ABSTRACT
The incidence of wound infection and delayed wound healing was greater in neonates and infants less than 3 months old who had undergone open heart surgery through a median sternotomy than in older patients. To reduce these problems, we stopped using continuous absorbable braided suture for skin and subcutaneous tissue closure in August 2005, and used interrupted non-absorbable monofilament suture instead. Around the same time, we adopted hydrocolloid dressing as a substitute for gauze dressing. We evaluated the effectiveness of wound management by comparing 28 patients who had undergone surgery before August 2005 with 22 patients who underwent surgery after that date. The age at surgery was 45±30 and 21±23 days, respectively. The patients in the earlier period were significantly older than in the later period. There were no significant differences in body weight at surgery, operating time, or cardiopulmonary bypass time between the groups. The time for wound closure was 30±11 and 22±4 min, respectively, and the patients were hospitalized after surgery for 61±41 and 44±31 days. Both were significantly shorter in the later group of patients. There was a single case of mediastinitis, in the earlier period. Wound infection or delayed wound healing occurred in 8 patients in the earlier period and in 3 patients in the later period. The only 4 patients who required wound resuturing were all in the earlier period. The incidence of wound infection and delayed wound healing tended to be low in the later period. We believe that interrupted non-absorbable monofilament sutures improved the wound microcirculation and that the hydrocolloid dressing accelerated wound healing via its moisturizing and heat-retention action, pH buffering ability, and bacteriostatic activity, and that all these contributed to the better outcomes in the later period.
ABSTRACT
A 36-year-old previously healthy woman with cardiomegaly on a routine chest X-ray was given a diagnosis of primary chylopericardium after pericardial puncture revealed milky effusion. Endoscopy-assisted ligation of the thoracic duct and creation of a pericardial window was performed. The operation was greatly facilitated by the preoperative three-dimensional CT scan with lymphangiography that precisely demonstrated the distribution of the thoracic duct and other lymphatic ducts.
ABSTRACT
A 16-year-old boy with multiple injuries suffered in a motorcycle accident was admitted to our hospital. On admission, X-ray films showed left hemothorax and bone fractures of the left humerus, thigh bone, and pelvis. Computed tomography of the chest revealed a pseudoaortic aneurysm approximately 6.0cm in diameter at the proximal portion of the descending aorta. Because of multiple severe associated injuries, we considered that conventional aortic repair in the acute phase would be difficult. We therefore performed an endovascular stent-graft treatment 140 days after injury. The postoperative course was uneventful and the pseudoaneurismal sac has confirmed to decrease. Transluminal placement of endovascular stent-graft is a technically feasible method for treatment of traumatic aortic aneurysm. However, because the long-term results are still unknown, we should follow-up carefully, particularly in young patients.
ABSTRACT
We report 4 cases of valvular injury following nonpenetrating cardiac trauma in 3 men and 1 woman ranging in age from 24 to 72 years. In all cases the cause of trauma was blunt chest trauma. One patient was operated in 4h, but the other 3 patients were operated on more than 6 months after the accidents. Lacerated aortic cusp was observed in 2 patients, ruptured anterior papillary muscle of mitral valve, and ruptured chordae tendinae of the tricuspid vale were observed in 1 patient each respectively. Three patients underwent valve replacement (2 aortic and 1 mitral valves), and another patient underwent chordoplasty in the tricuspid valve. Their post-operative courses were uneventful. Careful observation, such as echocardiography, were required following the blunt chest trauma.
ABSTRACT
A 75-year-old woman suffered from chest compression on effort. Detailed examinations showed aortic valve stenosis and unusual separation of the left coronary artery from the aorta. Surgical exposure revealed that the aortic valve was composed of 3 cusps. Two of 3 cusps were calcified, and another small cusp had fused to the aortic wall. Fusion of the cusp produced a cyst with a hole that was 1.5mm in diameter. Excision of the cyst disclosed the normal orifice of the left coronary artery. The aortic valve was resected and replaced with an artificial valve. Her postoperative course was uneventful, without any angina pectoris.
ABSTRACT
A 50-year-old man was admitted with a fusiform descending thoracic aortic aneurysm measuring 60mm. Chest CT scan revealed porcelain aorta from the aortic arch to the abdominal aorta. Severe calcification found on the descending aortic wall was considered to entail greater risk for conventional aortic repair and reconstruction of intercostal arteries. Therefore endovascular stent grafting was planned. The stent graft was deployed from near the origin of the left subclavian artery to the 10th thoracic vertebral level. Neither paraplegia nor other complication occurred. Endovascular stent grafting may be a safe and effective method for descending thoracic aneurysms with severely calcified aorta.
ABSTRACT
Since 1983, we have experienced endovascular treatment of intracranial AVMs.2)3) Superselective catheterization of feeding artery, embolization or feeding artery occlusion of the cerebral AVMs have been performed for 73 cases in 134 sessions. Endovascular treatment of intracranial AVMs such as embolization or feeding artery occlusion have been performed for 57 cases of AVMs in 95 sessions. In each time, endovascular approach was performed for two to five feeding arteries, so more than 300 feeding arteries were catheterized by microcatheters or balloon catheters. In this report, we present our experiences of endovascular treatment of intracranial AVMs and discuss embolic materials and the role of endovascular treatment of intracranial. AVMs.