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Volume 24, Issue 6
Displaying 1-15 of 15 articles from this issue
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Tatsuhiko Komiya, Kazuhiro Kohchi, Katsuhiko Imai, Kohtaro Shiraga, Sa ...1995 Volume 24 Issue 6 Pages 351-354
Published: November 15, 1995
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSTwenty-two cases with delayed cardiac tamponade following open cardiac surgery were divided into three groups according to the color and hematocrit value of pericardial fluid. In 7 patients (group B) more than half of pericardial fluid consisted of the patient's blood (mean hematocrit 31%), in 9 patients (group D) there was less blood (mean hematocrit 8%), and in 6 patients (group E) it was serous. In group B, compared with group E, the patients had more often received postoperative anticoagulant therapy (100% vs 37%, p<0.05), more often developed excess anticoagulation (thrombo test<15%) (71% vs 17%, p<0.05), and had undergone longer cardiopulmonary bypass (260±74 vs 194±49min, p<0.05). Postoperative anticoagulant therapy seems to be a risk for delayed cardiac tamponade due to intrapericardial bleeding.View full abstractDownload PDF (589K) -
Satoshi Ohba, Kenichi Kosuga, Kenichirou Uraguchi, Kazunari Yamana, Hi ...1995 Volume 24 Issue 6 Pages 355-358
Published: November 15, 1995
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSThe surgical anatomical bypass (ANA) procedures for juxtarenal aortic occlusion (JAO) have been recently developed. However, there are some critical conditions, in which we should be cautious concerning the indications of ANA. Between 1984 and 1993 in Kurume University Hospital, 17 patients with JAO were operated upon. The most common cheifcomplaint was claudication (70.6%). Acute deterioration due to ischemia was recognized in two patients (11.8%). ANA was performed in 15 patients (88.2%) and extra-anatomical bypass (EXT) in 2 with severe calcification of the aorta (11.8%). Hospital deaths occured in three patients with ANA (17.6%), whose background included two acute deterioration and one cerebral infarction with hemiplegia. As an early postoperative complication, acute renal failure occurred in one patient and subileus in two. In the presence of poor general condition, acute deterioration, or severe aortic calcification, the EXT-procedure is the choice of surgical treatment for JAO.View full abstractDownload PDF (1282K) -
Tomoe Katoh, Akihito Mikamo, Akihiko Furunaga, Yoshihide Minami, Kazuh ...1995 Volume 24 Issue 6 Pages 359-362
Published: November 15, 1995
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSFrom April 1990 to December 1993, 13 patients (8 males and 5 females; mean age, 62 years) who underwent surgery for DeBakey type I aortic dissection, were studied to determine pre- and postoperative complications due to original dissection and residual dissection. Ascending aortic replacement had been performed in 9 patients and replacement of the ascending aorta and aortic arch in 4. Preoperative complications were aortic regurgitation (AR) in 3 cases, shock in 4, cardiac tamponade in 5, myocardial ischemia in 2 and spinal cord ischemia in 1. Postoperative complications were visceral and limb ischemia in 1 case, left leg ischemia in 1, spinal ischemia in 2 and worsening AR in 1. The postoperative 30-day survival rate was 85% (11/13). Two patients who underwent urgent ascending aortic replacement with simultaneous coronary artery bypass grafting died within 30 days after surgery. One patient with visceral and limb ischemia died in the hospital. Two patients with spinal ischemia survived but became paraplegic. Cardiac, visceral or spinal ischemia was a common problem in this series. All four patients who underwent ascending aortic replacement with simultaneous aortic arch replacement were alive for 30 days after surgery. The incidence of residual dissection may be reduced by replacing the ascending aorta concomitantly with the aortic arch rather than replacing the ascending aorta only. If a patient with DeBakey type I aortic dissection is in fair preoperative condition and elective surgery is possible, replacement of the ascending aorta and the aortic arch should be considered.View full abstractDownload PDF (608K) -
Takaaki Sugita, Shoji Watarida, Masahiko Onoe, Takehisa Nojima, Kazuhi ...1995 Volume 24 Issue 6 Pages 363-367
Published: November 15, 1995
