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Volume 27, Issue 4
Displaying 1-15 of 15 articles from this issue
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Katsuhisa Onoguchi, Takashi Hachiya, Tatsumi Sasaki, Kazuhiro Hashimot ...1998 Volume 27 Issue 4 Pages 197-200
Published: July 15, 1998
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSWe report two cases of patch reconstruction for distal arch aneurysms. Supportive measures during operation included selective cerebral perfusion for brain protection and cardioplegic arrest for heart protection. During operation the whole body except for the heart was cooled down to 25°C, and only the heart was perfused at 36°C and kept beating. Both aneurysms were saccular, and after the resection of the aneurysm the defect of the aortic wall was reconstructed with woven double velour patches. The relationship between the pressure and the flow during coronary perfusion is not clear, but we thought the above measures should be taken when operating on distal arch aneurysm.View full abstractDownload PDF (1845K) -
Hiroshi Furukawa, Takato Hata, Yoshimasa Tsushima, Mitsuaki Matsumoto, ...1998 Volume 27 Issue 4 Pages 201-206
Published: July 15, 1998
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSAortic valve disease is frequently associated with coronary artery disease and arrythmia. Recently, the mortality of aortic valve replacement has decreased because of more effective myocardial protection, so operations that combine aortic valve replacement and coronary bypass grafting or the Maze procedure for atrial fibrillation have been performed. We treated 25 patients undergoing aortic valve replacement combined with coronary bypass grafting and 2 patients undergoing aortic valve replacement with a modified Maze procedure from 1990 to 1996. Among the patients undergoing aortic valve replacement combined with coronary bypass grafting, there were no perioperative deaths and no development of coronary artery disease, malfunction of mechanical valve, or thrombosis. Two patients undergoing aortic valve replacement with a modified Maze procedure and tricuspid valve annuloplasty have reverted to sinus rhythm from atrial fibrillation with no anti-arrythmic agent. Surgery for combined aortic valve disease and coronary artery disease or arrythmia resulted in an improvement of late survival and quality of life.View full abstractDownload PDF (1258K) -
Shinsuke Choh, Masato Ohhira, Tatsuya Inoue, Mitsumasa Hata, Mitsuo Na ...1998 Volume 27 Issue 4 Pages 207-211
Published: July 15, 1998
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSWe investigated the clinical results of coronary arterial bypass grafting (CABG), using a terminal warm blood cardioplegia (TWBCP) for myocardial preservation. In the past 6 years, 102 cases of CABG have been performed at our institution. These 102 cases were divided into the following two groups; (1) Group T, consisting of 41 cases, in which TWBCP was employed; (2) Group non-T, consisting of 61 cases, in which TWBCP was not employed. We performed a comparative study between the groups on the perioperative cardiac function and so on. Between the two groups, there were no significant differences in age, gender, preoperative ejection fraction (EF), operative time, cardiopulmonary bypass time (CPBT) and the level of CPK-MB. In group T, the number of grafts was significantly more than that in group non-T (p=0.002). Aortic cross-clamp time was significantly longer in group T. However, the duration of assisted circulation after aortic declamp was significantly longer in group non-T than that of group T (p=0.01). The incidence of ventricular fibrillation after release of aortic clamp in group T was 9.8%, while it was 67.2% in group non-T, showing a significant difference. Furthermore, the postoperative cardiac index in group T was significantly higher than that in group non-T. These results suggest that it is important for the myocardium, to recover from its ischemic damage caused by VF after release of aortic cross-clamp. In conclusion, we consider it effective to employ TWBCP in CABG to improve postoperative cardiac function.View full abstractDownload PDF (1446K) -
Ken Suzuki, Yoshiki Sawa, Shigeaki Ohtake, Hiroshi Imagawa, Satoshi Ta ...1998 Volume 27 Issue 4 Pages 212-216
Published: July 15, 1998
