Graft insertion technique for distal anastomosis in cases of ascending aortic aneurysm.

We describe a simple and reliable technique of making a secure graft for aorta anastomosis, involving sandwiching the friable aortic wall between the graft and a Teflon strip. This technique makes possible a secure anastomosis with the distal friable tissue and prevents bleeding from the junction.

[Long-term patency after the Blalock-Taussig operation--comparison between classic and modified shunts].

There is still a need for Blalock-Taussig shunt (BTS) in some situations involving complex heart diseases. This study demonstrates the long-term patency after shunt procedure in classic and modified BTS of different calibers using cineangiographic evaluation. Between January 1980 and December 1994, 150 patients 236 BTS including classic BTS (cBTS) in 62, modified in 174 procedures (GS: Golaski microknit graft in 112, EPTFE: expanded polytetrafluoroethylene graft in 62). Cineangiographic Evaluation for graft patency and freedom from stenosis (less than 50% in diameter) was performed a mean interval of 35 months after BTS. The five-year patency of cBTS was significantly superior to that of mBTS (EPTFE, p < 0.001). There was a significant superiority of three-year actuarial freedom from graft stenosis in cBTS compared to that after mBTS with GS (p < 0.01) and in mBTS with EPTFE compared to mBTS with GS (p < 0.05). In cases receiving small caliber grafts (4 mm or less), cBTS showed significantly better patency after five years compared to mBTS with GS (p < 0.05) and showed significant advantages in three-year actuarial freedom from graft stenosis compared to that after mBTS (p < 0.05). This study demonstrated the superior patency and freedom from stenosis after cBTS compared to that after mBTS, especially in cases receiving GS grafts. MBTS with GS graft and with small caliber EPTFE grafts could not be expected to maintain freedom from stenosis for three years.

[Anomalous origin of the left coronary artery from the pulmonary artery coronary revascularization under normothermic coronary perfusion in an infant].

A 5-months-old baby was hospitalized with congestive heart failure. Anomalous origin of the left coronary artery from the pulmonary artery was diagnosed on echo cardiography and coronary angiogram. Preoperative examination revealed severe left ventricular dysfunction (left ventricular end-diastolic pressure was 32 mmHg, left ventricular ejection fraction was 16%). Coronary revascularization was performed by anastomosis of the neo-left coronary artery to the aorta using an autologous pulmonary arterial roll under normothermic coronary perfusion. Although postoperative CPK-MB was within normal limits, the patient died on the 12th postoperative day due to ventricular arrythmia. Autopsy revealed severe endomyocardial fibroelastosis.

[A successful repair of aortic regurgitation and right ventricular aneurysm long after correction of tetralogy of Fallot].

Twenty-seven years after correction of tetralogy of Fallot, a 35-year-old man, suffered from dyspnea on effort and palpitations, underwent repair of aortic regurgitation and right ventricular aneurysm. Aortic regurgitation was due to a perforation at the base of the right coronary cusp, probably caused during the initial VSD patch closure, and it was repaired by suture. The right ventricular aneurysm was excised and the defect was closed directly. After operation, only slight aortic regurgitation was observed and premature ventricular contractions, presumably related to right ventricular aneurysm, were decreased markedly. His postoperative course has been uneventful and satisfactory for these 15 months.

[Dissection of the pseudointima followed by lethal obstruction of the prosthetic graft--a case report].

One-year-old boy who previously had modified Van Praagh procedure for interruption of the aortic arch (Celoria-Patton type A) and double inlet left ventricle with ventriculoarterial discordance was admitted for progressive cyanosis. He underwent reconstruction of the left pulmonary artery and additional left common carotid-left pulmonary artery shunt. During this procedure, severe hypotension of the lower extremities and heart failure occurred for unknown cause. He died on the 7 postoperative day for lung bleeding with disseminated intravascular coagulopathy. Autopsy revealed dissection of the pseudointima and obstruction of the prosthetic graft (interposed between the main pulmonary artery and the descending aorta). This complication seems very rare but a great care should be taken when a prosthetic graft is manipulated later.

Bridging annuloplasty for common atrioventricular valve regurgitation.

Progressive common atrioventricular valve regurgitation is a serious condition in children with a univentricular heart. We developed a repair procedure that consists of using a Teflon tape bridge and total circular annuloplasty to divide the common atrioventricular valve into two atrioventricular valves. This procedure was performed in 2 infants, and the results were satisfactory. Details of the technique are described.

[The left-sided atrioventricular replacement of corrected transposition of the great arteries through a left thoracotomy].

In a 17-year-old female with dextrocardia and corrected transposition of the great arteries, whose VSD and PFO had been surgically closed through median sternotomy two years previously, the left-sided atrioventricular valve replacement was performed for its severe insufficiency. The left anterolateral thoracotomy was chosen to have good visual field and to prevent unnecessary dissection of the adhesion. The postoperative course was uneventful.

[Warm heart surgery facilitates atrioventricular valve repair].

The valve structure varies with cases in children's atrioventricular valvular regurgitation. Filling the left ventricle simply with cold saline solution and testing the valve competency in the cold cardioplegic arrest do not clarify true valve function, although it was the widely used method. Three dimensional evaluation of the lesion in the dynamic and more nearly normal state and the very fine operative procedure in the static state are required for the successful repair. For this purpose we employed the warm heart surgery on 12 children for valve repair (age 1.3-10.1 years, body weight 6.6-28.2 kg). Because no topical cooling was used, preparation of the heart from the adhesion caused by previous operation was not necessary. The aorta was cross clamped at the temperature of 34 degrees of centigrade with continuous coronary perfusion and the lesion in the valve structure and the regurgitation stream were inspected in the beating state, then the repair was performed in the arrest state obtained by infusing the potassium into the coronary perfusion line. Beating and arrest was repeated 2-5 times by on-off potassium infusion until the repair seems satisfactory. In two cases, the repair was not feasible and mitral valve replacement was performed, but in other 10 cases, the postoperative regurgitation decreased down to the grade 2. Despite prolonged aortic cross clamping (65-216 min), post-operative course was quite satisfactory without low-output syndrome in any cases. Postoperatively administered maximum dose of Dopamine was 4.0 +/- 2.2 micrograms/kg/min. CK-MB at 1 POD was also within normal range.(ABSTRACT TRUNCATED AT 250 WORDS)

Retrograde gastric varices in a patient with total cavopulmonary shunt.

Gastric varices formed in a patient who had undergone a total cavopulmonary shunt operation 7 years previously. The varices were found to be due to development of collaterals from high-pressure systemic vein to low-pressure portal vein. Bleeding gastric varix can be a late complication of total cavopulmonary shunt.

Diagnosis of cardiac allograft rejection by the detection of circulating plasma cardiac myosin light chains.

Twenty adult male Japanese monkeys of the species Macaca fuscata were randomly paired and subjected to heterotopic cardiac transplantation performed by the Ono-Lyndsey method. Without immunosuppression, graft survival ranged between 8 and 27 days, with a mean survival of 14 days. Plasma cardiac myosin light chains were measured by radioimmunoassay, which showed transient increases in myosin levels just following transplantation. Three hearts showed high values at this period and stopped beating when the myosin levels decreased (type 1). The other 7 hearts showed low myosin values after transient increases and 5 of them were rejected with a preceding reincrease in the myosin levels (type 2). Pathological study revealed myocardial necrosis, perivascular cuffing of mononuclear cells and/or neutrophils and/or plasma cells in the type 1 hearts. Measurement of the plasma myosin light chain level was therefore revealed to be of great value in the monitoring of cardiac allograft rejection.