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Volume 23, Issue 6
Displaying 1-15 of 15 articles from this issue
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Susumu Ishikawa, Yoshimi Ootani, Masahiro Aizaki, Akio Ootaki, Yasushi ...1994 Volume 23 Issue 6 Pages 381-384
Published: November 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSSurgical results in eight octogenarians who were operated upon for abdominal aortic aneurysms were compared to those of 42 patients under 80 years of age. Seven of eight octogenarians were operated on an emergency basis, and four of them were ruptured aneurysms. The size of the ruptured aneurysms was over 6cm in all cases of both groups. Postoperative complications occurred more frequently and postoperative mortality were significantly higher in octogenarians than in patients under 80. Early surgical intervention is recommended for elderly cases with large abdominal aortic aneurysms.View full abstractDownload PDF (457K) -
Shin Yamamoto, Katsuo Fuse, Yosinori Naruse, Yasunori Watanabe, Tosiya ...1994 Volume 23 Issue 6 Pages 385-388
Published: November 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSCoronary artery bypass grafting using hypothermic circulatory arrest and ventricular fibrillation without aortic cross clamping in 6 patients with severely calcified aortas is described. The use of hypothermic circulatory arrest or ventricular fibrillation has not been established in coronary artery bypass grafting. We recently used aortic no-touch technique in 6 patients. All patients were supported and cooled with cardiopulmonary bypass, and circulatory arrest was performed in 3 patients. With the exception of one hemodialysis patient, 5 patients survived without neurological deficit. We think the aortic no-touch technique is safe and reliable in coronary artery bypass grafting with severe calcified aortas.View full abstractDownload PDF (581K) -
Hideaki Ichikawa, Susumu Ishikawa, Humio Kunimoto, Toru Takahashi, Kyo ...1994 Volume 23 Issue 6 Pages 389-394
Published: November 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSBlood oxygen saturation, keton boby ratio and endotoxin concentration of arterial and hepatic venous blood were measured in 12 adult patients before, during and after extracorporeal circulation (ECC). When rectal temperature returned to 32°C during ECC, the levels of hepatic venous blood oxygen saturation (ShvO2) and arterial keton body ratio, hepatic venous keton body ratio decreased. The serum level of endotoxin concentration was within normal limits on the operative day and increased at the first and second day after surgery. In three patients in whom the level of ShvO2 was under 50% at 60 minutes after ECC, postoperative liver dysfunction occurred frequently. Endotoxin changes on the first day after surgery is probably due to recovery differences between hepatic and gastrointestinal circulations.View full abstractDownload PDF (651K) -
Hiroaki Norita, Hitoshi Ohteki, Kyouichi Nakamura1994 Volume 23 Issue 6 Pages 395-398
Published: November 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSThe effects of Argatroban, a selective thrombin inhibitor, in anticoagulation therapy following cardiovascular surgery is reported. The agent was administered in 28 patients by means of continuous intravenous infusion, adjusted to maintain the activated coagulation time at from 170 to 200 seconds. The activated coagulation time was well controlled at a mean rate of 0.482± 0.26μg/kg/min by intravenous drip infusion, and the dose of Argatroban reached a steady state within a few hours. Both the percent rate of prothrombin time and the activated partial thromboplastin time were significantly decreased to 49% and to 36% respectively by Argatroban, and recoverd to the normal range the day after cessation of the drug. Thrombin-antithrombin III complex, an index of coagulation activity, decreased from 35μg/l in the postoperative state to 14 μg/l 4 hours after the infusion of the drug, which demonstrated the good control of anticoagulation status. Clinically, no adverse reactions such as abnormal bleeding tendency was observed. We conclude that Argatroban is a safe and effective agent for anticoagulation therapy in the early postoperative phase.View full abstractDownload PDF (464K) -
Sakae Enomoto, Tadaomi Miyamoto, Hitoshi Okabayashi, Ichiro Shimada, N ...1994 Volume 23 Issue 6 Pages 399-403
