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Volume 39, Issue 6
Displaying 1-21 of 21 articles from this issue
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Originals
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Makoto Taoka, Eiichi Tei, Imun Tei, Atsushi Fukumoto, Kazuki Satoh2010 Volume 39 Issue 6 Pages 285-288
Published: November 15, 2010
Released on J-STAGE: December 29, 2010
JOURNAL FREE ACCESSIn 306 patients who underwent elective coronary artery bypass graft (CABG) between January 2005 and July 2008, low cardiac functions (EF<35%) were seen in 24 patients. Of these, 7 (EF, 22.7±5.4%, NYHA 3.4±0.4) had a left ventricular epicardial lead implanted during surgery. On completion of bypass anastomosis, a screw-in-type epicardial lead was implanted. The mean threshold at implantation was satisfactory (1.1±0.4 V). There were no complications related to intraoperative lead placement. In the aforementioned 7 patients, combined Cardiac resynchronization therapy defibrillator (CRT-D) implantation was performed in 4 during the postoperative period while they were still in the hospital. In 1 other patient, the procedure was conducted when he was readmitted for heart failure 3 months after discharge. The threshold for the left ventricular myocardial lead was satisfactory (1.0±0.1 V). No postoperative complications, such as infections, hemorrhage, or twitching, were noted. For those patients who are likely to have a CRT-D placed after CABG, a left ventricular lead showed be implanted if possible for the safe and fast postoperative placemens of a defibrillator. However, the indications of myocardial lead implantation must be considered carefully.View full abstractDownload PDF (272K) -
Manabu Sato, Etsuro Suenaga, Shugo Koga, Hiromitsu Kawasaki2010 Volume 39 Issue 6 Pages 289-293
Published: November 15, 2010
Released on J-STAGE: December 29, 2010
JOURNAL FREE ACCESSThe objective of this study was to evaluate the inflammatory responses in patients who received 1 of 2 different types of woven Dacron grafts. Abdominal aortic surgery was performed in 154 patients between 2002 and 2006, and 102 patients were enrolled in this study. Sealed woven Dacron grafts (INTERGARDTM woven graft, Group I) were implanted in 77 patients and non-sealed woven Dacron grafts (UBE woven graft, Group N) were implanted in 25 patients. All patients received either a bifurcated graft or straight graft replacement. Body temperature (BT), white blood cell counts (WBC), and C-reactive protein (CRP) levels were measured preoperatively and on postoperative days 1, 3, 5, 7 and 14, and were compared between the 2 groups. There were no differences in the patient's mean ages, 73±9 and 71±7 years, or operation time, 213±57 and 210±63 min, between Groups I and N, respectively. Postoperative changes in BT and WBC were similar in both groups. CRP levels were higher in Group N than Group I on postoperative days 5 and 7, but these differences were clinically insignificant. Prolonged inflammatory response which lasted longer than 2 weeks occurred in 2 patients in Group I and in 1 patient in Group N. All patients eventually returned to baseline conditions without special treatments. Thus the postoperative inflammatory responses to coated and non-coated woven Dacron grafts were similar in abdominal aortic surgery.View full abstractDownload PDF (428K) -
Satoshi Kugawa2010 Volume 39 Issue 6 Pages 294-299
Published: November 15, 2010
Released on J-STAGE: December 29, 2010
JOURNAL FREE ACCESSSystemic inflammation after cardiac surgery using cardiopulmonary bypass (CPB), is closely associated with postoperative organ dysfunction. We evaluated the efficacy of continuous hemodiafiltration (CHDF) in controlling postoperative organ dysfunction, focusing on serum inflammatory substances and organ protection. We enrolled 14 patients with postoperative circulatory collapse. The mean age of patients was 71 years. Heart valve surgery was performed in 9 patients, coronary artery bypass grafting in 5 and graft replacement of the thoracic aorta in 2. The mean CPB time was 297±28 min. CHDF was initiated on the first or second postoperative day in 12 patients. A polysulfone membrane dialyzer and nafamostat mesilate were used for CHDF. 1) On blood examinations, serum IL-6 and IL-8 concentrations decreased 12 h after the initiation