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Volume 26, Issue 1
Displaying 1-15 of 15 articles from this issue
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Kazunari Yamana, Hidetoshi Akashi, Yoshiteru Higa, Keiichiro Tayama, E ...1997 Volume 26 Issue 1 Pages 1-5
Published: January 15, 1997
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSWe present the outcome of surgical management for thoracoabdominal aneurysms in 27 patients during the past 22 years. Ischemia of visceral organs was successfully prevented by axillo-femoral temporary bypass using a 10mm PTFE graft with an 8mm branch for main visceral vessels and partial extracorporeal circulation perfusing visceral organs. No other significant problems were encountered. Paraplegia occurred in 5 patients (18.5%). Three of them had received reconstruction of the intercostal arteries. Patients treated by spinal fluid drainage developed no paraplegia. The Crawford inclusion and Piehler bypass techniques were useful in reconstructing the main visceral vessels. Two patients died of ruptured proximally anastomosed thoracic aorta after a thromboexclusion technique. Early death occurred in three patients and late death in one.View full abstractDownload PDF (629K) -
Katsuhiko Yoshida, Hideki Ohshima, Fumihiko Murakami, Yasuhiro Tomida, ...1997 Volume 26 Issue 1 Pages 6-10
Published: January 15, 1997
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSThe combined superior transsseptal approach (CSTA) has been used for 12 mitral or left atrial myxoma operations. This approach provided excellent exposure of the mitral valve or myxoma. This approach was compared with the transseptal and left atrial approaches in 1 and 3 cases, respectively. There were no differences in operative time, cardiopulmonary bypass time, anoxic time, bleeding volume, blood transfusion volume and postoperative arrhythmic complications. We use CSTA for cases with tricuspid valve disease, small left atrium, reoperation and left atrial myxomas.View full abstractDownload PDF (559K) -
A Comparison Study with Ischemic Heart DiseaseSatoshi Ohki, Hisao Kumakura, Shouichi Tange, Shuichi Ichikawa, Yoshio ...1997 Volume 26 Issue 1 Pages 11-15
Published: January 15, 1997
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSIn order to elucidate risk factors in arteriosclerosis obliterans (ASO), histories and physical and laboratory findings were reviewed in 163 patients with ASO, and the results were compared with ischemic heart disease (IHD) patients. Patients with ASO were much older and smoked more than patients with IHD. Such complications as hypertension, cerebrovascular disease were significantly more frequent in ASO patients than in IHD patients. On the other hand, the levels of serum total cholesterol, triglycerides, Apo A-II and Apo B were significantly lower in ASO patients than in IHD patients, although lipoprotein(a) tended to be higher in ASO. In ASO, remnant-like particles cholesterol tended to be higher when other presumable atherosclerotic risk factors were absent. The present results indicate that male gender, aging, smoking habit, hypertension and cerebrovascular disease are major risk factors in ASO patients. Although abnormal lipid metabolism may contribute to the development of ASO, we postulate that it plays a less significant role in IHD.View full abstractDownload PDF (584K) -
Hajime Sakurai, Mitsuya Murase, Masanobu Maeda, Syuji Tamaki, Takao Ni ...1997 Volume 26 Issue 1 Pages 16-21
Published: January 15, 1997
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSThirteen cases of ruptured abdominal aortic aneurysm were treated during a period of 7 years and 5 months. In 6 cases, left thoracotomy was used before laparotomy to clamp the descending thoracic aorta. The merits and demerits of this method were evaluated in this study. It is useful for early improvement of cerebral and coronary circulation and prevention of sudden spurting hemorrhage, especially in cases with the previous laparotomies. On the other hand, this method has a shorter clamp time limit and requires much time in cases with pleural adhesions. It may increase the amount of operative bleeding and the incidence of postoperative respiratory insufficiency. It may also cause an intraoperative thoracic aortic dissection and rupture of thoracic aortic aneurysms if present. It is considered that this method is advantageous, but should be used only in selected cases.View full abstractDownload PDF (758K) -
