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Kawarai SI, Katahira S, Miyatake M, Itagaki K, Tsuruoka N, Haga Y, Saiki Y. Development of modified laser Doppler flowmetry device for real-time monitoring of esophageal mucosal blood flow: a preclinical assessment with an animal model. J Artif Organs 2024; 27:284-292. [PMID: 37418161 DOI: 10.1007/s10047-023-01408-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 05/31/2023] [Indexed: 07/08/2023]
Abstract
This study aimed to modify a laser Doppler flowmeter designed and assembled at our institute. After measuring sensitivity evaluation in ex vivo experiments, we confirmed the efficacy of this new device for monitoring real-time esophageal mucosal blood flow changes after thoracic stent graft implantation by simulating various clinical situations in an animal model. Thoracic stent graft implantation was performed in a swine model (n = 8). Esophageal mucosal blood flow decreased significantly from baseline (34.1 ± 18.8 ml/min/100 g vs. 16.7 ± 6.6 ml/min/100 g, P < 0.05) in the lower esophagus (Th6-Th8) where the stent graft covered the aorta. In the hemorrhagic shock model (shock index ≥ 1.0), esophageal mucosal blood flow showed a remarkable change from baseline in the upper esophagus (Th1-Th3), where the stent graft did not cover the aorta (20.8 ± 9.8 ml/min/100 g vs. 12.9 ± 8.6 ml/min/100 g, P < 0.01); however, it returned to the baseline value within a 30-min period. Mucosal blood flow remained stable in the esophagus, where the stent graft did not cover the aorta. After elevating the mean blood pressure to > 70 mmHg with continuous intravenous noradrenaline infusion, esophageal mucosal blood flow increased significantly in both regions; however, the reaction was different between the two regions. Our newly developed laser Doppler flowmeter could measure real-time esophageal mucosal blood flow changes in various clinical situations during thoracic stent graft implantation in a swine model. Hence, this device can be applied in many medical fields by downsizing it.
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Affiliation(s)
- Shun-Ichi Kawarai
- Division of Cardiovascular Surgery, Hachinohe City Hospital, 3-1-1 Tamukai, Hachinohe, Aomori, 031-8555, Japan
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-Ku, Sendai, 980-8574, Japan
| | - Shintaro Katahira
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-Ku, Sendai, 980-8574, Japan.
| | - Midori Miyatake
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-Ku, Sendai, 980-8574, Japan
| | - Kota Itagaki
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-Ku, Sendai, 980-8574, Japan
| | - Noriko Tsuruoka
- Tohoku University Graduate School of Engineering, 6-6-12 Aoba, Aramaki, Aoba-Ku, Sendai, 980-8579, Japan
| | - Yoichi Haga
- Tohoku University Graduate School of Biomedical Engineering, 6-6-12 Aoba, Aramaki, Aoba-Ku, Sendai, 980-8579, Japan
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-Ku, Sendai, 980-8574, Japan
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Kyuchukov D, Simeonov P, Nachev G, Alexieva M, Yankov G. A rare case of posttraumatic aortic rupture, treated with an endovascular stent graft implantation and complicated with esophageal rupture. J Cardiothorac Surg 2022; 17:199. [PMID: 35999551 PMCID: PMC9400209 DOI: 10.1186/s13019-022-01955-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Esophageal necrosis and perforation after thoracic endovascular aortic repair (TEVAR) for ruptured traumatic aortic aneurysm is extremely rare. It is difficult to manage, and patients rarely survive without treatment. Although, there is no certain consensus in relation with the optimal treatment we present a subsequent successful management of both life-threatening conditions. CASE PRESENTATION A 52-year-old man experienced a blunt chest trauma after motor vehicle collision with mild symptoms of pain and fractured ribs. On the 12th day he had severe chest pain and computed tomography (CT) revealed a ruptured traumatic thoracic aortic aneurysm with massive mediastinal hematoma. An emergency thoracic endovascular aortic repair (TEVAR) was performed. Several days later the patient developed a fever. CT suspected a pneumomediastinum, a sign of esophageal rupture, but no confirmation from esophagography and esophagoscopy was achieved. Because of deteriorated septic condition, patient was referred for exploratory thoracotomy. The rupture was found and esophagectomy was performed, with an esophagostomy and gastrostomy to enable enteral nutrition. Almost one year after the esophagectomy, gastric conduit reconstruction through the retrosternal route was performed. The patient was still alive and symptom-free more than 1 year after the reconstruction and no infection of the stent graft was observed. CONCLUSION We successfully managed a rare case of esophageal necrosis after TEVAR for ruptured traumatic thoracic aortic aneurysm. It is essential to diagnose the esophageal necrosis at an early stage and provide appropriate treatment to increase survival.
