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Volume 23, Issue 2
Displaying 1-15 of 15 articles from this issue
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Hiroshi Watanabe, Haruo Miyamura, Masaaki Sugawara, Yoshiki Takahashi, ...1994 Volume 23 Issue 2 Pages 73-77
Published: March 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSThirty-four patients with congenital cardiac disease were studied to evaluated the role of ultrafiltration after cardiopulmonary bypass without homologous blood transfusion. We used either polypropylene microporous hollow fiber hemoconcentrator (HC-30M or 100M) or polyacrylonitrile microporous hollow fiber hemoconcentrator (PHC-500). Ultrafiltration was useful in the reduction of fluid overloading after cardiopulmonary bypass with extreme hemodilution. Thirty-two patients tolerated the procedure uneventfully without donor blood transfusion and were discharged from the hospital. The values of hematocrit, serum protein and free hemoglobin increased significantly after ultrafiltration with either type of hemoconcentrator. However the degree of concentration of blood components was significantly higher with polyacrylonitrile hemoconcentrator than those with polypropylene hemoconcentrator. These results indicated that ultrafiltration was useful for maintaining water balance after cardiopulmonary bypass without homologous blood transfusion in pediatric cardiac surgery and that polyacrylonitrile microporous hollow fiber hemoconcentrator should be employed in patients with shorter bypass time and less hemolysis.View full abstractDownload PDF (674K) -
Kenichi Sudo, Tadashi Koishizawa, Kyouichiro Tsuda, Nobunari Hayashi, ...1994 Volume 23 Issue 2 Pages 78-83
Published: March 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSFrom January 1987 to October 1992, 60 consecutive patients operated on for infrarenal abdominal aortic aneurysm (AAA) were reviewed to evaluate the effect of previous laparotomies giving on the results of aneurysmal surgery. Eleven of 60 patients had previous laparotomies. Two of them required emergency operation for ruptured aneurysms. One of them died during surgery as a result of excessive hemorrhage prior to cross-clamping the aorta. Severe peritoneal adhesion had made if difficult to properly expose the aorta for cross-clamping to control hemorrhage. There were no statistical significance in mortality between the previous laparotomy and non-laparotomy groups. Excluding ruptured cases, we compared the previous laparotomy group (9 patients) and non-laparotomy group (37 patients) with reference to perioperative factors, including operation time, blood loss, non-oral feeding days, bed-ridden days, and hospital stay but there were no statistically significant differences. These results suggested that previous laparotomy is not a serious risk factor in operations for AAA.View full abstractDownload PDF (698K) -
Susumu Nagamine, Hiromasa Abe, Yoshiyuki Okada, Michitoshi Ottomo1994 Volume 23 Issue 2 Pages 84-87
Published: March 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSNine patients underwent surgical repair of ventricular septal defect (VSP) following acute myocardial infarction in our hospital during the past 5 years. Sites of perforation were apex ventricular septum (A-VSP) in five, high anterior ventricular septum (H-VSP) in one and posterior ventricular septum (P-VSP) in three. A-VSPs were closed by single patch on the left ventricular side of the septum. H-VSP was closed by double patch and ventriculotomy was closed directly. For P-VSPs, three different operative procedures were performed. Patch closure of VSP and reconstruction of free ventricular wall was done in one, while in other two VSP was closed by single patch on the left or right side of the septum. There were two operative deaths, one A-VSP and one P-VSP. We think that patch closure through right ventriculotomy is useful in cases of small P-VSP.View full abstractDownload PDF (1151K) -
Taijiro Sueda, Kazumasa Orihashi, Takayuki Nomimura, Saiho Hayashi, Yo ...1994 Volume 23 Issue 2 Pages 88-91
