Avoiding Homologous Blood Transfusion Ameliorates Postoperative Lung Oxygenation in Pediatric Open Heart Operations / 日本心臓血管外科学会雑誌

Homologous blood transfusion may increase generalized inflammation by stimulating a patient's immune system during an open heart operation using cardiopulmonary bypass (CPB). We examined the beneficial effects on lung function of having no homologous blood transfusion during pediatric open heart operations. Thirty-three consecutive patients with ventricular septal defect were divided into (a) an autologous blood transfusion (AB) group (<i>n</i>=16) consisting of patients in whom predonation of autologous blood was undertaken and so homologous blood was not transfused, and (b) a control group (<i>n</i>=17) consisting of patients in whom homologous blood was used with a leukocyte removal filter during and after operation. Patients' age, sex, body weight, and contents of primed solution of the bypass circuit were similar in the 2 groups. Arterial blood gas analysis was carried out several times and the respiratory index (RI) calculated. Postoperative duration of intubation, white blood cell counts, and CRP titer were also compared. RI immediately after CPB did not differ between the AB and control groups, but RIs 3 and 6h after operation were significantly lower in the AB than in the control group (0.43±0.08 vs. 0.79±0.15 and 0.38±0.07 vs. 1.60±0.17). Duration of intubation, white blood cell counts, CRP titer were not statistically different. The results suggest that avoiding transfusion of whole homologous blood elements works effectively for preventing lung dysfunction after CPB.

A Case of Pseudoaneurysm of the Ascending Aorta Found at Onset of Acute Aortic Dissection after Aortic Valve Replacement / 日本心臓血管外科学会雑誌

A pseudoaneurysm of the ascending aorta is a complication found in aortic valve surgery. A 66-year-old man who had a previous history of aortic valve replacement due to infectious endocarditis was admitted to our hospital suffering from chest pain. Follow-up chest X-ray and transthoracic echocardiogram had revealed no findings of pseudoaneurysm during the intervening period. At admission, computed tomographic scan and transesophageal echocardiogram each showed a Type A acute aortic dissection and a pseudoaneurysm of the ascending aorta. Under cardiopulmonary bypass and deep hypothermic circulatory arrest, an ascending aortic graft replacement was carried out uneventfully. The patient is well 14 months postoperatively. Postoperative examinations following aortic surgery should be performed not only from the view point of cardiac function, but also from that of a pseudoaneurysm.

Two Cases of Graft Replacement Combined with Wrapping Procedure for Thoracoabdominal Aortic Aneurvsm / 日本心臓血管外科学会雑誌

The results of complete graft replacement for thoracoabdominal aortic aneurysm remains unsatisfactory. The operative strategies, including the method of reconstruction of visceral vessels and the protection of abdominal organs and spinal cord, are controversial. Two male patients (53 and 59 years of age) had thoracoabdominal aortic aneurysms including the celiac artery and small abdominal aortic aneurysm in the renal arterial part. They underwent replacement of a large aneurysm using a Dacron prosthesis with reconstruction of the celiac artery. The remaining small aneurysm was wrapped by a bandage of Teflon tape 3mm in width. This wrapping technique was easy to perform and could be sufficiently adapted to the aneurysm preserving visceral arterial branches. The postoperative courses were uneventful. Their postoperative enhanced CTs (41 months and 26 months after surgery, respectively) revealed no enlargement of the wrapped aortic aneurysm and no stenosis of the visceral branches. This result suggests that our wrapping method is useful to reinforce the wall of small aortic aneurysms.