Harumasa Yasuda, Taizo Hiraishi, Toru Kobayashi1997 Volume 26 Issue 1 Pages 22-26
Published: January 15, 1997
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSCoronary artery disease (CAD) is common in patients with abdominal aortic aneurysms (AAA). Myocardial infarction is the leading cause of postoperative death and late death after AAA repair. In an attempt to reduce the incidence of perioperative myocardial infarction, routine coronary angiography has been recommended in all patients scheduled for elective AAA repair, and staged myocardial revasculization has been performed using percutaneous transluminal coronary angioplasty (PTCA), if indicated. From March 1987 to February 1995, 40 consecutive patients receiving elective repair of AAA underwent preoperatively coronary angiography. Twenty-one of the 40 patients (53%) had CAD, and in 9 coronary revasculization was indicated. Seven of those patients underwent successful PTCA prior to surgery. One patient had PTCA following surgery for AAA because of technical difficulties in advancing a catheter due to the elongated abdominal aorta. The other patient with triple vessel disease was considered to be unsuitable for PTCA in those days and underwent coronary bypass grafting before AAA repair. There was no operative mortality or perioperative myocardial infarction during and after the repair of AAA. Our results suggest that PTCA should be considered one of the best treatment strategy options for patients with coexistent AAA and CAD.View full abstractDownload PDF (1409K) -
Toru Sato, Tadashi Isomura, Nobuhiko Hayashida, Takaya Higashi, Ikutar ...1997 Volume 26 Issue 1 Pages 27-33
Published: January 15, 1997
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSPostoperative cardiac function, changes of LV wall motion and exercise tolerance test were studied in 49 patients who received coronary artery bypass grafting (CABG) using antegrade intermittent warm blood cardioplegia (IWBC) and had postoperative left ventriculography (LVG). The mean aortic cross clamp (ACC) time was 68.2±22.8 minutes, and the coronary perfusion time during ACC was 12.6±6.9 minutes (18.2±7.1% of total ACC time). Spontaneous return of normal sinus rhythm was seen in 45 patients (92%). Perioperative myocardial infarction occurred in only one patient and one patient required inotropic support>5μg/kg/min after operation. The mean cardiac index measured by Swan-Ganz catheter improved postoperatively, and the postoperative LVG revealed improvement of the LV wall motion in comparison with that of preoperative LVG, and no local asynergy due to inadequate distribution of IWBC was seen in the early postoperative period. The mean postoperative exercise tolerance performed in 24 patients was 6.6 METS (metabolic equivalents), and no patient revealed myocardial ischemia at exercise. In conclusion, the IWBC is considered to be an easy and safe technique for distal anastomoses of CABG with no influence upon the postoperative cardiac function and LV wall motion.View full abstractDownload PDF (854K) -
Toru Sato, Ken-ich Kosuga, Nobuhiko Hayashida, Munetaka Kumate, Tadash ...1997 Volume 26 Issue 1 Pages 34-39
Published: January 15, 1997
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSThe operative results in case of aortic coarctation (CoA) were studied. Between June 1980 and June 1995, 37 children with CoA underwent surgical intervention during their first year of life in our institute. The aortic lesion was repaired by the subclavian flap (SCF) method in 27, direct anastomosis (DA) method in 7, grafting or other methods in 3 children, respectively. The mean follow up period was 7.4±5.3 years (6 months-13 years). Rate of re-stenosis of the aorta was 10% (2 in 20 children) after SCF method, 0% (0 in 7 children) after DA method. The stenotic lesion was successfully dilated by the percutaneous balloon reconstruction in one child. Perioperative mortality was 25% (1/4) in one-stage repair, while one-stage repair was successfully performed in the last three cases and 16.6% (3/18) in two-stage repair for CoA associated with ventricular septal defect (VSD). The mortality was 60% (6/10) of CoA associated with other complex anomalies. In conclusion, one-stage repair seems to be recommendable for the operation of CoA with VSD, and two-stage repair seems to be safe for CoA with complex anomalies.View full abstractDownload PDF (704K) -
Kenzo Itoh, Tetsuya Kitagawa, Takashi Kitaichi, Yasushi Fukuta, Fumio ...1997 Volume 26 Issue 1 Pages 40-45
Published: January 15, 1997