Published: March 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSTwelve cases of ruptured abdominal aortic aneurysm (RAAA) were treated during 5 years. Nine showed severe hypotension (systolic pressure below 70mmHg) and three required cardiac massage prior to operation. At the beginning of this study, direct laparotomy was conducted on 4 cases but mortality was high mortality (75%). Left thoracotomy with antero-lateral incision through the 7th intercostal space was carried out to access the thoracic aorta for clamping before laparotomy, since the major mortality of this disease is due to abrupt bleeding following anesthesia and operation. Left thoracotomy before laparotomy was conducted on 8 cases, half of whom required aortic clamping during operation (clamping time 21min). Operative mortality following thoracotomy decreased (12.5%). The aneurysm size and the time of operation for the groups with or without thoracotomy were the same, though the degree of bleeding significantly differed (3, 925ml in the group with thoracotomy, 7, 193ml in the group without thoracotomy). Left thoracotomy befor laparotomy obtained good results in case of RAAA.View full abstractDownload PDF (499K) -
Hiroaki Kuroda, Seiichiro Sasaki, Shingo Ishiguro, Yohichi Hara, Takaf ...1994 Volume 23 Issue 2 Pages 92-96
Published: March 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSIn the past 11 years, we treated 41 patients with Stanford type B aortic dissection. Principally, medical therapy was carried out and surgery was performed only when complications related to the dissection occurred. Twenty two patients (53.7%) had complications, including 5 (12%) with peripheral limb ischemia, 3 (7%) with rupture, 13 (32%) with dilatation of the aorta, 4 (10%) with extension of dissection (type A dissection). Seventeen patients received surgery including palliative operation. Among 41 patients, 3 died due to aortic rupture and 2 died at surgery for type A dissection, while 4 of them had developed proximal extension of the dissection. The 5-year survival rate for all patients was 86.7±6.6%. Long term survival will improve in patients with Stanford type B aortic dissection when the operative mortality for type A dissection is reduced and sound management policies are developed.View full abstractDownload PDF (678K) -
Keishu Yasuda, Makoto Sakuma, Yoshiro Matsui, Norihiko Shiiya, Masakat ...1994 Volume 23 Issue 2 Pages 97-100
Published: March 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSWe report 18 cases of thoracoabdominal aortic aneurysm repair. Most causes of the thoracoabdominal aortic aneurysm were atherosclerotic lesions (56%) or inflammatory changes (39%), such as Takayasu's aortitis and Behçet's disease. The Crawford procedure was performed in 13 patients, patch aortoplasty in 3, the Hardy procedure in 1 and extra-anatomic bypass in 1. As an adjunct, temporary bypass was employed in 8 patients and F-F bypass in 7 patients. Visceral arteries were perfused selectively during aortic cross-clamp. A total of 39% of all patients required emergency surgery for rupture, and among inflammatory aneurysms 86% of them ruptured. The early mortality rate was 0% in non-ruptured thoracoabdominal aneurysms, 42.9% in ruptured and 16.7% overall. There were 3 severe post-operative complications including one each of paraplegia, non-occlusive intestinal ischemia and rupture. All of them turned resulted in in-hospital death and the in-hospital mortality rate was 33.3%. There was no late death among atherosclerotic thoracoabdominal aortic aneurysms. However both Behçet's disease cases required re-operation for rupture at the anastomotic site in the late postoperative period and one patient died. One Marfan's syndrome patient also died 3 years postoperatively. We conclude that the Crawford procedure with F-F bypass is an effective and safe approach to thoracoabdominal aortic aneurysm repair and yields good clinical results.View full abstractDownload PDF (617K) -
Keishu Yasuda, Norihiko Shiiya, Hiroshi Matsuura, Masatoshi Miyama, Ju ...1994 Volume 23 Issue 2 Pages 101-105
