ABSTRACT
The left atrium and left atrial appendage have unique genetic anatomical and physiological features. Recently, advances in diagnostic imaging technology have provided much new knowledge. Clinically, the risk of developing atrial fibrillation increases with age. In order to reduce the public health burden such as cerebral infarction caused by atrial fibrillation, we need to find some predictive risk factors and preventive strategies for cerebral infarction and more effective treatments. The new concept of atrial myopathy has emerged, and animal models and human studies have revealed close interactions between atrial myopathy, atrial fibrillation, and stroke through various mechanisms. Structural and electrical remodeling such as fibrosis and deterioration of the balance of autonomic nerves and complicated interactions between these mechanisms lead to deterioration of atrial fibrillation and a continuous vicious cycle, and finally thrombosis in the left atrial appendage. Although anticoagulant therapy for patients with atrial fibrillation is strongly recommended, it is difficult for many patients to continue optimal treatment. In the nearly future, it will be important to understand the anatomy and physiology of the left atrial appendage and to understand the shape changes, size and the changes of autonomic function, and thrombus formation conditions associated with LAA remodeling during atrial fibrillation, and then we should provide early therapeutic intervention.
ABSTRACT
A 60-year-old man, who underwent repair of ventricular septal defect (VSD) 40 years previously, presented with dyspnea on effort and leg edema. Further examination showed residual VSD, mitral and tricuspid valve insufficiency, atrial flutter and pulmonary hypertension. We performed repair of the residual VSD, mitral valve replacement, tricuspid valve annuloplasty, and the Maze procedure. After surgery, systolic pulmonary arterial pressure decreased from 70 to 39 mmHg. On the 4th postoperative day, his hemodynamic state was stable and he weaned from ventilator. He showed hypoxia with sticky excretions, and reintubation was done 10 h after extubation. After intubation, pulmonary hypertension continued, nitroglycerine administration was not effective but inhaleted nitric oxide (NO) improved pulmonary hypertension. On the 15th postoperative day, sildenafil administration from nasogastric tube was started the day before extubation. On postoperative echocardiogram on the 35th postoperative day, the systolic pulmonary arterial pressure was 30-40 mmHg and left ventricular function was severely impaired because of the paradoxical movement of the ventricular septum after repair VSD. Sildenafil was safely used for the patient with heart failure and secondary pulmonary hypertension associated with congenital heart disease.
ABSTRACT
Objective To summarize and analyze the clinical experience in the use of ultrasonic scalpel in skeletonized internal using bilateral sketetonized internal mammary artery harvested by ultrasonic scalpel in Juntendo University Hospital.Results The number of distal anastomoses was(4.1±1.5).Major complieations included severe arrhythmia in 2 patients.cerebral infarction complicated with sepsis in 1,diffuse intraveseular coagulopathy complicated with multiple organ failure in 1 patient.and pneumonia in 2 patients.There were 2 patients dead in-hospital.The mean follow-up period Was(15.6±3.2)months.There Was no late death or cardiac-related events during the follow-up periods.Condusion It is simple and safe to skeletonize the internal mammary artery using the ultrasonic scalpel.The early effect of bilateral skeletonized internal mammary artery grafting was satisfactory.
ABSTRACT
The patient was a 74-year-old man with a history of previous aorto-coronary bypass grafting 14 years previously. Echocardiography showed severe aortic valve stenosis. Computed tomography showed severe circumferential aortic calcification of the whole aorta, including the aortic root. Coronary cineangiography showed patency of the endoric graft. Avoiding graft injury and aortic cross clamping, we performed apicoaortic conduit. His postoperative course was uneventful, he was discharged very much improved on the 11th postoperative day. This procedure is useful in high risk patients with aortic valve stenosis.
ABSTRACT
A 71-year-old woman was admitted with severe back pain. She was diagnosed of type A dissecting aortic aneurysm and two-vessel coronary disease by CT scan and angiography. An acute-phase operation was started 32 hours after onset, performing replacement of ascending aorta and a two-vessel bypass. The affected aortic wall was so thin and fragile that the cut ends of these wall were treated with 25% solution of glutaraldehyde, a fastacting crosslinking agent, for 7min. As a result, a sufficient degree of reinforcement was obtained to complete the anastomotic procedure safely. She made a good recovery of cardiac function after the surgery, but was left with such complications as permanent complete atrioventricular block and a little aortic regurgitation. Following pacemaker insertion she was discharged and has returned to her normal activity. It appears that when treating the affected aortic wall with glutaraldehyde, a piece of gauze placed in the left ventricular cavity stopped up the aortic valve by half. As a result, glutaraldehyde was perhaps transferred from the gauze to the aortic valve and a part of the conduction system, causing injury to them. If meticulous care is exercised during the procedure to avoid unnecessary invasion of surrounding tissues, this technique will provide a useful means to accomplish safe anastomoses of cardiac vessels.