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Volume 21, Issue 6
Displaying 1-20 of 20 articles from this issue
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Basic Experiments and Clinical ApplicationTakashi ADACHI, Masayoshi YOKOYAMA, Toshinari ITAOKA, Takamasa ONUKI, ...1992 Volume 21 Issue 6 Pages 525-528
Published: November 15, 1992
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSSurgery and cryoablation have been the preferred method for treating drug resistant ventricular tachycardia (VT). Cryoablation, the therapeutic usefulness of which has been documented in many reported studies, is nevertheless not free from technical difficulaties. The advent of Bard® System 6000 Argon beam coagulator (ABC) as a new procedure alternative to cryoablation offered us a hope for solving problems with conventionally used techniques. Preliminary experiments with this device on dog myocardium permitted us to determine therapeutically adequate irradiation time and depth of cauterization and to locate an optimum area of myocardium to be coagulated. Based on these experiences, an attempt was made to use ABC as an adjunct to surgery in the surgical treatment of 4 patients with monofocal non-ischemic VT. In 1 of these 4 patients, VT disappeared postoperatively, making use of antiarrythmia drugs quite unnecessary, while in the remaining 3, a marked diminution of ventricular arrhythmia with a consequent reduction of drug dosage was achieved, use of the device thus being judged to be beneficial. These results led to the conclusion that ABC will provide a valuable adjunct to operation in selected cases of VT and, if the probe and other appliances are further refined, can reasonably be anticipated to be used as frequently as cryoablation.View full abstractDownload PDF (2013K) -
Yasunobu HARUTA, Tadashi TASHIRO, Ko TANAKA, Masahiko NAGATA, Masanao ...1992 Volume 21 Issue 6 Pages 529-533
Published: November 15, 1992
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSWe experienced 26 cases of free internal mammary artery (IMA) grafting for coronary artery bypass (CABG) during past 44 months. There were 3, 6 distal anastomoses per patient and 1.6 distal anastomoses per patient were performed with free IMA. The early mortality rate (within 1 month after surgery) was 3.8%. The surgical complications were 0 in mediastintis requiring operation, 0 in reoperation for bleeding and 1; phrenic nerve paralysis with respiratory dysfunction, the patency rate at 1 month after surgery were 97.2% in free IMA and were 96.1% in in-situ IMA. Conclusion was as followed that the use of free IMA for CABG provided excellent result in early period and we would anticipate to expand the use of IMA.View full abstractDownload PDF (631K) -
Emergency Coronary Bypass Surgery for Acute Myocardial Infarction in Patients Aged 75 Years or OlderKei SAKAI, Nobuaki HIRATA, Shigehiko SAKAKI, Susumu NAKANO, Hikaru MAT ...1992 Volume 21 Issue 6 Pages 534-539
Published: November 15, 1992
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSThirty-nine patients underwent emergency coronary bypass surgery for acute myocardial infarction, Patients were divided into two age groups; 10 patients aged 75 years or older and 29 patients under the age of 75 years. In addition, we compared these two groups and another 23 patients aged 75 years and older who recieved reperfusion therapy alone. The rate of mortality was 30% in the patients 75 years or older, 31% in the patients under 75 years and 52% in the patients with reperfusion therapy alone. There were no significant differences between the three groups. The majority of two groups of surgical patients died of low cardiac output after the operation. Fifty percents of the patients who recieved reperfusion therapy alone died of extension of myocardial infarction or reinfarction. However, no surgical patients died of reinfarction. There were no significant differences in Killip's class, preoperative hemodynamics and the number of diseased vessels between two surgical groups. In the patients of 75 years or older, the post-operative cardiac output did not increase in comparison with the patients under the age of 75 years. They required a longer period for oral uptake and a longer recovery period after the surgery. Therefore, emergency coronary bypass surgery for acute myocardial infarction was effective in the elderly population aged 75 years or older, although it still carried a high operative mortality.View full abstractDownload PDF (850K) -
Taizo HIRAISHI, Tohru KOBAYASHI, Makoto SAKURAI, Hisashi SATOH, Toshih ...1992 Volume 21 Issue 6 Pages 540-543
Published: November 15, 1992
