Effect of Sildenafil on Pulmonary Hypertension after a Case of Residual Shunt of Ventricular Septal Defect / 日本心臓血管外科学会雑誌

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.

Y-graft Replacement for Ruptured of Abdominal Aortic Aneurysm in an Elderly Patient / 日本心臓血管外科学会雑誌

Y-graft replacement was successfully performed in a patient aged 93 years with ruptured infrarenal abdominal aortic aneurysm. The patient was in shock on arrival and underwent an emergency operation with the administration of cathecholamines. The ruptured infrarenal abdominal aortic aneurysm with a large hematoma, which was located in the area of the left common iliac artery, was 10cm in the maximum diameter. The bilateral common iliac arteries were strongly calcified and occluded. The distal end of the graft was anastomosed to the external iliac artery. The patient's postoperative course was uneventful.

The Efficacy of Continuous Hemodiafiltration (CHDF) in the Management of Two Cases or Chronic Renal Failure in the Early Postoperative Period Following Cardiovascular Surgery / 日本心臓血管外科学会雑誌

The early postoperative use of continuous hemodiafiltration (CHDF) was effective in the postoperative management of two patients with chronic renal failure (CRF) undergoing cardiovascular operation. The first case was a 74-year-old man with a ruptured abdominal aortic aneurysm who underwent emergency Y-shaped artificial graft replacement. The second case was a 55-year-old man with aortic valve stenosis and regurgitation who underwent aortic valve replacement with a mechanical cardiac valve. Both patients had had chronic renal failure for several years before the operation, and the second patient had been on intermittent hemodialysis. Although a large amount of blood transfusion was needed postoperatively in both cases, CHDF enabled us to maintain the electrolytes in the normal range and control the water balance. The influence on the hemodynamics was minimized by adjusting the filtration rate. In conclusion, CHDF is useful for the management of CRF in the early postoperative period following cardiovascular surgery.