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSWe have experienced 3 successful repair surgeries for insufficient bicuspid aortic valve. The operative procedure consisted of combinations of suture placation, raphe triangular resection, commisural annuloplasty, and patch closure of perforation due to infectious endocarditis. The postoperative course was uneventful and postoperative echocardiography showed residual regurgitation as only trivial or mild. Retrospective study done on 19 previous cases with insufficient bicuspid aortic valve demonstrated that this operative procedure could have been applied in 15 (79%) of the cases. These results showed that repair surgery for insufficient bicuspid aortic valve is useful and has a wide application.View full abstractDownload PDF (574K) -
Ken Suzuki, Shigeaki Ohtake, Hiroshi Imagawa, Hikaru Matsuda1998 Volume 27 Issue 4 Pages 217-221
Published: July 15, 1998
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSFour patients with multiple dissecting aortic aneurysms treated surgically from 1960 to 1996 were evaluated clinically. The incidence of multiple dissecting aortic aneurysms was 3.2% of all surgically treated cases of aortic dissection. Only one case suffered from Marfan's syndrome. Morphologically, all cases showed chronic DeBakey II+III type dissection. Case 1 was treated by Bentall's operation for DeBakey II type dissection and the residual aortic aneurysm was not treated surgically. Case 2 underwent a two-staged operation: Bentall's operation first, followed by entry closure with plication of the DeBakey III type aneurysm. Case 3 underwent a two-staged operation: graft replacement of the ascending aorta combined with coronary artery bypass grafting in the first operation and graft replacement of descending and abdominal aorta in the second. Case 4 was treated by graft replacement of the hemiarch, resuspension of the aortic valve and entry closure of the DeBakey III type dissection. Among them, two cases (Cases 1 and 2) whose aneurysms were treated incompletely showed a rapid growth and rupture of residual DeBakey III type aneurysm. In conclusion, one-staged aggressive and complete operation should be done for the patients with multiple dissecting aortic aneurysms. When a two-staged operation is selected, more intensive follow-up of the residual aortic aneurysm is needed.View full abstractDownload PDF (634K) -
Masakazu Sogawa, Akira Saito, Osamu Namura, Hajime Ohzeki, Hisanaga Mo ...1998 Volume 27 Issue 4 Pages 222-226
Published: July 15, 1998
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA minimally invasive approach to coronary artery revascularization without cardiopulmonary bypass has been performed recently and its feasibility and effectiveness have been proved. However, occlusion of the coronary artery during anastomosis in the beating heart is liable to cause myocardial ischemia or infarction. To prevent these and to perform minimally invasive coronary artery bypass on the beating heart safely, intra-coronary shunt was developed and applied in animal experiments. Materials and methods: The left internal mammary artery was harvested endoscopically and anastomosed to the left anterior descending coronary artery in the beating heart without cardiopulmonary bypass in seven pigs. Three of them utilized intracoronary shunt tubes (group S) and the other did not (group C). Results: Use of an intracoronary shunt tube facilitated non-blood exposure of the coronary artery during anastomosis. In group C, three pigs out of four had ventricular fibrillation during occlusion for the anastomosis. In group S the anastomosis was accomplished without change of ECG except one case and without any elevation of CPK-MB and Troponin T during and after the anastomosis. Conclusion: These results showed that an intra-coronary shunt can prevent myocardial ischemia and may be very useful especially to those who do not develop collateral branches from other coronary arteries.View full abstractDownload PDF (1259K) -
Nobuhiko Hayashida, Hiroshi Maruyama, Eiki Tayama, Hiroshi Tomoeda, Ts ...1998 Volume 27 Issue 4 Pages 227-232
Published: July 15, 1998
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSWe studied the effects of intermittent tepid blood cardioplegia on patients with prolonged aortic cross-clamping. Forty patients undergoing coronary artery bypass grafting with cross-clamp time of greater than 120 minutes were studied. The patients were divided into two groups according to the cardioplegic solutions, cold (4°C) crystalloid cardioplegia (Cold) and tepid (30°C) blood cardioplegia (Tepid). Cardiac function, myocardial enzyme and clinical outcomes were compared between the groups. Mean aortic cross-clamp time were 150±10 minutes in the Cold group and 149±4 minutes in the Tepid group. Recovery rate of spontaneous rhythm after cross-clamp removal and postoperative left ventricular stroke work index were significantly greater in the Tepid group than those in the Cold group. Duration of ventilation and ICU stay were significantly shorter and total release of CK-MB, requirements of dopamine during 48 hours after the operation and the incidence of low-output syndrome were significantly less in the Tepid group. There were no early deaths in the Tepid group versus three early deaths in the Cold group. In conclusion, intermittent tepid blood cardioplegia provided superior postoperative cardiac function and clinical results to conventional cold crystalloid cardioplegia, thus the technique appears to be safe for patients requiring prolonged aortic cross-clamping.View full abstractDownload PDF (765K) -
