ABSTRACT
<p>We report a case of syphilitic aortitis (SA) associated with severe right coronary ostial stenosis, aortic regurgitation (AR), and annuloaortic ectasia (AAE). A 48-year-old man presented to a regional hospital with easy fatigability and nocturnal dyspnea. Echocardiography revealed Seller's grade 3 AR. A computed tomography scan showed AAE, dilatation of the ascending aorta, and calcification of both coronary ostia. Coronary angiography demonstrated that the left coronary artery was intact ; however, the right coronary artery was obscure. Active syphilis was detected on routine blood tests on admission. Therefore, the patient was started on a course of ampicillin/sulbactam (ABPC/SBT). Subsequently, he underwent the Bentall procedure and coronary artery bypass grafting with the right internal thoracic artery. The intraoperative findings showed degeneration of the aorta and severe right coronary ostial stenosis. The pathological findings of the aortic wall and aortic valve were consistent with SA. The postoperative course was uneventful. The patient continued receiving ABPC/SBT for 3 weeks postoperatively, and was then switched to oral amoxicillin.</p>
ABSTRACT
<b>Background</b> : Several studies have shown that Fontan circulation may lead to liver congestion and possible structural liver alteration. The aim of this study is to analyze the relationships between biochemical fibrosis markers and hemodynamic parameters in the long term after the Fontan operation.<br><b>Methods</b> : The study enrolled 51 patients who underwent total cavopulmonary connection between March 1994 and July 2010. We analyzed the relationships between the 5 liver fibrosis markers (hyaluronic acid, retinol-binding protein, procollagen type III peptide, type IV collagen 7S, type IV collagen) and the 6 hemodynamic parameters (pulmonary artery pressure, pulmonary artery index, pulmonary vascular resistance, ejection fraction, atrioventricular valve regurgitation, cardiac index).<br><b>Results</b> : Hyaluronic acid and type IV collagen 7S positively correlated with pulmonary artery pressure. Hyaluronic acid negatively correlated with ejection fraction, and type IV collagen 7S positively correlated with atrioventricular valve regurgitation in patients followed up for more than 8 years after Fontan completion. Pulmonary artery pressure was significantly higher in patients in whom type IV collagen 7S was elevated. Hyaluronic acid correlated with pulmonary vascular resistance (<i>p</i>=0.0035) and ejection fraction (<i>p</i>=0.014), as well as type IV collagen 7S with pulmonary artery pressure (<i>p</i>=0.0001) by multiple regression analysis.<br><b>Conclusion</b> : Hyaluronic acid and type IV collagen 7S reflected the degree of hepatic congestion, and cardiac function, in the long term after the Fontan operation.
ABSTRACT
Recent studies have reported parasympathetic ganglia supplying the regions around the sinoatrial node (SAN) are situated in the pulmonary vein fat pad (PVFP). Otherwise, in coronary artery bypass grafting (CABG) without cardiopulmonary bypass, cardiac surgeons expect effective support technique on heart rate. The purpose of this study was to determine the feasibility of inducing sinus bradycardia by stimulating these parasympathetic nerve fibers to the SAN in humans. Nine patients were anesthetized and median sternotomy was performed. Bipolar electrodes were sewn onto PVFP to stimulate parasympathetic nerve fibers to the SAN. PVFP was electrically stimulated with a 4-9 V pulse of 0.1msec and a frequency of 5, 10, 20, or 50Hz. Sinus bradycardia was induced by selective stimulation of the parasympathetic nerve fibers to the sinoatrial node. The response was frequency-dependent up to 20Hz. Heart rate was significantly reduced from 90.1±12.4 to 71.4±15.7 (beats/min) at 20Hz. This technique could be applied for reducing heart beats in CABG without cardiopulmonary bypass. However, there are problems in maintaining of the effect.
ABSTRACT
The possibility of anastomotic pseudoaneurysms as a life-threatening complication following prosthetic graft replacement for an aneurysmal disease or an arterial occlusive disease is well known. However the pseudoaneurysm at an anastomosis between two prostheses is rarely reported. We present a successful surgical treatment for an anstomotic pseudoaneurysm between two prostheses. A 75-year-old man underwent total arch replacement for a true aortic arch aneurysm with the aid of selective cerebral perfusion five years previously. The graft used was a composite prosthesis consisting of 26mm woven Dacron graft for the aortic arch to which a hand-made three-tributary graft was sutured for major three arch vessels. An anastomotic pseudoaneurysm at an anastomotic site between the 26mm graft and a tributary graft was suspected on a chest CT and then differentially diagnosed by aortography. The anastomotic pseudoaneurysm was surgically resected and the anastomosis was repaired with 3-0 polypropylene continuous sutures with the aid of hypothermic circulatory arrest. Anastomotic aneurysm can occur only between a native vessel and a prosthesis but also between two prostheses. Therefore we should make periodical examinations such as CT after prosthetic graft replacement.
ABSTRACT
One hundred and thirty cases of closed mitral commissurotomy were followed for up to 25 years and 10 months. There was no operative death, but 31 cases died during the follow-up period. Eight cases died suddenly of unknown cause, 7 due to heart failure, 5 due to thromboembolism, 4 on reoperation, and 6 due to other reasons. In the 7 cases who died of heart failure late after commissurotomy, 3 cases refused reoperation. Each of the remaising 4 cases were not operated on because of associated severe liver dysfunction, left ventricular dysfunction plus pulmonary hypertension, respiratory failure due to bronchial asthma, and unknown reasons, respectively. The actuarial survival rate was 93.6% 10 years after surgery, and 72.2% 20 years after surgery. Forty-two cases had reoperation with a mean interval of 12 years and 6 months. Reoperation-free survival rate was 88.7% 10 years after the first operation and 42.8% 20 years after the first operation. Incidence of major thromboembolism was 1.25%/patient-year. Thromboembolism and sudden death of unknown cause constituted the leading cause of late death and played a key role in long term results. Cardiac event-free survival rate was 65.7% 10 years after surgery and 32.6% 20 years after surgery. From these results it was concluded that the clinical limitations of the effectiveness of closed mitral commissurotomy was around ten years after surgery. We believe that these findings provide useful information for percutaneous transvenous mitral ommissurotomy.