Résumé
When performing aortic valve replacement (AVR) in patients with a past history of coronary artery bypass grafting (CABG) using the internal thoracic artery (ITA), the patent ITA graft needs to be detached from the surrounding tissue and occluded to properly protect the myocardium. However, detaching the ITA graft from the surrounding tissue takes time, and caution must be exercised to avoid damaging the graft. Two patients with a past history of CABG using the ITA were scheduled to undergo AVR. To simplify AVR, a balloon was placed preoperatively, and was inflated during aortic occlusion to occlude the ITA graft. The myocardium was adequately protected in this manner. Furthermore, since adhesion detachment was limited to around the ascending aorta, operative duration was short and bleeding volume was low. Balloon occlusion of the ITA graft appears to be useful in reducing the invasiveness of AVR in patients with a past history of CABG.
Résumé
A 56-year-old Japanese woman underwent hemi-arch replacement with selective cerebral perfusion for acute aortic dissection of DeBakey type I. A postoperative computed tomographic scan of the brain showed extensive infarction of the right hemisphere, a midline shift, and right uncal herniation. The patient received right fronto-temporo-parietal craniectomy and external decompression followed by mild brain hypothermia, targeting a rectal temperature of 34°C. Despite residual left hemiparesis, she became alert and successfully recovered. She was discharged 147 days after the operation. We conclude that external decompression with mild brain hypothermia was therapeutically useful, with no major complications, for the treatment of extensive cerebral infarction associated with acute aortic dissection.
Résumé
A patient developed perioperative coronary artery spasms (CAS) twice, in initial and redo open heart operations for mitral stenosis. CAS was shown by sudden ST segment elevation, hypotension, bradycardia, and decreased cardiac output. The patient, a female, had the first CAS attack in the ICU following open mitral commissurotomy at the age of 48. The Second CAS attack occurred during redo surgery for mitral valve replacement at age of 56. Preoperative coronary angiography before both operations did not indicate significant organic lesions. Intraaortic balloon pumping in conjunction with intravenous nitroglycerin and norepinephrine were effective to treat CAS in this case.