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSFive patients with vascular graft infections were surgically treated over a 16-year period. Primary diseases were arteriosclerosis obliterans in 3 cases and invasion of malignant diseases in 2 cases. The most common site of infection was the groin (3 of 5). Staphylococcus aureus was the most common pathogen. Administration of antibiotics, drainage and lavage with povidone iodine solution were performed in 4 patients (40-64 days). All patients underwent graft resection and reconstruction. Infected parts of the previous grafts were removed. Total removal of the previous graft was performed in 2 cases and partial removal was performed in 3 cases. To avoid re-infection, long extra-anatomical bypass was performed in 4 cases. The post operative courses of the five patients were uneventful.View full abstractDownload PDF (653K) -
Hidetoshi Akashi, Keiichiro Tayama, Shuji Fukunaga, Eizo Kai, Yuji Han ...1997 Volume 26 Issue 1 Pages 46-50
Published: January 15, 1997
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSBetween 1961 and 1994, 121 patients our hospital were treated by conservative and surgical therapy for acute (67 patients) and chronic (54 patients) type B aortic dissection. Among the acute type B aortic dissections, two patients died before operation and 4 patients underwent surgical treatment in the acute phase. The false channel was occluded due to thrombosis in 30 patients. 9 in 31 patients with patent false channels required surgical therapy in the chronic phase. 46 of 54 patients with chronic type B aortic dissection underwent surgical treatment and 9 other patients were not operated on because of the false channel was not enlarged, nearly thrombosed type and refusal to operate. The long-term survival rate appeared to be better in cases acute closing aortic dissection than in cases of aortic dissection with patent false channels. Among the 54 patients who required surgical treatment in the chronic phase, there were eight early deaths (13.3%). Among chronic phase surgical cases, the long term survival rate appeared to be similar to that in type B aortic dissections treated by conservative therapy. Therefore, we consider that type B aortic dissections with acutely thrombotic false channels should be treated by medical therapy, while type B aortic dissection with patent false channel should be treated surgical treatment in the subacute phase or early chronic phase.View full abstractDownload PDF (563K) -
Masahiro Yoshida, Hiroshi Kohnosu, Hayazou Kubo, Kazuhiro Yoshii, Nobu ...1997 Volume 26 Issue 1 Pages 51-54
Published: January 15, 1997
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSSurgical mortality associated with ruptured abdominal aneurysm remains high, especially in elderly patients, despite recent progress in improved patient management. We present the successful salvage of a 90-year-old woman with ruptured abdominal aortic aneurysm. She was transferred from another hospital because of severe abdominal and back pain and pulsatile abdominal tumor. One hour after admission, shock suddenly developed. We diagnosed her illness as ruptured abdominal aneurysm on enhanced CT scan. Emergency surgery was performed. The hematoma surrounding the aneurysm occupied the retroperitoneal space below the level of the diaphragm (Fitzgerald III). Aortic cross clamp was quickly performed below the level of the diaphragm approaching from the lesser omentum. After controlling bleeding, the site of the aortic cross clamping was changed to the infrarenal aorta. The aneurysm was resected and replaced by a knitted Dacron Y-graft (albumin coated). Duration of surgery was 5 hours and 5 minutes. Blood loss was 6200ml. After surgery, artificial ventilation was required for ten days to avoid hypoxemia. On the 5th postoperative day disseminated intravascular congulation (DIC) developed but she recovered. On the 30th postoperative day, she was discharged. Advanced age may not be an absolute contraindication for surgical treatment even in cases of rupture.View full abstractDownload PDF (2044K) -
Takahiko Aoyama, Kensuke Shioi, Takenori Mase, Hideitsu Nogaki, Yoshih ...1997 Volume 26 Issue 1 Pages 55-58
Published: January 15, 1997