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSWe experienced unusual dilatation of gelatin-impregnated knitted Dacron prostheses after abdominal aortic aneurysm surgery. Therefore, we investigated dilatation of gelatin impregnated knitted Dacron grafts compared with other types of Dacron grafts after abdominal aortic aneurysm surgery. Eighteen grafts inserted after abdominal aortic aneurysm surgery were studied for to evaluate dilatation. Enhance CT was used to determine the external diameter of the most dilated portion of the abdominal aortic grafts and high speed plain CT was used to determine the most dilated internal diameter. The gelatin-impregnated knitted Dacron grafts dilated from 25% to 43.8% (mean 31.8±7.2%), significantly more than collagen impregnated woven Dacron grafts (p=0.0003). Moreover, high fever was frequently noticed after these grafts implantation (66.7%). Therefore, caution must be used concerning these implantation in aortic lesions and careful follow-up study should be performed after implantation.View full abstractDownload PDF (2548K) -
Osamu Shigemitsu, Tetsuo Hadama, Yoshiaki Mori, Tatsunori Kimura, Shin ...1995 Volume 24 Issue 6 Pages 368-372
Published: November 15, 1995
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSThe diagnosis of ruptured dissecting limited abdominal aortic aneurysm was made in four cases. The sex ratio (M/F) was 1/3, and mean age was 63.5 years (from 53 to 78yr). Only one of these cases die due to intraoperative bleeding. Other three cases were discharged from our hospital. Intraluminal proximal anastomosis after fixed dissected aortic wall due to mattress suture and end to end anastomosis with reinforcement by Teflon felt were good results. The one case who was anastomosed simple intraluminal method has pseudoaneurysm in the proximal portion. It is important to diagnose preoperatively dissection and to make end to end anastomosis with Teflon felt.View full abstractDownload PDF (2106K) -
Relationship between Graft Flow and Patency in Patients Undergoing Femoro-Popliteal Bypass OperationYuji Fujita, Kouji Dairaku, Noriyasu Morikage, Syuji Toyota, Kentarou ...1995 Volume 24 Issue 6 Pages 373-376
Published: November 15, 1995
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSPreoperative and operative evaluation of the arterial reconstructive tract is very important to obtain a high reconstructed graft patency rate after femoro-popliteal bypass. We analyzed the graft patency rate of 40 cases in which the graft flow was measured immediately after completion of arterial reconstruction. The mean graft flow was 122.6ml/min in patients with above-knee (AK) reconstruction and 57.4ml/min in those with below-knee (BK) reconstruction. In cases with AK reconstruction, the three-year cumulative patency rates of grafts with a blood flow of 120ml/min or more (n=12) or less than 120ml/min (n=11) were 100% and 80.8%, respectively (p<0.05). In cases with BK reconstruction, the three-year cumulative patency rates of grafts with a blood flow of 55ml/min or more (n=9) and less than 55ml/min (n=8) were 62.2% and 50.0%, respectively. All early occlusions (n=5) occurred in patients with BK reconstructions. Despite having a blood flow greater than 55ml/min, two cases became occluded in the early stage due to knee joint bending. It is considered that intraoperative measurement of the graft flow is one index to predict graft patency.View full abstractDownload PDF (1084K) -
Akihiko Ohkado, Takayuki Nakajima, Yoshitaka Shiina, Jun Hirota, Yasuh ...1995 Volume 24 Issue 6 Pages 377-379
Published: November 15, 1995
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA 68-year-old male was admitted as an emergency case because of two severe back pain episodes in one week. Chest X-ray showed a marked prominence of the aortic knob. A remarkable bulging of the distal aortic arch and a crescentic low density area along the descending aorta on enhanced chest CT suggested a closing aortic dissection. Operation revealed extensive collapse of the very fragile intima of the aneurysmal wall and extraluminal hematoma along the descending aorta due to bleeding from the ruptured site. The ruptured aneurysm of this type should be accurately differentiated from the DeBakey type III closing aortic dissection which can be followed up medically.View full abstractDownload PDF (1213K) -
Hideaki Nishimori, Kunihiko Hirose, Takashi Fukutomi, Katsushi Oda, At ...1995 Volume 24 Issue 6 Pages 380-383
