Study on Myocardial Temperature Cooling during Myocardial Protection Using Thermography / 日本心臓血管外科学会雑誌

Objective: The control of myocardial temperature is very important in myocardial protection methods. We investigated the validity of myocardial protection methods at our institution using noninvasive thermography as a means of determining the effectiveness of myocardial protection, with the aim of confirming that myocardial protection solution is correctly infused. Methods: Of 52 extracorporeal circulation cases with cardiac arrest from May 2020 to June 2022, 10 cases with cardiac arrest by progressive myocardial protection with Microplegia, a blood myocardial protection, were included. Infusion was performed at an infusion temperature of 20℃, with an intracircuit pressure of less than 300 mmHg and a flow rate of 250-350 ml/min maintained in a progressive manner. Myocardial temperature in the anterior region of the heart was measured using a thermographic camera at a distance of 80 cm from the heart. Results: The cardiac surface temperature before the start of myocardial protection was 32.5±1.0℃. After the start of infusion, the cardiac surface temperature at the time cardiac arrest was obtained was 27.4±1.3℃. In all cases, the cardiac surface temperature at the time of cardiac arrest was visually heterogeneous. Further infusion was continued, and the average time to reach the lowest visually uniform surface temperature was 342±23 s. The mean cardiac surface temperature at the end of myocardial protection was 22.4±1.3℃. At the start of myocardial protection solution infusion, the myocardial surface cooled faster in muscle than in visible fat, in the order aorta>myocardium from the apex>cardiac base. The postoperative course was generally good in all cases with respect to EF, CKMB, catecholamine use, extubation time, postoperartive hospital stay, and outcomes. Conclusion: It was found that a time of about 360 s is needed to uniformly cool the myocardial temperature during infusion of myocardial protection solution. Furthermore, by confirming the cooling of the base of the heart, it is suggested that it is inferred that the whole is cooled. To avoid problems caused by inadequate myocardial protection, it is suggested that measuring myocardial temperature using a non-invasive, simple thermal imaging camera can assist in determining the effectiveness of myocardial protection, and is expected to establish the safety of further myocardial protection.

A Case of Inferior Mesenteric Artery Aneurysm in Association with Arteriosclerosis Obliterans / 日本心臓血管外科学会雑誌

Inferior mesenteric artery aneurysm (IMAA) is a rare disease among visceral aneurysms. We encountered an open repair of IMAA in association with arteriosclerosis obliterans (ASO). The case was 74-year-old man who had progressive intermittent claudication for 10 years. Preoperative enhanced CT demonstrated IMAA and ASO due to the occlusion of right common iliac artery, the coil embolization was initially considered as a therapeutic option. However, since CT also revealed the occlusion of superior mesenteric artery, the open repair of the aneurysmal resection and subsequent IMA reconstruction were performed in order to avoid mesenteric necrosis. During the procedure, we confirmed bilateral arterial flow of the lower extremities and the good color of the small intestine before closing the abdomen. The patient was started on food intake on postoperative day (POD) 3, and CT showed intact arterial flow of the inferior mesentery. Postoperative course was uneventful and the patient was discharged on POD 16.

A Case of Abdominal Aortic Aneurysm in Association with Congenital Factor XI Deficiency / 日本心臓血管外科学会雑誌

Congenital factor XI deficiency is a rare intrinsic coagulation factor. We treated a 67-year-old man with abdominal aortic aneurysm, in whom activated partial thromboplastin time (APTT) found to be prolonged preoperatively. After fresh frozen plasma (FFP) was given before surgery, aneurysm was successfully replaced by a woven Dacron graft. No bleeding tendency was noted during the operation and FFP was also administered during and after surgery. The patient recovered without incident and left the hospital 13 days after the operation. Since several days are required to determine factor XI activity, APTT is useful as a parameter of coagulation factor activity in the perioperative period.