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSSix patients with malignant retroperitoneal tumor extending into the inferior vena cava (VCI) were surgically treated with use of a normothermic extracorporeal circulation (ECC). Origin of malignant tumor was renal cancer in four, adrenal cancer in one and seminoma in one. Four patients excluding two of renal cancer had metastasis to the lung or bone preoperatively. One of renal cancer with lung metastasis and invasion to the colon died six months after surgery. The remaining five patients have been alive and well with follow up of 1 year to 7 years (mean 3 years 3 months). Cytological examination of an arterial filter of ECC and intra-circuit blood was made and negative in two patients. Long term results and cytology revealed a rare chance of intraoperative dissemination of malignant cells. These results suggested feasibility of surgery using normothermic ECC for the treatment of malignant retroperitoneal tumor with extension into VCI.View full abstractDownload PDF (459K) -
Satoshi IWABUCHI1992 Volume 21 Issue 6 Pages 544-551
Published: November 15, 1992
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSAnn experimental study was performed to evaluate the influences of various annular plication on the mitral annulus. With the aid of extracorporeal circulation, lead markers were sutured on the annulus of 25 adult mongrel dogs. Annular plication was not done for 5 dogs of control group (Group I). Annular plications were performed at the posterior commissural side in 5 dogs (Group II), at the middle part in 5 dogs (Group III), at the anterior commissural side in 5 dogs (Group IV). Entire annulus of posterior leaflet was plicated following the modified technique of De Vega in 5 dogs (Group V). The areas surrounded by radiopaque markers and the distances between markers were measured at the various phases of cardiac cycle. In Group II dogs, changes of annular area in the cardiac cycle were similar to those in control group. Contraction of annular area was well maintained. Contraction of the posterior part of nonplicated annulus of posterior leaflet was prominent at the time of ventricular contraction. In Group III dogs, the posterior part of plicated annulus was drawed to anterior leaflet. In Group IV dogs, annuluar contraction at the time of ventricular contraction was weak. In Group V dogs, reduction of area at the time of atrial contraction was not noticed.View full abstractDownload PDF (2172K) -
Masahiko ONOE, Atsumi MORI, Shoji WATARIDA, Takaaki SUGITA, Shoichiro ...1992 Volume 21 Issue 6 Pages 552-555
Published: November 15, 1992
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSCPK-MM, one of the CPK-isozyme, is divided into the three subbands (isoform) MMa, MMb, MMc. It has reported that in acute myocardial infarction serum MMa and MMa/MMc increased earlier than other myocardial intracellular enzyme, such as CPK-MB. In this study, we measured serum CPK, CPK isozyme, and CPK isoforms during and after open heart surgery and examined whether CPK isoforms would serve as a marker for myocardial damage during open heart surgery. CPK-MB peaked at 153.3±85.1IU six hours after cardiopulmonary bypass (CPB) was taken off and subsequently decreased. On the other hand, MMa/MMc peaked at 5.6±2.2 immediately after CPB was taken off. Moreover, we found that there was a statistically significant positive correlation (Y=24.46X+16.68, r=0.63, p<0.05) between MMa/MMc immediately after CPB was taken off and CPK-MB six hours after CPB was taken off. The maximum value of CPK-MB correlates with the degree of myocardial damage. Therfore, it is reasonable to suggest that the maximum value of MMa/MMc immediately after CPB is taken off also correlates with the degree of myocardial damage. We concluded that serum CPK isoform, especially MMa/MMc served as a marker to estimates the degree of myocardial damage in open heart surgery at an early stage.View full abstractDownload PDF (480K) -
Kiyoshige INUI, Susumu NAGAMINE, Yoshiyuki OKADA, Michitoshi OTTOMO, M ...1992 Volume 21 Issue 6 Pages 556-560
Published: November 15, 1992
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSThere were 10 patients of left ventricular free wall rupture accompanied with acute myocardial infarction in our coronary care unit from Jan. 1987 to Jan. 1991, while 872 AMI patients in the same period. Five of 10 ruptured patients died. All these 5 patients were acute type of rupture. Elder patient, female, 1st attack of infarction and PTCA were considered to be risk factors of rupture. We managed 5 subacute and chronic type ruptured patients successfully at emergent operation with using fibringlue-oxycellulose. Fibringlue-oxycellulose method was useful especially for woozing from infarcted myocardium. The management for acute type rupture is difficult because of its clinical time course, it is considered that prevention of rupture for high risk patient is most important to reduce the mortality of AMI patients in the coronary care unit.View full abstractDownload PDF (1472K) -
