A Surgical Case of CABG with Subclavian Steal Syndrome and Bilateral Iliac Type ASO / 日本心臓血管外科学会雑誌

Ischemic heart disease (IHD) may coexist with aorto-iliac occlusive disease, and concomitant revascularization procedures may be required. This study reports our experience with ascending aorta to left femoral bypass grafting (Ao-ltFG) to prepare for intra-aortic balloon pumping (IABP). A 73-year-old man with chest pain was admitted to our hospital. Coronary angiography revealed coronary aneurysm and IHD. Enhanced computed tomography showed coronary aneurysm, complete left subclavian artery occlusion and bilateral external iliac artery occlusion. We planned a two-stage operation. In the first operation, we chose coronary artery bypass grafting, excision of the coronary aneurysm and simultaneously Ao-ltFG to prepare for IABP. In the second operation, we chose axillo-axillo bypass grafting and Ao-ltFG to right femoral artery bypass grafting. Although in the operative findings no coronary aneurysm was recognized, we performed the other operations and the postoperative course was uneventful without IABP.

A Case of Ischemic Cardiomyopathy and Left Bundle-Branch Block Surgically Treated with Coronary Artery Bypass Grafting, Therapeutic Angiogenesis and Biventricular Pacing / 日本心臓血管外科学会雑誌

A 67-year-old man was referred to our department for surgical treatment of ischemic cardiomyopathy. Chest X-ray showed cardiomegaly with a cardiothoracic ratio of 62% and pulmonary congestion. CAG revealed multiple obstructive lesions in the left coronary artery system. LVG and UCG showed ventricular dilatation and dysfunction. ECG showed complete left bundle branch block with a QRS duration of 180ms. He underwent autologous bone marrow cell implantation and biventricular pacing concomitant with coronary artery bypass grafting. He is doing well after 15 months without any complications. Combination with therapeutic angiogenesis and cardiac resynchronization therapy may contribute to the development of new regenerative strategy for patients with severe ischemic cardiomyopathy.

A Case of Endovascular Stent Graft Placement for a Proximal Anastomotic Aneurysm after Abdominal Aortic Aneurysm Surgery / 日本心臓血管外科学会雑誌

A 77-year-old man was hospitalized for a proximal anastomotic aneurysm 9 years after surgery for an abdominal aortic aneurysm. The aneurysm was located 3cm distal to the renal artery. The maximum diameter was 55mm. His medical history included a reoperation for the proximal anastomotic aneurysm and cerebral infarction. Endovascular stent grafting was performed because it was possible anatomically. Postoperatively, no endoleak nor migration were found. At present, the patient is being followed up regularly in the outpatient department. Endovascular stent graft placement can be an effective method for reoperation cases of an abdominal aortic aneurysm, and if it is possible anatomically, it should be attempted.

Coronary Artery Bypass Surgery in Patients with End-Stage Renal Disease / 대한흉부외과학회지

BACKGROUND: As cardiac disorders, especially coronary artery disease is increasing in end-stage renal disease patients, the indications for coronary artery bypass surgery are increasing now. They have high risks for postoperative morbidity and mortality after coronary artery bypass surgery. MATERIAL AND METHOD: Between March of 1996 and May of 2000, medical records of 25 patients with end-stage renal disease who underwent coronary artery bypass surgery at Asan medical center were reviewed retrospectively. We reviewed the short-term results of preoperative risk factors, preoperative renal function, perative methods, operation results, hospital course, postoperative morbidity and mortality. RESULT: Preoperative creatinine clearance was 12.68+/-5 ml/min and serum creatinine level was 6.18+/-3 mg/dL(range 1.7-14. 4). Preoperatively, 11 patients(44%) received dialysis and the others(14 patients, 56%) were not supported by dialysis due to adequate urine output. Of the non-dialysis patients(14 cases), 8 patients were newly supported by dialysis, perioperatively. Of the preoperative hemodialysis patients(9 cases), two patients changed dialysis method postoperatively to peritoneal dialysis. Operative mortality occured in 2 patients(8%) and the causes of death were sepsis from aspiration pneumonia and mediastinitis, and postoperative bleeding and mediastinitis, respectively. Postoperative complications were developed in 14 patients(56%). There were 2 cases(8%) late mortalities and the cause of death was catheter-induced peritonitis. The actuarial survival rates in hospital survivals at 4 years was 82+/-13%. CONCLUSION: The coronary artery bypass surgery of end-stage renal disease patients were performed with acceptable mortality(8%). However , because the morbidity and mortality from morbidity were very frequent, perioperative prevention of infectious complications and careful patient management are very important.

