Yuchen Cao - Academia.edu (original) (raw)
Papers by Yuchen Cao
Journal of Cardiac Surgery, 2021
Background: The high incidence of postoperative pulmonary venous obstruction (PVO) is a major mor... more Background: The high incidence of postoperative pulmonary venous obstruction (PVO) is a major mortality-associated concern in patients with right atrial isomerism and extracardiac total anomalous pulmonary venous connection (TAPVC). We evaluated new anatomical risk factors for reducing the space behind the heart after TAPVC repair. Methods: 18 patients who underwent TAPVC repair between 2014 and 2020 were enrolled. Sutureless technique was used in 12 patients and conventional repair in six patients. The angle between the line perpendicular to the vertebral body and that from the vertebral body to the apex was defined as the "vertebral-apex angle (V-A angle)." The ratio of post-and preoperative angles, indicating the apex's lateral rotation, was compared between patients with and without PVO. Results: The median (interquartile range) age and body weight at repair were 102 (79-176) days and 3.8 (2.6-4.8) kg, respectively. The 1-year survival rate was 83% (median follow-up, 29 [11-36] months). PVO occurred in seven patients (39%), who showed an obstruction of one or two branches in the apex side. The postoperative V-A angle (46°[45°-50°] vs. 36°[29°-38°], P = 0.001) and the ratio of post-and preoperative V-A angles (1.27 [1.24-1.42] vs. 1.03 [0.98-1.07], P = 0.001) were significantly higher in the PVO group than in the non-PVO group. The cutoff values of the postoperative V-A angle and ratio were 41°and 1.17, respectively. Conclusions: A postoperative rotation of the heart apex into the ipsilateral thorax was a risk factor for branch PVO after TAPVC repair.
World Journal of Cardiovascular Diseases
Kyobu geka. The Japanese journal of thoracic surgery, 2020
Thoracic endovascular aortic repair (TEVAR) has become a major procedure for thoracic aortic aneu... more Thoracic endovascular aortic repair (TEVAR) has become a major procedure for thoracic aortic aneurysm and its indication is expanding. On the other hand, TEVAR specific complication is rather critical and its treatment is of increasing interest. Especially, open repair after TEVAR is sometimes demanding and case based strategy is mandatory. We experienced a case of open repair for aneurysm infection and endoleak after fenestrated TEVAR in 76-year-old man. He underwent initial aneurysmal repair using fenestrated graft 2 years ago. Five months later, debridment of infected tissue was performed because of aneurysmal infection. Type Ⅰ endoleak appeared after the surgery and expansion of the aneurysm made us decide extensive open repair. The operation was done under hypothermic circulatory arrest and selective cerebral perfusion. Partial removal of stent-graft and insertion of the open stent-graft, replacement of ascending aorta and reconstruction of neck vessels were done. Postoperative...
Kyobu geka. The Japanese journal of thoracic surgery, 2020
A 63-year-old man had ventricular septal defect (VSD) and had been followed up without heart fail... more A 63-year-old man had ventricular septal defect (VSD) and had been followed up without heart failure. Recently, he had palpitation caused by atrial fibrillation and the echocardiography revealed moderate aortic valve regurgitation and stenosis with right coronary cusp prolapse due to subpulmonary ventricular septal defect. He underwent patch closure of VSD, aortic valve replacement with mechanical valve, and maze procedure. In recent years, advanced case like this patient is rare because most of patients with subpulmonary VSD and right coronary cusp prolapse are operated in childhood.