Yasuhiro ITOH, Masahiro OHUCHI, Mikio OHMI1992 Volume 21 Issue 6 Pages 561-565
Published: November 15, 1992
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSDuring past 4 years, 15 patients over 50 years of age with secundum atrial septal defect underwent surgery in our hospital. The ages ranged from 50 to 70 years with a mean of 59.7 years. Before operation, 8 were in functional class II, 7 in class III (New York Heart Associasion classification). Thirteen patients had pulmonary hypertension, 8 had right-to-left shunt and 6 had atrial fibrillation. Pulmonary function test showed decreased %VC and FEV1.0% with a mean of 74% and 65%, respectively. Cardiothoracic ratio ranged from 48 to 77 with a meam of 60%. Preoperative laboratory data showed significant inverse correlations between CTR and %VC and between pulmonary arterial pressure and %VC. The defects were closed directly in 6 patients and closed using patches in 9. All patients survived the operation. Postoperatively, antithrombotic agents were administered to the patients with patch closure. After operation, all but one improved to functional class I and no patients had embolic episode.View full abstractDownload PDF (559K) -
Shin YAMAMOTO, Katsuo FUSE, Yosihiro NARUSE, Yasunori WATANABE, Tosiya ...1992 Volume 21 Issue 6 Pages 566-569
Published: November 15, 1992
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA 72 year-old man underwent coronary angiography (CAG) with a diagnosis of unstable angina pectoris, and 90% stenosis of the LMT was found. Since idiopathic interstitial pneumonia (IIP) had been diagnosed previously, percutaneous transluminal coronary angioplasty (PTCA) was performed. However, his unstable angina recurred after about 2 months restenosis of the LMT to 90% was shown by CAG, and coronary artery bypass grafting (CABG) was performed. In the preoperative chest X-ray, diffuse granular opacities were seen in both lower lungfields, and Velcro rales were heard by ausculation. A spirogram could not be obtained because of his unstable angina, but the PaO2 was a reasonable 70mmHg when breathing room air. In consideration of the age of the patient, a double coronary artery bypass grafting using a saphenous vein graft (SVG) was performed to minimize duration of anesthesia. His PaO2 showed a transient decrease after the end of cardiopulmonary bypass (CPB), but the perioperative hemodynamics and respiratory status were stable and extubation was performed on the 1st postoperative day. No aggravation of his IIP occurred postoperatively and he was discharged on the 29th postoperative day.View full abstractDownload PDF (1786K) -
Hiroshi TOMIE, Masaki O-HARA, Nobuya ZEMPO, Kentarou FUJIOKA, Kensuke ...1992 Volume 21 Issue 6 Pages 570-574
Published: November 15, 1992
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA case of a reflex sympathetic dystrophy syndrome (RSD) asscciated with the internal iliac arterio-venous fistula was reported. The patient was a 36-year old woman, and had the left oophorectomy at 21-year old and the lumbar laminectomy at 36-year-old. She complained of coldness and paresthesia of the right lower extremity 14 days after the lumbar laminectomy. A stenosis or occlusion of the arteries in both legs were not demonstrated by arteriogram. The coldness and paresthesia disappeard after the epi-dural block. RSD of the right leg was diagnosed which occurred at the lumbar laminectomy. Lumbar sympathectomy (L2∼L4) was performed simultaneously with closure of the internal iliac arteriovenous fistula. Postoperative clinical course was uneventful. Symptoms we were immediately disappeared. Sympathetic ganglion block has same efficiency as lumbar sympathectomy. Therefore sympathetic ganglion block is more suitable if patient has RSD only.View full abstractDownload PDF (1396K) -
A Successful Surgical Case with Recovery of Renal FunctionKozo KANEDA, Kanji KAWACHI, Ryuichi MORITA, Tsutomu NISHII, Kiyoshi IN ...1992 Volume 21 Issue 6 Pages 575-578
Published: November 15, 1992
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSThe sudden onset of anuria in a 71-year-old man was found to be caused by the non-inflammatory (atherosclerotic) large abdominal aortic aneurysm compressing the bilateral ureters. A computed tomography scan demonstrated the bilateral extrinsic ureteral obstructions due to the large aneurysm of 13cm in diameter, left hydronephrosis and no thick layer of perianeurysmal fibrotic tissue. On the 9th day from the onset of anuria, an emergency operation was performed. There was no fibrotic adhesions around the aneurysm and mobilization of the aorta was easy. A straight Dacron prosthesis was inserted between the infrarenal aorta and the bifurcation of the abdominal aorta following resection of the aneurysm of the atherosclerotic origin. Soon after the operation, the patient had very good urinary output with adequate recovery of renal function. This case seems to be very uncommon, but very important in the surgical management of abdominal aortic aneurysm complicated by oliguria or anuria.View full abstractDownload PDF (1361K) -