of CHDF (216±50→92±27 pg/dl, 71±23→30±7 pg/dl, respectively). Serum aldosterone decreased at 12 h (144±20→104±21 pg/ml). Four hours after the initiation of CHDF, systemic blood pressure significantly increased from 94±6 to 123±6 mmHg. The systemic vascular resistance index significantly increased from 1,431±137 dyn·sec·cm-5·m2 to 1,893±167. Urine volume significantly increased from 42±38 to 100±29 ml/h. Serum creatinine decreased from 2.1±0.3 mg/dl to 1.7±0.2 mg/dl on the second day. Respiratory function had significantly improved at 24 h. Early induction of CHDF reduced serum inflammatory substances, resulting in quick circulatory recovery without organ failure.View full abstractDownload PDF (546K) -
Mitsuhiro Yamamura, Masataka Mitsuno, Hiroe Tanaka, Masaaki Ryomoto, S ...2010 Volume 39 Issue 6 Pages 300-304
Published: November 15, 2010
Released on J-STAGE: December 29, 2010
JOURNAL FREE ACCESSThis study aimed to clarify whether continuous hemodiafiltration (CHDF) or hemodialysis (HD) was more effective after open heart surgery in dialysis patients. We evaluated 48 consecutive hemodialysis patients (28 men and 20 women, mean age : 68±10 years) who underwent coronary artery bypass grafting (CABG) and/or aortic valve replacement (AVR) between January 2003 and December 2008. The patients were divided into 2 groups according to their postoperative dialysis treatment either continuous hemodiafiltration (CHDF) (CHDF group, n=36) or hemodialysis (HD) (HD group, n=12). Surgery in the CHDF group included 13 concomitant operations, 16 CABGs and 7 AVRs. There was only 1 concomitant surgery in the HD group, and there were 6 CABGs and 5 AVRs. There was no difference between the 2 groups regarding operation time, aortic clamp time, cardiopulmonary bypass time or intraoperative volume balance. CHDF was started significantly earlier than HD (8.0±5.8 vs. 21.0±1.0 h, p <0.01), which resulted in the removal of a greater volume of body fluid, during the first postoperative 24 h in the CHDF group (1,200±110 vs. 550±50 ml, p <0.01). However, there was no difference between the 2 groups regarding the amount of postoperative chest drainage. There were 6 hospital deaths in the CHDF group (17% ; 3 heart failures, and 1 each of pneumonia, arrhythmia and massive intestinal necrosis). There was also 1 hospital death in the HD group (8.3% ; heart failure). Most of the hospital deaths occurred after concomitant operations (6/7, 86%). It is beneficial to start CHDF soon after open heart surgery in hemodialysis patients.View full abstractDownload PDF (460K)
Case Reports
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Koyu Tanaka, Yoshihito Irie, Takao Imazeki, Kyu Rokkaku, Masahito Sait ...2010 Volume 39 Issue 6 Pages 305-308
Published: November 15, 2010
Released on J-STAGE: December 29, 2010
JOURNAL FREE ACCESSA 51-year-old man admitted to our hospital because of an ECG abnormality pointed out by his local doctor. He had been hospitalized for scarlet fever at age 10. A coronary artery CT scan showed coronary artery aneurysm of the left main trunk (LMT), and coronary angiography showed 3-vessel disease including a chronic total occlusion of the right coronary artery (RCA). We performed conventional coronary artery bypass grafting (CABG) using an arterial graft and aneurysmectomy. The patency of the graft was confirmed by coronary angiography postoperatively. The pathological diagnosis of the coronary aneurysm was Kawasaki disease. CABG is a standard procedure for coronary artery aneurysms with Kawasaki disease. However, there are no established treatment guidelines on whether to perform aneurysmectomy. We chose CABG with aneurysmectomy because of the possibility of intra-aneurysmal thrombosis leading to peripheral occlusion, and the cause of the coronary artery aneurysm could not be determined. However, even if additional treatment by percutaneous coronary intervention (PCI) is not possible, it is important to avoid occlusion of the graft.View full abstractDownload PDF (837K) -
Kazuyoshi Kanno, Taira Kobayashi, Tatsuhiko Komiya2010 Volume 39 Issue 6 Pages 309-313
Published: November 15, 2010
Released on J-STAGE: December 29, 2010