Kyobu geka. The Japanese journal of thoracic surgery, 2019
Ross procedure has been found to have a lower incidence of infective endocarditis compared to oth... more Ross procedure has been found to have a lower incidence of infective endocarditis compared to other aortic replacement procedure using prosthetic valves. We report a case of 25-year-old man who underwent Ross procedure for congenital aortic stenosis and regurgitation when he was 7 years old. He presented with fever and was highly suspected of infective endocarditis. All sets of blood cultures were positive for Heamophilus parainfluenzae. Autologous pericardial pulmonary valve was severely stenotic and computed tomography (CT) scan and radio isotope (RI) scan revealed infection at the stenotic valve. We performed right ventricle (RV)-pulmonary artery (PA) conduit replacement and he was discharged after completion of intravenous antibiotic treatment. We experienced a rare case of infective endocarditis in a patient late after Ross procedure. Prophylaxis against infective endocarditis is mandatory even in patients with infection resistant Ross procedure.
Japanese Journal of Cardiovascular Surgery, 2021
The mainstream strategy for blunt traumatic thoracic aortic injuries BTAI has been shifting from ... more The mainstream strategy for blunt traumatic thoracic aortic injuries BTAI has been shifting from conventional open repair OR to thoracic endovascular aortic repair TEVAR. Accordingly, we reviewed the short-and mid-term outcomes following surgical procedures of BTAI, comparing OR with TEVAR. : We retrospectively collected data of consecutive cases of BTAI in a single institution from March 2001 to August 2019. : Eighteen cases were identified. Of these, 7 patients 38.9%, mean age 62.0 15.2 years were treated with OR and 11 61.1%, mean age 61.8 21.3 years were treated with TEVAR. There was significant reduction in the mean operative duration OR 444 145 vs TEVAR 65 14 min ; p 0.001 , the mean intraoperative blood loss OR 2,787 1,578 vs TEVAR 210 376 ml ; p 0.001 , the volume of blood transfusions OR 5,042 2,219 vs TEVAR 929 751 ml ; p 0.001 , and the mean dose of heparin infusion OR 20.3 4.1 vs TEVAR 7.9 8.5 ml ; p 0.01. Postoperative 30-day mortality of OR and TEVAR were 28.6 and 0% p 0.14 , respectively. There was no endoleak, 1 case of paraparesis, and 1 case of bilateral cerebellar infarction in the TEVAR group. There was no significant difference in the length of stay in the intensive care unit, the duration of hospital stay, the rate of home discharge, or the mid-term mortality and re-intervention rate average follow-up period of 42.0 56.9 months. : Compared with OR, TEVAR took less operative time with less bleeding, and required less blood transfusions and heparin. The short-and mid
Asian Journal of Endoscopic Surgery, 2018
The early and accurate diagnosis of reduction en masse followed by proper treatment is important ... more The early and accurate diagnosis of reduction en masse followed by proper treatment is important but has been difficult. Here, we report the case of a 58-year-old Japanese man who presented with abdominal pain and vomiting at a nearby clinic. He was referred to our hospital on suspicion of small bowel obstruction. Despite the total disappearance of his symptoms, the abdominal X-ray examination showed distended loops of small bowel. The preoperative diagnosis of small bowel strangulation due to an internal hernia was made by CT, and we therefore performed emergency exploratory laparoscopy. We intraoperatively diagnosed the patient with the reduction en masse of a right inguinal hernia, and we conducted a transabdominal preperitoneal hernioplasty. This patient's case demonstrates that even when a patient is asymptomatic after the reduction of an inguinal hernia, the possibility of a reduction en masse remains.
Kyobu geka. The Japanese journal of thoracic surgery, 2019
A 70-years old man was referred to our department for acute heart failure due to post myocardial ... more A 70-years old man was referred to our department for acute heart failure due to post myocardial infarction papillary muscle rupture. We planned emergent surgery, but he refused blood transfusion because of religious reason( Jehovah's Witness). Therefore, we chose medical therapy using intra-aortic balloon pumping and catecholamine. He was also treated with subcutaneous erythropoietin and intravenous iron supplement to increase preoperative hemoglobin. One month later, we decided to undergo mitral valve repair because he was stabilized with medical treatment. The patient underwent mitral valve repair with artificial chordae through median sternotomy. The mitral valve A3 prolapse was caused by posterior papillary muscle rupture. No blood transfusion was given and postoperative course was uneventful. We experienced successful mitral repair for post infarction papillary muscle rupture in a Jehova's Witnessess patient.
