Résumé
Atherosclerotic morbidity of the ascending aorta is associated with an increased risk of perioperative cerebral damage during cardiac surgery. To minimize the risk, we developed a refined method for occluding the diseased ascending aorta. From April 2005 to December 2007, 18 patients underwent cardiac surgery. Just before aortic cross-clamping, the aorta was opened during brief circulatory arrest in order to flush out any possible remaining atheromatous debris. The specially designed intra-aortic occluder was applied to an extremely calcified aorta. There were no hospital mortalities or cerebrovascular accidents. In conclusion, our technique can greatly contribute to the prevention of embolic complications in patients with a severely diseased ascending aorta.
Résumé
Cryoablation was performed simultaneously with mitral valve plasty for a 65-year-old man with atrial fibrillation and mitral insufficiency. The sites of cryoablation were determined during atrial fibrillation using a computer-atrial-mapping system when the operation was performed. The site of repetitive activation was found at the area between the left atrial appendage and the superior left pulmonary vein. That area and the surrounding area were cryoablated five times (-60°C, 5min). After operation, normal sinus rhythm returned without the continuous use of any antiarrythemic drugs. Furthermore, the patient who underwent mitral valve plasty, does not need any anticoagulant drugs. This procedure was very effective and had little operative risk in this case. The patient is doing well with normal sinus rhythm 6 months after the operation.
Résumé
To determine the hemostatic effets of aprotinin in coronary artery bypass surgery, a prospective study was performed. Thirty four patients (group A) who received aprotinin (2×10<sup>6</sup> unit) in the cardiopulmonary circuit were compared with 31 control patients (group C) who did not. Activated clotting time was measured in group A for 60 minutes during cardiopulmonary bypass, but no significant difference was observed in the platelet counts of the two groups. Intraoperative blood loss was 366ml in group A compared with 514ml in group C, and postoperative blood loss was 354ml versus 570ml, respectively (<i>p</i><0.05). Total blood loss was significantly reduced in group A by 34% compared with group C (720ml versus 1, 084ml, <i>p</i><0.05). There was no difference in incidence of perioperative myocardial damage. It seems necessary to investigate the complications of the hemostatic effects of aprotinin and it effects on graft patency.
Résumé
Coronary artery bypass surgery in a 54-year-old female with severe calcified ascending aorta was performed with aortic no touch technique, Extracorporeal circulation with femoral cannulation was performed, and bilateral internal thoracic acteries and gastroepiploic artery were used as grafts under ventricular fibrillation and hypothermia without aortic cross-clamping. No neurological complication was observed and postoperative course was uneventful. We think the aortic no touch technique is safe and reliable in the coronary revascularization with severe calcified aorta.
Résumé
A case of 38-year-old woman with corrected transposition of great arteries is reported. She was admitted for acute cardiac failure caused by not only the left-side atrioventricular regurgitation for the ruptured chordae tendineae, but also the right-side one. We have to perform double valve replacement emergently due to the progression of biventricular failure. Very few reports have described a surgical repair of the right-sided valve replacement. The postoperative course was favorable.