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Volume 23, Issue 3
Displaying 1-15 of 15 articles from this issue
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Keiji Kumon, Jun-ichi Hayashi, Yasunaru Kawashima, Shoji Eguchi, Fumim ...1994 Volume 23 Issue 3 Pages 139-151
Published: May 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSThis multicenter study was designed to clarify the positive effects of recombinant human erythropoietin (EPO; epoetin alfa) by subcutaneous administration on anemia after autologous blood donation in cardiac surgery. A total of 55 patients undergoing elective heart surgery were enrolled in this study and subcutaneously given EPO at a dose of 200IU/kg (200IU group, n=23), 400IU/kg (400IU group, n=16) or 600IU/kg (600IU group, n=16) once a week for 3 weeks prior to surgery. Autologous blood (400g) was drawn twice from each patient, at 14 days and 7 days before surgery. Oral iron was given daily throughout this study. The mean reticulocyte counts increased significantly 2 weeks after the first administration of EPO in the 200IU group or 1 week after the first administration in the 400IU and 600IU groups. There was an increase in mean hemoglobin (Hb) levels 1 week after the initiation of EPO by 1.7, 2.8 and 2.1% in the 200IU, 400IU and 600IU groups, respectively. After the first drawing of autologous blood, the Hb levels decreased gradually in all groups despite the second administration of EPO. The change in Hb level immediately before surgery however, was a 4.2% decrease (p<0.05) in the 200IU group and 0.8% decrease (N. S.) in the 400IU group and 0.7% increase (N. S.) in the 600IU group in comparison with the initial Hb level. In conclusion, subcutaneous administration of EPO was effective in improving anemia after autologous blood donation in cardiac surgery.View full abstractDownload PDF (1603K) -
Ken-o Mashiko, Masamichi Nakano, Kazuhiko Suzuki, Asatoshi Mizuno, Yos ...1994 Volume 23 Issue 3 Pages 152-155
Published: May 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSWe performed coronary artery bypass operation on 258 patients from July 1974 to February 1993, of whom 10 underwent a total of 11 reoperations. These 10 patients were not significantly different from the other patients with respect to gender, coronary risk factors and number of grafts used in the first operation, aside from older age and lower LVEF. The interval between the two operations was <1 year (early) or about 10 years (late) in most instances. The most common reasons for reoperation were graft failure from technical problems in early and time-related alterations in graft and progression of original disease in late cases. The outcome of reoperation was less than satisfactory, with 2 operative deaths, IABP required in 5, reoperation for bleeding needed in 3 and severe sternal wound infection of the patent vein graft postoperatively, of which atheromatous debris released from the atherosclerotic vein graft was strongly suspected to be the cause. The old vein graft should be immediately ligated at the beginning of CPB in cases with diffuse atherosclerotic vein graft in which more than several years have passed since initial operation. In reoperation, arterial graft is preferable, especially GEA graft can be used advantageously even with a left thoracotomy approach. Bypass reoperation for occlusion of LAD or Cx should be performed by a left thoracotomy approach.View full abstractDownload PDF (1247K) -
Junya Katoh, Masaru Iwasaki, Shoji Suzuki, Shigeru Hosaka, Kihachiroh ...1994 Volume 23 Issue 3 Pages 156-160
Published: May 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSWater Jet flow was projected at normal human aortic walls and human chronic obstructive iliac arteries in the air or in the ordinary saline solution. Ordinary saline solution was used for the jet, which was projected at a pressure of 10kg·f/cm2 through a nozzle 0.10mm in diameter. When the Water Jet was projected at the normal aortic intima, damage to the wall was more severe with duration of fluid projection, and projection for ten sec ruprured the elastic fiber of the media. But when the fluid jet projected ordinary saline, damage to the aortic wall was slight and projection for 30sec only dissected the surface of the intima. Water Jet projection in air showed slight effect on thrombi of the chronic obstructive iliac arteries, and projection for 60sec only made small irregular holes in the thrombi. When the Water Jet was projected in ordinary saline solution, however, destructive effects on thrombi were stronger and the projection for 40sec could remove almost all the thrombi for a distance of 2cm, while damage to the initima was very slight. This study demonstrated that fluid jet projection using ordinary saline solution could remove thrombi in chronically obstructive artery safely and effectively and suggested the possibility of the Water Jet angioplasty.View full abstractDownload PDF (2835K) -
