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3. Topical Ripasudil Suppresses Retinal Ganglion Cell Death in a Mouse Model of Normal Tension Glaucoma

Author

Akaiwa, Kei, Namekata, Kazuhiko, Azuchi, Yuriko, Sano, Hiroki, Guo, Xiaoli, Kimura, Atsuko, Harada, Chikako, Mitamura, Yoshinori, and Harada, Takayuki

Subjects
glaucoma, genetic structures, ripasudil, neuroprotection, p38, sense organs, eye diseases, intraocular pressure
Abstract

PURPOSE. To assess if ripasudil has a neuroprotective effect using mice with excitatory amino acid carrier 1 (EAAC1) deletion (EAAC1 knockout [KO] mice), a mouse model of normal tension glaucoma. METHODS. Topical administration (5 μL/day) of two different concentrations of ripasudil (0.4% and 2%) were applied to EAAC1 KO mice from 5 to 12 weeks old. Optical coherence tomography, multifocal electroretinograms, the measurement of intraocular pressure (IOP), and histopathology analyses were performed at 5, 8, and 12 weeks old. Retrograde labeling of retinal ganglion cells (RGCs), immunoblot, and immunohistochemical analyses of phosphorylated p38 mitogen-activated protein kinase (MAPK) in the retina were performed at 8 weeks old. RESULTS. Topical ripasudil ameliorated retinal degeneration and improved visual function in EAAC1 KO mice at both 8 and 12 weeks old. Ripasudil reduced IOP and strongly suppressed the phosphorylation of p38 MAPK that stimulates RGC death in EAAC1 KO mice. CONCLUSIONS. These results suggest that, in addition to IOP reduction, ripasudil prevents glaucomatous retinal degeneration by neuroprotection, which is achieved by suppressing cell-death signaling pathways.

Published
2018

4. Multimodal Imaging of a Severe Case of Neonatal Acute Retinal Necrosis and Lens Vacuoles Associated with Herpes Simplex Virus Infection.

Author

Kinoshita, Takamasa, Hatanaka, Akira, Mori, Junya, Akaiwa, Kei, and Imaizumi, Hiroko

Abstract

To report a case of a neonate with acute retinal necrosis, lens vacuoles, and encephalitis associated with herpes simplex virus (HSV) infection. Case report. Retrospective chart review. A male neonate was brought for screening for retinopathy of prematurity at the corrected age of 32 weeks. Slit-lamp examination showed lens vacuoles in both eyes. Fundus examination revealed extensive retinal detachments with prominent retinal whitening, subretinal exudates, and retinal hemorrhage. Computed tomography of the brain showed encephalomalacia. Polymerase chain reaction of cerebrospinal fluid and anterior chamber fluid was both positive for HSV-1. Despite systemic anti-viral therapy, a rhegmatogenous retinal detachment and subsequent proliferative vitreoretinopathy developed in the patient's right eye. The retinal detachment in the left eye resolved, but significant chorioretinal degeneration occurred. With time lens vacuoles decreased in number. Clinicians should remember this rare, but devastating condition without specific prodromal symptoms. [ABSTRACT FROM AUTHOR]

Published
2022
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7. OCT parameters and visual outcome in anti-VEGF therapy for RVO

Author

Fujihara-Mino, Akiko, Mitamura, Yoshinori, Inomoto, Naoki, Sano, Hiroki, Akaiwa, Kei, and Semba, Kentaro

Subjects
genetic structures, visual acuity, retinal vein occlusion, spectral-domain optical coherence tomography, anti-VEGF therapy, sense organs, retinal sensitivity, eye diseases
Abstract