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA 2.5 year old male infant who had a ventricular septal defect and mild pulmonary stenosis was admitted for evaluation of fever and anemic complexion in February 1995. After admission, echo cardiography revealed massive vegetations from the outflow of the right ventricle to the right pulmonary artery through the pulmonary valve, and serial blood cultures were found to be positive for streptococcus mitis. Antibiotics did not relieve the high fever or decrease the volume of vegetation in the patient. At surgery, performed 2 weeks after the admission, the pulmonary valve was entirely destroyed and it was resected without prosthetic replacement after the excision of the vegetation and a Teflon patch was used for VSD closure. The post-operative course produced no noticeable complications. In the follow-up echocardiographic study, no vegetation was observed.View full abstractDownload PDF (1889K) -
Keiko Miyazaki, Kazuhiro Myojin, Jun Matano, Tatsuya Murakami, Takashi ...1997 Volume 26 Issue 1 Pages 59-61
Published: January 15, 1997
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSWe experienced a surgically treated case of chronic contained rupture of a common iliac artery aneurysm. A large number of cases of chronic contained ruptures of the abdominal aorta have been reported; however, that of the common iliac artery is very rare. A 66-year-old man was injured in a bicycle accident. Three months later, the patient felt a dull abdominal pain and noticed a tumor in the left lower abdomen. On presenting computed tomography (CT) scan revealed an aneurysm of the left common iliac artery. After further examinations, a contained rupture of the left common iliac artery aneurysm was diagnosed. At operation, the main aneurysm, 7.5×6.5cm in size, was seen in the left common iliac artery, extending to the right common iliac artery and the infrarenal abdominal aorta. A 5.0×3.0cm tear, was found oil the posterior wall of the left common iliac aneurysm, surrounded by a huge hematoma. The aneurysm was resected and the abdominal aorta and the common iliac arteries were replaced with a Bard Albumin-coated DeBakey vascular bifurcated graft (16×8mm). The postoperative course was uneventful.View full abstractDownload PDF (1333K) -
Saihou Hayashi, Masaru Sasaki, Jun Kawamoto1997 Volume 26 Issue 1 Pages 62-64
Published: January 15, 1997
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA 65-year-old woman presented with coughing and dyspnea. Giant left atrial myxoma was found by echocardiography. The tumor size was 7×5×4cm and its weight was 70g. The biatrial approach was chosen over left atriotomy or the transseptal approach. However, it may not be possible to decide on the correct incision line in cases of giant tumor. Intraoperative trans-esophageal echocardiogaphy was useful for evaluation of the mitral valve.View full abstractDownload PDF (1191K) -
Nobuyuki Yanagiya, Naobumi Fujii, Kazunori Nishimura1997 Volume 26 Issue 1 Pages 65-68
Published: January 15, 1997
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA 44-year-old woman in whom multiple descending aortic aneurysms with pseudocoarctation was diagnosed underwent graft replacement. The aneurysms consisted of two large and one small aneurysms. One of the large aneurysms was a fusiform type aneurysm (38mm in diameter), and another one was a saccular type aneurysm (53mm in diameter). There was a small saccular type aneurysm (12mm in diameter) the site of the at stenotic lesion, and the wall of the small aneurysm was very thin. Atherosclerotic changes were not found inside the aneurysmal wall. Aneurysm occurring at the proximal side of the stenotic lesions of pseudocoarctation are rare, and only four cases have been reported in Japan.View full abstractDownload PDF (1196K) -
Mohei Kohyama, Hiroshi Ishihara, Yoshio Ohno, Tatsuya Nakao, Yoshio Og ...1997 Volume 26 Issue 1 Pages 69-72
Published: January 15, 1997
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSMalignant pericardial mesothelioma was successfully resected in a 70-year-old man, who had been admitted complaining of palpitation. Chest X-ray films showed slight cardiac enlargement. A moderate amount of pericardial effusion was noted by echocardiography. Chest X-ray commputed tomography and MRI revealed a localized pericardial tumor. Total excision of the tumor was accomplished through a left thoracotomy approach because the tumor showed neither invasion to the myocardium nor dissemination to the pericardium. The patient was discharged following an uneventful postoperative course. No sign of recurrence has been encountered for nine months after surgery. However careful observation is needed.View full abstractDownload PDF (1422K)
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