ABSTRACT
A 73-year-old woman complaining of increased dyspnea, but no shock, was admitted under an echographic diagnosis of right atrial tumor. Echo-cardiogram at the time of admission did not reveal the right atrial tumor, and a massive pulmonary embolus was detected a pulmonary arteriography. After the infusion of tissue plasminogen activator and heparin, pulmonary arterial systolic pressure was decreased from 66 to 43mmHg, and dyspnea was improved. However, repeated pulmonary arteriograms showed no change of the pulmonary embolus, thus emergency pulmonary embolectomy was indicated. Massive thrombi, which were suspected to have moved from the lower extremities, were successfully removed. During operation, the following critical events were encountered; shock during IVC taping and severe hypoxia immediately after the pulmonary revascularization. These problems were successfully controlled by partial extracorporeal circulation. Pulmonary pressure decreased to 25mmHg postoperatively and she is doing well with anticoagulant therapy.
ABSTRACT
Two hemodialysis patients underwent coronary artery bypass grafting. Emergency coronary artery bypass grafting was performed in one patient with unstable angina and acute left ventricular failure. The other patient underwent a combined operation of coronary artery bypass grafting and replacement of abdominal aortic aneurysm. In both patients, hemofiltration was used during cardiopulmonary bypass. In the early postoperative periods, peritoneal dialysis and extracorporeal ultrafiltration method (ECUM) were used in Case 1, while Case 2 was treated by hemofiltration and ECUM. Postoperative coronary angiography showed that all grafts of both patients were patent, and both patients weve discharged from hospital without angina.
ABSTRACT
We report an unusual case of a 71 year-old man who developed chronic consumption coagulopathy caused by an abdominal aortic aneurysm. He was diagnosed as having the dissecting aortic aneurysm (DeBakey type IIIa) and the abdominal aortic aneurysm in 1989, and had been attending to our hospital as an outpatient since then. He developed macrohematuria in March 1990. The laboratory data showed the decrease in platelet, fibrinogen, plasminogen and α<sub>2</sub> plasmin inhibitor and the increase in FDP. The bleeding tendency was controlled by the administration of gabexate mesilate and heparin, but the laboratory data revealed that consumption coagulopathy continued. The abdominal aortic aneurysm was successfully replaced with a prosthetic vascular graft in June 1992. Postoperative hematological findings revealed the improvement, and he discharged 32nd day and doing well after operation.
ABSTRACT
Direct observation of the intravascular atherosclerotic change provides many diagnostic information and supports successful vascular surgery. Angioscopic inspections were performed in the 23 patients who underwent laser angioplasty for the peripheral arteries and 7 patients with aorto-coronary bypass surgery in this study. Useful images could be obtained in 19 (83%) of 23 observations in the peripheral arteries, and the successful rates of angioscopic observation were influenced by the diameter and the degree of kinking of each vessel. On the other hand, intraoperative observation of coronary artery with angioscope could be performed easily in all cases. From these findings, intraoperative application of angioscopy was considered to be useful procedure for the cardiovascular surgery.