Purpose: To determine the optical coherence tomography (OCT) parameters that are predictive of visual outcome after anti-VEGF therapy for a retinal vein occlusion (RVO). Methods: Fifty-seven eyes with macular edema (ME) secondary to a central or branch RVO treated with bevacizumab or ranibizumab were studied. Spectral-domain OCT and microperim¬etry were performed before, 1, 3, and 6 months after the treatment and at the final visit. Central retinal thickness (CRT), macular volume (MV), integrity of the external limiting membrane (ELM), ellipsoid zone (EZ), and foveal bulge (FB), and photoreceptor outer segment (PROS) length were determined. Results: The mean follow-up period was 17.8±11.5 months. In 46 of the 57 eyes, a resolution of the ME was achieved. The pretreatment CRT and MV, presence of intact ELM, EZ, and FB, and PROS length at the time of ME resolution were significantly correlated with the best-corrected visual acuity and retinal sensitivity at the final visit (P＞0.050). Multiple regression analyses showed that the pretreatment MV had the highest correlation with the posttreatment best-corrected visual acuity and retinal sensitivity (P＞0.050). Conclusion: The CRT, MV, ELM, EZ, FB, and PROS length are predictive factors for the visual outcome after anti-VEGF therapy for RVO.

Published
2016

10. Edaravone prevents normal tension glaucoma

Author

Akaiwa, Kei, Namekata, Kazuhiko, Azuchi, Yuriko, Guo, Xiaoli, Kimura, Atsuko, Harada, Chikako, Mitamura, Yoshinori, and Harada, Takayuki

Subjects
free radical, genetic structures, edaravone, EAAC1, oxidative stress, sense organs, NTG, eye diseases
Abstract

Glaucoma, one of the leading causes of irreversible blindness, is characterized by progressive degeneration of optic nerves and retinal ganglion cells (RGCs). In the mammalian retina, excitatory amino-acid carrier 1 (EAAC1) is expressed in neural cells, including RGCs. Loss of EAAC1 leads to RGC degeneration without elevated intraocular pressure (IOP) and exhibits glaucomatous pathology including glutamate neurotoxicity and oxidative stress. In the present study, we found that edaravone, a free radical scavenger that is used for treatment of acute brain infarction and amyotrophic lateral sclerosis (ALS), reduces oxidative stress and prevents RGC death and thinning of the inner retinal layer in EAAC1-deficient (KO) mice. In addition, in vivo electrophysiological analyses demonstrated that visual impairment in EAAC1 KO mice was ameliorated with edaravone treatment, clearly establishing that edaravone beneficially affects both histological and functional aspects of the glaucomatous retina. Our findings raise intriguing possibilities for the management of glaucoma by utilizing a widely prescribed drug for the treatment of acute brain infarction and ALS, edaravone, in combination with conventional treatments to lower IOP.

Published
2017

11. Effects of Exercise on the Structure and Circulation of Choroid in Normal Eyes

Author

Kinoshita, Takamasa, Mori, Junya, Okuda, Natsuki, Imaizumi, Hiroko, Iwasaki, Masanori, Shimizu, Miho, Miyamoto, Hirotomo, Akaiwa, Kei, Semba, Kentaro, Sonoda, Shozo, Sakamoto, Taiji, Mitamura, Yoshinori, Kinoshita, Takamasa, Mori, Junya, Okuda, Natsuki, Imaizumi, Hiroko, Iwasaki, Masanori, Shimizu, Miho, Miyamoto, Hirotomo, Akaiwa, Kei, Semba, Kentaro, Sonoda, Shozo, Sakamoto, Taiji, and Mitamura, Yoshinori

