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Volume 28, Issue 6
Displaying 1-17 of 17 articles from this issue
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Jun'ichi Oba, Hidetoshi Aoki, Toshihito Yoshida, Takeshi Kanaoka, Kimi ...1999 Volume 28 Issue 6 Pages 359-363
Published: November 15, 1999
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSWe report two cases of acute left main coronary artery obstruction. Because they were hemodynamically unstable and in cardiac arrest refractory to conventional resuscitation measures, emergency percutaneous cardiopulmonary support (PCPS) and intra-aortic balloon pump (IABP) were instituted, which successfully resuscitated the patients. Both of them underwent emergency coronary artery bypass grafting. The first patient survived the surgery and eventually discharged. The second patient was unable to be weaned from the support and died 2 days after surgery. One remarkable difference between these two patients was that reperfusion by PTCA was initially successful in the first patient while reperfusion was not achieved in the second patient. Also, catheter manipulation induced an acute obstruction of left main coronary artery in the second patient, which might have caused poor collateral flow to the circumflex area. In conclusion, initial PTCA is an effective and useful strategy for reperfusion following acute left main coronary artery obstruction. PCPS and IABP are powerful resuscitative tools which may stabilize the patient's hemodynamic condition.View full abstractDownload PDF (2106K) -
Hiroichiro Yamaguchi, Hideto Yamauchi, Shiro Hazama, Hirotsugu Hamamot ...1999 Volume 28 Issue 6 Pages 364-369
Published: November 15, 1999
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSWe assessed the change in intraoperative cerebral oxygen metabolism during coronary artery bypass grafting (CABG) in patients with cerebrovascular desease (CVD) identified by preoperative computed tomography or magnetic resonance imaging. The study population consisted of 36 patients who underwent consecutive CABG and were divided into two groups on the basis of preoperative CVD. With near-infrared spectroscopy, the change in oxygenated hemoglobin/total hemoglobin ratio (%Oxy-Hb), which was regarded as regional tissue oxygenation, was obtained. In addition, jugular venous bulb oxygen saturation (SjO2) was measured simultaneously. Moreover, the influence of intraoperative parameters on cerebral oxygenation was assessed by regression analysis. Thirteen patients (36%) were given a diagnosis of CVD preoperatively (group A) and were compared with the remaining 23 patients as controls (group B). All of group A were asymptomatic cerebral infarction. The average %Oxy-Hb was 51.2±4.1% in group A and 62.0±12.1% in group B (p=0.04), and SjO2 was 63.5±8.6%in group A and 68.1±7.7% in group B (p=0.12). In serial changes, %Oxy-Hb during the late phase of cardiopulmonary bypass (CPB) and SjO2 during the early phase of CPB were significantly lower in group A. The positive correlation between perfusion pressure and SjO2 was demonstrated in groupA (r=0.699, p<0.0001) while no correlation was observed in group B. It is concluded that patiens with silent cerebral infarctions had poorer intraoperative cerebral oxygen metabolism during CABG. It is necessary to keep a higher perfusion pressure in these patients during CPB because cerebral autoregulation may be impaired.View full abstractDownload PDF (826K) -
Tetsuya Kono, Hirohisa Goto, Tsuneo Nakajima, Hirofumi Nakano, Jun Ama ...1999 Volume 28 Issue 6 Pages 370-373
Published: November 15, 1999
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSDirect coronary artery reimplantation to the aorta and mitral valve repair were successfully performed in a 29-year-old female with Bland-White-Garland syndrome (BWG syndrome). Under cardiopulmonary bypass, the main pulmonary artery was completely transected and the left coronary artery was excised with a cuff of pulmonary artery wall. Then the left coronary artery was directly anastomosed to the ascending aorta. Mitral regurgitation was repaired with valvulo-annuloplasty. The post operative course was excellent.View full abstractDownload PDF (1525K) -
Hidenori Yoshitaka, Takato Hata, Yoshimasa Tsushima, Mitsuaki Matsumot ...1999 Volume 28 Issue 6 Pages 374-376
Published: November 15, 1999