JOURNAL FREE ACCESSA 58-year-old man presented with hydrothorax, an irregular heart rate, and symptoms of heart failure approximately equivalent to the New York Heart Association (NYHA) class 2. Echocardiographic and cardiac catheterization findings suggested constrictive pericarditis, but CT scans revealed only slight thickening of the pericardium. He had liver cirrhosis, to the extent that surgery appeared to be high risk in this case. The patient was thus managed medically but showed no tendency fowards improvement despite 6 months of treatment. He was then given a diagnosis of having hepatic dysfunction due to a congestive liver associated with constrictive pericarditis. Pericardiectomy was then performed. Postoperatively, his hepatic function improved markedly and his symptoms disappeared. This case is described, with reference to the literature.View full abstractDownload PDF (639K) -
Hajime Osawa, Toshihiro Fujimatsu, Fumie Takai, Hiroyuki Suzuki2010 Volume 39 Issue 6 Pages 314-317
Published: November 15, 2010
Released on J-STAGE: December 29, 2010
JOURNAL FREE ACCESSSpontaneous coronary artery dissection is a rare but often fatal cause of acute myocardial ischemia that occurs in young or middle-aged and otherwise healthy patients. We report a case of spontaneous left main coronary artery dissection in a young woman who was treated with emergency coronary artery bypass grafting. She improved after surgery but required a long recuperative period because of her cardiac failure and multiple organ failure, developed expiring on the 78th postoperative day. Spontaneous coronary artery dissection is unpredictable, and sudden death is the usual mode of clinical presentation. Prompt diagnosis and coronary artery revascularization are essential in order to achieve a favorable outcome in such cases.View full abstractDownload PDF (680K) -
Narihiro Ishida, Katsuya Shimabukuro, Yukihiro Matsuno, Hirofumi Takem ...2010 Volume 39 Issue 6 Pages 318-320
Published: November 15, 2010
Released on J-STAGE: December 29, 2010
JOURNAL FREE ACCESSThe ascending aorta and aortic arch were replaced in a 72-year-old woman with Stanford type A aortic dissection. Preoperative three-dimensional computed tomography (3D-CT) revealed that the anatomy of an isolated left vertebral artery was abnormal. After hypothermic circulatory arrest, a 12-mm sealed graft was connected to the island-shaped arch under retrograde cerebral perfusion, followed by antegrade cerebral perfusion via a branch of the graft. The main graft was distally anastomosed, and the graft of the cerebral arteries was subsequently anastomosed on the main graft under continuous cerebral and systemic perfusion. The patient tolerated all procedures well without cerebral or bleeding complications, and was discharged 18 days after surgery. This technique was useful for island reconstruction, even with abnormal cerebral arteries and bleeding control of this anastomosis was simple compared to the conventional island technique.View full abstractDownload PDF (369K) -
Masanori Nishimura, Mitsuhiro Yano, Hiroyuki Nagahama, Masakazu Matsuy ...2010 Volume 39 Issue 6 Pages 321-324
Published: November 15, 2010
Released on J-STAGE: December 29, 2010
JOURNAL FREE ACCESSWe report a case of tricuspid infective endocarditis with peripheral pulmonary artery aneurysm. A 31-year-old man with a history of intravenous drug abuse was admitted to our institution. Echocardiography showed severe tricuspid valve insufficiency and large vegetation (10 mm) attached to the tricuspid valve. Computed tomography (CT) revealed a right peripheral pulmonary artery aneurysm. We operated because of the large amount of vegetation. Before the operation, we performed coil embolization for peripheral pulmonary aneurysm. During the operation, we removed the posterior leaflet with vegetation, and performed tricuspid valve repair. The postoperative course was uneventful. Postoperative echocardiography did not show any tricuspid valve insufficiency or vegetation.View full abstractDownload PDF (673K) -
Kazuhiko Ishimaru, Hiroto Iwasaki, Toru Ishizaka, Hisashi Satoh, Takas ...2010 Volume 39 Issue 6 Pages 325-327
Published: November 15, 2010
Released on J-STAGE: December 29, 2010
JOURNAL FREE ACCESSA 72-year-old woman was admitted with a sensation of compression and shortness of breath. A mass was detected in the right atrium (RA) by transthoracic echocardiography. Preoperative chest computed tomography showed an RA tumor measuring 30×24 mm in the lateral wall. We performed resection under the cardiopulmonary bypass. Histopathological examination confirmed that this tumor was a lipoma.View full abstractDownload PDF (739K) -