Masaru Sasaki, Jun Kawamoto, Saihou Hayashi1998 Volume 27 Issue 4 Pages 233-236
Published: July 15, 1998
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA 62-year-old man was diagnosed as having atrial septal defect (ASD) and atrial fibrillation (Af) upon admission to our hospital with acute myocardial infarction. He was placed on medication for 3 years but surgery was considered necessary because of the further complication of angina pectoris. Coronary arterial bypass grafting, ASD closure and right atrial separation procedure which was a modification of the right-sided maze operation, were performed simultaneously. Although chronic Af disappeared immediately after surgery, it reappeared on the 8th postoperative day, and medicinal and electrical defibrillation had no effect. We considered that the main cause of Af accompanied by ASD had existed in the right atrium before surgery. Also, as the right atrial separation procedure was less invasive than the Cox/maze procedure for such complications in patients with ischemic heart disease, we chose this method. In our patient, postoperative left ventricular loading was considered to have been the cause of Af recurrence. Therefore the indications for this procedure should be decided carefully in patients with preoperative left ventricular hypofunction or left atrial dilatation.View full abstractDownload PDF (1123K) -
Hiroshi Sugimura, Koji Watanabe, Shuichiro Sugimura, Tadashi Iriyama, ...1998 Volume 27 Issue 4 Pages 237-240
Published: July 15, 1998
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA 58-year-old man was admitted for pneumonia after several business trips to Thailand, Vietnam, and Malaysia. Despite resolution of pneumonia on chest X-ray, high fever persisted. CT scan revealed a juxtarenal, atypical-shaped abdominal aortic aneurysm of 4.5cm in size, and this was thought to be the cause of persisting fever. After prolonged antibiotic treatment, surgical resection and prosthetic tube replacement of the aneurysm was performed. The aneurysm was a pseudoaneurysm, and histological examination showed chronic inflammation with no atherosclerotic change. It was thought to be of mycotic origin. On the 12th day after operation, he became febrile, and an arterial blood culture yielded Burkholderia pseudomallei. Antibiotics chosen according to sensitivity tests, were given. He was finally discharged with no exidence of persisting infection, on the 55th day after operation.View full abstractDownload PDF (1374K) -
Nobuchika Ozaki, Yoshihiro Otaki, Noboru Wakita, Tsutomu Shida1998 Volume 27 Issue 4 Pages 241-244
Published: July 15, 1998
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA 70-year-old man with a diagnosis of unstable angina pectoris (UAP) and arteriosclerosis obliterans (ASO) was admitted to our hospital with chest pain and intermittent claudication of both lower extremities. Coronary artery bypass grafting (CABG) was performed prior to peripheral arterial reconstruction due to UAP. He was in good condition after CABG, but he had sharp pain in both lower extremities suddenly on the 2nd postoperative day and the creatinine phosphokinase level increased to 17, 560IU/l. On the 3rd postoperative day axillo-bifemoral bypass was performed. However 5 hours after the revascularization, respiratory arrest and ventricular fibrillation occurred and he died in spite of attempted cardiopulmonary resuscitation.View full abstractDownload PDF (1336K) -
Takeshi Shimamoto, Mitsuhiko Matsuda, Takeshi Soeda, Masaki Aota, Kazu ...1998 Volume 27 Issue 4 Pages 245-248
Published: July 15, 1998
