ABSTRACT
Congenital anomalies of the coronary artery are rare. However, they can cause sudden death because of arrhythmia. We present a case of a 62-year-old man with severe aortic valve regurgitation associated with an anomalous origin of a narrowed right coronary artery (IB<sub>2</sub> according to the Shirani Classification) detected on preoperative coronary three-dimensional computed tomography (CT) . The patient underwent both aortic valve replacement for aortic regurgitation, and coronary artery bypass. The postoperative course was uneventful.
ABSTRACT
A 53-year-old man was admitted to Jichi Medical School Hospital because of low back pain and respiratory distress. Echocardiography revealed mitral valve regurgitation and mitral vegetations, and MR imaging showed destructive change in the lumbar vertebrae. The low back pain and inflammatory activity subsided with administration of antibiotics, but regurgitation-induced heart failure was medically intractable. The patient underwent mitral valve replacement with a bicarbon valve. The mitral valve showed destructive change with infective vegetation. Microbiologic study of preoperative blood samples and resected valve did not show any organism. Antibiotics were given for another 6 weeks. As of the last follow-up observation at 18 months, the patient was doing well.
ABSTRACT
Primary malignant cardiac tumors are extremely rare. Among these, leiomyosarcoma are particularly exceptional and only about 20 surgically treated cases have been extensively described. We describe a case of right atrial leiomyosarcoma which was accidentally found by computed tomography. The tumor was surgically resected under extracorporeal circulation. Two months later the patient had cerebral hemorrhage due to a brain metastasis, which almost completely disappeared after irradiation. There was no other evidence of recurrence for 12 months after operation.
ABSTRACT
To avoid homologous blood transfusion, the effectiveness of autologous blood predonation was evaluated in patients with elective abdominal aortic aneurysm (AAA) repair. From January 1993 to July 1996, 53 patients underwent Y graft replacement by using autologous rapid transfusion device AT1000<sup>®</sup> (Electromedics. Inc, Englewood, CO). The patients were devided in to 3 groups. Thirty one patients had no blood donation (Group A). Twelve patients had 400ml blood donation with administration of an iron preparation (Group B). Ten patients donated the same amount of blood as those in Group B, with administration of both an iron preparation and recombinant human erythropoietin (rHuEPO) (Group C). There were no significant differences in terms of age, gender, operating time, intraoperative bleeding, and total amount of homologous and autologous blood transfusion in the 3 groups. In Group A, the mean volume of homologous blood transfusion was 250±370ml and in both Groups B and C, no homologous blood was required and 400ml autologous blood was used. Homologous blood transfusion was avoided in 58.9 (18/31) of patients in Group A and all of the patients in Groups B and C. Due to the blood predonation prior to surgery, a hemoglobin level decreased significantly at the time of operation in Group B (without rHuEPO), but in Group C (with rHuEPO) the hemoglobin level was kept constant. During the first postoperative week, the minimum hemoglobin level in Group C was significantly higher than in the other groups. In conclusion, by donating 400ml autologous blood before surgery and using an intraoperative autotransfusion system, homologous blood transfusion could be avoided in elective AAA repair. With rHuEPO, the hemoglobin level could be maintained, despite predonation and intraoperative blood loss.
ABSTRACT
Coronary artery bypass grafting using hypothermic circulatory arrest and ventricular fibrillation without aortic cross clamping in 6 patients with severely calcified aortas is described. The use of hypothermic circulatory arrest or ventricular fibrillation has not been established in coronary artery bypass grafting. We recently used aortic no-touch technique in 6 patients. All patients were supported and cooled with cardiopulmonary bypass, and circulatory arrest was performed in 3 patients. With the exception of one hemodialysis patient, 5 patients survived without neurological deficit. We think the aortic no-touch technique is safe and reliable in coronary artery bypass grafting with severe calcified aortas.
ABSTRACT
A total of 961 patients underwent coronary artery bypass grafting (CABG) between 1982 and 1991, and we investigated perioperative cerebral infarction. The average age of operation in these case was 65±4 years. There was 9 patients with hypertension, 7 with diabetes mellitus and 5 with hyperlipidemia. Concerning cerebral infarction, there were 3 patients with multiple infarction, 6 with infarction of the mid cerebral artery area, 1 with infarction of posterior cerebral artery area, 1 with infarction of posterior cerebral artery area, 1 with infarction of pons and 1 with infarction of the ophthalmic artery. The courses of infarction involved atherosclerosis, hypoperfusion during cardiopulmonary bypass, thrombosis due to arterial fibrillation and thrombus on the left ventricular wall. Three patients who had critical cerebral infarction died after CABG. We consider that avoid perioperative cerebral infarction preoperative atherosclerosis, thrombus and to choose the proper procedure of the operation.
ABSTRACT
A 72 year-old man underwent coronary angiography (CAG) with a diagnosis of unstable angina pectoris, and 90% stenosis of the LMT was found. Since idiopathic interstitial pneumonia (IIP) had been diagnosed previously, percutaneous transluminal coronary angioplasty (PTCA) was performed. However, his unstable angina recurred after about 2 months restenosis of the LMT to 90% was shown by CAG, and coronary artery bypass grafting (CABG) was performed. In the preoperative chest X-ray, diffuse granular opacities were seen in both lower lungfields, and Velcro rales were heard by ausculation. A spirogram could not be obtained because of his unstable angina, but the PaO<sub>2</sub> was a reasonable 70mmHg when breathing room air. In consideration of the age of the patient, a double coronary artery bypass grafting using a saphenous vein graft (SVG) was performed to minimize duration of anesthesia. His PaO<sub>2</sub> showed a transient decrease after the end of cardiopulmonary bypass (CPB), but the perioperative hemodynamics and respiratory status were stable and extubation was performed on the 1st postoperative day. No aggravation of his IIP occurred postoperatively and he was discharged on the 29th postoperative day.
ABSTRACT
A case of 38-year-old woman with corrected transposition of great arteries is reported. She was admitted for acute cardiac failure caused by not only the left-side atrioventricular regurgitation for the ruptured chordae tendineae, but also the right-side one. We have to perform double valve replacement emergently due to the progression of biventricular failure. Very few reports have described a surgical repair of the right-sided valve replacement. The postoperative course was favorable.