[The efficacy of HFJV (high frequency jet ventilation) for ARDS (adult respiratory distress syndrome) following total arch replacement].

A 40-year-old man was admitted to the hospital with shock due to acute aortic dissection (type A of Stanford classification). The emergent total arch replacement was performed with the retrograde cerebral perfusion uneventfully. At the 3rd day after the operation, bilateral infiltrates were recognized on the frontal chest radiograph. The oxygenation was gradually decreased to less than 200 mmHg of PaO2/FiO2 in proportion with the growth of infiltrates and increase of LDH in blood. Steroid therapy was not effective. So then HFJV was introduced to improvement of hypoxygenation at the 16th day after the operation. HFJV made PaO2/FiO2 improve immediately to more than 300 mmHg and the inspiratrory pressure decrease to less than 30 mmHg. Bilateral infiltrates were diminished by HFJV. LDH in blood decreased apparently. HFJV had been used together during 15 days. The respirator was weaned at the 46th day after the operation. In this clinical course, the change of PaO2/FiO2 had the negative correlation with that of LDH in blood.

[Femoral artery pseudoaneurysm by intraaortic balloon pumping].

Femoral artery pseudoaneurysm is one of multiple vascular complications with intra aortic balloon pumping (IABP). In a series of 815 cases, the incidence of pseudoaneurysm formation was 0.61 percent. Six patients with this complication who underwent successful surgical repair were reviewed. Three cases in our series were obviously due to the unsuitable technique of balloon removal. Especially a patient who underwent IABP insertion after exposure of the femoral artery should undergo open removal of the balloon with reconstruction of the femoral artery. In conclusion, femoral artery pseudoaneurysms are expected to diminish by the appropriate technique of balloon removal.