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA 57-year-old man underwent subtotal graft replacement of the thoracic aorta for aneurysms of both the ascending and descending aorta. On the 20th post-operative day, pus was found to be draining from the sternotomy wound. The wound was opened and irrigated with 2% Povidoneiodine solution for a total of 3 months. Culture of the pus from the irrigation revealed Staphylococcus epidermidis. When there were no clinical indications of infection and wound cultures were negative, the necrotic sternum and surrounding tissue were debrided and an omental graft was placed in the cavity. Upon follow-up examination, the patient is doing well 10 months after the initial surgery.View full abstractDownload PDF (1146K) -
Shingo Ohuchi, Takayuki Nakajima, Yukihiro Minagawa, Kenji Komoda, Koh ...1999 Volume 28 Issue 6 Pages 377-380
Published: November 15, 1999
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA 73-year-old man complained of pain in the right lower abdomen with hypotension. The result of abdominal computed tomography (CT) suggested a rupture of an abdominal aortic aneurysm. Emergency Y graft replacement was performed. During surgery, a perforation of about 1cm in diameter was found in the posterior wall of the abdominal aorta just above the iliac bifurcation. The patient developed postoperative complication of retroperitonitis. The cultures of blood clots collected during surgery grew Bacteroides fragilis, as did postoperative drainage fluid from the retroperitoneum. On the 10th day of illness, axillo-bifemoral bypass was performed and the Y graft was removed. Although continuous lavage of the retroperitoneum was performed, he did not recover from retroperitonitis and died of sepsis 2 months after surgery. Infected abdominal aneurysm is rarely caused by Bacteroides. We discussed the infectious route and treatment of this rare condition with a review of the literature.View full abstractDownload PDF (1378K) -
Takahiko Aoyama, Takashi Ota, Chihiro Narumiya, Takenori Mase, Kensuke ...1999 Volume 28 Issue 6 Pages 381-384
Published: November 15, 1999
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSWe reported a case of left atrial myxoma with renal infarction as an initial clinical symptom. A 65-year-old man had severe right lumbago. A chest CT demonstrated right renal artery embolism. On emergency operation a right renal embolus was removed. Preoperative echocardiography and transesophageal echo showed a tumor in his left atrium which was close to the mitral valve. The tumor was resected one week after the first operation. Embolectomy of the right renal artery could not restore renal function. To the best of our knowledge, this type of cardiac myxoma with renal infarction as an initial clinical symptom is rare.View full abstractDownload PDF (2533K) -
Ichiro Morita, Hisao Masaki, Hiroshi Inada, Daiki Kikugawa, Atsushi No ...1999 Volume 28 Issue 6 Pages 385-388
Published: November 15, 1999
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA rare case of juxtarenal aortic occlusion due to Takayasu's arteritis is reported. A 46-year-old man who had been suffering from intermittent claudication from the age of 44 when Buerger's disease was suspected at another hospital because of exacerbation of the symptom. Occlusion of the abdominal aorta and severe aortic wall thickness were identified by the abdominal CT scan. After the improvement of inflammation, under the diagnosis of juxtarenal aortic occlusion due to inflammatory disease, we performed an aortobifemoral bypass grafting using a Y-shaped prosthesis (proximal anastomosis was end-to-end) found a tight inflammatory adhesion around the abdominal aorta. Histopathological examination of the resected specimen revealed an infiltration of lymphocytes, plasma cells in aortic media and adventitia, severe fibrosis in the aortic adventitia, and a diagnosis of Takayasu's arteritis was made. The postoperative course was uneventful but we should periodically check for inflammatory signs, and anastomotic aneurysms.View full abstractDownload PDF (1491K) -
Hidenori Sako, Tetsuo Hadama, Yoshiaki Mori, Osamu Shigemitsu, Shinji ...1999 Volume 28 Issue 6 Pages 389-391
Published: November 15, 1999
