[Is it unnecessary to attach a temporary pacing wire in off-pump coronary artery bypass?].

In open heart surgery, the efficacy of temporary pacing to control perioperative cardiac dysrhythmias is well known. However, a temporary pacing wire is not routinely attached during minimally invasive direct coronary artery bypass because of its less invasiveness. In case of off-pump coronary artery bypass (OPCAB) with mediansternotomy, is it also unnecessary? We report 2 patients undergoing OPCAB without postoperative temporary pacing wire who suffered from possibly fatal rhythm disturbances after operation, and needed long hospitalization. After these experiences, we routinely attach a temporary pacing wire during OPCAB with mediansternotomy. We believe, in case of OPCAB, a temporary pacing wire is as effective as in conventional CABG.

[Off-pump heart surgery for the removal of a ruptured, detached, and entrapped cutting balloon].

A 84-year-old female with a ruptured, detached, and entrapped cutting balloon was successfully undergone the surgical removal under beating heart. But the left anterior descending coronary artery (LAD) was severely dissected by ruptured cutting balloon. So we had to anastomose left internal thoracic artery (LITA) to the distal part of LAD. Postoperative coronary angiography showed the narrowing of LAD and the effective revascularization was not obtained. We must recognize that the intima of the coronary artery is impaired by the ruptured cutting balloon more severely than we expected.

Transvenous dual chamber pacing via a unilateral left superior vena cava.

A 74-year-old woman with a unilateral left superior vena cava required dual chamber permanent pacing after a radical cardiac operation for an incomplete from of endocardial cushion defect. An active fixation ventricular lead was used to prevent the instability induced by the strange course of the electrode. For atrial pacing, a ventricular passive fixation lead was used. A transvenous dual chamber pacemaker was successfully inserted via a unilateral left superior vena cava.

[Analysis of 4 cases of intralobar pulmonary sequestration].

Four cases with pulmonary sequestration treated in Tottori university hospital between January 1993 and December 1994 were reported. Case 1 was a 63-year-old male who had lung tumor without inflammatory findings. Differential diagnosis from lung cancer was needed, and aortography showed a aberrant artery from descending aorta. Pulmonary partial resection and division of aberrant artery were performed. Case 2 was a 71-year-old female who diagnosed pulmonary sequestration in other hospital 10 years ago. Tumor shadow did not progress compared with the old X-ray film. Because tumor size was remarkably diminished by aspiration of cystic tumor, conservative follow up was continued. Both case 3 and 4 were a 20-year-old man and 16-year-old female who had typical findings of pulmonary sequestration with inflammation and easily detection of aberrant artery by CT or aortography. Resection of sequestrated lung and division of aberrant arteries were performed in both cases. Pulmonary sequestration was the disease which should be always kept in our mind in differential diagnosis from various lung disease.

[A case of a single coronary artery in the presence of coexistent atherosclerotic coronary artery disease].

A 57-year-old female was admitted with 6-month history of effort angina. Ascending aortography showed that the right coronary artery (RCA) did not originate from the right coronary sinus. Coronary arteriography showed that the circumflex branch (CX) continued beyond the crux into the right atrioventricular groove to supply marginal branches to the right ventricle, that is, RCA originated from the CX at the crux. RCA had the 75% stenosis near the crux. Left anterior descending branch (LAD) also had 90% stenosis at segment 6. She did not have the additional congenital cardiac anomalies, and underwent coronary artery bypass grafting to LAD and RCA without problem.

[The influence of aging on cerebral blood flow and oxygen metabolism during moderate hypothermic cardiopulmonary bypass--a clinical study by means of transcranial Doppler ultrasound].

The purpose of this study was to determine the influence of aging on cerebral blood flow and oxygen metabolism during moderate hypothermic cardiopulmonary bypass (CPB) in 25 patients undergoing open heart surgery. the patients were subdivided into one of two groups according to their age (the cut off value was 40 years for males and 50 years for females). Ten patients were included in group A (YOUNG group), and 15 patients were included in group B (OLD group). In these 25 patients, blood flow velocity in the middle cerebral artery (MCAv) was measured by means of transcranial Doppler ultrasound, and cerebral oxygen consumption was estimated by relating the arterio-venous oxygen content difference to flow velocity (D-CMRO2) during surgery. MCAv and D-CMRO2 were expressed as percent of the values determined at 30 minutes before CPB. High dose fentanyl anesthesia was employed and alpha-stat strategy (uncorrected for body temperature), moderate hemodilution and nonpulsatile flow pattern were maintained during CPB with moderate hypothermia. In both groups, MCAv and D-CMRO2 changed in parallel in proportion to the change in body temperature during the procedure. Thus, there was a good correlation between flow velocity and D-CMRO2 during CPB (group A: r = 0.648, p < 0.001, B: r = 0.636, p < 0.001). This result suggests that the coupling between cerebral blood flow and oxygen consumption was maintained throughout CPB in spite of aging. In group B, however, the usual of significant increase in the flow velocity and D-CMRO2 from the rewarming to the weaning stage of CPB tended to be delayed and suppressed.(ABSTRACT TRUNCATED AT 250 WORDS)