Japanese Journal of Cardiovascular Surgery
Online ISSN : 1883-4108
Print ISSN : 0285-1474
ISSN-L : 0285-1474
Volume 20, Issue 9
Displaying 1-15 of 15 articles from this issue
  • Tohru YAMAZAKI, Akira HAKOSHIMA, Mikio ISHIKAWA, Shin ISHIMARU, Kin-ic ...
    1991 Volume 20 Issue 9 Pages 1465-1469
    Published: December 15, 1991
    Released on J-STAGE: April 28, 2009
    JOURNAL FREE ACCESS
    To assess coronary artery disease in arteriosclerosis obliterans (ASO), the efficacy of a dipyridamole-loaded ECG was evaluated. Subjects consisted of 35 patients who underwent surgery for ASO between November 1988 and December 1989. A dose of 0.568mg/kg of dipyridamole was intravenously infused for over 4min. Changes of systemic blood pressure, heart rate and standard 12-lead ECG were accumulated. In eleven cases loaded ECG was considered to be positive and coronary arteriographies were performed. Stenotic lesions of 75% or over were observed in 10 cases, among them CABG was performed in one symptomatic case. In another positive but asymptomatic cases, only the existing ASO lesions were surgically treated. No intraoperative or postoperative ECG abnormality was observed and postoperative courses were uneventful. Negative cases (24 cases) underwent complete revascularization. These findings indicate that a dipyridamole-loaded ECG is a non-invasive preoperative means detecting coronary artery disease preoperatively is useful to decide operative procedure.
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  • A Preriminary Report
    Yasunori MOROHOSHI, Hiroshi OUCHI, Syuzou KAMIOKI, Tuneo OHKUMA, Syouz ...
    1991 Volume 20 Issue 9 Pages 1470-1475
    Published: December 15, 1991
    Released on J-STAGE: April 28, 2009
    JOURNAL FREE ACCESS
    Intraoperative descending saphenography was performed in 20 legs (17 patients) with primary varicose veins to determine the sites of venous reflux (the sites of valve incompetence) in the great saphenous vein. By this phlebography, the sites of valve incompetence in the great saphenous trunk could be visualized when a pressure gradient was produced between deep and superficial venous systems by our manual compression technique. There were variations in the sites of truncal reflux; the retrograde flow of the contrast media was observed in the entire length of the great saphenous vein (type 1), normal portions were present in the trunk at the lower leg (type 2), or the trunk was normal at the thigh (type 3). In some cases, retrograde venous flow from the saphenous trunk entered once into variceal branches and further drained into the trunk passing some distance (3 legs). Type 2 and 3 accounted for 15 legs (75%), and selective stripping operation with preservation of the normal portion of the trunk was considered to be possible in these types. Since the length of the portion that could be preserved was 20.5±4.0cm (mean±SD) in type 2, and less than 15cm in 2 legs, use of the vein for arterial reconstruction seems to be limited.
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  • Kazuhito OSADA
    1991 Volume 20 Issue 9 Pages 1476-1482
    Published: December 15, 1991
    Released on J-STAGE: April 28, 2009
    JOURNAL FREE ACCESS
    Laser thermal angioplasty with a metal hot tip probe was performed on 34 cases of arteriosclerosis obliterans of the lower limbs, instead of conventional balloon angioplasty. Initial angiographic and clinical success was achieved in 48 of 53 (90.5%) arterial lesions. The initial success rates were 91.6%, 87.8% and 100% for lesions of the iliac, femoral and popliteal arteries respectively. The initial success rate was 66.6% in occlusive lesions, and was 100% in stenotic lesions. Five of seven (71.4%) occlusions less than 10cm length, and five of eight (62.5%) occlusions longer than 10cm were successfuly treated. Higher laser energy was necessary for ablation in occlusive lesions than in stenotic lesions. The ankle pressure index improved postoperatively in both occlusive and stenotic lesions. Satisfactory long term patency was achieved in 27 of 35 successfully treated lesions (77.1%). These results suggest that laser thermal angioplasty is effective for the treatment of arteriosclerotic disease in the lower limbs.
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  • Malondialdehyde Changes in Venous Blood
    Nobuo HATORI, Eriya OKUDA, Yozo URIUDA, Masafumi SHIMIZU, Yoshiyuki HA ...