Sumio KANO, Keiiti TOKUHIRO, Yoshinori WATANABE, Tsuyoshirou FUJII, No ...1992 Volume 21 Issue 6 Pages 579-582
Published: November 15, 1992
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSOperations were performed 3 times on ventricular septal perforation after acute myocardial infarction which exhibited cardiogenic shock, and the patient's life was saved successfully. The case was a female aged 64. Ventricular septal perforation developed in 6 hours after onset of acute myocardial infarction, and an emergency operation was performed because the patient exhibited cardiogenic shock. Intraventricular re-shunt was observed on the postoperative 5th day, and second operation was performed on the postoperative 7th day because a trend of cardiac insufficiency was intensified. Intraventricular re-shunt was observed again on the 5th day of the second operation, but third operation with a principle that further operation is to be performed awaiting regeneration of the tissue on the perforated margin to occur since the circulatory kinetics were seen to have been stabilized. The postoperative course was favorable, and the patient was discharged on 53 rd day of the third operation with the symptom alleviated. It was considered that our policy is to have to repeat operation when the patient's movement of circulation deteriorate at re-shunt from our experience of this time.View full abstractDownload PDF (503K) -
Sugato NAWA, Kazuhiro TSUJI, Kohichi KINO, Shigeru TERAMOTO, Kenji HAY ...1992 Volume 21 Issue 6 Pages 583-588
Published: November 15, 1992
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSCase 1 presented congestive heart failure with atrial fibrillation. Echocardiography and cardiac catheterization demonstrated mitral regurgitation and communications between the right and left coronary arteries and pulmonary artery (PA). The fistula orifice was directly closed and mitral annuloplasty was done at the same time. Case 2 had a history of open mitral commissurotomy for mitral atenosis (MS), and was diagnosed as to be re-MS. Selective coronary angiography (CAG) newly documented an aberrant artery originating from the left coronary artery and draining into the distal right PA. At operation, the origin of the aberrant artery was successfully ligated, and mitral valve was replaced with a prosthetic one. This paper presented relatively rare types of coronary artery fistulae, focusing on the importance of routine CAG before open heart surgery and of consideration on the association of this anomaly in respect to perioperative myocardial protection.View full abstractDownload PDF (3180K) -
Saihou HAYASHI, Yoshiharu HAMANAKA, Taijiro SUEDA, Tetsuya KAGAWA, Yui ...1992 Volume 21 Issue 6 Pages 589-592
Published: November 15, 1992
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA 78-year-old man consulted our hospital with complaint of abdominal mass. Blood examination indicated a inflammatory reaction. An abdominal aortic aneurysm, 5.5cm in size, was found by CT scanning examination. Its wall quite thick (mantle sign), and enhanced by contrast medium. Y graft replacement was carried out. Microscopic hiatological examination of the aneurysmal wall indicated severe inflammation being assisted of chronic inflammatory cells, like lymphocytes and plasma cells at the adventitia. Ten cases of inflammatory abdominal aortic aneurysm reported in Japan so far are reviewed and features of this disease are discussed.View full abstractDownload PDF (1385K) -
Takaaki SUGITA, Syoji WATARIDA, Masahiko ONOE, Shoichiro SHIRAISHI, Ta ...1992 Volume 21 Issue 6 Pages 593-596
Published: November 15, 1992
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA 59-year-old man underwent an aorto-bifemoral bypass operation for aorto-iliac arteriosclerotic occlusive disease. The total aortic occlusion time was 38min. Soon after the operation, the patient was found to have motor and sensory loss between right L2 and S1, which did not improve. We considered that spinal cord damage was caused by occlusion of the lumbar artery as a result of side clamping of the atherosclerotic abdominal aorta. Therefore, side clamping of the atherosclerotic aorta should be avoided to prevent this serious complication.View full abstractDownload PDF (2015K) -
Setsuo KURAOKA, Shigetaka KASUYA, Takao IRISAWA, Satoshi GOTO, Hajime ...1992 Volume 21 Issue 6 Pages 597-599
Published: November 15, 1992
