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We encountered a challenging case of endovascular repair for distal stent graft-induced new entry (SINE) using the AFX aortic cuff. Postoperative computed tomography revealed no endoleak with a preferable conformation change of the externally mounted graft material of the AFX cuff against the tear.

Background & Aim: Traumatic aortic injury (TAI) is a life-threatening condition. We present cases of 7 patients with TAI limited at the isthmus. Case description: Seven patients with TAI were treated between January 2015 and December 2018; TAI was caused by motor vehicle crashes in all cases. The patient characteristics and the post-operation data were collected and analyzed. We performed thoracic endovascular aortic repair (TEVAR) for five patients during their first hospitalization using Relay Plus® (Japan Lifeline, Japan). While patient 6 underwent TEVAR 5 years after the injury, patient 7 was recommended conservative care because she had dementia. Since most of these patients did not have a history of hypertension, they were not on antihypertensive medications after TEVAR. Conclusions: In cases of TAI, intervention by TEVAR in the acute phase improves the patient’s quality of life. Additionally, TEVAR is expected to prevent TAI from enlarging to form an aortic aneurysm.

A 60-year-old man presented with chest pain after an accidental fall. Chest x-ray showed massive opacification of the left lung, implying haemothorax ( Panel A ). Echocardiography revealed not only a tiny pericardial effusion but also a subtle flow signal with a 0.38 m/s peak systolic velocity from the right ventricle (RV) into the pericardial …

62歳，女性．24歳時にファロー四徴症と診断された．今回，発熱，呼吸困難を訴え来院した．NYHA IV度であり，心臓超音波検査でファロー四徴症，三尖弁閉鎖不全症を認め手術適応と判断した．心臓カテーテル検査で主要大動脈肺動脈側副動脈（MAPCAs）を認めた．術中の心腔内還流血や修復術後の左室容量負荷残存を考慮し，MAPCAsコイル塞栓術を先行した後，心内修復術（Medtronic FreeStyle Valve，Transannular patchを用いた右室流出路再建＋心室中隔欠損閉鎖＋三尖弁輪縫縮）を行った．術後第2病日に人工呼吸器を離脱し，第37病日に退院となった．退院時はNYHA I度で術後10年を経過した現在も外来通院中である．高齢者のファロー四徴症であっても肺動脈弁逆流，三尖弁逆流を残存させない術式の選択やMAPCAsコイル塞栓術を先行することにより安全に心内修復術を施行し得た．

A 63-year-old man presented to a nearby doctor with fever and lumbago. Enhanced computed tomography showed a thoracoabdominal aortic aneurysm and enhancement of soft tissue around the aneurysm. He was diagnosed with an infected thoracoabdominal aortic aneurysm and given antibiotics. After 2 weeks, the infection was controlled and he underwent in situ replacement with a bovine pericardial roll graft. A week after the operation, the inflammatory reaction was increased, but the bovine pericardial roll graft was not infected. This suggests that a bovine pericardial roll graft is a suitable material for use in patients with bacterial infections.

We recently demonstrated that ischemic preconditioning (PC) induced by cyclic episodes of short duration of ischemia and reperfusion potentiates a signal transduction cascade involving Janus kinase (JAK) 2 and signal transducer and activator of transcription 3 (STAT3). A rapid activation of JAK and several STATs, including STAT3, STAT5A, and STAT6 also occurred during myocardial ischemia and reperfusion. This study sought to examine whether STAT5A and STAT6 were also involved in PC. Two different animal models were used: isolated perfused working rat hearts and STAT5A and STAT6 knockout mouse hearts. The results of our study indicated phosphorylation of STAT 5A and STAT6 in the preconditioned myocardium. Tyrphostin AG490, a JAK2 inhibitor, or 4-amino-5-(4-methylphenyl)-7-( t-butyl)-pyrazolo-3,4-d-pyrimidine (PPI), a Src kinase blocker, blocked STAT5A phosphorylation, whereas STAT6 phosphorylation was blocked only with tyrphostin. As expected, significant cardioprotection was achieved in the preconditioned heart as evidenced by reduced myocardial infarct size and decreased number of apoptotic cardiomyocytes. PC-mediated cardioprotection was partially abolished when hearts were pretreated with tyrphostin, PPI, or LY-294002, a phosphatidylinositol (PI)-3 kinase inhibitor. Studies with STAT5A and STAT6 knockout mouse hearts revealed that STAT6 knockout mouse hearts, and not STAT5A knockout mouse hearts, were resistant to myocardial ischemia-reperfusion injury. The hearts from STAT5A knockout mice could not be preconditioned, whereas those from STAT6 knockout mice were easily preconditioned. The results of the present study demonstrate that STAT5A, and not STAT6, plays a role in ischemic PC. For the first time, the results also indicated a role of Src kinase pathway in STAT5A PC and PI-3 kinase-Akt pathways appear to be the downstream regulator for STAT5A-STAT6 signaling pathway.

Multichannel near-infrared spectroscopy (NIRS) could detect change in the regional cerebral oxygenation by following animated pictures of oxy-hemoglobin (OxyHb), deoxy-hemoglobin (DeoxyHb) and total hemoglobin in operations for three surgical cases of thoracic aortic aneurysm with selective cerebral perfusion (SCP). Simultaneously measured jugular venous oxygen saturation (SjO2) showed no change in parallel to OxyHb or DeoxyHb of NIRS. It was concluded that SjO2 represented the entire rather than the local findings of the cerebral oxidative metabolism. Assessment of the intra cranial oxidative metabolism using a multichannel NIRS provided real-time information about the efficacy of SCP, while SjO2 had a comprehensive limited value. The animation enabled the detection of regional hypoperfusion visually and instantly during SCP. This multichannel NIRS was a new real-time monitoring method and was useful to prevent cerebral neurological complication due to hypoperfusion during SCP.