ABSTRACT
A 72-year-old man was admitted with an abnormal shadow on chest X-ray. Chest CT and aortography showed double saccular aneurysms at the aortic arch and the descending thoracic aorta. Three-dimensional CT was useful to detect the association between the arch aneurysm and neck vessels. Graft replacement, from the distal arch to the descending thoracic aorta, was performed by the lateral approach with hypothermic arrest and open proximal method. The aorta had severe atherosclerotic changes and the intima was absent at the orifices of the aneurysms. Pathological examination showed the aneurysmal wall to be composed of fibrous tissue without medial components. These macroscopic and pathological findings of aneurysms corresponded with double pseudo-aneurysms originating from the penetrating atherosclerotic ulcer.
ABSTRACT
This clinical study was peformed to clarify the postoperative cardiac functions after coronary artery bypass graft surgery in the cases associated with decreased left ventricular ejection fraction (EF) or increased end-diastolic volume index (EDVI). The patients were divided into two groups by preoperative EF. The EF of Group I ranged from 31 to 39% in 42 cases, and the EF of Group II was below 30% in 27 cases. Several parameters of cardiac function such as EF, peak ejection rate (PER), peak filling rate (PFR) or early diastolic peak filling rate were evaluated with radionuclide ventriculography. Postoperative mean values of these parameters significantly improved in both Group I and Group II compared to preoperative values. Although these parameters and left ventricular wall motion did not improve in the 7 cases with an EDVI over 140ml/m<sup>2</sup> in Group II, the clinical results of these 7 cases were good during the follow-up period except one case which preoperatively had frequent ventricular arrythmia. The clinical condition improved remarkably in the 3 patients who had preoperative angina pectoris among these 7 cases. Surgical indications must be carefully determined in cases with increased EDVI and frequent ventricular arrythmia.
ABSTRACT
The effects of Argatroban, a selective thrombin inhibitor, in anticoagulation therapy following cardiovascular surgery is reported. The agent was administered in 28 patients by means of continuous intravenous infusion, adjusted to maintain the activated coagulation time at from 170 to 200 seconds. The activated coagulation time was well controlled at a mean rate of 0.482± 0.26μg/kg/min by intravenous drip infusion, and the dose of Argatroban reached a steady state within a few hours. Both the percent rate of prothrombin time and the activated partial thromboplastin time were significantly decreased to 49% and to 36% respectively by Argatroban, and recoverd to the normal range the day after cessation of the drug. Thrombin-antithrombin III complex, an index of coagulation activity, decreased from 35μg/<i>l</i> in the postoperative state to 14 μg/<i>l</i> 4 hours after the infusion of the drug, which demonstrated the good control of anticoagulation status. Clinically, no adverse reactions such as abnormal bleeding tendency was observed. We conclude that Argatroban is a safe and effective agent for anticoagulation therapy in the early postoperative phase.
ABSTRACT
Behcet's disease is generally recognized as a chronic multi-system disease. Approxymately 8% of patients with Behct's disease will have serious vascular compilcations which is called vasculo-Behcet's disease. A male patient of 41 year old was admitted to our clinic, complaining pain of left popliteal fossa and hypesthesia of left lower leg. A popliteal aneurysm was found. Resection of the aneurysm and a saphenous vein graft were successfully performed. Neuropathy disappeared after the surgery. Aneurysms in Behcet's disease mainly appear in major arteries, and rarely in peripheral arteries. Compression neuropathy in the popliteal aneurysm of Behcet's disease has been rarely reported. Early resection of aneurysm before completion of neuropathy is recommended for succsessful outcome.