ABSTRACT
For aortic root replacement in annuloaortic ectasia (AAE), an artificial prosthesis is commonly sutured to the aortic annulus (hemodynamic ventriculoaortic junction). We consecutively had 6 cases of aortic root replacement using anatomic ventriculoaortic junction suture. This anatomic ventriculoaortic junction suture is a simplified and practical method for aortic root replacement in the same way as using stentless bioprostheses or homografts.
ABSTRACT
We encountered a case of cerebral oncotic aneurysms and intracerebral hemorrhage after resection of a left atrial myxoma. A 67-year-old woman underwent resection of the left atrial myxoma. She was followed by ultrasound cardiography on an ambulatory basis. About one and a half years later, she was hospitalized because of neural symptoms. Multiple cerebral aneurysms and intracerebral hematoma were found, and the hematoma was removed. With the neural symptoms recurring repeatedly thereafter, however, she eventually died due to pneumonia. The pathological examination of the intracerebral hematoma removed at operation and cerebral aneurysms at autopsy revealed myxoma cells causing embolisms in the artery and invading the atrial wall with some hemorrhage. It is known that cardiac myxoma occasionally causes a cerebral lesion. The lesion is presumed to be caused by embolism as in our case. So it is nessesary to evaluate morphologic characteristics of cardiac myxoma before operation and to pay attention to the occurrence of embolism during operation. Making a rigorous follow-up of the general progress by computed tomography after operation is also considered important.
ABSTRACT
The cause of atrial fibrillation (AF) after coronary artery bypass grafting (CABG) is not clear yet. Speculating that the extension of pulmonary vein (PV) would induce AF after CABG, we analyzed 39 cases in which a Swan-Ganz catheter was inserted at the onset of AF. The cardiac index (CI), systolic pulmonary artery pressure (sPA), diastolic pulmonary artery pressure (dPA) were measured continuously after operation. The “occupation index” was defined as “(value just before the AF onset-minimum value)/(maximum value-minimum value) × 100%.” The mean values of the occupation index for CI, sPA and dPA were 16±30%, 77±36%, 76±38% (mean±SD) respectively. Furthermore, cases in which CI just before the AF onset showed a minimum value in all the collected data consisted of 27 of the 39 cases (69%), and sPA/dPA just before the AF onset showed a maximum value in all the collected data in 26/25 of the 39 cases (67%, 64%). About two-thirds of AF cases occurred in the descending phase of CI, and in the ascending phase of sPA/dPA. We considered these conditions to be equivalent to the extension condition of PV and surmised that PV extension might be one of the causes of AF after CABG.
ABSTRACT
We experienced 2 rare cases of acute myocardial infarction (AMI) complicated by ventricular septal perforation (VSP) and right ventricular free wall rupture. Case 1 was a 70-year-old woman who developed VSP and cardiac rupture after percutaneous coronary artery thrombolytic therapy for AMI (total occlusion of left anterior descending branch (LAD) # 6) and died of cardiac tamponade. Postmortem examination showed right ventricular free wall rupture. Case 2 was a 76-year-old woman. She developed VSP 6 days after percutaneous coronary artery intervention (stenting) for AMI (total occlusion of LAD # 8). VSP was closed by the double patch repair technique. During operation, right ventricular free wall rupture (oozing type) was found, so hemostasis with fibrinogen was added. She was discharged in a satisfactory condition 4 weeks after surgery. Right ventricular rupture after AMI of the LAD region is rare. VSP may be associated with right ventricular free wall rupture complicated by AMI of LAD region because all of our cases were accompanied by VSP.
ABSTRACT
Methylprednisolone (MP) has anti-inflammatory properties. We evaluated the influence of MP on systemic inflammatory response syndrome (SIRS) in a conventional coronary artery bypass grafting (CABG) operation. We compared three groups: (1) the HD-MP group (high-dose MP group): injecting 30mg/kg MP before extracorporeal circulation, (2) the LD-MP group (low-dose MP group): injecting 5mg/kg MP, (3) the N-MP group (non-MP group): no MP injected. Postoperative SIRS duration was shorter in the HD-MP and LD-MP groups than in the N-MP group, although low-dose MP had a shortening effect on the duration of SIRS. Interleukin 6 (IL-6) and interleukin 8 (IL-8) showed lower values in the HD-MP and LD-MP groups than in the N-MP group, although low-dose MP had an inhibitory effect on the production of interleukin. However, there were no differences between the three groups in the organ protective action of MP, such as total dose of catecholamine (as an index of cardiac dysfunction), intubation period (pulmonary dysfunction), GPT/D-Bil abnormality (liver dysfunction), or BUN/Cr abnormality (renal dysfunction). The maximum value of the postoperative white blood cell count showed a higher value in the HD-MP group than in the N-MP group. In conclusion, the usage of low dose (5mg/kg) MP in a conventional CABG operation is able to shorten SIRS duration and inhibit the production of IL-6 and IL-8 without increasing the risk of infection.