A Case of Abdominal Aortic Aneurysm Associated with Horseshoe Kidney / 日本心臓血管外科学会雑誌

We describe the case of an 80-year-old man who underwent surgical repair for abdominal aortic aneurysm with horseshoe kidney. We performed open surgery by a transperitoneal approach via a standard median laparotomy, and noted that the right accessory renal artery had 1 branch and the left accessory renal artery had 2. We safely dissected these arteries using a Harmonic scalpel. The aneurysm was successfully replaced using a Dacron straight graft, and all renal arteries were preserved. Renal infarction and renal dysfunction did not occur during the uneventful postoperative course.

Aortic Arch Replacement for Arch Aneurysm with a Porcelain Aorta Using Transapical Aortic Cannulation / 日本心臓血管外科学会雑誌

Porcelain aorta entails a high risk of cerebral as well as systemic embolism. We describe a case of aortic arch aneurysm with a circumferentially calcified aorta. The patient was a 61-year-old man on chronic hemodialysis who received aortic arch replacement. However, since chest CT scan revealed a totally calcified porcelain aorta and heavily calcified axillary artery, axillary artery cannulation was deemed to be contraindicated. On the other hand, possible complications caused by femoral artery cannulation are also well known, such as cerebral embolization. Therefore, transapical aortic cannula was used and aortic arch replacement was performed under deep hypothermic circulatory arrest. The patient was weaned from cardiopulmonary bypass without difficulty and had an uneventful recovery without any neurologic complications.

The Long-Term Survival and Predictors of Heart Failure after Endoventricular Circular Patch Plasty / 日本心臓血管外科学会雑誌

Endoventricular circular patch plasty (the Dor procedure) has been demonstrated to improve outcome in patients with ischemic cardiomyopathy. However, in some of them congestive heart failure (CHF) occurred during follow-up. This study examined the effects of the Dor procedure on the long-term survival and predictors of CHF after this procedure. Hemodynamic and clinical results were analyzed and predictors of CHF were examined. Postoperative ESVI in the CHF group was larger than that in the non-CHF group. The delayed MR rate was greater following the CHF group (82.4%) compared to the non-CHF group (19.2%). Despite mitral valve repair (<i>N</i>=8), 3 patients had delayed MR. All of them were greater than MR³. Hemodynamic and clinical results were improved by the Dor procedure. However, cardiac events were usually occurred during the follow-up. The predictor of CHF was delayed MR. Therefore, patients with preoperative MR should be treated. If preoperative MR is greater than 3, there will be MR recurrence cases after MVP only. Therefore, patients with preoperative MR (3 or 4) should be treated by alternative surgical procedures.

Valve Replacement in Hemodialysis Patients in Japan / 日本心臓血管外科学会雑誌

A retrospective review was performed on 43 patients on hemodialysis undergoing valve surgery between May 1999 and August 2004. Ages ranged from 36 to 80 years (mean, 63.8 years). Twenty aortic, 9 mitral, 8 aortic and mitral and 6 valvuloplasties were performed. Twenty-three aortic mechanical valves, 5 aortic bioprosthetic valves, 13 mitral mechanical valves and 4 mitral bioprosthetic valves were implanted. Twenty-five of the 28 aortic valve replacement were hypoplasia of the aortic valve ring. There were 3 hospital deaths (heart failure, pneumonia and sepsis). There were 10 late deaths (2 heart failure, 2 pneumonia, wound infection, cerebral infarction, 2 cancer, arteriosclerosis obliterans and unknown death). Survival at 1, 3 and 5 years was 81%, 74% and 47%. There were three documented major bleedings or thromboembolisms in the 29 patients with mechanical valves (10%) and none in the 9 patients with bioprosthetic valves (0% no significance). Three reoperations were performed for premature degeneration of bioprosthetic valve (19, 24 and 50 months) due to accelerated calcification. These results demonstrate that the prosthetic valve-related major bleedings and strokes in hemodialysis patients are similar for both mechanical and bioprosthetic valves, and that bioprosthetic valves will undergo premature degeneration. Therefore, preference should be given to mechanical valve prostheses in hemodialysis patients.