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Volume 23, Issue 1
Displaying 1-15 of 15 articles from this issue
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Shin Yamamoto, Shirou Sasaguri, Yasumasa Hirooka, Minoru Tahara, Norio ...1994 Volume 23 Issue 1 Pages 1-5
Published: January 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSWe controlled the hemodilution and electrolyte levels during coronary artery revascularization in chronic hemodialysis patients by hemofiltration during the period of extracorporeal circulation. Subjects comprised 7 chronic hemodialysis patients (males, average age 53) undergoing coronary artery revascularization in our department from January 1988 to December 1989. All patients had been undergoing hemodialysis for chronic renal failure and in one patient, after admission, continuous ambulatory peritoneal dialysis (CAPD) was additionally performed. During surgery, the dialyzer was equipped with an extracorporeal circulation circuit and the electrolyte level and hemodilution were adjusted using transfusion (1, 270±372ml). A large infusion volume (12, 657± 3, 966ml) was maintained and removal of water was carried out by ultrafiltration. After surgery, all patients underwent hemodialysis twice or more by the 3rd day of recovery. Concentrations of electrolytes were maintained at appropriate levels throughout the day of surgery except for one case of postoperative hypokalemia, but no marked changes in hemodynamics were observed during and after surgery. Hemofiltration during extracorporeal circulation is safe and useful in coronary surgery because it is simpler and requires less time than hemodialysis.View full abstractDownload PDF (671K) -
Setsuo Kuraoka, Takao Irisawa, Shigetaka Kasuya, Hiroshi Kanazawa, Hum ...1994 Volume 23 Issue 1 Pages 6-10
Published: January 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSBetween 1970 and October, 1992, 120 cases of abdominal aortic aneurysms (AAA) were treated for surgical repair. Thirteen of these cases (11%) were performed with simultaneous repair for coexistent visceral vascular diseases and other intestinal organ diseases. Another 9 patients (7.5%) were treated with coronary revascularization for combined ischemic heart disease. Six of these cases received both operations during the same hospital stay. Our surgical strategy for coexistent AAA and ischemic coronary artery disease is basically a staged operation. Coronary revascularization should precede AAA repair. Operative mortality was 1.1 percent for elective AAA repair. Long-term survival was 78% for elective surgery with a mean follow-up of 51 months, and 52% for emergency surgery with a mean follow-up of 46 months. Major risks for late death were malignant neoplasms and ischemic coronary artery disease. Survival rate of the 9 patients with successful concomitant coronary revascularization and AAA repair was 89% after 51 months of mean follow-up. We conclude that re-evaluation for coexistent ischemic heart disease is the most important point for management before and after AAA repair.View full abstractDownload PDF (602K) -
Susumu Ishikawa, Masahiro Aizaki, Akio Otaki, Hajime Yanagisawa, Yoshi ...1994 Volume 23 Issue 1 Pages 11-14
Published: January 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSIn a consecutive series of abdominal aortic aneurysm repairs, a non-washing autotransfusion unit system was used in 47 patients, and was not used in 25. In the 47 patients treated with the autotransfusion unit, the average amount of autotransfused blood was 1, 109±131ml in elective cases. The amount of banked blood transfusion was significantly smaller in autotransfused patients (mean; 712ml), compared to non-autotransfused patients (mean; 1, 405ml). Postoperative levels of serum bilirubin were higher in patients with greater autotransfused blood volumes than those with smaller volumes. The combination of preoperative autologous blood donation (2-3 units) and intraoperative autotransfusion is necessary to perform abdominal aortic aneurysm repair without homologous blood transfusion.View full abstractDownload PDF (461K) -
Koji Kawahito, Hirofumi Ide, Takashi Ino, Hideo Adachi, Akihiro Mizuha ...1994 Volume 23 Issue 1 Pages 15-20