Kyobu geka. The Japanese journal of thoracic surgery, 2021
Management of tricuspid regurgitation( TR) before right ventricular dysfunction is critical in pa... more Management of tricuspid regurgitation( TR) before right ventricular dysfunction is critical in patients with hypoplastic left heart syndrome (HLHS);however, appropriate tricuspid valvuloplasty (TVP) is challenging. We report a TVP technique for TR in a 4-year-old girl with HLHS, who had undergone Norwood operation, bidirectional cavopulmonary shunt, and TVP. Preoperative echocardiography revealed the etiology of TR as anterior leaflet prolapse, annulus dilatation, and relative tethering of the septal leaflet. We performed surgical reconstruction of the anterior leaflet with artificial chordae. Before annuloplasty, the posterior leaflet and a part of the septal leaflet were detached from the annulus with a 1 mm margin using the Key-Reed technique. Furthermore, the posterior leaflet was slid to augment the septal leaflet. We managed to regulate the TR by enlarging the septal leaflet, thus increasing the coaptation zone. We believe that this technique will be useful for TR with annulus...
The Annals of Thoracic Surgery, 2021
In recent years, external stenting has been used as a reliable method to relieve airway compressi... more In recent years, external stenting has been used as a reliable method to relieve airway compression of the trachea and main bronchi in young children with acceptable age-proportional airway growth. However, to our knowledge, no literature supporting this approach for the distal airway has been published. A 1-year-old girl with absent pulmonary valve syndrome who had recurrent respiratory infections was diagnosed with bronchomalacia. She underwent an external stenting; the infections disappeared postoperatively. This is the first reported case of successful external stenting for malacia of the bronchus intermedius, which exhibited short- and mid-term safety and effectiveness.
Journal of Cardiac Surgery, 2019
Surgical treatment of cardiac fibroma is rare in patients with left ventricular noncompaction (LV... more Surgical treatment of cardiac fibroma is rare in patients with left ventricular noncompaction (LVNC). Although several case reports regarding cardiac fibroma have been published, resection in a patient with LVNC has not been described. Here, we describe the surgical treatment of left ventricular fibroma in a child with LVNC. We resected a cardiac fibroma in a 10-year-old boy with LVNC to control ventricular arrhythmia. Partial resection with careful tumor dissection was performed to avoid
The Annals of Thoracic Surgery, 2019
A 47-year-old man presented with occasional palpitations. He had a history of mitral valve repair... more A 47-year-old man presented with occasional palpitations. He had a history of mitral valve repair thorough a right thoracotomy that was performed for infective endocarditis at the age of 11 years. Echocardiography demonstrated a unicuspid aortic valve and moderate aortic regurgitation with a dilated left ventricle. Computed tomography revealed a severely kinked aortic arch with a dilated ascending and descending aorta without collateral circulation (Fig 1A) with a concurrent patent ductus arteriosus. The ascending aorta and descending aorta measured 56 and 48 mm, respectively. There was no difference in blood pressure between the patient's arms and legs. Electrocardiography showed atrial flutter.
World Journal of Cardiovascular Diseases, 2020
A left-sided lesion of a coronary cameral fistula (CCF) is extremely rare. Surgical closure of th... more A left-sided lesion of a coronary cameral fistula (CCF) is extremely rare. Surgical closure of the fistula is indicated when symptoms emerge or as a preventive strategy, while surgical approaches depend on the individual anatomical structures. In particular, a CCF forming a "fistula lake" with multiple inflow vessels is so unique that few studies have focused on the technique to close it. We report the successful management of a CCF originating from multiple coronary arteries and draining into the left ventricle via a "fistula lake" by ligation and clipping of associated communication tracts. On the postoperative coronary computed tomography angiography, the fistula lake and the small vessels entering it had all disappeared.
