Sternotomy Approach in a Case of Giant Ascending Aortic Aneurysm and Annuloaortic Ectasia Previously Operated for Pure Pulmonary Stenosis / 日本心臓血管外科学会雑誌

A 29-year-old man, who had undergone valvotomy for pure pulmonary stenosis at 6 months of age, was admitted to our institution for surgical treatment of a giant ascending aortic aneurysm and annuloaortic ectasia. Chest MRI revealed a 14-cm ascending aneurysm in contact with the sternum. After establishing femoro-femoral bypass for hypothermia, a left lateral thoracotomy was perfomed at the 4th intercostal space. Pulmonary artery cannulation was performed for left heart venting, and the proximal aortic arch was dissected for aortic cross-clamping. Median sternotomy was performed under circulatory arrest at 18°C and the aortic arch was opened. Under retrograde cerebral perfusion, the proximal arch was replaced by an artificial graft, and then aortic root replacement was completed using a composite graft under CPB. The postoperative course was uneventful, and the patient was discharged on the 37th postoperative day. He has been well without any complications. This case suggests that our method of approach to the giant aortic aneurysm with sternal adhesion and aortic regurgitation, and the use of extracorporeal circulation in view of the annuloaortic ectasia is effective and safe in case of reoperation.

Autologous Blood Donation and Recombinant Human Erythropoietin in Heart Surgery to Reduce the Amount of Homologous Blood Transfusion / 日本心臓血管外科学会雑誌

To reduce the amount of homologous blood transfusion, recombinant human erythropoietin (rHuEPO) administration or preoperative autologous blood donation were performed in 42 patients who underwent elective heart surgery. rHuEPO was administrated intravenously every two days from the 14th preoperative day to the 14th postoperative day (Group E; 19 cases). Preoperative autologous blood donation was done from the 14th day prior to operation once or twice (Group S; 13 cases). There were another 10 cases who did not receive rHuEPO administration or make preoperative blood donations (Group C). In every case, autologous blood donation was performed during preparation for cardiopulmonary bypass at operation. No homologous blood transfusion was done in 14 cases of Group E (74%), 11 cases of Group S (85%), and 6 cases of Group C (60%). Of the 11 patients who required homologous blood transfusion, one was elderly (>65y. o.), 3 had prolonged cardiopulmonary bypass (>3hr), 3 had low body weight (<45kg), 1 had anemia at administration with a red blood cell count of <3.5×10⁶/mm³, and 2 cases had large blood loss during operation (>1, 200ml).