Published: January 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSAn emergency percutaneous cardiopulmonary support system (PCPS) was employed 11 arrest victims (5 males, 6 females; mean age 59.3 years) refractory to conventional resuscitation measures. Cardiac operation was subsequently performed in two patients and coronary angioplasty in two. The 7 other patients continued on cardiopulmonary support by PCPS after successful resuscitation. Duration of support was 10.5±9.1 (mean±S. D.) hours, the flow rate was 2.5±0.7l/min, and PCPS was applied 5-70min (mean, 24.9min) following the onset of cardiac arrest. The entire intraluminal surface of PCPS device had been heparin coated, activated coagulation time was maintained about 150 seconds, with or without minimal systemically administered heparin. Seven of 11 patients (63.6%) were successfully weaned from the PCPS. The early survival (<30 days) was 6 patients (54.5%), and late survival was 4 patients (36.4%). We conclude that PCPS can improve survival in patient unresponsive to conventional resuscitation when instituted soon after cardiac arrest.View full abstractDownload PDF (848K) -
Hajime Yanagisawa, Kenichi Sudo, Akio Ohtaki, Tadashi Koishizawa, Nobu ...1994 Volume 23 Issue 1 Pages 21-27
Published: January 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSFrom April 1987 to March 1990, we performed open heart surgery using extracorporeal circulation in 90 patients (average age, 51.8 years old) and vascular surgery (graft replacement of abdominal aortic aneurysm and surgery for ASO) in 29 patients (average age, 58.1 years old). Among there, 8 patients with open heart surgery (EEC group) and 9 patients with vascular surgery (vascular group) had suffered from renal insufficiency preoperatively. In the two groups, we compared operative mortality, complications and postoperative severity of renal failure. Preoperative renal insufficiency was defined as a serum creatinine level of more than 1.4mg/dl and postoperative renal failure was defined as 2.0mg/dl. There was no significant difference in operative mortality, in postoperative creatinine, Ccr, BUN and serum potassium and in effectiveness of hemodialysis in the two groups. In conclusion, it seems that we should not hesitate to perform cardiovascular surgery with extracorporeal circulation for patients with renal insufficiency or in hemodialized patients.View full abstractDownload PDF (811K) -
Fumiaki Oguma, Junichi Hayashi, Shoichi Tsuchida, Hirofumi Okazaki, Ha ...1994 Volume 23 Issue 1 Pages 28-32
Published: January 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSAscending aorta-infrarenal abdominal aorta bypass was performed in 8 patients: 4 patients with dissecting aortic aneurysm, 3 patients with thoracic aneurysm and 1 patient with stenosis of the thoracic aorta after grafting for congenital thoracic aneurysm. Four patients who had aortic dissection underwent the thromboexclusion method, but thromboexclusion of the thoracic aorta occured in only one patient after additional clamp to the distal thoracic aorta. He is the only long-term survival in this series. The thromboexclusion method was also performed in two patients with infectious thoracic aortic aneurysm, but they died of aneurysmal rupture within 13 months after operation. One patient who undewent resection of a thoracic aneurysm with extra-anatomic bypass, developed respiratory insufficiency and paraplegia, and died of pneumonia. The patient with thoracic aortic stenosis is alive and well 11 years after operation. The indications of the thromboexclusion method for thoracic aneurysm should be limited only to very poor-risk patients who seem to be inaccessible to a direct approach. Ascending aorta-abdominal aorta bypass is recommended in cases of thoracic aortic stenosis.View full abstractDownload PDF (683K) -
Hirono Satokawa, Fumio Iwaya, Tsuguo Igari, Kenichi Hagiwara, Masahiro ...1994 Volume 23 Issue 1 Pages 33-37
Published: January 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSTo investigate the effect of nafamostat mesilate (FUT) for disseminated intravascular coagulation (DIC) after surgery using cardiopulmonary bypass, we studied DIC scores and parameters of coagulation and fibrinolysis in the DIC cases. Although 12 patients developed DIC, the platelet counts improved by administration of FUT apart from one complicated by sepsis. The DIC scores decreased as a result of the increase of platelets and fibrinogen and improvement of FDP. Thrombin-antithrombin III complex, D-dimer and plasmin-α2 plasmin inhibitor complex showed an even higher value at the endpoint of FUT administration. These results indicate that patients with DIC after cardiopulmonary bypass may have severe fibrinolytic acceleration and that administration of FUT can be useful in those cases.View full abstractDownload PDF (716K) -