Published: November 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSFrom May 1975 to August 1991, 90 patients (56 males and 34 females) underwent Bentall's operations or its modified technique. In our modified technique the coronary ostium is cut out like a button and anastomosed to the aortic graft and aortic grafts are not wrapped by the aortic wall. Preoperative diagnoses were AAE (25 patients, 28%), Stanford type A dissection (19, 21%), Marfan's syndrome (16, 18%), aortitis syndrome (12, 13%), AR+ascending aortic aneurysm (6, 7%), syphilitic aortitis (5, 6%), AS+ascending aortic aneurysm (3, 3%), Valsalva's sinus aneurysm (2, 2%) and other diseases (2, 2%). The hospital mortality rate was 17% (15/90) for all cases. The hospital mortality for aortic dissection (37% (7/19)) and reoperation cases (75% (3/4)) were very high. There were 10 cases of late death and the 10 year actuarial survival rate was 66.3%. Among 11 cardiovascular events which occured in the late phase, 5 were dissection at other aortic sites in the type A dissection and Marfan syndrome cases, and 3 were pseudoaneurysm formation at the site of coronary or the aortic anastomosis in the aortitis syndrome cases, and a detachment of the composite graft in the Marfan's syndrome cases. The 10-year event-free rate was 92.0% for non-specific AAE, 68.8% for aortitis syndrome, 61.9% for Marfan's syndrome and 47.3% for Stanford type A dissection. Non-specific AAE had excellent long-term results, but Marfan's syndrome and dissection had poor results. The button technique for coronary reconstruction is effective for all cases and its long term results are good, but, even with this technique, coronary pseudo-aneurysm occured in cases of aortitis syndrome.View full abstractDownload PDF (2173K) -
Tatsuo Kaneko, Toshio Konishi, Tamiyuki Obayashi, Toshihide Ohki1994 Volume 23 Issue 6 Pages 404-408
Published: November 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSTo determine the hemostatic effets of aprotinin in coronary artery bypass surgery, a prospective study was performed. Thirty four patients (group A) who received aprotinin (2×106 unit) in the cardiopulmonary circuit were compared with 31 control patients (group C) who did not. Activated clotting time was measured in group A for 60 minutes during cardiopulmonary bypass, but no significant difference was observed in the platelet counts of the two groups. Intraoperative blood loss was 366ml in group A compared with 514ml in group C, and postoperative blood loss was 354ml versus 570ml, respectively (p<0.05). Total blood loss was significantly reduced in group A by 34% compared with group C (720ml versus 1, 084ml, p<0.05). There was no difference in incidence of perioperative myocardial damage. It seems necessary to investigate the complications of the hemostatic effects of aprotinin and it effects on graft patency.View full abstractDownload PDF (587K) -
Kenichiro Azuma, Hajime Hirose, Kouji Matsumoto1994 Volume 23 Issue 6 Pages 409-414
Published: November 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSIschemic heart disease (IHD) poses some serious problems in the surgical treatment of arteriosclerosis obliterans of the lower extremities (ASO) and aortic aneurysm (AA). The surgical management of these vascular diseases in patients with IHD was evaluated. Thirty-five patients had ASO and 31 had AA. All patients underwent coronary arteriogram. IHD was detected in 24 patients (69%) with ASO and in 12 (39%) with AA. The severity of coronary artery disease was graded by the coronary score (CS) proposed by Leaman et al., and the scores were compared with the mode of surgical treatment. In patients with ASO, both the revascularization of coronary arteries (CABG) and of peripheral arteries were performed in one stage in 3 patients with a CS of 16-22. Only arterial revascularization of the lower extremities was performed in 19 patients with a CS of below 5.5. In AA, surgical treatment was performed with consideration of the severity of the coronary artery disease and the surgical approach. Both CABG and aortic reconstruction were performed in one stage in 3 patients with abdominal aortic aneurysm (CS: 9.5-13.5) and in 2 patients with aortic arch aneurysm (CS: 3.5, 8) with a coronary lesion in the left anterior descending branch (LAD). Only aortic repair was performed in 5 patients with a CS below 8 (without LAD lesion). The patients with ASO (CS≤5.5), and those with AA (CS≤8, no LAD lesion) underwent reconstruction only in the arteries of the lower extremities and aortic aneurysms, respectively, without any complications from the associated IHD.View full abstractDownload PDF (866K) -
Hirokazu Ohashi, Yasushi Tsutsumi, Akira Murakami, Keisi Ueyama, Akio ...1994 Volume 23 Issue 6 Pages 415-418
