ABSTRACT
<p>We report a case of endovascular surgery in a patient of common iliac artery aneurysm with arteriovenous (A-V) fistula. A 60-year-old woman was admitted because of dyspnea. She had a clinical history of lumbar disk surgery at age of 40. On physical examination, we detected a pulsatile mass and pansystolic murmurs in her left lower abdomen. A chest X-ray film demonstrated severe cardiomegaly with 70% of cardiothoracic ratio. Contrast-enhanced CT revealed left common artery aneurysm with A-V fistula between the left common iliac artery and the left common iliac vein. Three-dimensional CT showed hyper-vascularity in the region from the pelvic vein to IVC. We considered that she had high risk of intraoperative massive bleeding for open abdominal surgery. We conducted endovascular repair for this iliac artery aneurysm with A-V fistula by the GORE EXCLUDER C3<sup>®</sup> stent graft system. Postoperative contrast-enhanced CT showed complete exclusion of both left common iliac artery aneurysm and A-V fistula. After surgery, her symptoms improved significantly.</p>
ABSTRACT
We report a rare case of isolated intracavitary metastatic esophageal cancer of the right atrium and ventricle. A 67-year old woman had been treated for esophageal carcinoma for three years. Combined radiotherapy and chemotherapy had been performed, and partial remission had been achieved. Recent follow up computed tomography of the chest revealed intracavitary cardiac mass in her right atrium and right ventricle. On echocardiography a mobile, irregularly shaped large mass was detected in her right atrium. She was admitted for emergency operation. We resected the mass under cardiopulmonary bypass. The pathological examination revealed intracavitary metastasis of squamous cell carcinoma of the esophagus. She was discharged on the 29th postoperative day. Six months later, she died from multiple metastases of squamous cell carcinoma. Even though the operation was not curative, it might have been effective for preventing tumor embolism to the lung and elongating life expectancy.
ABSTRACT
A 61-year-old woman was admitted with abdominal and low back pain. The patient underwent graft replacement for inflammatory abdominal aortic aneurysm. One month postoperatively, the patient fell into hypovolemic shock with massive melena and hematemesis. Laparotomy and duodenotomy revealed a fistula between the third portion of the duodenum and the distal anastomosis of the vascular prosthesis. The fistula of the aorta was repaired with omentopexy, gastrojejunostomy and Braun's anastomosis. One month later, aortoduodenal fistula recurred. The vascular prosthesis was partially removed and the aorta was closed at the infrarenal level. After the closure of the posterior duodenal defect, a left axillo-femoral bypass was constructed. She fully recovered and discharged.
ABSTRACT
The purpose of this study was to consider the cause of the prolonged inflammatory reaction that sometimes appears after endovascular stent-graft repair for dissecting aortic aneurysm. Endovascular stent-grafting was performed in 12 patients (11 men and 1 woman, mean age 60±9.8). Endovascular stent-grafting was indicated to close the entry of type B dissections in 10 patients and to exclude ulcer-like projections (ULP) in 2 patients. On the 7th postoperative day (POD), aortography showed no endoleak in 7 type B cases (A-group), remaining endoleak in 3 type B cases (B-group), and complete exclusion in 2 ULP cases (C-group). The value of FDP-E in the A-group was high on the first POD and then decreased gradually. FDP-E also increased up to the 7th POD in the B-group, and increased very slightly after the operation in the C-group. The values of WBC and CRP increased up to the 3rd POD in all groups, but in the A-group it was still high on the 7th POD. On contrast-enhanced CT performed after the procedure and on the 7th POD, edema (over 10mm in thickness) around the descending thoracic aorta was demonstrated in 5 out of 7 cases in the A-group, but in none of the cases in the B- and C-groups. A segmental atelectasis in the left lung was detected in 6 out of 7 cases in the A-group, but in none of the cases in the Band C-groups. In the A-group, endovascular stent-grafting influenced thrombus formation, and the thickened edema around the descending thoracic aorta and the atelectasis produced in the left lung were prominent more than in the other groups. These results suggest that the Inflammation around aortic wall induced by thrombosis in the false lumen, might contribute to the development of the edema around the descending thoracic aorta and the atelectasis in the left lung. We conclude that the inflammatory reaction might have prolonged the postoperative course in the A-group patients.
ABSTRACT
Cardiac operations involving cardiopulmonary bypass can cause a systemic inflammatory response such as elevation of inflammatory cytokines, which can cause organ failure. We investigated cytokine production and its inhibition by ulinastatine in patients undergoing elective coronary artery bypass grafting under cardiopulmonary bypass. Thirty-three patients received either ulinastatine (300, 000 units, intracoronary artery injection immediately after aortic closs-clamping, UTI group, <i>n</i>=16) or no ulinastatine (control group, <i>n</i>=17). Arterial blood samples were obtained at aortic closs-clamping, 5 minutes after aortic declamping, and 6, 12 and 18 hours after surgery and there were assayed for interleukin-6 (IL-6), interleukin-8 (IL-8), and polymorphonuclear leukocyte elastase (PMNE). In addition, we examined liver function (GOT, GPT, and total bilirubin), renal function (blood urea nitrogen and serum creatinine), and oxygenatory function (PaO<sub>2</sub>/FIO<sub>2</sub>) postoperatively. IL-8 levels at 5 minutes after aortic declamping and maximum IL-8 levels were significantly lower in the UTI group than in the control group (25.5±12.8 vs. 47.8±38.9pg/dl, <i>p</i><0.05, and 28.6±13.2 vs. 58.4±40.0pg/dl, <i>p</i><0.05). Blood urea nitrogen on the second post operative day (POD) and three POD and creatinine on the second POD were also significantly lower in the UTI group than the control group. Furthermore, IL-8 and PMNE levels significantly correlated positively with blood urea nitrogen and creatinine. There was significant negative correlation between IL-8 and oxygenatory function. These results shows that the ulinastatine can inhibit IL-8 levels following cardiac surgery. To combat the increase of inflammatory cytokines such as IL-8 after cardiopulmonary bypass, the ulinastatine should be used for anticytokine therapy to protect the kidneys, lungs, and other organs, and thereby decrease the risk of complications.
