A Case of Transient Stenotic Valve Failure after Porcine Prosthetic Valve Replacement for Mitral Regurgitation / 日本心臓血管外科学会雑誌

A 62-year-old man was admitted because of cardiac failure caused by mitral valve regurgitation. After his cardiac and general conditions had been evaluated, he underwent an operation. Some of chordae tendineae of both leaflets were ruptured and both leaflets had deformities. Since his mitral valve could not be repaired, it was replaced with a 29mm Hancock II bioprosthesis. Two weeks after operation, transesophageal echocardiography (TEE) and left ventriculography revealed that one of the three leaflets of the prosthesis was fixed in the closed position, and mild mitral valve stenosis without regurgitation was recognized. But he had no complaints and there were no other major disorders. He was observed every 2 weeks as an outpatient. Six months after operation, TEE showed good opening and closing of all 3 leaflets and showed no major abnormalities, although the cause of the failure was unknown. He is healthy 2 years after operation, but is being observed carefully.

Peroneal Artery Bypass Grafting through a Median Approach in Two Cases of Thromboangitis Obliterans / 日本心臓血管外科学会雑誌

In two cases of thromboangitis obliterans (TAO) a popliteal-posterior tibial-peroneal artery sequential bypass was attempted through a median approach. The 1st case underwent the operation successfully with non-reversed saphenous vein graft. However, only popliteal-peroneal bypass was carried out in the 2nd patient because the posterior tibial artery was severely affected. In surgery of TAO patients, careful assessment of preoperative angiographic findings is important to select the site of distal anastomosis. We found that the posterior tibial artery and the peroneal artery are easily accessible through the medial route in the proximal half of the lower leg and that peroneal artery revascularization was effective for limb salvage.

Surgery of Descending Thoracic Aortic Aneurysms with Use of a Centrifugal Pump. Usefulness of the Autotransfusion System / 日本心臓血管外科学会雑誌

We reviewed the results of 14 patients who underwent the operation of thoracic aneurysms using a centrifugal pump. Nine patients had atherosclerotic aneurysms and 5 had aortic dissections. The autotransfusion system (ATS) was used to keep hemodynamic stability by rapid transfusion. The ATS consisted of a roller pump, a 2, 000ml reservoir and a heat exchanger. Two mg/kg of heparin was given to the patients to keep ACT over 400 seconds. All patients survived. Body temperature increased 0.08±0.59°C during bypass with the ATS, and no patients showed hemodynamic instability after aneurysmotomy under the help of the ATS. We conclude that 1) the centrifugal pump is a useful and safe assisting means for the surgery of thoracic aneurysms, 2) the autotransfusion system has advantages as follows: keeping stable circulation and preventing loss of body temperature during bypass.