Keitaro Watanabe, Satoru Maeba, Takahiro Taguchi2010 Volume 39 Issue 6 Pages 328-331
Published: November 15, 2010
Released on J-STAGE: December 29, 2010
JOURNAL FREE ACCESSA 65-year-old man was admitted with a high fever and back pain. Because magnetic resonance imaging revealed osteomyelitis in the lumbar spine, we started antibiotic therapy. Echocardiography revealed large vegetation on the tricuspid valve, and abdominal contrast computed tomography revealed a pancreatic abscess. As the vegetation increased in size and mobility it became non-responsive to medical treatment, and surgical removal of the vegetation with tricuspid valve repair were therefore performed. After additional antibiotic therapy, he was discharged 42 days after surgery. No further recurrence of endocarditis has been observed as of the time of writing.View full abstractDownload PDF (703K) -
Akira Katayama, Naomichi Uchida, Kentaro Tamura, Miwa Sutoh, Naoki Mur ...2010 Volume 39 Issue 6 Pages 332-334
Published: November 15, 2010
Released on J-STAGE: December 29, 2010
JOURNAL FREE ACCESSAn 82-year-old woman fell into a state of shock during the treatment for a urinary tract infection. Computed tomography and transthoracic echocardiography revealed massive pericardial effusion. Pericardiectomy was performed in the operating room and hemorrhagic effusion was observed. Emergent sternotomy was performed, and the bleeding site was located at the posterior portion of the left ventricular outflow. We diagnosed a rupture of a left ventricular outflow tract pseudoaneurysm after infectious endocarditis. A pericardium patch closure of the pseudoaneurysm and an aortic valve replacement were performed. The patient was discharged 35 days after the operation without recurrence of infection. Left ventricular outflow tract pseudoaneurysms is an uncommon complication following infective endocarditis, aortic valve surgery or chest trauma. Transesophageal echocardiography and multidetector-row computed tomography (MDCT) is useful for identifying such lesions.View full abstractDownload PDF (665K) -
Takahiro Inoue, Kazuhiro Hashimoto, Yoshimasa Sakamoto, Michio Yoshita ...2010 Volume 39 Issue 6 Pages 335-338
Published: November 15, 2010
Released on J-STAGE: December 29, 2010
JOURNAL FREE ACCESSInfected aortic aneurysm is very difficult to treat and is associated with a high mortality rate. A 78-year-old man had been scheduled to undergo selective endovascular repair for distal aortic arch aneurysm. While standby, however, he was admitted to our emergency room because of hemoptysis. Rapid dilatation of the aneurysm shown on serial CT and elevated of inflammatory reactions yielded a diagnosis of infected aortic aneurysm. Because the aneurysm had ruptured into the left lung, emergency surgery was performed. Six days after the first operation, critical bleeding due to anastomotic disruption of the distal aorta caused by infection and subsequent cardiac arrest occurred. We immediately started open chest massage and controlled the bleeding manually in the ICU, while an operating room was prepared. In the redo operation, anastomotic disruption was repaired using the visceral pleura under deep hypothermic circulatory arrest. Anastomotic bleeding is a potentially life-threatening condition, therefore extremely prompt measures are vital. Appropriate management based on the assumption of anastomotic bleeding was very important in the postoperative course of this case of infectious aortic aneurysm.View full abstractDownload PDF (528K) -
Mitsuhisa Kotani, Masaaki Toyama, Masanori Katoh, Yuji Kato, Kazuhiro ...2010 Volume 39 Issue 6 Pages 339-342
Published: November 15, 2010
Released on J-STAGE: December 29, 2010