Abstract

Aims To determine the effects of dynamic exercise on the circulation and the luminal and stromal areas of the choroid in normal eyes. Methods This was a prospective interventional study of 38 eyes of 38 normal subjects enrolled by invitation. The systolic and diastolic blood pressures, heart rate, intraocularpressure, mean ocular perfusion pressure (MOPP), choroidal blood velocity, and enhanced depth imaging optical coherence tomographic (EDI-OCT) images were recorded before, and immediately after mild dynamic exercise. The same measurements were recorded after 10 min of rest. The choroidal blood velocity was measured bylaser speckle flowgraphy, and the mean blur rate was used for the evaluations. The horizontal EDI-OCT images of the subfoveal choroid were converted to binary images. The central choroidal thickness (CCT), total cross sectional choroidal area, luminal areas, stromal areas, and the ratio of luminal area to total choroidal area (L/C ratio) were determined from these images. Results The systolic and diastolic blood pressures, heart rate, MOPP, and the mean blur rate were significantly increased immediately after the exercise and significantly decreased 10 minutes after the exercise. There wereno significant changes in the mean CCT, the mean total choroidal area, the mean luminal and stromal areas, and the mean L/C ratio after the exercise. Conclusions Our results suggest that a rest period is needed before measurements of blood flow velocity but not necessary for the EDI-OCT imaging to determine the choroidal thickness and area.

Published
2016

12. Changes in Choroidal Structures in Eyes with Chronic Central Serous Chorioretinopathy after Half-Dose Photodynamic Therapy

Author

Kinoshita, Takamasa, Mitamura, Yoshinori, Mori, Terumi, Akaiwa, Kei, Semba, Kentaro, Egawa, Mariko, Mori, Junya, Sonoda, Shozo, Sakamoto, Taiji, Kinoshita, Takamasa, Mitamura, Yoshinori, Mori, Terumi, Akaiwa, Kei, Semba, Kentaro, Egawa, Mariko, Mori, Junya, Sonoda, Shozo, and Sakamoto, Taiji

Abstract

Purpose To determine the structural changes in the choroid after half-dose photodynamic therapy (hPDT) in eyes with chronic central serous chorioretinopathy (CSC). Methods This was a retrospective interventional study of 29 eyes of 29 patients who underwent hPDT for chronic CSC with serous retinal detachment (SRD) and were followed for ≥3 months. Enhanced depth imaging optical coherence tomographic (EDI-OCT) images of the subfoveal choroid were converted to binary images. The central choroidal thickness (CCT), the cross sectional subfoveal choroidal area, the hyporeflective and hyperreflective areas of the inner, outer, and whole choroid were determined at the baseline, and at 1, 3, and 12 months after the hPDT. Results The SRDs were resolved in 26 (89.7%) eyes at 3 months after the hPDT. The mean CCT (P = 0.001), the total choroidal area (P = 0.001), and the hypo-reflective area (P = 0.003) of the whole choroid were significantly decreased from the baseline at 3 months. The hyperreflective area of whole choroid was not significantly changed during the study period (P = 0.083). The hyperreflective but not the hyporeflective area of the inner choroid was significantly decreased at 3 months (P = 0.001, P = 1.000, respectively). The hyporeflective but not the hyperreflective area of the outer choroid was significantly decreased at 3 months (P = 0.001, P = 1.000, respectively). Conclusions The hyperreflective area of the inner choroid and hyporeflective area of the outer choroid were significantly decreased after hPDT for chronic CSC. Because the hyperreflective and hyporeflective area correspond to the choroidal stroma and vessels, respectively, the decreased CCT and subfoveal choroidal area after hPDT may be attributed to a decrease in the exudative changes in the inner choroidal stroma and the reduction of the dilation of the outer choroidal vessels.

Published
2016

13. Correlation between optic nerve head circulation and visual function before and after anti-VEGF therapy for central retinal vein occlusion : prospective, interventional case series

Author

Nagasato, Daisuke, Mitamura, Yoshinori, Semba, Kentaro, Akaiwa, Kei, Nagasawa, Toshihiko, Yoshizumi, Yuki, Tabuchi, Hitoshi, Kiuchi, Yoshiaki, Nagasato, Daisuke, Mitamura, Yoshinori, Semba, Kentaro, Akaiwa, Kei, Nagasawa, Toshihiko, Yoshizumi, Yuki, Tabuchi, Hitoshi, and Kiuchi, Yoshiaki