Published: November 15, 1995
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA 78-year-old man with obstruction of the right common femoral artery due to arteriosclerosis obliterans underwent successful amputation of his leg. On the first postoperative day he received transfusion of three units of preserved blood. He continued to recover until postoperative day 7, when he developed a high fever, erythroderma and diarrhea. His condition gradually deteriorated and on postoperative day 15 he demonstrated severe and progressive leukopenia and thrombocytopenia. Although he underwent intensive treatment he died on postoperative day 20. A skin biopsy specimen revealed evidence of post-transfusion graft-versus-host disease.View full abstractDownload PDF (1862K) -
Naruto Matsuda, Minoru Okada, Iwao Taniguchi, Takeshi Yamaga1995 Volume 24 Issue 6 Pages 384-387
Published: November 15, 1995
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSThoracic aorta injury caused by blunt chest trauma is often fatal. A 26-year-old male with bilateral pneumohemothorax and disruption of the thoracic descending aorta due to a traffic accident was referred to our hospital. The chest X-ray film and CT scanning showed neither mediastinal widening nor periaortic hematoma. Three weeks after admission, aortography revealed flap formation at the aortic isthmus. Two months after trauma, we replaced the injured aorta with a vascular prosthesis using a centrifugal pump. Pathological examination showed separation of a medial layer of the aorta. His postoperative course was uneventful.View full abstractDownload PDF (2012K) -
Teruo Yamashita, Chojiro Yamashita, Keiji Ataka, Naoki Yoshimura, Masa ...1995 Volume 24 Issue 6 Pages 388-391
Published: November 15, 1995
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSDrug refractory atrial flutter (AF) with secundum atrial septal defect (ASD) and pulmonary valvular stenosis was treated by surgical correction and intraoperative radiofrequency (RF) current ablation. Supraventricular arrhythmia, especially AF, is frequently found in aged patients with ASD. Perioperative managements for this arrhythmia were difficult because of drug refractoriness. We performed this ablation combined with intracardiac corrections, and sinus rhythm has been maintained without any drugs for 18 months. This case indicated that RF current ablation during open-heart surgery is useful and safe method of treatment of AF.View full abstractDownload PDF (1558K) -
Toshiro Ohbuchi, Takeshi Miyairi, Hirotaka Inaba, Akira Mizuno1995 Volume 24 Issue 6 Pages 392-394
Published: November 15, 1995
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSThe early postoperative use of continuous hemodiafiltration (CHDF) was effective in the postoperative management of two patients with chronic renal failure (CRF) undergoing cardiovascular operation. The first case was a 74-year-old man with a ruptured abdominal aortic aneurysm who underwent emergency Y-shaped artificial graft replacement. The second case was a 55-year-old man with aortic valve stenosis and regurgitation who underwent aortic valve replacement with a mechanical cardiac valve. Both patients had had chronic renal failure for several years before the operation, and the second patient had been on intermittent hemodialysis. Although a large amount of blood transfusion was needed postoperatively in both cases, CHDF enabled us to maintain the electrolytes in the normal range and control the water balance. The influence on the hemodynamics was minimized by adjusting the filtration rate. In conclusion, CHDF is useful for the management of CRF in the early postoperative period following cardiovascular surgery.View full abstractDownload PDF (384K) -
Makoto Takeda, Kuniyosi Yagyu, Yutaka Kotsuka, Masahide Chikada, Akira ...1995 Volume 24 Issue 6 Pages 395-397
Published: November 15, 1995
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA 34-year-old male with chest pain and shock was admitted as an emergency case to our unit. Ruptured acute aortic dissection with annuloaorticectasia was suspected and emergency operation was performed. Acute aortic dissection was localized at the aortic root. The right coronary orifice was involved with the dissection, and an intimal tear was found just above it. Aortic root replacement with composite graft was performed as follows. The aortic wall around the coronary orifice was incised in a circular manner like a button and the dissection of the aorta around the coronary orifice was repaired. Dacron tubes with xenopericardial skirts were interposed between the coronary orifices and the composite graft. Wrapping of the composite graft was completed using the aortic wall and xenopericardium. The postoperative course was uneventful with only slight bleeding. Our procedure is useful for acute aortic dissection around the coronary orifice.View full abstractDownload PDF (1033K) -