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA 55-year-old man was admitted with anterior chest pain. He had received aorto-renal bypass for left renal artery stenosis at the age of 24. His coronary angiography with ergotamine malate provocation showed 99% stenosis in the left anterior descending artery and circumflex artery and abdominal aortography revealed an aneurysm with a diameter of 4cm at the proximal site of the graft anastomosis. The patient was surgically treated with aneurysmectomy and PTFE grafting (7mm) between abdominal aorta and the already-implanted graft to the left renal artery. His postoperative course was uneventful and no major complication such as renal failure were observed. Anastomotic aneurysm is a fairly common complication associated with arterial reconstruction which is most common in the common femoral artery. This is the first reported case of anastomotic aneurysm complicated by aorto-renal bypass.View full abstractDownload PDF (1687K) -
Kazuhiko Higuchi, Atushi Harada, Toshio Konishi, Mutumi Fukata, Shinzi ...1998 Volume 27 Issue 4 Pages 249-252
Published: July 15, 1998
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSCryoablation was performed simultaneously with mitral valve plasty for a 65-year-old man with atrial fibrillation and mitral insufficiency. The sites of cryoablation were determined during atrial fibrillation using a computer-atrial-mapping system when the operation was performed. The site of repetitive activation was found at the area between the left atrial appendage and the superior left pulmonary vein. That area and the surrounding area were cryoablated five times (-60°C, 5min). After operation, normal sinus rhythm returned without the continuous use of any antiarrythemic drugs. Furthermore, the patient who underwent mitral valve plasty, does not need any anticoagulant drugs. This procedure was very effective and had little operative risk in this case. The patient is doing well with normal sinus rhythm 6 months after the operation.View full abstractDownload PDF (2083K) -
Jun Kawamoto, Masaru Sasaki, Saihou Hayashi1998 Volume 27 Issue 4 Pages 253-255
Published: July 15, 1998
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSThe patient was a 71-year-old man with intermittent claudication. Angiography indicated severe stenosis of the right common iliac artery. The right femoral artery was anastomosed to an artificial graft by conventional hand-sewn suturing and the left femoral artery by the Vascular Closure Staples (VCS). Postoperatively, the patient had an uneventful recovery and was discharged. This new procedure minimizes trauma to the vascular intima since the arcuate legged clip is non-penetrating. Suturing with VCS is more extensive than by the conventional method. VCS has been applied by the authors to treat arteriosclerosis obliterans lesions.View full abstractDownload PDF (1410K) -
Masaya Hirai, Shigeo Maki, Takashi Yasuda, Masafumi Kondo, Masaki Hatt ...1998 Volume 27 Issue 4 Pages 256-259
Published: July 15, 1998
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA 59-year-old woman has presented symptoms of fatigue since January 1996. Atypical coarctation due to aortitis syndrome had been diagnosed 8 years earlier. Her upper-limb blood pressure was 200mmHg and antihypertensive drugs were administered. An aortogram showed severe stenoses of the aorta at the level of the diaphragm and renal artery. A computed tomogram showed extensive calcification of the aorta below the origin of the left subclavian artery. She underwent a bypass operation with a 16-mm-diameter prosthetic graft from the ascending aorta to the infrarenal abdominal aorta. She has progressed well after the bypass and her upper-limb blood pressure is almost normal.View full abstractDownload PDF (1793K) -
Katsuhiko Matsuyama, Yuichi Ueda, Hitoshi Ogino, Takaaki Sugita, Tetsu ...1998 Volume 27 Issue 4 Pages 260-262
Published: July 15, 1998
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA 64-year-old woman with dyspnea on exertion was referred to our hospital. CT revealed type B aortic dissection with 7cm of aneurysm including a thrombus in the false lumen at the distal aortic arch. Four intimal tears at the distal aortic arch were closed directly during hypothermic circulatory arrest, and the descending thoracic aorta was tailored without a prosthetic graft after fixation of the dissecting adventitia to the intima at the distal portion of the false lumen. The postoperative course was uneventful and this patient was discharged on the 22nd postoperative day. Three years after surgery, the postoperative CT revealed no evidence of dilatation of the descending thoracic aorta as far as the abdominal aorta although the dissection of thoracoabdominal aorta remained. This technique is effective as an surgical option for chronic type B aortic dissection to minimize operative stress and complications.View full abstractDownload PDF (1321K)
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