Long-Term Function of Hydrofit as Hemostatic Agent / 日本心臓血管外科学会雑誌

Bleeding control during aortic surgery is one of the most important issue. The well-known fibrinogen-based hemostat contains the blood product, which means the potential risk of the blood-related infection. Recently, the newly-designed hemostat “Hydrofit”, which is assembled with urethane-based polymer without blood product (Matsudyte : Sanyo-chemical industry, Kyoto, Japan). Hydrofit is applicated for the hemostasis of thoracic aortic surgery. In sealing of the Hydrofit gel to the anastomosis site of aorta, water-contact initiation boosts the chemical change to the forming elastomer and adheres around anastomosis site rapidly. We experienced the extirpation of the Hydrofit which was used over 4 years ago. The patient is 42 year-old female who was operated aortic valve replacement and graft replacement of ascending aorta using a Hydrofit as a hemostat at 4 year 8 months ago due to the aortitis syndrome. Re-sternotomy and re-AVR was performed because of the prosthetic valve dehiscence due to the active aortitis syndrome. Hydrofit left around suture line without infection, and functioned very well as the elastic sealant for the long-term period.

A Case Which Presented Morbidity Considered to Be Anaphylactoid Purpura after Thoracic Endovascular Aortic Repair / 日本心臓血管外科学会雑誌

We herein report a 79-year-old man who developed anaphylactoid purpura after thoracic endovascular aortic repair, which he underwent for a distal aortic arch aneurysm of saccular type. On the third postoperative day he had purpura over his lower legs and abdomen accompanied by intermittent fever. His serum C-reactive protein concentration reached a maximum of 12 mg/dl, and remained at around 4 mg/dl thereafter. A dermatologist diagnosed anaphylactoid purpura ; this gradually improved with topical steroid and the nature and dosage of the oral medication. We suspected the presence of malignancy ; however, appropriate investigations failed to identify a cause for the purpura. During 6 months of outpatient follow up he has been free of recurrence. Anaphylactoid purpura occurs most frequently in childhood, often after an upper respiratory tract infection, whereas this condition is rare in adults. Triggers for anaphylactoid purpura include surgery, infection, certain medications, chronic lung, liver, or renal failure, and malignancy. We believe that the stress of undergoing thoracic endovascular aortic repair was the trigger in this case. Anaphylactoid purpura may be complicated by arthritis, gastrointestinal involvement and renal manifestations. There were no such complications in this case.

Emergent Redo-Mitral Valve Replacement during Pregnancy at 23 Weeks and 4 Days of Gestation due to Bioprosthetic Valve Deterioration / 日本心臓血管外科学会雑誌

We report a case of emergent redo-mitral valve replacement during pregnancy at 23 week and 4 days of gestation. A 23-year-old woman, who underwent mitral valve replacement with a bioprosthetic valve (Carpentier-Edwards Perimount^® 27 mm) for infective endocarditis 5 years ago, was transferred to our hospital due to severe congestive heart failure. Echocardiography revealed structural valve deterioration of the mitral prosthesis and severe mitral stenosis. Emergent redo-mitral valve replacement with a bioprosthetic valve was performed to save the patient with top priority. Cardiopulmonary bypass was operated under normothermic, high flow, high pressure and pulsatile fashion. Fetal heart rate was continuously monitored during the operation. Although her baby was delivered vaginally just after operation weighing only 520 g, she was treated by the neonatologists successfully.

Laparotomy for Acute Cholecystitis after Extracorporeal Left Ventricular Assisted System Implantation / 日本心臓血管外科学会雑誌

A 37-year-old man presented with extensive myocardial infarction due to total occlusion of the left main trunk, complicated with near-fatal heart failure. An extracorporeal left ventricular assisted system LVAS (NIPRO-Toyobo LVAS) was implanted in our hospital. Although his postoperative course was relatively good, acute cholecystitis occurred on the 31st postoperative day, and emergeney cholecystectomy was indicated. His PT-INR was 4.13 because of taking Warfarin orally, and the cannulas of LVAS passed through his skin at the subxiphoid region. Therefore, we preoperatively transfused fresh frozen plasma quickly to reverse the PT-INR (approximately 2.0) and performed open cholecystectomy via the right side of the para-rectus abdominal muscle. His postoperative course was uneventful, and he is waiting for heart transplantation in our hospital.

Direct Implantation of the Left Coronary Artery to the Ascending Aorta in Bland-White-Garland Syndrome / 日本心臓血管外科学会雑誌

We herein describe the findings of a 32-year-old female was known to have had an electrocardiogram abnormalities and had avoided excessive exercise since her high school student days. She suddenly lost consciousness due to ventricular fibrillation (Vf) in July 2007. As a result she was taken to our hospital by ambulance. Emergency coronary angiography demonstrated an anomalous origin of the left coronary artery from the pulmonary artery (Bland-White-Garland Syndrome). She therefore underwent surgery. During the operation, the main pulmonary artery (PA) was transected while on the cardiopulmonary bypass and the left main coronary trunk (LMT) ostium was detected. Antegrade cold blood cardioplegia was induced, and retrograde continuous cold blood cardioplegia was subsequently applied to the coronary sinus, thus obtaining a complete cardiac standstill. The LMT ostium was excised with a cuff of the main PA wall as a button. During further dissection of the LMT distally to the bifurcation, the LMT wall was injured, thus resulting in the need to repair it under deep hypothermic circulatory arrest (DHCA) in order to obtain a bloodless surgical field. During core cooling, the LMT was anastomosed to the left posterolateral wall of the ascending aorta, then the LMT was repaired with a patch consisting of a non-treated autologous saphenous vein (SV) under DHCA. Several surgical techniques for BWG syndrome have been reported. Among these techniques, the direct implantation of the left coronary artery to the ascending aorta is the most physiological and therefore is considered to be the best technique. In this case, direct implantation was accomplished, however, the LMT also had to be repaired.

Selection of Candidates for Circulatory Support Devices as a Bridge to Heart Transplantation / 日本心臓血管外科学会雑誌

Circulatory support devices have become an important component for transplantation programs as they successfully bridge unsalvageable patients who would otherwise die. Between October 1997 and April 2001, 6 patients in profound heart failure were treated with a percutaneous cardiopulmonary support system (PCPS), or with ventricular assist device (VAD), or with both PCPS and VAD. Two patients were treated only with a PCPS, and one weaned case survived. Another 2 patients, who had dilated cardiomyopathy, was treated with VAD. They improved hemodynamically, and their general conditions made them fit to be candidates for heart transplantation. Two other patients who had PCPS insertion before VAD died due to multiple organ failure. Before the application of VAD, the levels of total bilirubin were 14.9 and 20.9mg/dl respectively. In acute worsening of hemodynamics, PCPS is useful to maintain total circulation by quick application. However, long-term support with VAD should be considered to resuscitate impaired end-organ function by carefully selecting the timing of a VAD implantation.