Published: November 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSOne hundred and thirty cases of closed mitral commissurotomy were followed for up to 25 years and 10 months. There was no operative death, but 31 cases died during the follow-up period. Eight cases died suddenly of unknown cause, 7 due to heart failure, 5 due to thromboembolism, 4 on reoperation, and 6 due to other reasons. In the 7 cases who died of heart failure late after commissurotomy, 3 cases refused reoperation. Each of the remaising 4 cases were not operated on because of associated severe liver dysfunction, left ventricular dysfunction plus pulmonary hypertension, respiratory failure due to bronchial asthma, and unknown reasons, respectively. The actuarial survival rate was 93.6% 10 years after surgery, and 72.2% 20 years after surgery. Forty-two cases had reoperation with a mean interval of 12 years and 6 months. Reoperation-free survival rate was 88.7% 10 years after the first operation and 42.8% 20 years after the first operation. Incidence of major thromboembolism was 1.25%/patient-year. Thromboembolism and sudden death of unknown cause constituted the leading cause of late death and played a key role in long term results. Cardiac event-free survival rate was 65.7% 10 years after surgery and 32.6% 20 years after surgery. From these results it was concluded that the clinical limitations of the effectiveness of closed mitral commissurotomy was around ten years after surgery. We believe that these findings provide useful information for percutaneous transvenous mitral ommissurotomy.View full abstractDownload PDF (523K) -
Yukio Kuniyoshi, Kageharu Koja, Kiyoshi Iha, Mituru Akasaki, Kazufumi ...1994 Volume 23 Issue 6 Pages 419-423
Published: November 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSDuring the last 15 years, isolated aortic valve replacement was performed in 122 patients, 12 of whom had severe elevated pulmonary systolic pressure (PAS) of 50mmHg or over. A comparative study of preoperative and postoperative data was done between two groups; group I (n=12), with a pulmonary systolic pressure 50mmHg or over, and group II, with a value of under 50 mmHg (n=45). On preoperative evaluation, cardiomegaly and constrictive pulmonary dysfunction were found in group I and also PAWP, mean pressure of PA, PAS, LVEDP and RVEDP were of a higher value in group I than group II. The LVEDP was high in group I and correlated well with PAS preoperatively, suggesting that pulmonary hypertension was a consequence of severe LV dysfunction. There was no difference in the operative mortality and postoperative complication between these two groups. CTR, PAWP, mPA and PAS decreased to within the normal range postoperatively. It was concluded that pulmonary hypertension does not adversely effect the operative mortality and postoperaive complications of AVR, and the cause of the elevated pulmonary pressure was thought to be due to the impaired LV function.View full abstractDownload PDF (569K) -
Hajime Otani, Tokumitsu Ko, Yasushi Kato, Yoshiya Sakurai, Kazuho Tana ...1994 Volume 23 Issue 6 Pages 424-428
Published: November 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSLeft ventricular hypertrophy in patients with aortic valve disease has long been recognized as a significant risk factor for aortic valve replacement. Higher operative mortality in such patients has been attributed to poor myocardial preservation. In these patients improvement of left ventricular subendocardial blood flow during reperfusion seems to be mandatory to avoid subendocardial injury. Therefore, we attempted to increase subendocardial blood flow during reperfusion by terminal warm blood cardioplegia (TWBCP) followed by controlled aortic root reperfusion (CARR) in patients requiring isolated aortic valve replacement. The patients with TWBCP and CARR had a tendency towards severe left ventricular hypertrophy and more advanced NYHA function class compared to those with hypothermic cardioplegia alone. Nevertheless, the patients with TWBCP and CARR showed significantly better recovery of left ventricular function, i.e., spontaneous recovery of beating and higher cardiac index as well as left ventricular stroke work index, despite significantly less catecholamine support. These resuls suggest that TWBCP followed by CARR may offer significant benefits over unmodified reperfusion during aortic valve replacement for patients with severe left ventricular hypertrophy.View full abstractDownload PDF (671K) -
Masamitsu Endo, Makoto Tsubota, Masahiro Seki, Takashi Iwa1994 Volume 23 Issue 6 Pages 429-432
