At the same time, rosuvastatin therapy was started. However, she experienced repeated in-stent restenosis (ISR). Treatment with a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor along with rosuvastatin (5 mg/day) reduced plasma low-density lipoprotein cholesterol to 10 mg/dL, but failed to prevent further ISR. Eventually, an increase in the rosuvastatin dose to the permitted maximum of 20 mg/day succeeded in preventing further in-stent restenosis. Rather than using PCSK9 inhibitors, intensive statin treatment, using the maximum dose of statins, should be prioritized for the secondary prevention of coronary artery disease.
Sarcopenia is closely associated with postoperative prognosis in patients undergoing cardiovascular surgery. Growth differentiation factor (GDF)-15 is involved in the pathogenesis of cardiovascular disease. We examined the relationship between the serum GDF-15 concentration and muscle function in patients receiving aortic valve replacement and healthy elderly subjects.Forty-three female patients undergoing aortic valve surgery (79.9 ± 6.4 years; transcatheter aortic valve replacement [TAVR] n = 19, conventional surgical aortic valve replacement [SAVR] n = 24) and 64 healthy elderly female subjects (75.9 ± 6.1 years) were included. Walking speed, grip strength, and skeletal muscle mass index (SMI) by a multifrequency bioelectrical impedance analyzer were measured to determine the presence of sarcopenia. Preoperative serum GDF-15 concentration was measured by enzyme-linked immunosorbent assay.The GDF-15 level was higher in patients receiving aortic valve replacement than in healthy elderly subjects (aortic valve replacement: 1624 ± 1186 pg/mL vs. healthy: 955 ± 368 pg/mL, p < 0.001). Multivariate linear regression analysis showed that the serum GDF-15 level determined grip strength independently of the high-sensitivity C-reactive protein level and eGFR, even after adjusting for age (β = -0.318, p = 0.025). Sarcopenia was found in 12.5% of healthy elderly subjects, 83.3% of patients with TAVR, and 64.3% of patients with SAVR. The GDF-15 concentration that defined sarcopenia was 1109 pg/mL in subjects including patients receiving aortic valve replacement.The preoperative serum GDF-15 concentration, which was higher in female patients receiving aortic valve replacement than in healthy elderly subjects, may be a serum marker of sarcopenia.