JOURNAL FREE ACCESSA 78-year-old woman underwent mitral valve replacement (MVR) with bioprosthesis in 1984. By 1997 the valve had become dysfunctional and was replaced with a Mosaic valve. Dyspnea on exertion occurred in 2005 and a systolic murmur was detected at that time. Echocardiography revealed severe mitral regurgitation (MR). The mitral valve was replaced for the third time. The explanted valve showed commissural dehiscence at the stent position and calcified leaflets. The mitral valve of a 70-year-old man was replaced with a bioprosthesis in 1986, and again with a Mosaic valve in 1997 because the original bioprosthesis had become dysfunctional. Seven years later, a systolic murmur appeared and echocardiography revealed severe MR. The valve was replaced for the third time. A leaflet tear was found in the removed valve. The Mosaic valve is a third generation porcine bioprosthesis that reportedly has excellent long-term durability. However, in these cases, the Mosaic valves deteriorated prematurely, and no obvious causes of this early structural deterioration could be identified. Continued long-term follow up is necessary, and the possibility of premature deterioration should be considered when selecting bioprostheses.View full abstractDownload PDF (781K) -
Pleuro-peritoneal Shunting for Refractory Pericardial Effusion after Coronary Artery Bypass GraftingTakashi Matsumoto, Masayoshi Umesue, Hironori Baba, Kanzi Matsui2010 Volume 39 Issue 6 Pages 343-346
Published: November 15, 2010
Released on J-STAGE: December 29, 2010
JOURNAL FREE ACCESSA-75-year-old man had refractory late cardiac tamponade after an off-pump coronary artery bypass grafting. He was initially treated by pericardiocentesis with oral nonsteroidal anti-inflammatory drugs, but the treatment failed. Pericardial fenestration was conducted twice for refractory pericardial effusion during his hospitalization. He presented again with recurrence of cardiac tamponade 2 months after the last pericardial fenestration. Therefore, a pleuroperitoneal shunt system was implanted. He recovered well and was discharged without reaccumulation of pericardial effusion.View full abstractDownload PDF (447K) -
Shogo Obata, Shogo Mukai, Hironobu Morimoto, Daisuke Futagami2010 Volume 39 Issue 6 Pages 347-350
Published: November 15, 2010
Released on J-STAGE: December 29, 2010
JOURNAL FREE ACCESSWe report 2 cases of postinfarction ventricular septal perforation (VSP) attributable to obstruction of the right coronary artery. Case 1 was a 63-year-old man in whom VSP developed after percutaneous coronary angioplasty for complete obstruction of the right coronary artery. He developed papillary muscle rupture intraoperatively, requiring mitral valve replacement and subsequent treatment for right-side heart failure. He was discharged l7 weeks after surgery. Case 2 was a 77-year-old man. During catheterization following the detection of 99% obstruction of the #2 segment of the right coronary artery, VSP was found and the patient underwent emergency surgery. Postoperative echocardiography and ventriculography did not reveal a residual shunt or mitral regurgitation (MR). However, he suddenly developed acute MR in the 4th postoperative week and died of acute heart failure. VSP attributable to obstruction of the right coronary artery is difficult to repair surgically because of its anatomical location, among other reasons, and mitral valve replacement is sometimes needed if VSP is accompanied by necrosis of the mitral valve papillary muscle. Appropriate care is therefore needed in this case.View full abstractDownload PDF (963K) -
Naotaka Atsumi, Haruo Yamauchi, Mitsuhiro Kawata, Takeshi Yoshii2010 Volume 39 Issue 6 Pages 351-354
Published: November 15, 2010
Released on J-STAGE: December 29, 2010
JOURNAL FREE ACCESSA 10-day-old male neonate underwent repair of mixed-type total anomalous pulmonary venous connection. The left upper pulmonary vein connected to the left innominate vein by way of a vertical vein. The other veins converged to form a common pulmonary vein and drained to the coronary sinus. As the common pulmonary vein was not stenotic, normal coronary sinus unroofing was undertaken and the postoperative course was uneventful. Five months later pulmonary vein stenosis (PVS) occurred at the junction of the common pulmonary vein and coronary sinus. At reoperation the common pulmonary vein was deeply incised to the point near the pulmonary venous orifice, and the stenotic tissue was resected. Although he was discharged from the hospital on the 10th postoperative day, PVS recurred at age 9 months and a second reoperation was undertaken. This time, the common pulmonary vein was excised and the anterior wall of each pulmonary vein was incised to drain independently and directly to the left atrium without causing turbulence. The left upper pulmonary vein was anastomosed to the left atrial appendage. Pulmonary angiography 18 months after the second reoperation revealed the pulmonary venous pathway to be nonstenotic.View full abstractDownload PDF (541K) -
