【背景】人工心肺(CPB)を使用した心臓外科手術において，術後に呼吸不全が生じることがある．これには CPB により活性化された好中球による肺傷害が関与すると考えられている．CPB を使用する心臓外科手術において，好中球の活性化の指標として，血中の好中球エラスターゼ活性(NEA)の経時変化を検討した．
【対象と方法】CPB を使用する成人予定心臓外科手術において CPB 前，CPB 30 分後，CPB 1 時間後，CPB 終了時に採血し，NEA を測定した．
【結果と考察】NEA は CPB 前には測定限界以下であったが，CPB 開始とともに漸増し CPB 終了時に有意に増加した．CPB 時間は 126±52 分(平均値±SD)であった．好中球が CPB に暴露されて 2～3 時間後に NEA が上昇することが示唆された．

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2010年1月から2011年2月までに開心術・大血管手術を施行された成人患者 70 症例を対象に，成人心臓血管外科手術における Modified ultrafiltration(MUF)の有用性を後ろ向きに検討した．MUF 施行により収縮期血圧は有意に上昇した．MUF 施行群は，少ない赤血球濃厚液投与量で，体外循環前後および体外循環終了後のヘマトクリット値を MUF 非施行群とほぼ同等に保つことができた．MUF 群は，MUF 非施行群と比較して，晶質液および膠質液の投与量も有意に少なかった．本研究の結果から，MUF は小児開心術に限らず，成人心臓外科手術においても有用であることが示唆された．

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Case Study: Male, 82 years old.
Present Illness: Enhanced CT scan revealed an infrarenal abdominal aortic aneurysm(60mm) and an aortic arch aneurysm(45mm). We placed a stent graft on the abdominal aortic aneurysm using a Gore Excluder^®. The post-operative period passed without incident and led to outpatient observation. A follow-up CT scan revealed expansion(50mm) of the aortic arch aneurysm and the decision was made to operate.
Operation: First we performed a right axillary-left common carotid artery-left subclavian artery bypass operation using Ringed Gelsoft 8mm. We placed a Talent^® thoracic stent graft just distal of the brachiocephalic trunk. Just subsequent to balloon fixation, INVOS^® values fell. It was determined that the stent graft had covered the inlet of the brachiocephalic trunk, resulting in stenosis. We immediately inserted a balloon catheter through the right radial artery, avoiding the stent graft at the inlet of the brachiocephalic trunk, and placed a stent at the inlet of the brachiocephalic trunk. INVOS values improved.
Results: Whole brain ischemia occurred for about 5 minutes. Postoperative recovery from anesthesia was delayed and there was right hemiplegia. This gradually improved and the patient was able to walk unassisted at time of discharge.
Summary: INVOS^® was an effective cerebral blood flow monitor during TEVAR in the aortic arch.

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A St. Jude Medical(SJM) Trifecta valve was developed as a new tissue valve by improving the previous tissue valve. The effective orifice area is wider than that of Epic tissue valve. The efficacy of the new valve has not been reported yet. Recently, we first performed aortic valve replacement(AVR) with the SJM Trifecta valve for aortic valve stenosis. A case 74-year-old female was admitted to our hospital with dyspnea and angina on exertion. She was diagnosed aortic valve stenosis. She underwent AVR with a 19 mm Trifecta^TM tissue valve. According to the intra-operative direct simultaneous pressure measurement conducted after weaning of cardio pulmonary bypass, the peak pressure gradient of the prosthetic valve was 11 mmHg, the mean pressure gradient was 5 mmHg. According to the results of echocardiography conducted 10 days postoperatively, the peak pressure gradient of the prosthetic valve was 24.4 mmHg, the mean pressure gradient was 16.5 mmHg. She was discharged 18 days after surgery without complications. Implantation of a 19mm SJM Trifecta^TM valve produced excellent result reflected by lower pressure gradient and absence of patient-prosthetic mismatch. In the future, the new valve is expected to be the optimum tissue valve for a narrow annulus.

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