Abstract

Background: To determine the correlation between the optic nerve head (ONH) circulation determined by laser speckle flowgraphy and the best-corrected visual acuity or retinal sensitivity before and after intravitreal bevacizumab or ranibizumab for central retinal vein occlusion. Methods: Thirty-one eyes of 31 patients were treated with intravitreal bevacizumab or ranibizumab for macular edema due to a central retinal vein occlusion. The blood flow in the large vessels on the ONH, the best-corrected visual acuity, and retinal sensitivity were measured at the baseline, and at 1, 3, and 6 months after treatment. The arteriovenous passage time on fluorescein angiography was determined. The venous tortuosity index was calculated on color fundus photograph by dividing the length of the tortuous retinal vein by the chord length of the same segment. The blood flow was represented by the mean blur rate (MBR) determined by laser speckle flowgraphy. To exclude the influence of systemic circulation and blood flow in the ONH tissue, the corrected MBR was calculated as MBR of ONH vessel area – MBR of ONH tissue area in the affected eye divided by the vascular MBR – tissue MBR in the unaffected eye. Pearson’s correlation tests were used to determine the significance of correlations between the MBR and the best-corrected visual acuity, retinal sensitivity, arteriovenous passage time, or venous tortuosity index. Results: At the baseline, the corrected MBR was significantly correlated with the arteriovenous passage time and venous tortuosity index (r = -0.807, P < 0.001; r = -0.716, P < 0.001; respectively). The corrected MBR was significantly correlated with the best-corrected visual acuity and retinal sensitivity at the baseline, and at 1, 3, and 6 months (all P < 0.050). The corrected MBR at the baseline was significantly correlated with the best-corrected visual acuity at 6 months (r = -0.651, P < 0.001) and retinal sensitivity at 6 months (r = 0.485, P = 0.005). Conclusions: The

Published
2016

14. Optical coherence tomography parameters predictive of visual outcome after anti-VEGF therapy for retinal vein occlusion

Author

Fujihara-Mino,Akiko, Mitamura,Yoshinori, Inomoto,Naoki, Sano,Hiroki, Akaiwa,Kei, Semba,Kentaro, Fujihara-Mino,Akiko, Mitamura,Yoshinori, Inomoto,Naoki, Sano,Hiroki, Akaiwa,Kei, and Semba,Kentaro

Abstract

Akiko Fujihara-Mino, Yoshinori Mitamura, Naoki Inomoto, Hiroki Sano, Kei Akaiwa, Kentaro Semba Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan Purpose: To determine the optical coherence tomography (OCT) parameters that are predictive of visual outcome after anti-VEGF therapy for a retinal vein occlusion (RVO). Methods: Fifty-seven eyes with macular edema (ME) secondary to a central or branch RVO treated with bevacizumab or ranibizumab were studied. Spectral-domain OCT and microperimetry were performed before, 1, 3, and 6 months after the treatment and at the final visit. Central retinal thickness (CRT), macular volume (MV), integrity of the external limiting membrane (ELM), ellipsoid zone (EZ), and foveal bulge (FB), and photoreceptor outer segment (PROS) length were determined. Results: The mean follow-up period was 17.8±11.5 months. In 46 of the 57 eyes, a resolution of the ME was achieved. The pretreatment CRT and MV, presence of intact ELM, EZ, and FB, and PROS length at the time of ME resolution were significantly correlated with the best-corrected visual acuity and retinal sensitivity at the final visit (P<0.050). Multiple regression analyses showed that the pretreatment MV had the highest correlation with the posttreatment best-corrected visual acuity and retinal sensitivity (P<0.050). Conclusion: The CRT, MV, ELM, EZ, FB, and PROS length are predictive factors for the visual outcome after anti-VEGF therapy for RVO. Keywords: anti-VEGF therapy, retinal sensitivity, retinal vein occlusion, spectral-domain optical coherence tomography, visual acuity