Kenji Takahashi, Koji Nagao, Atushi Narita, Satoshi Iwabuchi1994 Volume 23 Issue 3 Pages 161-166
Published: May 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSIn our department, we perform CABG operations using arterial grafts as much as possible, and in the present study, we investigated 96 patients who underwent CABG operations using arterial grafts alone during the 4-year period from October 1988 to August 1992. The sex ratio (M/F) was 64/32, and the mean age was 63.2 years. Of those 56 patients underwent bypass surgery for one artery each, using a total of 56 grafts. In 18 cases of bypass surgery for 2 arteries 34 grafts were used for 36 arteries, and in 16 patients who underwent surgery for 3 arteries, 42 grafts were used for 48 arteries. In 6 patients who underwent bypass surgery for 4 arteries, 16 grafts were used for 24 arteries. All 148 arteries harvested from 96 patients were available. Forty-one RITAs were used for 43 arteries, 68 LITAs for 72 arteries and 39 RGEAs for 49 arteries. There were 2 (2.0%) operative deaths. Among 135 grafts for 146 arteries on which arteriography was performed after operation, 133 grafts (98.6%) among 142 arteries (97.3%) were patent. In detail, the patency rate of ITA was 98 of 100 grafts (98.0%) and 102 of 105 arteries (97.1%), that of RGEA was 35 of 35 grafts (100%) and 40 of 41 arteries (97.6%), and therefore, good patency was observed in both ITA and RGEA.View full abstractDownload PDF (1459K) -
An Analysis of Factors Influencing Postoperative Complications and Long Term ResultsYukinori Moriyama, Hitoshi Toyohira, Masahiko Hashiguchi, Hideaki Saig ...1994 Volume 23 Issue 3 Pages 167-171
Published: May 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSFrom 1978 through 1992, 103 patients (mean age: 69 years) underwent elective repair of abdominal aortic aneurysm (eAAA) at our institute. One or more postoperative complications occurred in 30 patients (29%), with mortality rate of 1.9%. Factors significantly associated with postoperative complications by univariate analysis included male sex (p=0.0082), operation time (p=0.0006), size of aneurysm (p=0.0045), blood loss during operation (p=0.0037), decreased pulmonary function (p=0.0155), and the number of platelet counts (p=0.0468). Simple linear regression analysis showed that there was a significant correlation among AAA size, operation time and blood loss. Age at operation, however, did not have any influence on morbidity and mortality. Complete survival information was obtained in 96 (follow up rate of 95%) patients, and the influence of preoperative risk factors on late survival was also examined by the Kaplan-Meier method. Factors influencing long-term survival were renal dysfunction and age at time of operation.View full abstractDownload PDF (575K) -
Shigeo Yamauchi, Tetsuo Asano, Atsushi Harada, Masatoshi Ikeshita, Shi ...1994 Volume 23 Issue 3 Pages 172-178
Published: May 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSWe performed surgery for atrial fibrillation and mitral valve disease on 3 patients along with atrial mapping. Macroreentrant circuits were found in 2 patients and the other patient showed a preexcitation ectopic focus in the left atrium. Right atrial excitation was chaotic in all three patients. Of the two patients with reentry circuits, one patient underwent biatrial incisions and the other patient had only a left atrial incision. In the patient with a preexcitation ectopic focus, we performed cryoablation of that focus and made a left atrial incision in order to prevent the reoccurrence of atrial fibrillation after surgery. Following surgery, one patient experienced transient atrial fibrillation, however, continuous atrial fibrillation was resolved by this procedure and all patients returned to a normal sinus rhythm.View full abstractDownload PDF (1495K) -
Koki Tsuchida, Akimasa Hashimoto, Shigeyuki Aomi, Touitsu Hirayama, Ma ...1994 Volume 23 Issue 3 Pages 179-185
Published: May 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSThis report describes 5 patients in whom extensive graft replacement was performed using a combination of median sternotomy with antero- or postero-lateral thoracotomy: 3 of them received replacement from the ascending to the descending thoracic aorta through the transverse aortic arch, and 2 of them received replacement from the transverse aortic arch to the descending thoracic aorta. Four of the 5 patients had catastrophic pulmonary bleeding during surgery and died immediately after the surgery. Histological investigations on 3 of the 5 patients revealed the presence of bleeding in bilateral alveola; edema in the pulmonary parenchymal tissues; and heavy bleeding