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA 39-year-old man received Bentall's operation for annuloaortic ectasia in July 1985. He was admitted with a high fever in July 1998. On the 2nd day of his admission, he suddenly suffered from headache and dizziness. Head computed tomography showed multiple low density areas in the right cerebrum and cerebellum. A transesophageal echocardiogram revealed massive vegetation around the prosthetic valve. The patient underwent emergency operation using cardiopulmonary bypass. The left ventricle outflow was almost occluded by thrombi. The prosthetic valve and graft were removed completely and replaced with a 24mm Gelseal® graft and a 23mm St. Jude Medical® valve. The right coronary ostium was reimplanted directly on the prosthesis, and the left coronary ostium was reinserted using a 10mm graft. The patient's intraoperative tissues grew S. aureus and parenteral antibiotics were administered for 5 weeks after surgery. The patient was discharged on the 45th postoperative day and is doing well 9 months after the operation.View full abstractDownload PDF (1193K) -
A Case Report and a Review of the Literature in JapanYoshinobu Hattori, Kouji Watanabe, Kouji Negi, Isao Takeda, Tadashi Ir ...1999 Volume 28 Issue 6 Pages 392-395
Published: November 15, 1999
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSLeft ventricular myxoma is very rare and only 13 cases have been reported in Japan. A 14-year-old girl was admitted to a local hospital in November, 1983, with a sudden onset of right hemiparalysis. Two-dimensional echocardiograms and left ventricular angiograms revealed two left ventricular tumors. The patient was transferred to our hospital for the operation which was performed one month later. Two tumors originating from the apical interventricular septum were removed with resection of the septum through a left ventriculotomy. The tumors were 2.0×1.7cm in size and 1.9g in weight, 1.9×1.5cm in size and 1.1g in weight, respectively. The pathological diagnosis was myxoma. Her postoperative course was uneventful, and there has been no recurrence for 15 years after surgery. Japanese literature on the subject was reviewed.View full abstractDownload PDF (1460K) -
Koji Akasu, Tomokazu Kosuga, Satoru Tobinaga, Shinsuke Hayashi, Hirosh ...1999 Volume 28 Issue 6 Pages 396-398
Published: November 15, 1999
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA 36-year-old woman was admitted because of dyspnea on exertion and palpitations, during follow-up for ventricular septal defect since age 5. Physical examination revealed a grade IV/VI ejection systolic murmur at the second left intercostal space. Echocardiogram failed to recognize an unruptured aneurysm of the sinus of Valsalva protruding into the right ventricle which was seen on right ventriculogram (type I of Konno). Surgical treatment was successfully performed. Right ventriculography was much more effective rather than echocardiography in this case.View full abstractDownload PDF (1234K) -
Yoshinobu Hattori, Tadashi Iriyama, Kouji Watanabe, Kouji Negi, Mitsur ...1999 Volume 28 Issue 6 Pages 399-402
Published: November 15, 1999
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSUrgent surgical repairs were successfully performed in four patients with blunt traumatic ruptures of the thoracic aorta. All 4 patients were involved in traffic accidents and had ruptures immediately distal to the aortic isthmus. The diagnoses were achieved by IV-DSA in case 1, by IV-DSA and enhanced CT in case 2 and by enhanced helical CT in cases 3 and 4. Intraoperative transesophageal echocardiography was performed in case 4. Operations were accomplished with the aid of temporary shunt in case 1, pulmonary-femoral artery bypass in case 2 and partial left heart bypass in cases 3 and 4. Prosthetic graft interposition was performed in cases 1, 3 and 4 and end-to-end aortic anastomosis was performed in case 2. There was no postoperative paraplegia in any patient. Early diagnosis and urgent surgical repair are important in treating blunt traumatic rupture of the thoracic aorta. Enhanced helical CT and transesophageal echocardiography are useful for the diagnosis of this type of injury.View full abstractDownload PDF (1897K) -
Taijiro Sueda, Kenji Okada, Masanobu Watari, Kazumasa Orihashi, Hiroo ...1999 Volume 28 Issue 6 Pages 403-405
Published: November 15, 1999