Tomohiko Sakamoto, Yasushi Tsutsumi, Osamu Monta, Keitaro Koshi, Yousu ...2010 Volume 39 Issue 6 Pages 355-358
Published: November 15, 2010
Released on J-STAGE: December 29, 2010
JOURNAL FREE ACCESSWe report 2 cases of successful proximal reoperations after acute type A dissection. Case 1 : A 53-year-old man underwent ascending aorta and aortic arch replacement and aortic valve re-suspension for acute type A dissection with aortic valve regurgitation in 1992. Thirteen years after the first operation, computed tomography demonstrated a Valsalva aneurysm (74 mm) and Doppler echocardiography showed moderate aortic valve regurgitation. Therefore, we performed an operation. We could not locate the dissection in the Valsalva sinus, and the aortic valve cusps had organic change. A David procedure was performed. The postoperative course was uneventful and he was discharged on the 19th postoperative day. Case 2 : A 65-year-old woman underwent ascending aorta replacement and aortic valve resuspension for acute type A dissection with aortic valve regurgitation in 1997, but 11 years after the first operation, computed tomography demonstrated a Valsalva aneurysm (55 mm) and arch aneurysm (65 mm) with stenosis of the innominate vein and she had facial and left arm edema. Doppler echocardiography showed moderate aortic valve regurgitation. We could not find the location of dissection in the Valsalva sinus or aortic arch, and aortic valve cusps had no organic change. A Bentall procedure and total arch replacement were performed and her postoperative course was uneventful.View full abstractDownload PDF (402K) -
Takashi Igarashi, Shoichi Takahashi2010 Volume 39 Issue 6 Pages 359-362
Published: November 15, 2010
Released on J-STAGE: December 29, 2010
JOURNAL FREE ACCESSWe report a case of quadricuspid aortic valve concomitant with infective endocarditis. A 73-year-old woman was admitted to our hospital because of general fatigue, loss of body weight and high fever. Transthoracic echocardiography showed moderate aortic regurgitation and left ventricle-right atrium fistulae with vegetation. Infectious endocarditis was diagnosed. Since her fever and hemolytic anemia were not controlled by antibiotics, we operated and the aortic valve had four cusps and there were vegetations on the aortic valve and left ventricle outflow tract. Perforation of the membranous septum was observed. Complete debridement and aortic valve replacement with patch repair of a left ventricle-right atrium (LV-RA) fistula was performed. Although she needed a permanent pacemaker due to complete AV block, her postoperative course was uneventful.View full abstractDownload PDF (584K) -
Yukiharu Sugimura, Mitsuhisa Kotani, Masanori Katoh, Yuji Kato, Kazuhi ...2010 Volume 39 Issue 6 Pages 363-366
Published: November 15, 2010
Released on J-STAGE: December 29, 2010
JOURNAL FREE ACCESSVasculo-Behçet disease (VBD) is a special type of Behçet disease (BD) involving some vascular disorders like aneurysmal formation, arterial occlusion, and venous thrombosis in various vessels. VBD has a poor prognosis due to aneurysmal rupture or recurrence of vascular disorders despite optimal treatment. However, definite diagnosis in BD is made on the basis of clinical features, and early diagnosis is difficult. We report 2 patients whose first clinical symptoms were femoral-pseudoaneurysms. They received a diagnosis of VBD after surgery. The first patient was a 69-year-old man, who underwent autologous-vein patch closure of a perforated region in the left femoral artery. One year later, he had a pseudoaneurysm of the right profunda femoris artery, which was ligated. The second patient was a 51-year-old man, who underwent the interposition of the saphenous vein for defective artery due to left superficial femoral-pseudoaneurysm.View full abstractDownload PDF (697K)
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2010 Volume 39 Issue 6 Pages 6_i-6_v
Published: November 15, 2010
Released on J-STAGE: December 29, 2010
JOURNAL FREE ACCESSDownload PDF (571K)
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