A Simple Modified Infarct Exclusion Technique for a Patient with Large Ventricular Septal Perforation / 日本心臓血管外科学会雑誌

A 79 year-old woman was given a diagnosis of acute myocardial infarction and was immediately transferred to our hospital by a helicopter. Cardiologists successfully revascularized the occluded left anterior descending artery which was considered to be the care of this case. After that, they detected a large ventricular septal perforation by transthoracic echocardiography. We performed repair of the ventricular septal perforation 4 days later, with a modified infarct exclusion technique. Residual shunt flow was not seen by echocardiography after the operation. This patient recovered uneventfully and was discharged on postoperative day 55.

Two Cases of Postinfarction Ventricular Septal Perforation due to Obstruction of the Right Coronary Artery / 日本心臓血管外科学会雑誌

We report 2 cases of postinfarction ventricular septal perforation (VSP) attributable to obstruction of the right coronary artery. Case 1 was a 63-year-old man in whom VSP developed after percutaneous coronary angioplasty for complete obstruction of the right coronary artery. He developed papillary muscle rupture intraoperatively, requiring mitral valve replacement and subsequent treatment for right-side heart failure. He was discharged l7 weeks after surgery. Case 2 was a 77-year-old man. During catheterization following the detection of 99% obstruction of the #2 segment of the right coronary artery, VSP was found and the patient underwent emergency surgery. Postoperative echocardiography and ventriculography did not reveal a residual shunt or mitral regurgitation (MR). However, he suddenly developed acute MR in the 4th postoperative week and died of acute heart failure. VSP attributable to obstruction of the right coronary artery is difficult to repair surgically because of its anatomical location, among other reasons, and mitral valve replacement is sometimes needed if VSP is accompanied by necrosis of the mitral valve papillary muscle. Appropriate care is therefore needed in this case.

A Case Report of Dor's Operation for Left Ventricular Aneurysm with Cardiac Failure 19 Years after the Operation for Post Infarction Ventricular Septal Perforation / 日本心臓血管外科学会雑誌

We encountered a case of Dor's operation for left ventricular aneurysm with cardiac failure 19 years after operation for post-infarction ventricular septal perforation. A 70-year-old man, who had undergone patch closure for ventricular septum perforation due to acute anteroseptal myocardial infarction, was admitted for congestive heart failure. Preoperative left ventriculography (LVG) revealed large anteroseptal and ventricular septal aneurysm. The left ventricular ejection fraction (LVEF) was 39%, and the left ventricular end diastolic volume (LVEDV) was 200ml. Dor's operation and coronary artery bypass grafting to the left circumflex branch was performed. The postoperative course was uneventful and the patient was discharged 33 days after the operation. Postoperative LVG revealed improved left ventricular function and showed that LVEF was 45% and LVEDV was 171ml. The large akinetic aneurysm was formed 19 years after operation following the linear closure method. LVG after Dor's operation showed remarkable improvement for left ventricular function. These findings indicated that Dor's operation is superior to the linear method.

Operative Treatment of Lumbar Spondylolisthesis using Steffee VSP and Cut Pedicle Screw: New Operative Technique / 대한척추외과학회지

STUDY DESIGN: The authors have investigated the clinical results for the lumbar spondylolisthesis treated operatively using the Steffee VSP and cut pedicle screw for satisfactory reduction with saving of functioning segment. OBJECTIVES: To demonstrate the effectiveness of short segment fusion using the Steffee VSP and cut pedicle screw. SUMMARY OF LITERATURE REVIEW: Spondylolisthesis has been recognized as one of the leading cause of low back pain. Most are successfully managed with conservative treatment, but operative treatment is indicated if conservative treatment fails. Operative treatments are categorized into decompression, reduction and fusion. Especially, in the methods of fusion, there are some controversies between short segment fusion for saving of functioning segment and extended fusion for more amount of reduction. MATERIALS AND METHODS: We report 29 cases of lumbar spondylolisthesis which were treated operatively using the Steffee VSP and cut pedicle screw from March 1994 to Feb. 1996. The reduction was done by cork screw pulling back mechanism and the short segment fusion was done. The each case was followed up for 1 year 6 months to 3 years 1 month. RESULTS: Satisfactory reduction was obtained from preoperative 23.3% slippage to postoperative 3.7% by Taillard method. In the functional results, 90% was above good according to the Gill`s criteria without any serious complications. CONCLUSIONS: We had satisfactory results after this operation. When compared to operative treatment with S-shaped VSP reported by same authors, this procedure had following advantages ; ease to make and decrease of complication such as laminar sclerosis due to wider contact. It is necessary that long-term follow up about pressure effect of cut pedicle screw on above facet joint and lamina, fusion rate and saving of above functioning segment after implant removal.

Experience of Management of Unstable Thoraco-Lumbar Spine Using V.S.P(Variable Screw Placement) Plate

Fourteen consecutive patients underwent application of V.S.P(Variable Screw Placement) spinal plate between January 1989 and July 1989. Operative indications were spondylolisthesis, spinal stenosis, segmental instability, herniated disc with instability, pseudoarthrosis. unstable fracture, and failed surgery syndrome. Our patients consist of 8 cases of spondylolisthesis, 4 cases of fracture-dislocation, one case of spondylolysis with instability, one case of herniated disc(L1- 2 interspace). Overall results showed 36% excellent, 50% good, 7% fair, 7% poor. Two deep wound infections were observed. Screw alignment and the angular relationship of each screw to the spinal plate is considered as important technical factors in minimizing screw failure.