ABSTRACT
Clinical cases of normothermic extracorporeal circulation (ECC) are increasing, but the possibility of brain damage is not clear.In emergencies, the brain protective effects of mild (33-34°C) hypothermic therapy have been clearly confirmed. Natural Temperature decrease ECC was conducted in this study, hoping to obtain the advantages of both normothermic ECC and brain protection by mild hypothermia. These were 12 cases at high risk of brain damage (10 cases of brain infarction and 2 cases of severe carotid artery stenosis). In all cases, coronary artery bypass grafting operation with natural temperature decrease ECC was performed. The average laryngeal temperature dropped to 33.0±0.3°C. There was no brain infarction or ICU syndrome. Evaluation of post-operative brain condition by the patients themselves and their families was good. The possibility of natural temperature decrease ECC for high risk cases of brain damage was demonstrated.
ABSTRACT
For aortic root replacement in annuloaortic ectasia (AAE), an artificial prosthesis is commonly sutured to the aortic annuls (hemodynamic ventriculoaortic junction). In this case report, suturing was conducted using the anatomic ventriculoaortic junction along with full-thickness-suturing. The first case was a 28-year-old man and the second, his 31-year-old brother. The former showed AAE (maximum diameter, 120mm) with 4°AR and the latter, AAE (maximum diameter, 54mm) without AR. The present method is simple due to the flat suture line and is quite reliable owing to full-thickness-suturing.
ABSTRACT
The patient was a 71-year-old man with intermittent claudication. Angiography indicated severe stenosis of the right common iliac artery. The right femoral artery was anastomosed to an artificial graft by conventional hand-sewn suturing and the left femoral artery by the Vascular Closure Staples (VCS). Postoperatively, the patient had an uneventful recovery and was discharged. This new procedure minimizes trauma to the vascular intima since the arcuate legged clip is non-penetrating. Suturing with VCS is more extensive than by the conventional method. VCS has been applied by the authors to treat arteriosclerosis obliterans lesions.
ABSTRACT
A 62-year-old man was diagnosed as having atrial septal defect (ASD) and atrial fibrillation (Af) upon admission to our hospital with acute myocardial infarction. He was placed on medication for 3 years but surgery was considered necessary because of the further complication of angina pectoris. Coronary arterial bypass grafting, ASD closure and right atrial separation procedure which was a modification of the right-sided maze operation, were performed simultaneously. Although chronic Af disappeared immediately after surgery, it reappeared on the 8th postoperative day, and medicinal and electrical defibrillation had no effect. We considered that the main cause of Af accompanied by ASD had existed in the right atrium before surgery. Also, as the right atrial separation procedure was less invasive than the Cox/maze procedure for such complications in patients with ischemic heart disease, we chose this method. In our patient, postoperative left ventricular loading was considered to have been the cause of Af recurrence. Therefore the indications for this procedure should be decided carefully in patients with preoperative left ventricular hypofunction or left atrial dilatation.
ABSTRACT
A comparison was made of the three-dimensional CT angiography (3D-CTA) images of four grafts (IMPRA, Bionit, GELSOFT, and saphenous vein). All patent grafts were visualized by 3D-CTA, and opacification of the graft interior was noted in all cases on transverse sections of CT. Occluded GELSOFT and saphenous vein grafts could not be visualized by 3D-CTA. In spite of occlusion, IMPRA and Bionit were visualized by 3D-CTA. However, opacification of the graft interior could not be noted on transverse sections of CT. Confirmation should be made of the following: 1. distal portion of native artery shown on 3D-CTA, 2. recognition of opacification (high density) of graft interior on transverse sections of CT. When the CT threshold changed, occluded IMPRA and Bionit showed spotty images. This phenomenon should facilitate accurate diagnosis.
ABSTRACT
Conventional CT and three-dimensional CT angiography (3D-CTA) were conducted after peripheral arterial bypass surgery on 17 patients (26 grafts) from October, 1994 to April, 1996. Seventeen grafts were patent. The following objectives were satisfied in these cases: 1. Prosthetic graft or saphenous vein was depicted by 3D-CTA, 2. The distal portion of the native artery was depicted by 3D-CTA, and 3. Opacification of the graft interior was recognized by transverse section of CT. Nine grafts were occluded but prosthetic grafts were depicted in 5 cases, and prosthetic grafts and the distal portions of native arteries in 3 cases. Opacification of the graft interior was not seen in any case. Achievement of the above three objectives was considered necessary to determine graft patency.
ABSTRACT
Preoperative and postoperative evaluation was conducted on 25 patients (33 lesions) with arteriosclerosis obliterans (ASO) by three-dimensional CT angiography (3D-CTA) and intraarterial digital subtraction angiography (IA-DSA). The usefulness and problems of 3D-CTA for diagnosis of ASO were studied. Both methods had equal ability to detect lesions in the area of the iliac artery and the femoral artery. Totally occlusive lesions were accurately diagnosed by 3D-CTA, but diagnosis of stenotic lesions was much less accurate. To confirm blood flow following vascular reconstruction 3D-CTA was useful and IA-DSA was not required. 3D-CTA images can be obtained from desired directions and clearly detect calcification and blood clots with little health risk involved. They are useful for the diagnosis of ASO.