Fumitaka Yamaki, Kouki Tsuchida1994 Volume 23 Issue 1 Pages 38-41
Published: January 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSAbdominal aortic injury caused by blunt trauma is rare. We examined a 69-year-old-male with acute abdominal aortic occlusion due to a steering wheel injury in an automobile accident. At the time of the emergency operation, the infra-renal abdominal aorta was occluded with a complete transection of the intima and media, resulting in a flap formation and thrombosis. Aortoiliac arterial replacement was performed with a bifurcated Dacron graft. The postoperative course was complicated and included acute cardiac failure, respiratory distress, and myonephropathic metabolic syndrome. The patient gradually recovered, and to date remains well, 6 months after surgery.View full abstractDownload PDF (2000K) -
Makoto Kamada, Ryosei Kuribayasi, Satosi Sekine, Hiroaki Aida, Keiji S ...1994 Volume 23 Issue 1 Pages 42-45
Published: January 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA rare case of left coronary ostial stenosis following aortic valve replacement (AVR) was reported. A 67-year-old man had undergone AVR for aortic stenosis and regurgitation. During the procedure basket tip cannula was utilized for selective coronary perfusion. He began to complain of chest pain 4 months after surgery, and coronary arteriography revealed a 99% stenosis at the left coronary ostium. Emergency coronary artery bypass grafting (CABG) to the LAD using a saphenous vein graft was successfully performed. The angina pectoris developing after AVR suggests that coronary ostial injury was caused by selective coronary perfusion cannula. The disease progresses rapidly in the absence of sufficient collaterals, and emergency CABG is needed to prevent critical myocardial infarction and sudden death.View full abstractDownload PDF (1354K) -
Masaaki Koga, Toshiyuki Yuda, Toshiaki Miyazaki, Hitoshi Toyohira, Aki ...1994 Volume 23 Issue 1 Pages 46-49
Published: January 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA 70-year-old woman was admitted with precordial pain. Two-dimensional echocardiography revealed a right atrial tumor. CT scan also showed a high density tumor in the right atrium. Right atriography demonstrated a mobile tumor with a stalk arising from the vicinity of the Eustachian valve. On open heart surgery the stalk of the tumor seen to be attached to the Eustachian valve. The tumor was very hard because of massive calcification. Removal of the tumor was accomplished in the standard fashion, excising the Eustachian valve together with surrounding endocardium to prevent recurrence. The weight of the tumor was 20g and the size was 6×3×2cm. Histologic examination of the tumor revealed myxoma. Thirty five cases of right atrial myxoma have been reported in Japan. There was only one previous report which reported a case originating from an Eustachian valve.View full abstractDownload PDF (1783K) -
Masahiro Sakurai, Toshihide Maeyama1994 Volume 23 Issue 1 Pages 50-53
Published: January 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA 55-year-old male on regular hemodialysis was referred to our department for evaluation of intermittent claudication. Abdominal aortography demonstrated occlusion of the abdominal aorta below the superior mesenteric artery. The patient underwent reconstruction of the abdominal aorta by Y-grafting. The occluded abdominal aorta was filled with a gelatin like tumor in which malignant cells were identified histopathologically. Immunohistochemical examination of the malignant cells showed negative results for factor VIII antigen but positive results for actin antigen, which suggested that the cells were of smooth muscle cell origin and the tumor was diagnosed as leiomyosarcoma. The patient's condition gradually deteriorated and he died at eleven months after the initial surgery because of generalized dissemination of the tumor.View full abstractDownload PDF (1970K) -
Hitoshi Ogino, Ario Yamazato, Masaharu Hanada, Shogo Nakayama1994 Volume 23 Issue 1 Pages 54-58
