ABSTRACT
A 72-year-old woman underwent thoracic endovascular aortic repair (TEVAR) for an aortic arch aneurysm at a previous hospital. During follow-up, although the aneurysm was found to have become bigger, no further treatments were given, except for conservative follow-up. The patient sought a second opinion and thus visited our hospital. Enhanced computed tomography (CT) revealed a type I endoleak that required repair. Total arch replacement with removal of the partial stent-graft system was performed under deep hypothermic circulatory arrest. The patient made a steady progress postoperatively and was discharged without any complications. Endovascular repair is minimally invasive and frequently used in various medical facilities but carries a considerably high risk of reintervention. Treatment strategies for aortic aneurysm, including open surgery, should be carefully chosen.
ABSTRACT
Porcelain aorta entails a high risk of cerebral as well as systemic embolism. We describe a case of aortic arch aneurysm with a circumferentially calcified aorta. The patient was a 61-year-old man on chronic hemodialysis who received aortic arch replacement. However, since chest CT scan revealed a totally calcified porcelain aorta and heavily calcified axillary artery, axillary artery cannulation was deemed to be contraindicated. On the other hand, possible complications caused by femoral artery cannulation are also well known, such as cerebral embolization. Therefore, transapical aortic cannula was used and aortic arch replacement was performed under deep hypothermic circulatory arrest. The patient was weaned from cardiopulmonary bypass without difficulty and had an uneventful recovery without any neurologic complications.
ABSTRACT
A 54-year-old male with sudden back pain was diagnosed as having acute aortic dissection of Stanford type A. He underwent an aortic arch replacement under the deep hypothermic circulatory arrest and retrograde cerebral perfusion. During retrograde cerebral perfusion, the central venous pressure was maintained at 20mmHg, the perfusion flow rate was 400ml/min and the lowest rectal temperature was 19°C. The duration of retrograde cerebral perfusion was 135 min, but the patient recovered successfully without any evidence of neurological complications. This report suggests that retrograde cerebral perfusion associated with deep hypothermic circulatory arrest has the possibility to prolong the safety time limit of antegrade cerebral circulatory arrest up to 135min.
ABSTRACT
Surgical treatment of two abdominal and two thoracic aneurysms in hemodialysis patients were performed from 1991 to 1993. Two elective cases survived, but two emergency cases died. The causes of death were PMI and respiratory failure. Ruptured aneurysms are critical and probably result in higher mortality and morbidity than elective replacement of aneurysms. In view of the documented risk of rupture and current operative risk, we believe that elective surgical treatment of aneurysm is a much better treatment than following the aneurysms until they produce symptoms or significantly enlarge.
ABSTRACT
Coronary artery bypass grafting using hypothermic circulatory arrest and ventricular fibrillation without aortic cross clamping in 6 patients with severely calcified aortas is described. The use of hypothermic circulatory arrest or ventricular fibrillation has not been established in coronary artery bypass grafting. We recently used aortic no-touch technique in 6 patients. All patients were supported and cooled with cardiopulmonary bypass, and circulatory arrest was performed in 3 patients. With the exception of one hemodialysis patient, 5 patients survived without neurological deficit. We think the aortic no-touch technique is safe and reliable in coronary artery bypass grafting with severe calcified aortas.
ABSTRACT
We controlled the hemodilution and electrolyte levels during coronary artery revascularization in chronic hemodialysis patients by hemofiltration during the period of extracorporeal circulation. Subjects comprised 7 chronic hemodialysis patients (males, average age 53) undergoing coronary artery revascularization in our department from January 1988 to December 1989. All patients had been undergoing hemodialysis for chronic renal failure and in one patient, after admission, continuous ambulatory peritoneal dialysis (CAPD) was additionally performed. During surgery, the dialyzer was equipped with an extracorporeal circulation circuit and the electrolyte level and hemodilution were adjusted using transfusion (1, 270±372ml). A large infusion volume (12, 657± 3, 966ml) was maintained and removal of water was carried out by ultrafiltration. After surgery, all patients underwent hemodialysis twice or more by the 3rd day of recovery. Concentrations of electrolytes were maintained at appropriate levels throughout the day of surgery except for one case of postoperative hypokalemia, but no marked changes in hemodynamics were observed during and after surgery. Hemofiltration during extracorporeal circulation is safe and useful in coronary surgery because it is simpler and requires less time than hemodialysis.
ABSTRACT
A total of 961 patients underwent coronary artery bypass grafting (CABG) between 1982 and 1991, and we investigated perioperative cerebral infarction. The average age of operation in these case was 65±4 years. There was 9 patients with hypertension, 7 with diabetes mellitus and 5 with hyperlipidemia. Concerning cerebral infarction, there were 3 patients with multiple infarction, 6 with infarction of the mid cerebral artery area, 1 with infarction of posterior cerebral artery area, 1 with infarction of posterior cerebral artery area, 1 with infarction of pons and 1 with infarction of the ophthalmic artery. The courses of infarction involved atherosclerosis, hypoperfusion during cardiopulmonary bypass, thrombosis due to arterial fibrillation and thrombus on the left ventricular wall. Three patients who had critical cerebral infarction died after CABG. We consider that avoid perioperative cerebral infarction preoperative atherosclerosis, thrombus and to choose the proper procedure of the operation.
ABSTRACT
A 72 year-old man underwent coronary angiography (CAG) with a diagnosis of unstable angina pectoris, and 90% stenosis of the LMT was found. Since idiopathic interstitial pneumonia (IIP) had been diagnosed previously, percutaneous transluminal coronary angioplasty (PTCA) was performed. However, his unstable angina recurred after about 2 months restenosis of the LMT to 90% was shown by CAG, and coronary artery bypass grafting (CABG) was performed. In the preoperative chest X-ray, diffuse granular opacities were seen in both lower lungfields, and Velcro rales were heard by ausculation. A spirogram could not be obtained because of his unstable angina, but the PaO<sub>2</sub> was a reasonable 70mmHg when breathing room air. In consideration of the age of the patient, a double coronary artery bypass grafting using a saphenous vein graft (SVG) was performed to minimize duration of anesthesia. His PaO<sub>2</sub> showed a transient decrease after the end of cardiopulmonary bypass (CPB), but the perioperative hemodynamics and respiratory status were stable and extubation was performed on the 1st postoperative day. No aggravation of his IIP occurred postoperatively and he was discharged on the 29th postoperative day.