Published: November 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSWe recently experienced a case of Y graft replacement for recurrent blue toe syndrome (BTS) following cardiac catheterization. A 64-year-old male, who had undergone cardiac catheterization, complained of bilateral multiple toe cyanosis and pain. Angiograms revealed that infrarenal aortic stenosis was the recurrent embolic source. He refused surgical treatment because he thought the BTS was an iatrogenic complication. No conservative therapy was effective. He finally suffered from right foot and all left toe necrosis after nine months. Then he recieved Y graft replacement. Thereafter no embolic episode was seen. Cardiac catheterization recently has become a routine examination. However, informed consent is very important because it is difficult to anticipate BTS following the examination. Surgical treatment is recommended for recurrent BTS because conservative therapy fails in most cases.View full abstractDownload PDF (2138K) -
Shin Yamamoto, Shiro Sasaguri, Yasuyuki Hosoda, Kenji Takazawa, Norio ...1994 Volume 23 Issue 6 Pages 433-436
Published: November 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSSurgical treatment of two abdominal and two thoracic aneurysms in hemodialysis patients were performed from 1991 to 1993. Two elective cases survived, but two emergency cases died. The causes of death were PMI and respiratory failure. Ruptured aneurysms are critical and probably result in higher mortality and morbidity than elective replacement of aneurysms. In view of the documented risk of rupture and current operative risk, we believe that elective surgical treatment of aneurysm is a much better treatment than following the aneurysms until they produce symptoms or significantly enlarge.View full abstractDownload PDF (2310K) -
Fumitaka Yamaki, Kouki Tsuchida1994 Volume 23 Issue 6 Pages 437-440
Published: November 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA 74-year-old male was admitted to our hospital with a complaint of high fever, abdominal pain, and increasing anemia. Abdominal CT and angiography revealed a ruptured abdominal aneurysm. In an emergency operation the aneurysm was located between the superior mesentemic artery and the renal amtery. Aneurysmectomy and graft interposition were done. Bacteriological examinations of the exudate in retroperitoneal space confirmed the positive diagnosis of aneurysm due to Salmonella choleraesuis infection. The patient continues to remain well 10 months after the operation.View full abstractDownload PDF (2283K) -
Hideyuki Shimizu, Toshihiko Ueda, Ryohei Yozu, Yasushi Kato, Takashi H ...1994 Volume 23 Issue 6 Pages 441-444
Published: November 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSMarfan's syndrome associated with multiple arterial aneurysms of the abodominal aortic branches in a pair of identical twins is described. The first case, a 21-year-old male, visited our affiliated hospital because of severe upper abdominal pain. Computed tomography (CT) and aortography (AOG) demonstrated multiple abdominal aneurysms, i.e., celiac artery, bilateral renal arteries and superior mesenteric artery, but there were no findings of dissecting aneurysm of the aorta. The aneurysm of the superior mesenteric artery, which had ruptured, was replaced with a greater saphenous vein graft. The postoperative course was uneventful until sudden cardiac arrest occurred on the 5th POD. An autopsy revealed a dissecting aortic aneurysm (DeBakey type I), massive intrathoracic hemorrhage, and subarachnoidal hemorrhage. Two years later, the second case, the 23-year-old twin brother of the prior case, visited our hospital because of upper abdominal pain similar to that of his brother. The clinical course bore a close resemblance to his brother's. CT and AOG revealed the intact aorta and aneurysms of the celiac artery and right renal artery. The ruptured aneurysm of the celiac artery was ligated. Immediately after his returning to the ICU, he developed sudden massive intrathoracic bleeding and cardiac arrest. This is the fourth report of identical twins with Marfan's syndrome in Japan. It is also noteworthy that in both cases rupture of the extra-aortic aneurysm occurred prior to the aortic dissection or aneurysmal formation.View full abstractDownload PDF (1999K) -
Hitoshi Suzuki, Ryuji Hirano, Toru Mizumoto, Takune Hiraiwa, Isao Yada ...1994 Volume 23 Issue 6 Pages 445-447
Published: November 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA 51-year-old male, who had undergone aortic valve replacement (BS27A) 13 years ago, was admitted with a sudden onset of cerebral stroke and SVC syndrome. Computed tomography and aortography revealed aneurysmal dilatation and dissection of the ascending thoracic aorta with occlusion of the superior vena cava and the right pulmonary artery. A modified Collins procedure was performed and the postoperative course was uneventful.View full abstractDownload PDF (1338K)
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