    1991 Volume 20 Issue 9 Pages 1483-1488
    Published: December 15, 1991
    Released on J-STAGE: April 28, 2009
    JOURNAL FREE ACCESS
    The procedure of cross clamping and declamping of the infra-renal abdominal aorta is common in the reconstructive abdominal aortic surgery. However, little is known to the oxygen free radical formations during the surgery. To evaluate the oxygen radical production, the malondialdehyde (MDA) levels in venous blood were measured prior to, during and after the operation with other metabolites such as C3, C3a, granulocytes, CPK, amylase, BUN, creatinine, beta-2-microglobulin, total protein (TP), hematocrit (Ht), GOT, GPT, LDH, lactate, potassium, and myoglobulin in ten patients of the infra-renal aortic aneurysm. The average of the aortic occlusion time was 63±18min in the patients. The levels of MDA (from 3.2±0.7nmol/ml to 2.3±0.5nmol/ml), C3, TP and Ht were decreased during the operation and there were significant correlations between the levels of MDA (r=0.486, p<0.01), C3 (r=0.59, p<0.01) and TP. It is, therefore, likely that the reduction of MDA and C3 levels is due to the blood dilution by the bleeding, fluid infusion and blood transfusion during the operation. The levels of C3a did not increase during and after the operation. The levels of CPK (from 73±40U/l to 920±705U/l) and amylase (from 183±87U/l to 444±420U/l) were temporary increased on the first day after the operation. The level of lactate was increased during the occlusion of the aorta (from 9.0±3.0mg/dl to 20.2±5.8mg/dl) and until the just after the operation (23.2±18.6mg/dl). The other metabolites such as GOT, GPT, BUN, creatinine and beta-2 microglobulin did not change throughout the investigation period. There was a substantial ischemia of lower extremities during the aortic occlusion resulted in significant increase of lactate level. These results suggest that the temporary occlusion of the infra-renal aorta during the common reconstructive abdominal aortic surgry does not produce the oxygen free radical formation which increases the lipidperoxidation level in the systemic circulation.
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  • Yoshihiko TSUJI, Masayoshi OKADA, Masato MORIMOTO, Masato YOSHIDA, Hir ...
    1991 Volume 20 Issue 9 Pages 1489-1493
    Published: December 15, 1991
    Released on J-STAGE: April 28, 2009
    JOURNAL FREE ACCESS
    Direct observation of the intravascular atherosclerotic change provides many diagnostic information and supports successful vascular surgery. Angioscopic inspections were performed in the 23 patients who underwent laser angioplasty for the peripheral arteries and 7 patients with aorto-coronary bypass surgery in this study. Useful images could be obtained in 19 (83%) of 23 observations in the peripheral arteries, and the successful rates of angioscopic observation were influenced by the diameter and the degree of kinking of each vessel. On the other hand, intraoperative observation of coronary artery with angioscope could be performed easily in all cases. From these findings, intraoperative application of angioscopy was considered to be useful procedure for the cardiovascular surgery.
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  • Shigeaki AOYAGI, Hiroshi HARA, Eiki TAYAMA, Hiroshi YASUNAGA, Ko TANAK ...
    1991 Volume 20 Issue 9 Pages 1494-1497
    Published: December 15, 1991
    Released on J-STAGE: April 28, 2009
    JOURNAL FREE ACCESS
    Cor triatriatum is one of the rare congenital cardiac malformations and once the diagnosis is correctly established, this is amenable to surgical correction. We reported a case of 25-year-old male of cor triatriatum, who had symptomes of easy fatiguability. The diagnosis of cor triatriatum was suspected preoperatively by two-dimensional echocardiogram at first, detecting abnormal diaphragm in the left atrium, and it was confirmed by color Doppler echocardiogram and transesophageal two-dimensional echocardiogram. Cardiac catheterization revealed high pulmonary capillary wedge pressure and the abnormal diaphragm in the left atrium was showed by the pulmonary arteriography. On the operation, the abnormal diaphragm was excised by the trans-septal approach, which had a small fenestration of 8mm in diameter at posterolateral site. Some considerations for clinical diagnosis and surgical treatment are discussed.
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  • Report of a Case and Review of the Literature
    Hidehito SAKAGUCHI, Soichiro KITAMURA, Kanji KAWACHI, Ryuichi MORITA, ...