Journal of Cardiac Surgery, 2021
Background: The high incidence of postoperative pulmonary venous obstruction (PVO) is a major mor... more Background: The high incidence of postoperative pulmonary venous obstruction (PVO) is a major mortality-associated concern in patients with right atrial isomerism and extracardiac total anomalous pulmonary venous connection (TAPVC). We evaluated new anatomical risk factors for reducing the space behind the heart after TAPVC repair. Methods: 18 patients who underwent TAPVC repair between 2014 and 2020 were enrolled. Sutureless technique was used in 12 patients and conventional repair in six patients. The angle between the line perpendicular to the vertebral body and that from the vertebral body to the apex was defined as the "vertebral-apex angle (V-A angle)." The ratio of post-and preoperative angles, indicating the apex's lateral rotation, was compared between patients with and without PVO. Results: The median (interquartile range) age and body weight at repair were 102 (79-176) days and 3.8 (2.6-4.8) kg, respectively. The 1-year survival rate was 83% (median follow-up, 29 [11-36] months). PVO occurred in seven patients (39%), who showed an obstruction of one or two branches in the apex side. The postoperative V-A angle (46°[45°-50°] vs. 36°[29°-38°], P = 0.001) and the ratio of post-and preoperative V-A angles (1.27 [1.24-1.42] vs. 1.03 [0.98-1.07], P = 0.001) were significantly higher in the PVO group than in the non-PVO group. The cutoff values of the postoperative V-A angle and ratio were 41°and 1.17, respectively. Conclusions: A postoperative rotation of the heart apex into the ipsilateral thorax was a risk factor for branch PVO after TAPVC repair.
World Journal of Cardiovascular Diseases
Kyobu geka. The Japanese journal of thoracic surgery, 2020
Thoracic endovascular aortic repair (TEVAR) has become a major procedure for thoracic aortic aneu... more Thoracic endovascular aortic repair (TEVAR) has become a major procedure for thoracic aortic aneurysm and its indication is expanding. On the other hand, TEVAR specific complication is rather critical and its treatment is of increasing interest. Especially, open repair after TEVAR is sometimes demanding and case based strategy is mandatory. We experienced a case of open repair for aneurysm infection and endoleak after fenestrated TEVAR in 76-year-old man. He underwent initial aneurysmal repair using fenestrated graft 2 years ago. Five months later, debridment of infected tissue was performed because of aneurysmal infection. Type Ⅰ endoleak appeared after the surgery and expansion of the aneurysm made us decide extensive open repair. The operation was done under hypothermic circulatory arrest and selective cerebral perfusion. Partial removal of stent-graft and insertion of the open stent-graft, replacement of ascending aorta and reconstruction of neck vessels were done. Postoperative...
Kyobu geka. The Japanese journal of thoracic surgery, 2020
A 63-year-old man had ventricular septal defect (VSD) and had been followed up without heart fail... more A 63-year-old man had ventricular septal defect (VSD) and had been followed up without heart failure. Recently, he had palpitation caused by atrial fibrillation and the echocardiography revealed moderate aortic valve regurgitation and stenosis with right coronary cusp prolapse due to subpulmonary ventricular septal defect. He underwent patch closure of VSD, aortic valve replacement with mechanical valve, and maze procedure. In recent years, advanced case like this patient is rare because most of patients with subpulmonary VSD and right coronary cusp prolapse are operated in childhood.