Published
2016

16. Effects of Exercise on the Structure and Circulation of Choroid in Normal Eyes

Author

Kinoshita, Takamasa, primary, Mori, Junya, additional, Okuda, Natsuki, additional, Imaizumi, Hiroko, additional, Iwasaki, Masanori, additional, Shimizu, Miho, additional, Miyamoto, Hirotomo, additional, Akaiwa, Kei, additional, Semba, Kentaro, additional, Sonoda, Shozo, additional, Sakamoto, Taiji, additional, and Mitamura, Yoshinori, additional

Published
2016
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19. Diurnal variations in luminal and stromal areas of choroid in normal eyes

Author

Kinoshita, Takamasa, primary, Mitamura, Yoshinori, additional, Shinomiya, Kayo, additional, Egawa, Mariko, additional, Iwata, Akiko, additional, Fujihara, Akiko, additional, Ogushi, Yoko, additional, Semba, Kentaro, additional, Akaiwa, Kei, additional, Uchino, Eisuke, additional, Sonoda, Shozo, additional, and Sakamoto, Taiji, additional

Published
2016
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21. Prepapillary Vascular Loops Complicated by Suspected Macroaneurysm Rupture

Author

Akaiwa, Kei, Mitamura, Yoshinori, Katome, Takashi, Semba, Kentaro, Egawa, Mariko, and Naito, Takeshi

Subjects
genetic structures, Article Subject, sense organs, eye diseases
Abstract

We present a case of prepapillary vascular loops complicated by a suspected macroaneurysm rupture which was treated with intravitreal bevacizumab (IVB). A 62-year-old woman presented with decreased vision and myodesopsia in her left eye. Her best-corrected visual acuity (BCVA) was 0.6 in the left eye. Fundus examination disclosed an elevated, round, and reddish lesion, retinal hemorrhage at the superior aspect of the optic disc, retinal opacification along the superior branch retinal artery, and a small vitreous hemorrhage. Optical coherence tomography showed a serous retinal detachment, and indocyanine green angiography demonstrated prepapillary vascular loops and a hypofluorescent area with hyperfluorescent margins. These findings suggested the presence of a macroaneurysm. No filling of the dye in the aneurysm-like dilatation suggested a blockage of the lumen with a thrombus which might be associated with a branch retinal artery occlusion (BRAO). A diagnosis of prepapillary vascular loops complicated by a suspected macroaneurysm rupture and BRAO was made. Because of a persistent serous retinal detachment, IVB was performed. One month later, the BCVA improved to 1.0. Fundus examination disclosed an organized yellowish-white macroaneurysm and resolution of the serous retinal detachment. We recommend careful monitoring of patients with prepapillary vascular loops because of complications such as macroaneurysm rupture and BRAO.

Published
2014
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24. Correlation between optic nerve head circulation and visual function before and after anti-VEGF therapy for central retinal vein occlusion: prospective, interventional case series.

Author

Daisuke Nagasato, Yoshinori Mitamura, Kentaro Semba, Kei Akaiwa, Toshihiko Nagasawa, Yuki Yoshizumi, Hitoshi Tabuchi, Yoshiaki Kiuchi, Nagasato, Daisuke, Mitamura, Yoshinori, Semba, Kentaro, Akaiwa, Kei, Nagasawa, Toshihiko, Yoshizumi, Yuki, Tabuchi, Hitoshi, and Kiuchi, Yoshiaki

Subjects
OPTIC nerve diseases, LASERS, BLOOD flow measurement, BEVACIZUMAB, PEARSON correlation (Statistics), NEOVASCULARIZATION inhibitors, BLOOD circulation, VASCULAR endothelial growth factor antagonists, ANGIOGRAPHY, CARDIOVASCULAR disease diagnosis, HEMODYNAMICS, INJECTIONS, LONGITUDINAL method, OPTIC nerve, PERIMETRY, VISUAL acuity, OPTICAL coherence tomography, RETINAL vein occlusion, PHYSIOLOGY, THERAPEUTICS
Abstract