Jiro Hirai, Shinichi Satoh, Satoshi Niu, Keiichi Kanda, Kiyoshi Doi, T ...1995 Volume 24 Issue 6 Pages 398-400
Published: November 15, 1995
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA case of non-anastomotic aneurysms of a knitted Dacron graft is reported. The patient, a 35-year-old female, had had a bypass operation with a Cooley double velour knitted Dacron graft 11 years previously for stenosis of the descending thoracic aorta caused by aortitis syndrome, was admitted complaining of a painful pulsating tumor of the left hypochondral region. We diagnosed multiple aneurysms of Dacron graft with computerized tomography and aortography. The dilated Dacron graft was resected and replaced by a woven polyester graft. The resected specimen showed longitudinal ruptures macroscopically and a decrease of the number of Dacron fibers at the dilated portion was detected microscopically. The nonuniformity of the diameter of Dacron fibers and cracks in the fibers were observed with a scanning electron microscope. Thus, for patients implanted with a knitted Dacron graft, periodical careful follow-up is required for early detection of aneurysmal changes of the graft.View full abstractDownload PDF (1203K) -
Takashi Miyamoto, Testsuo Hadama, Yoshiaki Mori, Osamu Shigemitu, Tats ...1995 Volume 24 Issue 6 Pages 401-403
Published: November 15, 1995
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA 58-year-old man was admitted with pulsatile abdominal mass with fever and dull pain. Abdominal aortic aneurysm with left hydronephrosis due to obstruction of the left ureter was diagnosed by CT scanning. Aortic valve replacement was performed ten years previously for aortic regurgitation and recently his cardiac function deteriorated. On the 5th day after admission he suddenly suffered from hemorrhagic shock with massive melena. Emergency laparotomy was performed and ruptured abdominal aortic aneurysm was observed penetrating to the sigmoid colon with perianeurysmal abscess. The abdominal aorta was excluded and closed using two-layer sutures just below the renal artery, and bilateral common iliac arteries were also closed. The aneurysmal sac and the sigmoid colon were removed as a whole, and colostomy was made according to Hartmann's procedure. Permanent right axillo-bifemoral bypass graftiny was made to avoid infectious complications of the vascular graft. A successful vascular reconstruction was done without any complication of graft infection, however he died of cardiac failure due to dilated cardiomyopathy after 4 months postoperatively. We reported a successfully treated abdominal aortic aneurysm extending to the sigmoid colon with hemorrhagic schok.View full abstractDownload PDF (1241K) -
Masahisa Uematsu, Shuichi Kozawa, Tyojiro Yamashita, Keiji Ataka, Masa ...1995 Volume 24 Issue 6 Pages 404-410
Published: November 15, 1995
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA 34-year-old male patient was admitted to our hospital with sudden onset of severe chest pain. A diagnosis of acute aortic dissection (Stanford type A) was made based on the results of examinations such as CT-scan and angiography. An emergency surgical replacemant of the ascending aorta was carried out. Multiple malperfusion phenomena such as cerebral, renal, right upper extremity and visceral Ischemia appeared postoperatively. With strict conservative therapy and laparotomy (descending colectomy), he survived and was rehabilitated. Acute aortic dissection associated with malperfusion phenomena are frequent and potentially extremely poor complication. Therefore, prognosis is determined by accurate and rapid diagnosis and salvage of the ischemic organs. In treatment of the acute aortic dissection, the control of the blood pressure is important, but also close attention should be paid to sufficient perfusion of the major organs.View full abstractDownload PDF (3741K)
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