Published: March 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSNine patients with type IIIb dissecting aortic aneurysm underwent graft replacement of the thoracic and abdominal aorta between 1988 and 1992. The spiral opening method was used to expose the thoracic and abdominal aorta. Temporal bypass was employed in 2 patients and F-F bypass in 7 patients. Visceral arteries were perfused selectively during aortic cross-clamp. The entire descending thoracic aorta and abdominal aorta was reconstructed in 6 patients and the proximal descending thoracic aorta to renal arteries in 3 patients. The Crawford graft inclusion technique was used in all cases. Three patients required emergency surgery for rupture in one and impending rupture in 2. Operative deaths occurred in 2 patients (22.2%). Morbidity included renal failure (2), bleeding requiring reoperation (2), arrythmia (1), paraplegia (1), paraparesis (1), respiratory failure (1) and ileus (1). In the past two years, we operated on 5 cases of type IIIb dissecting aneurysms and there was neither operative death nor paraplegia.View full abstractDownload PDF (677K) -
Goro Ohtsuka, Masafumi Higashidate, Ikuo Hagino1994 Volume 23 Issue 2 Pages 106-110
Published: March 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSTo reduce the amount of homologous blood transfusion, recombinant human erythropoietin (rHuEPO) administration or preoperative autologous blood donation were performed in 42 patients who underwent elective heart surgery. rHuEPO was administrated intravenously every two days from the 14th preoperative day to the 14th postoperative day (Group E; 19 cases). Preoperative autologous blood donation was done from the 14th day prior to operation once or twice (Group S; 13 cases). There were another 10 cases who did not receive rHuEPO administration or make preoperative blood donations (Group C). In every case, autologous blood donation was performed during preparation for cardiopulmonary bypass at operation. No homologous blood transfusion was done in 14 cases of Group E (74%), 11 cases of Group S (85%), and 6 cases of Group C (60%). Of the 11 patients who required homologous blood transfusion, one was elderly (>65y. o.), 3 had prolonged cardiopulmonary bypass (>3hr), 3 had low body weight (<45kg), 1 had anemia at administration with a red blood cell count of <3.5×106/mm3, and 2 cases had large blood loss during operation (>1, 200ml).View full abstractDownload PDF (569K) -
Takahiro Souma, Yukio Maruyama1994 Volume 23 Issue 2 Pages 111-113
Published: March 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA 71-year-old man with lumbago went into shock in our emergency room and died despite attempted resuscitation. Autopsy revealed an abdominal aortic aneurysm that had ruptured into the subserosa of the sigmoid colon and the retroperitoneal cavity.View full abstractDownload PDF (1111K) -
Tsutomu Kawamura, Tomoe Katoh, Yasuhiko Takagi, Mamoru Kanazawa, Haruh ...1994 Volume 23 Issue 2 Pages 114-117
Published: March 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA 47-year-old male complaining of dyspnea and fever was admitted to our hospital and regurgitation of the aortic and mitral valves with mitral valve aneurysm due to infective endcarditis was diagnosed. The non-coronary and the right coronary cusps of the aortic valve had amount of vegetations, and also the anterior leaflet of the mitral valve had an aneurysm with vegetations. Both aortic and mitral valve replacement were performed. The postoperative clinical course was uneventful.View full abstractDownload PDF (1913K) -
Hidenori Sako, Tetsuo Hadama, Yoshiaki Mori, Osamu Shigemitsu, Tatsuno ...1994 Volume 23 Issue 2 Pages 118-121
Published: March 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA 27-year-old female with Marfan's syndrome underwent successful emergency surgery for rupture of an abdominal aortic aneurysm. Annulo-aortic ectasia with a saccular aneurysm of the aortic arch was revealed by angiography after the initial operation. Cabrol's operation with replacement of the aortic arch was performed. Because bleeding from the distal anastomotic portion was uncontrollable, the segment was ligated and an extra-anatomical bypass was performed from the ascending aortic graft to the bilateral femoral arteries. Intra-graft balloon pumping was carried out in the extra-anatomical bypass graft while the patient was in low cardiac output condition after the second operation. This was considered to be an effective circulatory assist procedure.View full abstractDownload PDF (1994K) -
Kenji Okada, Nobuhiko Mukohara, Kyoichi Ogawa, Tatsuro Asada, Masami N ...1994 Volume 23 Issue 2 Pages 122-124