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Affiliation(s)
- Dimitar Kyuchukov
- Heart Surgery Department, UMBAL "St. Ekaterina"- Medical University of Sofia, 52 A Slaveykov BLVD, 1431, Sofia, Bulgaria
| | - Peyo Simeonov
- Heart Surgery Department, UMBAL "St. Ekaterina"- Medical University of Sofia, 52 A Slaveykov BLVD, 1431, Sofia, Bulgaria
| | - Gencho Nachev
- Heart Surgery Department, UMBAL "St. Ekaterina"- Medical University of Sofia, 52 A Slaveykov BLVD, 1431, Sofia, Bulgaria.
| | - Magdalena Alexieva
- Thoracic Surgery Department, MBALBB "St. Sofia"- Medical University of Sofia, 19 Ivan Gechov BLVD, 1431, Sofia, Bulgaria
| | - Georgi Yankov
- Thoracic Surgery Department, MBALBB "St. Sofia"- Medical University of Sofia, 19 Ivan Gechov BLVD, 1431, Sofia, Bulgaria
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Kim JK, Son S, Suh I, Bae JS, Lim JY. Postoperative Dysphagia Aortica: Comparison with Other Dysphagia. Dysphagia 2021; 37:1112-1119. [PMID: 34546446 DOI: 10.1007/s00455-021-10370-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 09/10/2021] [Indexed: 02/06/2023]
Abstract
Dysphagia can be classified as oropharyngeal or esophageal, and functional or structural deficits of the esophagus can cause esophageal dysphagia. Dysphagia aortica (DA) is defined as dysphagia caused by extrinsic compression of the esophagus by the aorta. The aim of this study was to investigate the characteristics of DA by comparing the findings of videofluoroscopic swallowing studies (VFSS) with those of other dysphagia. Sixty-seven patients with postoperative dysphagia aortica (PDA), dysphagia after brainstem infarction (DBI), dysphagia after anterior cervical discectomy and fusion (DACDF), and subjective swallowing difficulty (SSD) without penetration and/or aspiration, who had undergone VFSS incorporating tests using 5 ml of thin and thick liquids, were included. The clinical data were collected retrospectively. The penetration-aspiration scale, functional dysphagia scale (FDS), esophageal transit time (ETT), and aortic lesion parameters (maximal diameter and distance between the lesion and the apex of the aortic arch) were assessed. The patients with PDA had higher FDS scores than the patients with SSD and lower scores than the patients with DBI did on thin liquids, while the FDS scores on thick liquids were lower in the patients with PDA than in those with DBI or DACDF. The patients with PDA had longer ETT than the other three groups. No correlation was found between the aortic lesion parameters and the VFSS findings. Although PDA has some oropharyngeal symptoms, the esophageal phase was affected mainly by PDA. After an operation on the aorta, VFSS should be considered before resuming oral feeding.
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Affiliation(s)
- Jong Keun Kim
- Department of Rehabilitation Medicine, Daejeon Eulji University Hospital, Eulji University School of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon, 35233, Republic of Korea
| | - Sangpil Son
- Department of Rehabilitation Medicine, Daejeon Eulji University Hospital, Eulji University School of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon, 35233, Republic of Korea
| | - InHyuk Suh
- Department of Rehabilitation Medicine, Daejeon Eulji University Hospital, Eulji University School of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon, 35233, Republic of Korea
| | - Jin Seok Bae
- Department of Rehabilitation Medicine, Daejeon Eulji University Hospital, Eulji University School of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon, 35233, Republic of Korea
| | - Jong Youb Lim
- Department of Rehabilitation Medicine, Daejeon Eulji University Hospital, Eulji University School of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon, 35233, Republic of Korea.
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Mureșan M, Mureșan S, Balmoș I, Sala D, Suciu B, Torok A. Sepsis in Acute Mediastinitis - A Severe Complication after Oesophageal Perforations. A Review of the Literature. J Crit Care Med (Targu Mures) 2019; 5:49-55. [PMID: 31161141 PMCID: PMC6534941 DOI: 10.2478/jccm-2019-0008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 04/23/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Despite recent advancements in antibiotic therapy and the progress made in critical care and modern diagnostic methods, acute mediastinitis continues to be a severe condition. DIAGNOSIS AND TREATMENT Acute mediastinitis can occur in the context of cardio-thoracic surgery, oesophageal perforations and oropharyngeal infections condition. Forty-five percent of oesophageal perforations occurs during simple endoscopy. Spontaneous perforation (Boerhaave syndrome) accounts for 15% of perforations, and twelve percent are due to the ingestion of foreign bodies. Other causes include blind or penetrating trauma, and circa 9% to intraoperative lesions. CT scan is the standard investigation that reveals direct signs of mediastinitis.The oral administration of contrast substances can underscore the level of oesophageal perforation. Conservative treatment is the first-choice treatment and surgical treatment is reserved only for specific situations.The principles of surgical treatment consist of drainage, primary suture, oesophageal exclusion with or without the application of oesophagectomy, endoscopic vacuum wound assisted therapy of the perforation and associated paraoesophageal mediastinal drainage and endoscopic stenting associated with drainage. CONCLUSIONS The lowest mortality rate is recorded in patients with perforations diagnosed less than twenty-four hours after the onset of symptoms. Surgical treatment remains the gold standard especially in cases of thoracic and abdominal perforations while further investigations are mandatory before endoscopic stenting is carried out.
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Affiliation(s)
- Mircea Mureșan
- University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Surgery Clinic No.2, Târgu Mureș, Romania
| | - Simona Mureșan
- University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Physiology Department, Târgu Mureș, Romania
| | - Ioan Balmoș
- University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Surgery Clinic No.2, Târgu Mureș, Romania
| | - Daniela Sala
- University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Surgery Clinic No.2, Târgu Mureș, Romania
| | - Bogdan Suciu
- University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Thoracic Surgery Department, Târgu Mureș, Romania
| | - Arpad Torok
- University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Surgery Clinic No.2, Târgu Mureș, Romania
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