extensively in the lung which was especially intensive in the pulmonary hilum and caused necrosis of that region in one case. We presume that long periods of total heparinization (extracorporeal circulation time>240min) performed during lateral thoracotomy, were the most important cause of the pulmonary bleeding. Other factors that could cause pulmonary bleeding are (i) avoidance of use of a double lumen endotracheal tube, (ii) pulmonary congestion due to heart failure during surgery, and (iii) pulmonary injury caused by surgical manipulation. We therefore consider that extensive graft replacement of the thoracic aorta through lateral thoracotomy using a pump-oxygenator, is associated with a high risk of pulmonary bleeding when it takes longer than 240min, and it is essential to perform the graft replacement in the possible shortest time.View full abstractDownload PDF (3053K) -
Yukinori Moriyama, Hitoshi Toyohira, Hideaki Saigenji, Shinji Shimokaw ...1994 Volume 23 Issue 3 Pages 186-190
Published: May 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSElective resection of abdominal aortic aneurysms is now a safe operation, though mortality related to ruptured abdominal aortic aneurysm (rAAA) remains high. To evaluate factors affecting survival after rAAA, 26 consecutive cases were studied. The operative mortality was 58% (15/26) compared with 1.8% for 110 elective AAA patients. Factors associated with poor prognosis were blood pressure of less than 90mmHg and profound acidosis of the arterial blood on admission, size of the aneurysm, and massive transfusion. The high mortality and morbidity rate for the rAAA patient emphasize the need for early and aggressive treatment of AAA in elective cases at high risk. In a follow-up study, however, the survival rate of rAAA, excluding hospital mortality, was 71% at five years and there was no significant difference in quality of life as compared with those patients who had elective AAA resection during the same time interval.View full abstractDownload PDF (604K) -
Akio Hirano, Kouichi Hisatomi, Eiki Tayama, Masanori Ohhashi, Tadashi ...1994 Volume 23 Issue 3 Pages 191-195
Published: May 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSWe evaluated the indications and limitations of IABP support for weaning for pump and postoperative heart failure after artificial valve replacement. Driving IABP as cardiac support in cases of acute cardiac failure during and after operation, it is most effective for transient cardiac failure-associated coronary artery spasms during and post operation, but it is not effective and is indeed limited for patients who need long term extracorporeal circulation because of operative technical failure, insufficient cardioplegia and delayed right ventricular failure after operation. The latter groups, in which IABP is insufficiently effective need additional assist devices such as V-A bypass and ventricular assist device (VAD).View full abstractDownload PDF (678K) -
Norihiko Kamada, Tomoyuki Yamada, Susumu Nakamoto, Minoru Aoshima, Fum ...1994 Volume 23 Issue 3 Pages 196-199
Published: May 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSThe subjects consisted of cases of unruptured abdominal aortic aneurysm operated upon between 1989 and 1992 with or without blood transfusion. The blood transfusion group contained 13 patients and the non-transfusion group consisted 17 patients. Non-transfusion cases accounted for 57% and there was no operative death in this group. In 6 patients a Cell saver was used, and it was effective in 3 patients (20%) for non-transfusion. There were significant differences in preoperative hemoglobin, preoperative hematocrit, maximum diameter of aneurysm and bleeding volume in the blood transfusion group and non-transfusion group (p<0.05). In non-transfusion operations the Cell saver appears advantageous.View full abstractDownload PDF (507K) -
Sachito Fukuda, Hisayoshi Suma, Masaru Nishimi, Taikoh Horii, Ikutaroh ...1994 Volume 23 Issue 3 Pages 200-204
Published: May 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSThe authors employed a modified CABG procedure to avoid cerebral infarction in cases of calcified ascending aorta. Among 348 cases of CABG surgery, we used the modified procedure in 14 cases (4%). The mean age was 66. Four patients had a history of previous stroke and one patient had arteriosclerosis obliterans. Our strategy is, (1) use femoral or aortic arch cannulation for cardiopulmonary bypass (CPB), (2) maximal use of in-situ arterial graft, (3) graft-coronary anastomosis under ventricular fibrillation (Vf) without aortic cross clamp, (4) proximal anastomosis of saphenous vein graft (SV), if used, was made at the arterial graft, otherwise direct anastomosis to the aorta was made under circulatory arrest. The internal thoracic artery (ITA) was used in 18 cases and the gastroepiploic artery (GEA) was used in 8 cases, SV was used in 4 cases. The mean Vf time was 48min and mean CPB time was 94min. The peak CPK was 805U and the peak CPK-MB was 52U. There was no significant difference between modified and conventional procedures in terms of operation time and myocardial protection. No cerebrovascular complication was noted with the modified procedure. In conclusion, the modified technique is safe for atherosclerotic-ascending aorta in CABG.View full abstractDownload PDF (639K) -