    1991 Volume 20 Issue 9 Pages 1498-1501
    Published: December 15, 1991
    Released on J-STAGE: April 28, 2009
    JOURNAL FREE ACCESS
    A case of coronary subclavian steal following coronary artery bypass grafting (CABG) using the internal thoracic artery (ITA) in the presence of the stenosis of the left subclavian artery (SCA) is reported. The patient was a 70-year-old woman who developed recurrent angina about one year and three months after CABG with an ITA to LAD, and then underwent postoperative coronary arteriography. Angiograms revealed retrograde flow through the ITA to the left SCA and severe stenosis of the origin of the left SCA. Restoration of antegrade flow througn a left ITA graft to the coronary artery was achieved by balloon angioplasty to the stenosis of SCA. This procedure resulted in resolution of symptoms. The coronary subclavian steal is an infrequent, but very important complication after CABG with an ITA, and should be kept in mind in this mode of CABG.
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  • A Case Report
    Yuzuru MATSUYAMA, Shigeo TANAKA, Junichi NINOMIYA, Tetsuo ASANO, Kiyos ...
    1991 Volume 20 Issue 9 Pages 1502-1507
    Published: December 15, 1991
    Released on J-STAGE: April 28, 2009
    JOURNAL FREE ACCESS
    Cystic adventitial disease of the popliteal artery is an uncommon disorder. 58-year-old male complained of left intermittent calf claudication and couldn't sit straight. He preferred playing baseball and jogging. Digital subtraction angiograms revealed a smooth extrinsic compression on the proximal left popliteal artery. Surgical procedure was performed with posterior approach. The left popliteal artery was confirmed to be surrounded by two adventitial cysts at operation. After the evacuation and removal of these cystic wall, peripheral popliteal artery pulse was improved. Postoperative course was smooth and calf claudication was completely disappeared, post operative angiogram showed no stenosis. Histological examination of the resected specimen showed degenerated elastic fiber and inflammatory granulation. We have found 40 cases previously reported in Japan and the present case was 2nd one in our institute.
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  • Tadashi OKUBO, Kaneyoshi KANEKO, Ryouhei HOSHINO, Chikao GOHKO
    1991 Volume 20 Issue 9 Pages 1508-1510
    Published: December 15, 1991
    Released on J-STAGE: April 28, 2009
    JOURNAL FREE ACCESS
    Percutaneous subclavian vein catheter hemodialysis has been accepted as a convienient method in acute need of hemodialysis, but recently, as a serious complication, not a few cases of venous obliterations were reported. Patients on hemodialysis with a functioning arteriovenous fistula become symptomatic with venous hypertension and painful edema. As fistula ligation renders the arm unsuitable for future blood access, venous reconstruction should be considered. In our series, two patients with right subclavian vein obstruction and innominate vein stenosis were treated by polytetrafluoroethylene bypass graft and by angioplasty, respectively. Their symptoms disappeared, and fistulas were preserved for 6 and 25 months.
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  • A Case Report
    Hiroaki KONISHI, Katsuo FUSE, Toshio KONISHI, Yasunori WATANABE, Kenji ...
    1991 Volume 20 Issue 9 Pages 1511-1514
    Published: December 15, 1991
    Released on J-STAGE: April 28, 2009
    JOURNAL FREE ACCESS
    A case of 38-year-old woman with corrected transposition of great arteries is reported. She was admitted for acute cardiac failure caused by not only the left-side atrioventricular regurgitation for the ruptured chordae tendineae, but also the right-side one. We have to perform double valve replacement emergently due to the progression of biventricular failure. Very few reports have described a surgical repair of the right-sided valve replacement. The postoperative course was favorable.
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  • Two Different Approaches to the Distal and the Proximal Left Main Coronary Artery (LMCA) Stenosis
    Tetsuro TAKAYAMA, Hisayoshi SUMA, Yasuhiko WANIBUCHI, Yasushi TERADA, ...
    1991 Volume 20 Issue 9 Pages 1515-1518
    Published: December 15, 1991
    Released on J-STAGE: April 28, 2009
    JOURNAL FREE ACCESS
    Three cases of LMCAP for the isolated LMCA stenosis were presentd. In two cases of the proximal LMCA stenosis, the connective tissue between the ascending aorta and the main pulmonary artery was prepared to detect the LMCA. From the left lateral wall of the ascending aorta to the anterior wall of the LMCA over the stenotic lesion was excised and the saphenous vein patch was sutured (anterior approach). In the third case, because the stenosis was locarized at the distal LMCA, the patch angioplasty using the saphenous vein was performed by direct opening of the distal LMCA accessed from the left lateral side of the main pulmonary artery without aortotomy (lateral approach). Ultrasonic cuser was quite useful to isolate the LMCA. LA-LV vent was indispensable to obtain the non-blood clean operation field. All three cases showed the successful enlargement of LMCA at the postopeorative coronary angiography.