ABSTRACT
The patient was an 83-year-old man. He had pyloric stenosis due to Borrmann type III gastric cancer. He also had an abdominal aortic aneurysm 7cm in length. We performed gastrectomy and Y graft replacement simultaneously. His postoperative course was good. We discussed the operative indications and operative method, especially with regard to simultaneous operation.
ABSTRACT
The author encountered two cases of iliac arteriosclerotic occlusive disease with the clinical symptoms due to plaque rupture. Lower leg pain was noted at the subacute onset. Stenosis and niche-like opacification of a common iliac artery were indicated by angiography. The stenotic portions were resected and replaced by prosthesis. Leg pain subsequently disappeared. Macroscopic findings showed plaque rupture at the inflow surface of the iliac artery and blood entered the plaque. Acute arterial thrombosis may possibly occur by the same mechanism.
ABSTRACT
A 65-year-old woman presented with coughing and dyspnea. Giant left atrial myxoma was found by echocardiography. The tumor size was 7×5×4cm and its weight was 70g. The biatrial approach was chosen over left atriotomy or the transseptal approach. However, it may not be possible to decide on the correct incision line in cases of giant tumor. Intraoperative trans-esophageal echocardiogaphy was useful for evaluation of the mitral valve.
ABSTRACT
A 53-year-old male patient was admitted with back pain. A diagnosis of DeBakey IIIb type dissecting aortic aneurysm was made based on the results of examinations such as CT-scan and MRI. The right renal artery bifurcated from the pseudolumen. The right iliac artery and left renal artery showed severe stenosis due to aortic dissection. Y-graft replacement of the abdominal aorta was carried out to save the right iliac artery and left renal artery. At the same time, a fenestration operation was carried out to maintain the blood flow of the right renal artery which bifurcated from the pseudolumen. Secondarily, replacement of the descending aorta was carried out with successful thrombotic obstruction of the pseudolumen.
ABSTRACT
This is a rare case of abdominal apoplexy encountered in a 50-year-old man who had aortic and mitral valve replacement due to dominant regurgitation resulting from infective eneocarditis. On the 4th day after the operation, retroperitoneal bleeding, probably due to rupture of the splenic artery aneurysm, occurred and he developed shock. On the 28th day, there was bleeding in the digestive tract and blood pressure was low, probably due to rupture of the microaneurysm of the small artery distributing to the ileum. Rupture of an abdominal vessel without a recognizable external cause is called abdominal apoplexy, and our case was caused by mycotic aneurysm caused by infective endocarditis. Angiography facilitated the accurate diagnosis.
ABSTRACT
A 74-year-old man presented with swelling in both lower limbs and fatigue. Venography indicated nozzle-like stenosis of the inferior <i>vena cava</i> that appeared during the inspiratory phase but disappeared during the expiratory phase. A large pressure gradient between the upper and lower portion of the stenosis was observed during the expiratory phase. Stenosis during the inspiratory phase was relieved by percutaneous transluminal angioplasty, and symptoms and signs disappeared. Although stenosis occurred only during the inspiratory phase, our patient exhibited symptoms characteristic of Budd-Chiari syndrome. We believe that this patient originally had stenosis of the diaphragmatic portion of the inferior <i>vena cava</i>, and that his symptoms derived from the formation of a parietal thrombus.
ABSTRACT
Fifty-one cases which underwent surgery for arteriosclerosis obliterans in the aorta and iliac artery at the First Department of Surgery, Hiroshima University School of Medicine were divided into two groups. The EAB group (18 cases) underwent extra-anatomic bypass operation, and the AB group (33 cases) underwent anatomic bypass operation. A comparative study showed the mean age of the EAB group to be 10 years higher than that of the AB group, and the former group exhibited severer symptoms. Renal and pulmonary function declined in the EAB group, and the occurrence rate of complications such as cerebral infarction was also higher At operation, the following approaches were employed; long-term administration of PGE-1 before and after operation, operation with a better visual field under light general anesthesia, simultaneous reconstructive operation in peripheral lesions, artificial vessels of externally supported velour knitted Dacron. There was no case of obstruction in the past 5 years. Extra-anatomic bypass operation therefore provides as good postoperative patency as anatomic operation.
ABSTRACT
Patients who underwent the bypass operation during 5 years from 1987 to 1992 in the 1st Department of Surgery, Hiroshima University School of Medicine, were divided into 2 groups; AIOD group (51 cases) had lesions in the aorta and iliac artery, and FPOD group (46 cases) had lesions in the femoral artery and popliteal artery. A comparative study of these two groups was made. There was no significant difference in age, sex, symptom severity, smoking history, serum cholesterol level, serum triglyceride level. The complication rate of peripheral lesions of the AIOD group was 24% and of the FPOD group was 57%. The cumulative patency rate for 5 years of the AIDO group was 100% and of the FPOD group was 61%. The AIOD group exhibited better patency. In addition to the lower complication rate of peripheral lesions, all the AIOD group had underwent reconstruction operation for peripheral lesions simultaneously. The run-off state of the peripheral region may thus possibly be related to patency.