Prognosis of Aortic Dissection (Type A) with a Thrombosed False Lumen. CT Findings and Operative Timing / 日本心臓血管外科学会雑誌

Several investigators have reported that aortic dissections with thrombosed false lumens has a better prognosis than those with open false lumens. However, the method of treating dissecting aorta with a thrombosed false lumen has not yet been clearly determined. The purpose of the present study is to determine the factors that would indicate surgical treatment for dissecting aorta with thrombosed lumen. Sixteen consecutive cases of type A dissecting aorta with a thrombosed lumen were classified into two groups: event-free group (group R, <i>n</i>=10), recanalization or ulcer-like projection group (group P, <i>n</i>=6). The maximum aortic diameter and thrombosed lumen diameter in group P were significantly greater than in group R (45.00±1.78 <i>vs</i>. 36.00±2.16mm: <i>p</i>=0.0182, 8.00±0.00 <i>vs</i>. 4.00±0.40mm: <i>p</i>=0.0004). In group P, the thrombosed lumen diameter significantly decreased after 1 month. In conclusion, the maximum aortic diameter (>45mm), the maximum lumen diameter (>8mm), and no decrease of the thrombosed lumen diameter are useful predictors for the risk of recanalization or ulcer-like projection. These cases would require surgical treatment.

The indication s to elective IABP for severe valvular heart disease at our hospital / 日本心臓血管外科学会雑誌

IABP is in wide clinical use as an effective adjunctive means for the management of seriously impaired cardiac function. Unfortunately, however, it is an undeniable fact that this specialized circulatory support technic has so far been used in severe heart disease cases in a desultory way, with no established criteria being available for indication of elective IABP for prophylactic purposes. Under such circumstances, it was felt worthwhile to analyze data on preoperative left ventricular function from a series of open heart surgery cases (25 treated with and 94 without IABP) encountered in our hospital since 1983 (when procedure for myocardial protection was virtually standardized) in an effort to formulate acceptable criteria for indication of elective IABP. Hemodynamic parameters studied were LVESVI, LVEF and LVEDP. The results led us to conclude that scheduled IABP can be regarded as indicated for use in each of the following valvular heart diseases if at least one of the respective criteria specified below is fulfilled: MR: LVESVI≥120ml/m², LVEF≤0.4, LVEDP≥21mmHg; AR: LVESVI≥135ml/m², LVEF≤0.4, LVEDP≥18mmHg; MS: LVESVI≥70ml/m², LVEF≤0.35, LVEDP≥23mmHg.