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  • Sadahiko KOUZU, Naobumi FUJII, Hidemasa NOBARA
    1991 Volume 20 Issue 9 Pages 1519-1523
    Published: December 15, 1991
    Released on J-STAGE: April 28, 2009
    JOURNAL FREE ACCESS
    A rare case with mycotic abdominal aortic pseudoaneurysm due to Salmonella Infection is described. A 75 year-old female had been diagnosed as an abdominal aortic aneurysm by ultrasonics at the other hospital during the examination of fever of unknown origin and abdominal pain. At admission to our hospital, the temperature was 39.5°C. A pulsatile mass, about the size of five cm in diameter, was present with no inflammatory findings in the abdomen. Ultrasonics and angiography revealed a saccular infrarenal aortic aneurysm. The blood culture was positive for Salmonella choleraesuis. Aneurysmectomy and graft interposition were performed five weeks after admission, because of enlargement of the size of aneurysm and the continuing infective signs in spite of antibacterial therapy. The patient narrowly escaped from rupture of the pseudoaneurysm by the body of third lumber vertebra. On microscopic examination, infective findings were seen in the wall of pseudoaneurysm. After treatment with antibiotics for four weeks, the patient was discharged from the hospital. She remains asymptomatic for a year after the operation. Only eight cases of mycotic abdominal aortic aneurysm have been reported previously in Japan, and five cases, including our case, were due to Salmonella infection. The results of this surgical operations, carefully considered for infection, were good, but it seems better to select alternatively the surgical operation as soon as possible when antibacterial therapy is not effective.
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  • Masahiko IIO, Katsuhiko MIYAMOTO, Osamu KURODA, Tadashi NAKAGAWA, Nobo ...
    1991 Volume 20 Issue 9 Pages 1524-1527
    Published: December 15, 1991
    Released on J-STAGE: April 28, 2009
    JOURNAL FREE ACCESS
    A 31-day-old infant with total anomalous pulmonary venous drainage (type I-A) suffered from severs left-sided heart failure unable to be weaned from cardiopulmonary bypass (CPB) after total repair. By reopening the vertical vein, the CPB was successfully terminated and the sternum was closed primarily. Percutaneous delayed closure of the vertical vein by lifting up the string which had been encircled the vertical vein at the time of repair was performed 3 days after repair. Systemic arterial pressure and left atrial pressure were unchanged after closure of the vertical vein. Postoperative cardiac study revealed satisfactory result and no left-to-right shunt through the vertical vein.
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  • Ko TANAKA, Shigeaki AOYAGI, Masashi KOGA, Shigemitsu SUZUKI, Nobuhiko ...
    1991 Volume 20 Issue 9 Pages 1528-1532
    Published: December 15, 1991
    Released on J-STAGE: April 28, 2009
    JOURNAL FREE ACCESS
    A 53 year-old male with mitral valve aneurysm was presented. This patient, who had no episodes of rheumatic fever, was admitted with complaints of general fatigue, dyspnea and continuing high fever. Echocardiographic examination showed an abnormal echo behind the anterior leaflet of mitral valve, protruding into the left atrium during systole. Angiogram showed the same abnormal change of mitral valve and mitral regurgitation (MR) and aortic regurgitation (AR). We diagnosed as mitral valve aneurysm with MR and AR due to infective endocarditis. At operation, it was revealed that the aortic valve was destroyed, resulting in severe AR, and the anterior leaflet of mitral valve was a large aneurysm itself. Both valves were replaced with St. Jude Medical valve prosthesis. Postoperative course was good and with no complications. In Japan, 21 cases of mitral valve aneurysm were reported. We discussed the clinical course and the operative procedure for mitral valve aneurysm in this report.
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  • Hiromi AKUTSU, Hiroyuki SUESADA, Kenji KAWACHI, Tsuyoshi SHIMIZU, Tets ...
    1991 Volume 20 Issue 9 Pages 1533-1535
    Published: December 15, 1991
    Released on J-STAGE: April 28, 2009
    JOURNAL FREE ACCESS
    We perfomed an aortic valve replacement and intraoperative plasma exchange with Cell Saver 4® made by Haemonetics for removal of bilirubin. Diluted blood after cardiopulmonary bypass and suctioned blood (total volume 11, 300ml) was washed, concentrated and transfused. Plasma bilirubin level was decreased to 5.4mg/dl from 9.9mg/dl during operation. It was concluded that intraoperative plasma excange with Cell Saver 4® was safe and effective technique for removal of bilirubin during open heart surgery.
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