Kyobu geka. The Japanese journal of thoracic surgery, 2019
Ross procedure has been found to have a lower incidence of infective endocarditis compared to oth... more Ross procedure has been found to have a lower incidence of infective endocarditis compared to other aortic replacement procedure using prosthetic valves. We report a case of 25-year-old man who underwent Ross procedure for congenital aortic stenosis and regurgitation when he was 7 years old. He presented with fever and was highly suspected of infective endocarditis. All sets of blood cultures were positive for Heamophilus parainfluenzae. Autologous pericardial pulmonary valve was severely stenotic and computed tomography (CT) scan and radio isotope (RI) scan revealed infection at the stenotic valve. We performed right ventricle (RV)-pulmonary artery (PA) conduit replacement and he was discharged after completion of intravenous antibiotic treatment. We experienced a rare case of infective endocarditis in a patient late after Ross procedure. Prophylaxis against infective endocarditis is mandatory even in patients with infection resistant Ross procedure.
Japanese Journal of Cardiovascular Surgery, 2021
The mainstream strategy for blunt traumatic thoracic aortic injuries BTAI has been shifting from ... more The mainstream strategy for blunt traumatic thoracic aortic injuries BTAI has been shifting from conventional open repair OR to thoracic endovascular aortic repair TEVAR. Accordingly, we reviewed the short-and mid-term outcomes following surgical procedures of BTAI, comparing OR with TEVAR. : We retrospectively collected data of consecutive cases of BTAI in a single institution from March 2001 to August 2019. : Eighteen cases were identified. Of these, 7 patients 38.9%, mean age 62.0 15.2 years were treated with OR and 11 61.1%, mean age 61.8 21.3 years were treated with TEVAR. There was significant reduction in the mean operative duration OR 444 145 vs TEVAR 65 14 min ; p 0.001 , the mean intraoperative blood loss OR 2,787 1,578 vs TEVAR 210 376 ml ; p 0.001 , the volume of blood transfusions OR 5,042 2,219 vs TEVAR 929 751 ml ; p 0.001 , and the mean dose of heparin infusion OR 20.3 4.1 vs TEVAR 7.9 8.5 ml ; p 0.01. Postoperative 30-day mortality of OR and TEVAR were 28.6 and 0% p 0.14 , respectively. There was no endoleak, 1 case of paraparesis, and 1 case of bilateral cerebellar infarction in the TEVAR group. There was no significant difference in the length of stay in the intensive care unit, the duration of hospital stay, the rate of home discharge, or the mid-term mortality and re-intervention rate average follow-up period of 42.0 56.9 months. : Compared with OR, TEVAR took less operative time with less bleeding, and required less blood transfusions and heparin. The short-and mid
Asian Journal of Endoscopic Surgery, 2018
The early and accurate diagnosis of reduction en masse followed by proper treatment is important ... more The early and accurate diagnosis of reduction en masse followed by proper treatment is important but has been difficult. Here, we report the case of a 58-year-old Japanese man who presented with abdominal pain and vomiting at a nearby clinic. He was referred to our hospital on suspicion of small bowel obstruction. Despite the total disappearance of his symptoms, the abdominal X-ray examination showed distended loops of small bowel. The preoperative diagnosis of small bowel strangulation due to an internal hernia was made by CT, and we therefore performed emergency exploratory laparoscopy. We intraoperatively diagnosed the patient with the reduction en masse of a right inguinal hernia, and we conducted a transabdominal preperitoneal hernioplasty. This patient's case demonstrates that even when a patient is asymptomatic after the reduction of an inguinal hernia, the possibility of a reduction en masse remains.
Kyobu geka. The Japanese journal of thoracic surgery, 2019
A 70-years old man was referred to our department for acute heart failure due to post myocardial ... more A 70-years old man was referred to our department for acute heart failure due to post myocardial infarction papillary muscle rupture. We planned emergent surgery, but he refused blood transfusion because of religious reason( Jehovah's Witness). Therefore, we chose medical therapy using intra-aortic balloon pumping and catecholamine. He was also treated with subcutaneous erythropoietin and intravenous iron supplement to increase preoperative hemoglobin. One month later, we decided to undergo mitral valve repair because he was stabilized with medical treatment. The patient underwent mitral valve repair with artificial chordae through median sternotomy. The mitral valve A3 prolapse was caused by posterior papillary muscle rupture. No blood transfusion was given and postoperative course was uneventful. We experienced successful mitral repair for post infarction papillary muscle rupture in a Jehova's Witnessess patient.