Iichiro Itoh, Kunihiko Abe, Yoshitaka Shiina, Satoru Chiba, Kouhei Kaw ...1994 Volume 23 Issue 3 Pages 205-208
Published: May 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSTwo cases who underwent emergency operation for papillary muscle rupture complicating acute myocardial infarction were presented. The first case was a 75-year-old female who had suffered myocardial infarction 26 days previously. Operation was performed on the 2nd day after onset of mitral insufficiency. The posterior papillary muscle was partially ruptured and the mitral valve was replaced with a mechanical prosthesis (SJM 25mm). The second case was a 76-year-old female who had suffered myocardial infarction 10 days previously. Emergency operation was performed on the 4th day after onset of mitral insufficiency. The posterior papillary muscle was completely ruptured. Mitral valve replacement with a mechanical prosthesis (Omnicarbon 25mm) was performed. In both cases, recovery from cardiogenic shock was not possible preoperatively even with pharmacologic and circulatory support, but the postoperative courses were uneventful in both cases. We recommend immediate surgical intervention for mitral insufficiency in patients with severe grade regurgitation and cardiogenic shock following acute myocardial infarction.View full abstractDownload PDF (1224K) -
Saihou Hayashi, Yasushi Kawaue1994 Volume 23 Issue 3 Pages 209-211
Published: May 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA 53-year-old male patient was admitted with back pain. A diagnosis of DeBakey IIIb type dissecting aortic aneurysm was made based on the results of examinations such as CT-scan and MRI. The right renal artery bifurcated from the pseudolumen. The right iliac artery and left renal artery showed severe stenosis due to aortic dissection. Y-graft replacement of the abdominal aorta was carried out to save the right iliac artery and left renal artery. At the same time, a fenestration operation was carried out to maintain the blood flow of the right renal artery which bifurcated from the pseudolumen. Secondarily, replacement of the descending aorta was carried out with successful thrombotic obstruction of the pseudolumen.View full abstractDownload PDF (1709K) -
Kiyoshige Inui, Hiroyuki Orita, Tetsuro Uchida, Satoshi Shiono, Masahi ...1994 Volume 23 Issue 3 Pages 212-216
Published: May 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSWe report a very rare case of annuloaortic ectasia with an etiology of both aortitis syndrome and Marfan's syndrome. A 25-year-old woman showed AAE and AR. Her mother had died of SLE, but there was no Marfan's syndrome in her family. Her eyes were normal but her finger was long enough to show wrist sign and thumb sign. Urgent operation was performed because of her progressive heart failure. The ascending aorta was enlarged and Valsalva sinuses showed asymmetrical dilatation. The Cabrol operation was done with a composite graft of 23mm Medtronic Hall valve and 26mm Gelseal graft. The valve was sutured to the graft for 5mm from the end of graft to minimize the tension for annulus because of the high invidence of valve detachment and leakage in aortitis syndrome. Pathological study showed findings of both aortitis syndrome and Marfan's syndrome. Postoperative aortography showed good valvular function, and the patient is doing well now at 6 months after operation.View full abstractDownload PDF (2900K) -
Toshihiko Shibata, Tadashi Yamada, Kanji Ishihara, Norio Suzuki, Masat ...1994 Volume 23 Issue 3 Pages 217-220
Published: May 15, 1994
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA case of abdominal aortic aneurysm associated with systemic lupus erythematosus (SLE) is described. SLE is rarely associated with aneurysm of great arteries. Histological investigation revealed marked infiltration of inflammatory cells in the aneurysmal aortic wall. Immunocytochemical analysis using anti-factor VIII-related antigen antibody showed a marked increase of the vasa vasorum with luminal narrowing due to intimal thickning. In this case the major etiology of aortic aneurysm is considered to be non-specific inflammation of the abdominal aorta, not arteriosclerosis.View full abstractDownload PDF (1698K)
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