RESUMO
An 82-year-old man was taken to a local clinic following the occurrence of syncope. Chest roentgenography and computed tomography (CT) findings led to a suspicion of a ruptured aortic aneurysm, and the patient was immediately transferred to our hospital. Upon admission, his consciousness was clear and blood pressure was 74/47mmHg. Enhanced chest CT images demonstrated pericardial effusion and a saccular aneurysm with a maximum diameter of 5cm, which was associated with a thrombus in the distal aortic arch. An emergency operation was performed under a diagnosis of a ruptured distal aortic arch aneurysm and hemorrhagic cardiac tamponade. During the procedure, a hole was found in the lesser curvature of the aneurysm, which had directly ruptured into the pericardial space, and a graft replacement of the aortic arch was performed using selective cerebral perfusion. The patient was discharged 19 days after surgery without any postoperative complications.
RESUMO
A 47-year-old man was referred to our hospital for multiple rib fractures and pneumohemothorax due to a traffic accident. After admission, tricuspid valve regurgitation and hypoxemia were also diagnosed. Although fixation of the fractured ribs with plates and removal of hematoma in the pleural cavity were performed, hypoxemia did not improve. He was discharged on home oxygen therapy. Ten months and 3 years after the traffic accident, pulmonary perfusion scintigraphy suggested a right-to-left shunt. Transesophageal echocardiography demonstrated an opening of the foramen ovale and a right-to-left interatrial shunt. Direct closure of the patent foramen ovale and tricuspid valve replacement with the Carpentier-Edwards bioprosthesis were performed and hypoxemia disappeared after the second operation. Traumatic tricuspid valve regurgitation with cyanosis is extremely rare. However, it is important to take the possibility of patent foramen ovale into consideration in patients with traumatic tricuspid valve regurgitation and cyanosis.
RESUMO
A 7-year-old boy suffered from isolated interruption of the aortic arch without any other complications or cardiovascular malformations. Cardiac murmur, which had been apparent since one month of age, had been left untreated because of the absence of any symptoms of heart failure. Isolated interruption of the aortic arch was noted during a routine physical examination at school and the patient was referred to our hospital for a complete medical evaluation. Blood-pressure difference was recognized not only between the right side and the left side of the upper extremities but also between the upper and lower extremities. On the basis of the results obtained via magnetic resonance angiography (MRA) and aortography, a definitive diagnosis of isolated interruption of the aortic arch was made. Reconstruction of the aortic arch by synthetic implant was indicated. The blood-pressure difference disappeared and the postoperative course was satisfactory.
RESUMO
Controlled Freezing-point Storage (CF Storage) is a new method of preserving foods in minus non-frozen temperature range. So, we tried to apply this method to entrails preservation and investigated the effect of controlled freezing-point storage of hearts on ventricular function in isolated perfused rat heart (male, Sprague dawley strain, in body about 300g weight). The hearts were perfused by working heart mode for 10min, and received infusion of cardioplegic solution which was followed by 4 hours of cardiac arrest at a myocardial temperature 4°C (4°C group) or minus non-frozen temperature (CF storage group). Then, the aerobic reperfusion by working heart mode was continued for an additional 30min. The recovery rate of cardiac output was 33.5% and 62.5% respectively of the preischemic value in 4°C group and CF storage group, which was statistically significant (<i>p</i><0.01). ATP activity after 4 hours of cardiac arrest in 4°C group was significantly lower than that in CF storage group (<i>p</i><0.05). These data suggest that CF storage of hearts might have a protective effect against an ischemic insult upon myocardial cell during hypothermic cardiac arrest.
RESUMO
IABP is in wide clinical use as an effective adjunctive means for the management of seriously impaired cardiac function. Unfortunately, however, it is an undeniable fact that this specialized circulatory support technic has so far been used in severe heart disease cases in a desultory way, with no established criteria being available for indication of elective IABP for prophylactic purposes. Under such circumstances, it was felt worthwhile to analyze data on preoperative left ventricular function from a series of open heart surgery cases (25 treated with and 94 without IABP) encountered in our hospital since 1983 (when procedure for myocardial protection was virtually standardized) in an effort to formulate acceptable criteria for indication of elective IABP. Hemodynamic parameters studied were LVESVI, LVEF and LVEDP. The results led us to conclude that scheduled IABP can be regarded as indicated for use in each of the following valvular heart diseases if at least one of the respective criteria specified below is fulfilled: MR: LVESVI≥120ml/m<sup>2</sup>, LVEF≤0.4, LVEDP≥21mmHg; AR: LVESVI≥135ml/m<sup>2</sup>, LVEF≤0.4, LVEDP≥18mmHg; MS: LVESVI≥70ml/m<sup>2</sup>, LVEF≤0.35, LVEDP≥23mmHg.