Kyobu geka. The Japanese journal of thoracic surgery, 2021
Management of tricuspid regurgitation( TR) before right ventricular dysfunction is critical in pa... more Management of tricuspid regurgitation( TR) before right ventricular dysfunction is critical in patients with hypoplastic left heart syndrome (HLHS);however, appropriate tricuspid valvuloplasty (TVP) is challenging. We report a TVP technique for TR in a 4-year-old girl with HLHS, who had undergone Norwood operation, bidirectional cavopulmonary shunt, and TVP. Preoperative echocardiography revealed the etiology of TR as anterior leaflet prolapse, annulus dilatation, and relative tethering of the septal leaflet. We performed surgical reconstruction of the anterior leaflet with artificial chordae. Before annuloplasty, the posterior leaflet and a part of the septal leaflet were detached from the annulus with a 1 mm margin using the Key-Reed technique. Furthermore, the posterior leaflet was slid to augment the septal leaflet. We managed to regulate the TR by enlarging the septal leaflet, thus increasing the coaptation zone. We believe that this technique will be useful for TR with annulus...
The Annals of Thoracic Surgery, 2021
In recent years, external stenting has been used as a reliable method to relieve airway compressi... more In recent years, external stenting has been used as a reliable method to relieve airway compression of the trachea and main bronchi in young children with acceptable age-proportional airway growth. However, to our knowledge, no literature supporting this approach for the distal airway has been published. A 1-year-old girl with absent pulmonary valve syndrome who had recurrent respiratory infections was diagnosed with bronchomalacia. She underwent an external stenting; the infections disappeared postoperatively. This is the first reported case of successful external stenting for malacia of the bronchus intermedius, which exhibited short- and mid-term safety and effectiveness.
Journal of Cardiac Surgery, 2019
Surgical treatment of cardiac fibroma is rare in patients with left ventricular noncompaction (LV... more Surgical treatment of cardiac fibroma is rare in patients with left ventricular noncompaction (LVNC). Although several case reports regarding cardiac fibroma have been published, resection in a patient with LVNC has not been described. Here, we describe the surgical treatment of left ventricular fibroma in a child with LVNC. We resected a cardiac fibroma in a 10-year-old boy with LVNC to control ventricular arrhythmia. Partial resection with careful tumor dissection was performed to avoid
The Annals of Thoracic Surgery, 2019
A 47-year-old man presented with occasional palpitations. He had a history of mitral valve repair... more A 47-year-old man presented with occasional palpitations. He had a history of mitral valve repair thorough a right thoracotomy that was performed for infective endocarditis at the age of 11 years. Echocardiography demonstrated a unicuspid aortic valve and moderate aortic regurgitation with a dilated left ventricle. Computed tomography revealed a severely kinked aortic arch with a dilated ascending and descending aorta without collateral circulation (Fig 1A) with a concurrent patent ductus arteriosus. The ascending aorta and descending aorta measured 56 and 48 mm, respectively. There was no difference in blood pressure between the patient's arms and legs. Electrocardiography showed atrial flutter.
World Journal of Cardiovascular Diseases, 2020
A left-sided lesion of a coronary cameral fistula (CCF) is extremely rare. Surgical closure of th... more A left-sided lesion of a coronary cameral fistula (CCF) is extremely rare. Surgical closure of the fistula is indicated when symptoms emerge or as a preventive strategy, while surgical approaches depend on the individual anatomical structures. In particular, a CCF forming a "fistula lake" with multiple inflow vessels is so unique that few studies have focused on the technique to close it. We report the successful management of a CCF originating from multiple coronary arteries and draining into the left ventricle via a "fistula lake" by ligation and clipping of associated communication tracts. On the postoperative coronary computed tomography angiography, the fistula lake and the small vessels entering it had all disappeared.