Published: January 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSWe report a 70 year old female patient who underwent three successful surgical repairs for the following postinfarction mechanical complications: left ventricular free wall rupture (LVFWR), ventricular septal perforation (VSP) and left ventricular pseudoaneurysm (LVPA). The patient had an oozing type LVFWR following PTCA and t-PA therapy for acute broad-anterior myocardial infarction. Initially, treatment of the LVFWR consisted of emergency pericardial wrapping over the infarcted myocardial area. However, on the second postoperative day the patient developed VSP, which necessitated patch closure of the VSP and patch plasty of the left ventricle. An LVPA, which was detected by UCG examination 38 days after the second procedure, was repaired successfully through a left antero-lateral thoracotomy and with femoro-femoral bypass. The patient made a full recovery and was discharged on the 200th postoperative day. In conclusion, UCG is an effective diagnostic method for postinfarction mechanical complications and pericardial wrapping over an infarcted area is a safe and useful method for an oozing type LVFWR. In addition, it is important that appropriate surgical repairs for postinfarction mechanical complications should be performed without delay.View full abstractDownload PDF (1789K) -
Tatsunori Kimura, Tetsuo Hadama, Hidemi Takasaki, Yoshiaki Mori, Osamu ...1994 Volume 23 Issue 1 Pages 59-62
Published: January 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSWe experienced a 51-year-old male case of CABG whose graftography one month after CABG revealed a 0.5cm venous bypass graft aneurysm. Anginal pain recurred in the eighth month after CABG. Re-graftography showed enlargement of the aneurysm and stenosis of the graft at the same site. Re-CABG was carried out successfully and his postoperative course was good. Venous graft aneurysm is a comparatively rare complication, and that of the present case was considered to be most ascribable to the fragility of the graft, caused by mediastinitis secondary to the first CABG. Thrombus formation was noted in the aneurysm, with a risk of causing rupture or myocardial infarction. Therefore, such graft aneurysms should be treated by re-CABG as soon as possible after detection.View full abstractDownload PDF (1852K) -
An Operated Case of Coronary Artery Bypass Grafting in a Patient with Progressive Systemic SclerosisTsutomu Ohi, Yuo Kanamori, Naohiko Kurata, Sekira Shoumura, Akinori Is ...1994 Volume 23 Issue 1 Pages 63-67
Published: January 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSThere are few reports of successful CABG for coronary lesions due to collagen disease. In particular, there is no report of CABG in progressive systemic sclerosis (PSS). A 60-year-old female with PSS underwent successful coronary artery grafting for angina pectoris. She had a history of PSS and had been on predonisolon for the previous 2 years. Three months prior to admission, she began to complain of angina on mild exersion. Selective coronary angiogram revealed 90% stenosis in the midportion of the right coronary artery and 90% stenosis in the proximal portion of the left anterior descending artery. Based on these findings she underwent saphenous vein grafting to the left anterior descending branch and the posterior descending branch of the RCA. Despite the history of PSS, the patient's postoperative course was uneventful and she is now doing well with no attack of angina. Postoperative angiography showed both vein grafts were patent, but there was a slight stenotic lesion in the midportion of the graft to the right coronary artery. From our experience, careful consideration of the bypass conduit is important in patients requiring steroids.View full abstractDownload PDF (3157K) -
Tohru Sakurada, Makoto Kamada, Yoshiki Shibata, Itsuro Yamagishi, Tada ...1994 Volume 23 Issue 1 Pages 68-71
Published: January 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA 64-year-old man with arteriosclerosis obliterans with huge multiple ulcers of the left leg was admitted for surgery. He had ichthyosis, and was diagnosed as X-linked ichthyosis by reduced steroid sulfatase activity and clinical examinations. Angiography revealed occlusions of the left common and external iliac arteries, left femoral artery, and right femoral artery. Aorto-left femoral bypass with a gelatin impregnated Dacron prosthesis and left femoro-popliteal bypass with a reversed saphenous vein graft were performed. Postoperatively the leg ulcers gradually healed and the patient was discharged in good condition. Leg ulcers with arteriosclerosis obliterans in patient with X-linked ichthyosis should be treated by the arterial reconstruction in the same way as in case with normal skin.View full abstractDownload PDF (2363K)
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