ABSTRACT
A 73-year-old woman was referred to our hospital with a feeling of chest compression. Coronary angiography revealed a giant coronary artery aneurysm, located in the middle of a coronarypulmonary artery fistula originating at the left anterior descending artery. Also another fistula was shown between the right coronary artery and the pulmonary artery. Surgical correction was indicated due to the risks of the aneurysm rupture and coronary events. Under cardiopulmonary bypass, suture-closure of the coronary artery aneurysm and ligation of the fistulae were carried out with success. Transesophageal echocardiography was useful to confirm disappearance of the abnormal shunts after the operative procedures. The postoperative course was uneventful. Postoperative coronary angiography showed no aneurysm or fistula. She was discharged on the 11th postoperative day on foot.
ABSTRACT
A 92-year-old woman was referred to our hospital with lower abdominal pain and lumbago. Her vital signs were stable at an emergency outpatient-clinic. An enhanced CT scan showed a sealed rupture of a right internal iliac artery aneurysm (85×73mm in diameter). An emergency operation was performed via median laparotomy. As predicted pre-operatively, a large hematoma was found in the retroperitoneal space and mesenterium surrounding the right internal iliac artery aneurysm (sealed rupture). Y-grafting was performed using a 16×8mm Intergard: proximal and distal ends of the graft were the abdominal aorta and bilateral femoral arteries, respectively. Left common iliac artery, right external iliac artery and right internal arterial aneurysm were suture-closed. The postoperative course was uneventful and she was discharged on the 13th postoperative day on foot.
ABSTRACT
A 68-year-old man was referred to our hospital with an abnormal shadow on chest X-ray film. Enhanced chest CT scan revealed intrathoracic left subclavian artery aneurysm (maximum diameter 4cm) just above the aortic arch. Surgery was indicated considering the risks of aneurysm rupture and distal embolism, although he was asymptomatic. Under left 4th posterolateral thoracotomy, the aneurysm was exposed. Cardiopulmonary bypass was initiated with cannulation of the left femoral artery and vein (to the right atrium). Circulatory arrest and isolated cerebral perfusion were achieved at 25°C core-temperature. The distal arch was replaced using a 26mm Hemashield graft and the left subclavian artery was reconstructed interposing an 8mm graft. The postoperative course was uneventful: he was extubated at 8h and was sent to the ward the next day. He was given an ambulatory discharge on the 13th postoperative day.
ABSTRACT
A 73-year-old woman was referred to our hospital for angina pectoris due to triple-vessel-disease. She underwent off-pump coronary artery bypass grafting ×3 (RITA-LAD, LITA-OM, SV-PDA). Her vital signs were stable during the operation and the postoperative status was steady in the ICU. However, on the next day, she suddenly had severe back pain with markedly elevated blood pressure. Urine output immediately shut down and respiratory failure progressed with time. An enhanced CT scan revealed aortic dissection (DeBakey type I and Stanford type A). An emergency operation was performed via re-sternotomy. Cardiopulmonary bypass was initiated and the body was cooled down to 20°C. Under circulatory arrest with isolated cerebral perfusion, the ascending aorta was replaced using a one-branched Hemashield graft (26mm in diameter). The entry of the dissection was located at the proximal anastomosis site of the vein graft. The postoperative course was uneventful and she was discharged on the 24th postoperative day.
ABSTRACT
A 62-year-old man was referred to us because of acute aortic dissection (Stanford type A). He had had liver cirrhosis (Child-Pugh class B) and hepatic cell carcinoma in the left lateral lobe, which had been resected 3 years ago. On admission he was drowsy and was in shock. CT showed dissection from the ascending aorta to the abdominal aorta. Echocardiography revealed severe aortic regurgitation. An emergency operation was indicated although it was a very high risk procedure. Under cardiopulmonary bypass with moderate hypothermia, the aortic root was replaced with a Freestyle valve (23mm). Then the ascending aorta was replaced with a woven Dacron graft (28mm) under cardiac arrest and isolated cerebral perfusion. Postoperatively, he had cardiac tamponade and cerebral infarction (perhaps due to the preoperative events). However, he was successfully discharged on the 34th postoperative day.
ABSTRACT
There have been many reports radial artery grafts (RA) are useful in CABG, but there were very few reports about hand grasping power (GP), edema and sensory disturbance after surgery. From January to April, 1999, RA were used for 14 patients (R group) and were not in 16 patients (C group) among a total of 30 coronary artery bypass grafting procedures. The patients in the two groups were statistically similar. RA were anastomosed to #12 in 9 patients and #14 in 5. GP and the circumference of forearms were examined and sensory disturbance was also checked preoperatively and at 1, 2 and 4 weeks postoperatively. In both groups, left GP decreased slightly after surgery but gradually recovered. Four weeks after surgery, it was 26.2±9.6kg in the R group and 26.2±7.5kg in the C group (NS). The difference between left and right circumference of forearms, which indicates the degree of edema, was significantly larger in the R group than in the C group (3.5±3.6mm vs. -0.5±3.8mm, 1 week postoperatively, <i>p</i><0.05). However, it gradually improved in the R group (2.1±2.6mm at 2 weeks and 1.9±2.6mm at 4 weeks postoperatively). No sensory disturbance was seen at any time. Therefore we conclude that using RA in CABG is not only useful but is also safe and does not increase postoperative risk.
ABSTRACT
Malignant hyperthermia (MH) and antithrombin III (AT III) deficiency are both rare, but once they occur, the patient's prognosis is very poor. A 67-year-old man was referred to our hospital with a diagnosis of unstable angina. A coronary angiography revealed stenosis of LMT and triple vessels. The patient was considered a candidate for CABG. He had been prescribed 50mg/day of dantrolene for frequent muscular convulsions of the lower extremities. He had had a high CK level for a few years. Therefore he was considered to be at high risk for malignant hyperthermia (MH). He underwent CABG (×4). Dantrolene was administered orally at a dose of 25mg and then 160mg intravenously before anesthesia and modified NLA was performed in order to avoid probable MH. During the operation, AT III deficiency was suspected because the reaction of ACT after heparinization was poor. AT III preparation (1, 500 units) was used and CABG under cardiopulmonary bypass was completed without any events. It was proved after the surgery that the AT III volume had been almost normal but its activity had decreased. His postoperative course was good. For possibly fatal MH and AT III deficiency, it is necessary and important to predict, prevent and diagnose as early as possible.