Capillary Hemangioma of the Right Ventricle: A Case Report / 대한흉부외과학회지

Cardiac capillary hemangioma is an extremely rare benign tumor. We report a case of 13 year old male patient who was admitted for dyspnea. After we confirmed the right ventricular mass with moderate flow obstruction by echocardiogram, we performed complete resection of the mass through the right atrium and identified the capillary hemangioma with pathologic examination. Therefore, we report the case with literature review.

The Clinical Analysis of the Intermittent Warm Blood Cardioplegia by Admixing Potassium Only / 대한흉부외과학회지

BACKGROUND: Since the introduction of warm blood cardioplegic myocardial protection, the results of numerous clinical trials have been reported. However , the increased reliance oncrystalloid cardioplegia with longer cross clamp time, the controversies surrounding the issue of right ventricular protection with retrograde cardioplegia, and problems of securing a good operative field of vision have all been pointed out as unresolved. To overcome these shortcomings, Antonio et al, in 1995 published the use of intermittent warm blood cardioplegia by admixing potassium only with good clinical results. The obj ectives of the current investigation were to assess the effects and applicability of warm blood cardioplegia with potassium only. MATERIAL AND METHOD: From May of 1998 to January of 1999, the results of coronary surgery or open heart surgery in 70 patients under intermittent warm blood potassium only cardioplegia were compared with the results of 70 case matched patients undergoing similar operations with intermittent cold blood cardioplegia. RESULT: The amount of cardioplegic solution required during cardiopulmonary bypass(1463+/-68.0 min, 3584+/-179 min, p<0.001), the time to recovery of consciousness postoperatively(3.5+/-0.4 min, 4.9+/-0.8 min, p=0.044), intubation duration(10.8+/-0.8 hr , 13.2+/-0.6 hr , p=0.017), and the inci-dence of rrhythmia requiring the use of lidocaine(75.2+/-6.8 mg, 114.5+/-7.2 mg, p=0.006), which were found to be less in the warm potassium only group were statistically significant. However, the differences in postoperative cardiac enzymne elevation and postoperative mortality and morbidity were statistically insignificant. CONCLUSION: The current study showed warm intermittent potassium only blood cardioplegia to be at least equally effective as cold intermittent blood cardioplegia in providing myocardial protection. Furthermore, the reduction in cardiopulmonary bypass, mental recovery and intubation times strongly support the use of this method for intraopertaive myocardial protection.

Traumatic Disruption and Surgical Repair of the Thoracic Descending Aorta / 日本心臓血管外科学会雑誌

Thoracic aorta injury caused by blunt chest trauma is often fatal. A 26-year-old male with bilateral pneumohemothorax and disruption of the thoracic descending aorta due to a traffic accident was referred to our hospital. The chest X-ray film and CT scanning showed neither mediastinal widening nor periaortic hematoma. Three weeks after admission, aortography revealed flap formation at the aortic isthmus. Two months after trauma, we replaced the injured aorta with a vascular prosthesis using a centrifugal pump. Pathological examination showed separation of a medial layer of the aorta. His postoperative course was uneventful.

Importance of Na+-Ca2+ Exchange System in Post-Ischemic Reperfusion Injury / 日本心臓血管外科学会雑誌

We studied the effects of the electrolyte composition (Na⁺, Ca²⁺) and amiloride, an inhibitor of Na⁺-Ca²⁺ exchange system on the postischemic reperfusion injury of rat hearts. The observed results are as follows: (1) Post-ischemic functional recovery increases with increased extracellular Na⁺ concentration of the initial reperfusate. (2) The recovery of cardiac performance is improved when the extracellular Ca²⁺ concentration of the initial reperfusate is reduced. (3) Amiloride, administered in the initial reperfustea, ameliorates cardiac damage in a dose-dependent manner (between 10^-6M and 10^-4M). It is concluded that the mechanism of post-ischemic reperfusion injury is dependent on the Na⁺-Ca²⁺ exchange system.