ABSTRACT
Continuous warm blood cardioplegia (CWBC) was compared with cold crystalloid cardioplegia (CCC) with regard to intraoperative cardiac aerobic metabolism. Thirty-six adult patients who underwent CABG were divided into two groups. The CWBC group (<i>n</i>=21) received continuous warm blood cardioplegia while the CCC group (<i>n</i>=15) received 4°C St. Thomas' Hospital cardioplegic solution. Some parameters of cardiac anaerobic metabolism were measured intraoperatively. We continuously measured the oxygen saturation of coronary sinus blood (ScsO<sub>2</sub>) after aortic declamping until 5 minutes after cardiopulmonary bypass (CPB). CK and CK-MB levels were measured at admission to ICU, and on the first and second postoperative day (POD) in both groups. CPB time, aortic-cross clamp time and incidence of postoperative low output syndrome were similar in the two groups. The spontaneous return to sinus rhythm after aortic declamping was significantly higher in the CWBC group. ScsO<sub>2</sub> was significantly higher in the CWBC group. The lactate uptake ratio of myocardium, excess lactate and redox potential were similar in the two groups. CK and CK-MB levels were significantly lower in the CWBC group. We concluded that the CWBC group was superior to the CCC group in terms ScsO<sub>2</sub>, CK and CK-MB levels. Other parameters of cardiac anaerobic metabolism were similar in the two groups.
ABSTRACT
Continuous warm blood cardioplegia (CWBC) was compared with cold crystalloid cardioplegia (CCC) with regard to postoperative cardiac function. 36 adult patients underwent CABG divided into two groups. The CWBC group (<i>n</i>=21) received continuous warm blood cardioplegia while the CCC group (<i>n</i>=15) received 4°C St. Thomas' Hospital cardioplegic solution. Some parameters or cardiac function, CK and CK-MB levels were measured at admission to ICU, and on the first and second postoperative day (POD) in both groups. The amount of dopamine and dobutamine were measured at admission to ICU and 6, 12, 18, 24 hours after admission to ICU in both groups. Cardiopulmonary bypass (CPB) time, aortic-cross clamp time and incidence of postoperative low output syndrome were similar in the two groups. The spontaneous return to sinus rhythm after aortic declamping was significantly higher in the CWBC group. The cardiac index measued at admission to ICU, 1 POD and 2 POD was significantly larger in the CWBC group. Pulmonary capillary wedge pressure and right atrial pressure measured at 1 POD and 2 POD were significantly lower in the CWBC group. Systemic vascular resistance measured at admission to ICU, at 1 POD and 2 POD were significantly lower in the CWBC group. Left ventricle stroke work index and left ventricle work index measured at admission to ICU were significantly larger in the CWBC group. Right ventricle stroke work index and right ventricle work index were similar in the two groups. The amount of dopamine at admission to ICU and at 6 and 12 hours after admission to ICU were significantly lower in the CWBC group. The amounts of dobutamine at admission to ICU and at 6, 12, 18 and 24 hours after admission to ICU were significantly lower in the CWBC group. CK levels measured at admission to ICU and at 1 POD were significantly lower in the CWBC group. CK-MB levels measured at admission to ICU, 1 POD and 2 POD were significantly lower in the CWBC group.
ABSTRACT
A 59-year-old man was hit by a car in the back of the knees. He had a cold sensation and pulselessness in the right leg. He did not have bone fractures, but had dirty skin injuries in the back of bilateral knees. DSA revealed complete obstruction of the right popliteal artery and good collateral flow to the peripheral arteries in the right lower leg. We did not perform emergency operation because of the good collateral flow and dirty skin injuries. After the healing of the skin injuries, we performed popliteal artery reconstruction with autologous saphenous vein graft. The postoperative course was uneventful with successful patency of the graft.
ABSTRACT
The Chiari network is an embryological remnant. It has rarely clinical importance but may very infrequently cause thrombosis and some other complications. Chest pain and pulmonary thrombosis were developed in a 23-year-old man. Cardiac ultrasonography revealed Chiari network in his right atrium, and no other thrombogenic lesions were found. Although anti-coagulant therapy was performed, pulmonary thrombosis were redeveloped. Chiari network was thought the cause of chest pain and pulmonary thrombosis. Operative removal of Chiari networks performed. The patient was postoperatively free from chest pain and pulmonary thrombosis.
ABSTRACT
There were 16 patients who developed acute renal failure (ARF) follwing cardiovascular operation using extracorporeal circulation. They were treated by either CPD or CAVH because their ARF were resistant to medical treatment. These patients were divided into three groups according to their treatment; 7 patients treated by CPD (Group A), 5 patients treated both CPD and CAVH (Group B), 4 patients treated by CAVH (Group C). The survival rate was 33% in Group A, 20% in Group B, and 0% in Group C. The prognosis of the each group was poor. CPD and CAVH were effective to control the concentration of serum potasium and water removing. But CPD and CAVH were not very effective to control the concentrations of serum creatinine and blood urea nitrogen. There were three patients who developed low proteinemia which was one of the side effects of CPD. Seven of nine patients treated by CAVH, developed bleeding. The side effects of CAVH were seemed to be more severe than those of CPD.