ABSTRACT
A 24-year-old woman underwent successful repair of a traumatic pseudoaneurysm of the aortic isthmus concomitant with right diaphragmatic hernia which developed after a traffic accident, and the steering wheel of the crashed car was considered responsible for both lesions. Due to the right diaphragmatic hernia, she could breathe mainly with the left lung only. The aortic isthmus aneurysm was considered to be a pseudoaneurysm, and because of the potential risk of rupture, we performed urgent aortic surgery. Prior to a left thoracotomy, we anastomosed an 8-mm prosthetic graft to the right axillary artery. When the left lung was collapsed in order to perform a femoro-femoral bypass, the SpO<sub>2</sub> level of her right index finger and her cerebral rSO<sub>2</sub> markedly decreased. Therefore, we administered additional perfusion via the right axillary artery, which provided sufficient oxygen to the upper body and brain. The patient underwent Marlex mesh reinforcement of the right diaphragmatic hernia 30 days after grafting, and is doing well 1 year postoperatively.
ABSTRACT
A 10-year-old girl was given a diagnosis of mitral stenosis due to a small prosthetic valve. She had undergone intra-cardiac repair operations for a complete atrioventricular septal defect by a two-patch method at 6 months after birth, and for left atrioventricular valve insufficiency by replacement with a mechanical prosthesis (SJM-HP-17mm) at 2 years of age. The cause of mitral stenosis was considered to be that the existing prosthesis was too small for her body growth. Reoperation was done with a trans-septal approach, but despite the resection of the old prosthesis and peripheral fibrous tissue her left atrioventricular annulus was not big enough to insert a larger prosthesis. We thus cut the previous VSD patch about 1cm toward the apex, and sutured a patch for annular enlargement. After this annular enlargement, we could insert a larger prosthesis (SJM-HP-21mm). Her postoperative course was uneventful. There was no left ventricular outflow obstruction and no worsening of her mild right atrioventricular regurgitation. There are few established procedures for enlargement of a left atrioventricular annulus. Our method presented here is safe and effective for left atrioventricular annular enlargement, but can only be applied to patients with atrioventricular septal defect.
ABSTRACT
Staged arterial switch operation without homologous blood transfusion was successfully performed in 5 patients weighing 4.1-11.0kg (double outlet right ventricle: 2 cases, transposition of great arteries: 3 cases). The postoperative hemodynamics and respiratory status were uneventful in all patients (initial central venous pressure after ICU admission: 9.0-14.5cmH<sub>2</sub>O, mean 12.5cmH<sub>2</sub>O, duration of intubation: 3.5-18.0h, mean 7.8h). Autologous blood donation immediately after induction of anesthesia and minimization of bypass circuit were effective methods for open heart surgery without homologous blood transfusion, particularly in staged arterial switch operation requiring prolonged cardiopulmonary bypass.