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA case is described of the staged surgical repair of thoracic aortic aneurysm after revascularization of single functioning ischemic kidney of a 68 year old man. A hitological evaluation of renal function was obtained before renal revascularization, which encouraging us to perform the repair of thoracic aortic aneurysm with less risk of post-surgical acute renal failure. In case of single ischemic kidney, renal revascularization should be preceded to other major surgeries in order to prevent renal shut down.View full abstractDownload PDF (1330K) -
Yoshihiro NAKAYAMA, Shinichirou MAGATA, Masafumi NATSUAKI, Tsuyoshi IT ...1992 Volume 21 Issue 6 Pages 600-604
Published: November 15, 1992
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSWe reported an operative case of bilateral coronary arteries to pulmonary artery fistula with giant saccular aneurysm. This 68 year-old female was admitted for evaluation of chest oppression and heart murmur. On coronary angiography, the diagnosis was made as a coronary artery fistula originating from right coronary artery and left anterior descending artery, and draining into the main pulmonary artery. The operation was indicated by giant saccular aneurysm, high shunt ratio, and positive finding of ischemic change on exercise electrocardiogram. The closure of coronary fistula and aneurysmorrhaphy were performed under cardiopulmonary bypass. The aneurysm was 25×30mm diamater, and not found arteriosclerotic change in operative finding. The fistula was completely disappeared by postopertive coronary angiography. We concluded that curative operation for coronary artery fistula with giant aneurysm can be done with minimal risk under cardiopulmonary bypass.View full abstractDownload PDF (2402K) -
The Effectiveness of Balloon Occlusion CatheterShoh TATEBE, Hajime OHZEKI, Shoh-ichi TSUCHIDA, Jun-ichi HAYASHI, Akir ...1992 Volume 21 Issue 6 Pages 605-608
Published: November 15, 1992
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA case of 65-year-old man of aorto-caval fistula induced by ruptured abdominal aortic aneurysm is reported. The symptoms were hematuria and chest pain, and an emergent operation was performed. In the operation, Fogarty's balloon occlusion catheter was used to reduce bleeding from inferior vena cava, and to prevent pulmonary embolism. The fistula was 3cm in size, and abdominal aorta was replaced with a low porosity polyester Y-graft. The symptoms of pulmonary congestion and hematuria were improved after operation. The balloon occlusion catheter was effective for reducing bleeding from IVC, and prevention from pulmonary embolism after operation.View full abstractDownload PDF (1909K) -
Yasuyuki SUZUKI, Akira SAKAI, Eizou KUBO, Masaki NIE, Mikio OOSAWA1992 Volume 21 Issue 6 Pages 609-613
Published: November 15, 1992
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSWe experienced three cases of triple shunts (VSD+ASD+PDA) for past ten years. All three cases admittied with cardiac failure and respiratory distress early in the infant period. Ligation of PDA, suture closure of ASD and patch closure of VSD were performed in the two cases. Another case was performed ligation of PDA because of low body weight (1, 700g). Triple shunts were correctly diagnosed in only one case. Another two cases were diagnosed VSD and PDA at operative period. The patient with low body weight was lost at 38 days after operation. Post operative course were uneventfull in the two cases of total repair. Triple shunts should be repaired in the same time. But two staged operations are consider to perform in the low body weight infant and patients with major general pediatric surgical disease.View full abstractDownload PDF (1366K) -
Hitoshi YAMAUCHI, Shigeo TANAKA, Junichi NINOMIYA, Kiyoshi KOIZUMI, Ma ...1992 Volume 21 Issue 6 Pages 614-618
Published: November 15, 1992
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSWe performed mitral valvuloplasty for 25 months old infant with endocardial fibroelastosis (EFE) and 21 months old infant with endomyocardial fibrosis (EMF). These two patients showing good post operative cause, have been followed up during 10 and 1 years respectively. The EFE and EMF are severe and progressive restrictive cardiomyopathy of unknown etiology. Most of cases with EFE and EMF have an enlarged left ventricle with incompetent atrioventricular valve. The prognosis of these patient is usually poor. We believe that the surgical treatment in early phase may be able to improve heart failure and also to protect the progression of these disease. This case with EMF is the first report of successfull surgical treatment for the patients with severe congestive heart failure whithin one year after birth in Japan.View full abstractDownload PDF (2921K)
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