Published: March 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSIn two cases of thromboangitis obliterans (TAO) a popliteal-posterior tibial-peroneal artery sequential bypass was attempted through a median approach. The 1st case underwent the operation successfully with non-reversed saphenous vein graft. However, only popliteal-peroneal bypass was carried out in the 2nd patient because the posterior tibial artery was severely affected. In surgery of TAO patients, careful assessment of preoperative angiographic findings is important to select the site of distal anastomosis. We found that the posterior tibial artery and the peroneal artery are easily accessible through the medial route in the proximal half of the lower leg and that peroneal artery revascularization was effective for limb salvage.View full abstractDownload PDF (1152K) -
Akiyuki Takahashi, Shinichi Sato, Jiro Hirai, Syunsuke Nakajima, Kazuh ...1994 Volume 23 Issue 2 Pages 125-128
Published: March 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA lower abdominal tumor with thrill and bruit was pointed out in a 59-year-old female. Angiography showed a pelvic arteriovenous malformation (AVM) with remarkably dilated vessels resembling an aneurysm. Feeding arteries for this AVM originated from the right internal iliac artery, right lumbar artery and right renal artery, and drainage blood flowed into the inferior vena cava from the dilated vessel via a large vein. At operation the right internal iliac artery and right lumbar artery were ligated and the dilated vessel with AVM, which connected with the right renal artery, was resected. An angiography 16 days after the operation revealed the normal arteries without AVM and the right internaal iliac artery filled through collateral arteries. Recently catheter embolization in frequently the first choice for treatment of AVM. However, in the case of AVM with aneurysmal dilated vessels, surgical resection should be selected.View full abstractDownload PDF (2216K) -
Norihiko Shiiya, Keishu Yasuda, Jun'ichi Oba, Masatoshi Miyama, Michia ...1994 Volume 23 Issue 2 Pages 129-132
Published: March 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSThe“elephant trunk”operation, first described by Borst and associates, is a multistage operation for diffuse aneurysmal disease. We report a 59-year-old man complaining of hoarseness, who had a diffuse aneurysm extending from the ascending aorta to the upper abdominal aorta with occlusive disease in the neck branches. His aorta was replaced in two stages using the“elephant trunk”operation. The first stage operation, replacement of the ascending aorta and transverse aortic arch, was performed through a median sternotomy under selective cerebral perfusion. The second stage operation, replacement of the descending thoracic and upper abdominal aorta, was performed under F-F bypass. He had occlusive disease on bilateral carotid arteries with a history of brain infarction, had lost his left lower limb because of arteriosclerosis, and had undergone replacement of the infrarenal abdominal aorta because of an aneurysm. Despite a complicated preoperative general condition, the postoperative course was uneventful. The“elephant trunk” operation facilitates staged operation for diffuse aneurysmal disease as presented here, and thereby improves opeative result by reducing surgical stress.View full abstractDownload PDF (1991K) -
Hironori Izutani, Satoru Kuki, Ryuichi Matsumura, Akihiro Okuda1994 Volume 23 Issue 2 Pages 133-137
Published: March 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA 56-year-old male had complained of serious facial edema 2 years after transvenous pacemaker implantation. Venography at admission showed complete occlusion of the left innominate vein and severe stenosis of the SVC. A 20mmHg pressure gradient was recognized between bilateral internal jugular veins and SVC. Various conservative therapeutic approaches had been ineffective, then surgical treatment was recommended. A median sternotomy was made, removing the pacing lead by a Locking Stylet easily and safely. The stenotic section was dilated, resecting the fibrous tissue in the thickened venous wall, and enlarged with a shaped pericardial patch. Symptoms diminished postoperatively. Histological findings revealed phlebosclerosis of the stenotic venous wall. This type of surgical approach is effective for lesions with irreversible occlusion or severe stenosis causing SVC syndrome and which do not respond to conservative therapy.View full abstractDownload PDF (2333K)
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