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA 34-year-old woman was referred to us because of severe aortic regurgitation and annuloaortic ectasia. She also showed a high level of CRP and stenosis of cervical arteries and aortitis syndrome was diagnosed. A translocated Bentall's procedure was performed after administration of corticosteroid. An SJM valve prosthesis was translocated from 1cm above the distal end of the graft and this composite graft was anastomosed to the aortic annulus with buttress sutures reinforced with Dacron felt. Both coronary orifices were reconstructed with small sized Dacron grafts, interposed from the coronary orifices to the composite graft. There was not any complication postoperatively. This procedure is preferable in cases with aortitis syndrome, because it decreases risk of prosthetic detachment in the aortic valve position.View full abstractDownload PDF (1110K) -
Tamotsu Yasuda, Sinichiro Yamamoto, Yoshinori Ishida1999 Volume 28 Issue 6 Pages 406-409
Published: November 15, 1999
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA 50-year-old woman who had received hemodialysis for 8 years was admitted due to lumbago, fever and leukocytosis. Computed tomography and angiography revealed a supraceliac saccular aneurysm and right pleural effusion. Impending rupture of an infected supraceliac aneurysm was strongly suspected, and an emergency operation was performed. The aneurysm was almost completely resected and replaced by a 24mm Hemashield graft with reconstruction of visceral and intercostal arteries using partial bypass and deep hypothermia. Staphylococcus aureus infection was diagnosed based on the culture of the aneurysmal wall. The postoperative course was uneventful without any adverse neurological symptoms. After surgery, antibiotics were administered for 4 weeks intravenously. The patient is well 22 months after the operation.View full abstractDownload PDF (1723K) -
Hirohisa Goto, Yukio Fukaya, Kazunori Nishimura, Jun Amano1999 Volume 28 Issue 6 Pages 410-413
Published: November 15, 1999
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSA 69-year-old man in whom two stents had been implanted on segments 6 and 7 was admitted to our hospital with acute myocardial infarction (AMI). Coronary angiography suggested a total occlusion of the left anterior descending (LAD) between two stents. Percutaneous transluminal coronary angioplasty (PTCA) was performed, but it made an acute coronary occlusion due to a dissection of left main trunk (LMT). As cardiogenic shock occurred, he was put on percutaneous cardioplumonary support (PCPS), and a perfusion catheter was introduced to the LAD and a guide wire to the circumflex (Cx). Emergency coronary artery bypass grafting (CABG) was performed on cardioplumonary bypass (CPB). First, an SVG was grafted to the LAD on ventricular fibrillation, and the other SVG was grafted to segment 13 on cardiac arrest after the perfusion catheter and guide wire was removed. This method allowed this operation to be performed with suitable myocardial protection.View full abstractDownload PDF (2424K) -
Fumiaki Kawazuma, Tsutomu Saito, Osamu Kamisawa, Yoshio Misawa, Katsuo ...1999 Volume 28 Issue 6 Pages 414-417
Published: November 15, 1999
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSInjury to the thoracic aorta is often fatal. We encountered a case of aortic rupture caused by a traffic accident. A 20-year-old man was transferred to our hospital because of right elbow fracture and enlargement of the upper mediastinum on X-ray. We diagnosed aortic isthmus rupture by chest CT with enhancement. He did not have chest pain, but complained of severe pain in the right elbow. His hemodynamic condition was stable, but his right arm become swollen with increasing sensory disturbance. Chest CT and blood cell count showed no interval change between results at a previous hospital and ours. So we decided to operate on his right arm before aortic rupture. After the open reduction of his fractured elbow, pleural effusion increased although his hemodynamic condition was stable. Then the descending aorta was replaced under partial cardio-pulmonary bypass. His post-operative course was uneventful.View full abstractDownload PDF (1341K) -
1999 Volume 28 Issue 6 Pages 418
Published: November 15, 1999
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSDownload PDF (150K) -
1999 Volume 28 Issue 6 Pages 419
Published: November 15, 1999
Released on J-STAGE: April 28, 2009
JOURNAL FREE ACCESSDownload PDF (126K)
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