Background: To determine the correlation between the optic nerve head (ONH) circulation determined by laser speckle flowgraphy and the best-corrected visual acuity or retinal sensitivity before and after intravitreal bevacizumab or ranibizumab for central retinal vein occlusion.Methods: Thirty-one eyes of 31 patients were treated with intravitreal bevacizumab or ranibizumab for macular edema due to a central retinal vein occlusion. The blood flow in the large vessels on the ONH, the best-corrected visual acuity, and retinal sensitivity were measured at the baseline, and at 1, 3, and 6 months after treatment. The arteriovenous passage time on fluorescein angiography was determined. The venous tortuosity index was calculated on color fundus photograph by dividing the length of the tortuous retinal vein by the chord length of the same segment. The blood flow was represented by the mean blur rate (MBR) determined by laser speckle flowgraphy. To exclude the influence of systemic circulation and blood flow in the ONH tissue, the corrected MBR was calculated as MBR of ONH vessel area - MBR of ONH tissue area in the affected eye divided by the vascular MBR - tissue MBR in the unaffected eye. Pearson's correlation tests were used to determine the significance of correlations between the MBR and the best-corrected visual acuity, retinal sensitivity, arteriovenous passage time, or venous tortuosity index.Results: At the baseline, the corrected MBR was significantly correlated with the arteriovenous passage time and venous tortuosity index (r = -0.807, P < 0.001; r = -0.716, P < 0.001; respectively). The corrected MBR was significantly correlated with the best-corrected visual acuity and retinal sensitivity at the baseline, and at 1, 3, and 6 months (all P < 0.050). The corrected MBR at the baseline was significantly correlated with the best-corrected visual acuity at 6 months (r = -0.651, P < 0.001) and retinal sensitivity at 6 months (r = 0.485, P = 0.005).Conclusions: The pre-treatment blood flow velocity of ONH can be used as a predictive factor for the best-corrected visual acuity and retinal sensitivity after anti-VEGF therapy for central retinal vein occlusion.Trial Registration: Trial Registration Number: UMIN000009072. Date of registration: 10/15/2012. [ABSTRACT FROM AUTHOR]

Published
2016
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25. CaCO3/Chitin hybrids: recombinant acidic peptides based on a peptide extracted from the exoskeleton of a crayfish controls the structures of the hybrids

Author

Kumagai, Hiromu, primary, Matsunaga, Ryou, additional, Nishimura, Tatsuya, additional, Yamamoto, Yuya, additional, Kajiyama, Satoshi, additional, Oaki, Yuya, additional, Akaiwa, Kei, additional, Inoue, Hirotaka, additional, Nagasawa, Hiromichi, additional, Tsumoto, Kohei, additional, and Kato, Takashi, additional

Published
2012
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28. Optical coherence tomography parameters predictive of visual outcome after anti-VEGF therapy for retinal vein occlusion.

Author

Fujihara-Mino A, Mitamura Y, Inomoto N, Sano H, Akaiwa K, and Semba K

Abstract

Purpose: To determine the optical coherence tomography (OCT) parameters that are predictive of visual outcome after anti-VEGF therapy for a retinal vein occlusion (RVO)., Methods: Fifty-seven eyes with macular edema (ME) secondary to a central or branch RVO treated with bevacizumab or ranibizumab were studied. Spectral-domain OCT and microperimetry were performed before, 1, 3, and 6 months after the treatment and at the final visit. Central retinal thickness (CRT), macular volume (MV), integrity of the external limiting membrane (ELM), ellipsoid zone (EZ), and foveal bulge (FB), and photoreceptor outer segment (PROS) length were determined., Results: The mean follow-up period was 17.8±11.5 months. In 46 of the 57 eyes, a resolution of the ME was achieved. The pretreatment CRT and MV, presence of intact ELM, EZ, and FB, and PROS length at the time of ME resolution were significantly correlated with the best-corrected visual acuity and retinal sensitivity at the final visit (P<0.050). Multiple regression analyses showed that the pretreatment MV had the highest correlation with the posttreatment best-corrected visual acuity and retinal sensitivity (P<0.050)., Conclusion: The CRT, MV, ELM, EZ, FB, and PROS length are predictive factors for the visual outcome after anti-VEGF therapy for RVO.

Published
2016
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29. Left ventricular outflow tract pseudoaneurysm after aortic valve replacement: case report.

Author

Aoyagi S, Fukunaga S, Otsuka H, Akaiwa K, Yokokura Y, and Yokokura H

Subjects
Aged, Female, Humans, Aneurysm, False etiology, Aortic Valve, Coronary Artery Disease etiology, Heart Valve Prosthesis Implantation adverse effects, Ventricular Outflow Obstruction etiology
Abstract

A 68-year-old woman was admitted for angina pectoris and general fatigue without symptoms or signs of infective endocarditis. The patient had undergone re-replacement of an aortic prosthetic valve three months previously. Transesophageal echocardiography revealed an echo-free cavity in the mitral-aortic intervalvular fibrosa region just below the aortic annulus, communication of the echo-free cavity with the left ventricular outflow tract, and turbulent flow into the cavity. Left ventriculography revealed a cavity that arose just below the aortic prosthetic valve, and which expanded in systole and collapsed in diastole. Coronary angiography showed significant stenosis of the proximal right coronary artery, but neither stenoses nor compression were found in the left coronary artery. Patch closure of the pseudoaneurysm and aortic root replacement using a Freestyle valve with reconstruction of the coronary arteries were successfully performed. Surgical trauma to the intervalvular fibrosa during removal of the original prosthetic valve may have caused pseudoaneurysm formation in this patient.

Published
2004

30. Left atrial thrombosis following mitral valve repair and maze procedure: case report.

Author

Aoyagi S, Tayama E, Fukunaga S, Akaiwa KI, Takagi K, and Shojima T

Subjects
Aged, Atrial Fibrillation diagnosis, Cardiac Surgical Procedures methods, Catheter Ablation adverse effects, Echocardiography, Transesophageal, Electrocardiography, Female, Follow-Up Studies, Heart Atria physiopathology, Humans, Mitral Valve Insufficiency diagnostic imaging, Mitral Valve Insufficiency physiopathology, Reoperation, Risk Assessment, Severity of Illness Index, Thrombectomy methods, Thromboembolism etiology, Treatment Outcome, Atrial Fibrillation surgery, Cardiac Surgical Procedures adverse effects, Catheter Ablation methods, Heart Atria surgery, Mitral Valve Insufficiency surgery, Thromboembolism surgery
Abstract

The case is described of a 71-year-old woman with left atrial thrombosis after successful mitral valve repair and a Kosakai-maze procedure. At three months after surgery, electrocardiography showed a normal sinus rhythm, but echocardiography revealed a mural thrombus on the posterior wall of the left atrium. During those three months, the anticoagulation level (thrombotest index range: 29-41%) was lower than target level. Anticoagulant therapy with heparin plus warfarin failed to reduce the thrombus size. Anticardiolipin antibodies were positive, and lupus anticoagulants negative. A Doppler study of the mitral valve indicated peak velocity 1.48 m/s, mean pressure gradient 4.5 mmHg, and valve area 2.1 cm2. During reoperation, an old spherical thrombus (weight 38 g) which was firmly adhered to the posterior wall and included an incision line of the Kosakai-maze procedure, was identified and totally removed. After reoperation, the patient received warfarin and an antiplatelet agent to maintain the INR at 2.5-3.5. Echocardiography performed at 11 months postoperatively revealed no thrombus formation on the left atrium.

Published
2003

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