Percutaneous angioplasty of stenosed gastroepiploic artery grafts.

OBJECTIVES: This report describes our early experience and results with percutaneous transluminal coronary angioplasty of gastroepiploic artery grafts in 12 patients. BACKGROUND: Angioplasty has been successfully performed in saphenous vein and internal thoracic artery grafts; however, experience with angioplasty in gastroepiploic artery/coronary artery bypass grafts is limited. METHODS: Balloon angioplasty was performed in 12 patients (11 men, 1 woman; mean age 58 +/- 8 years) with either total occlusion (6 patients) or severe stenosis (6 patients) of a gastroepiploic artery/coronary artery anastomosis. In seven patients, a guide wire/balloon catheter system was used through a 7F sheath inserted into the celiac trunk. In seven patients, including two who had unsuccessful wire/balloon angioplasty, an over the wire system was used through a 6.5F Cobra or 7F JR4 guide catheter, selectively inserted into the gastroduodenal artery. RESULTS: Angioplasty was successful in five (83%) of six patients with stenosis and in one of six patients with total occlusion (p = 0.08, 1 - beta = 0.68). The guide wire could not be advanced through the lesion in five patients, and the balloon catheter did not cross the lesion in one patient whose gastroepiploic artery was tortuous. Catheters exhibited better trackability and pushability when the over the wire system was used, and five of the six successes were achieved using this approach. Follow-up arteriography was performed in five patients, and all of the gastroepiploic artery grafts were patent without stenosis. CONCLUSIONS: Angioplasty can be safely performed in stenosed gastroepiploic artery grafts. An over the wire system that uses a thin balloon catheter inserted through a guide catheter in the gastroduodenal artery seems optimal.

[A case of coronary artery bypass grafting without cardiopulmonary bypass in a patient with left ventricular dysfunction].

A 54-year-old man who had severe deterioration of left ventricular function (cardiac index ; 1.6 l/min/m2, left ventricular ejection fraction ; 26%) due to two myocardial infarcts underwent bypass of the left anterior descending artery using the left internal thoracic artery under IABP assist without extracorporeal circuration or cardiac arrest. Two hours postoperatively, he was extubated. Subsequent clinical course was uneventful with a satisfactory outcome. These findings suggest that coronary artery bypass without extracorporeal circulation or cardiac arrest is a safe and effective procedure in patients with left ventricular dysfunction.

[A case of atrial septal defect complicated by persistent left superior vena cava in whom hemophagocytic syndrome appeared after operation].

The patient was a 22-year-old woman and suffered from atrial septal defect (ASD) complicated by persistent left superior vena cava (PLSVT). The patient underwent a patch closure using calf pericardium. Despite favorable progress immediately after the operation, fever, enlarged cervical lymph nodes, and leukocytopenia appeared beginning day 8 after the operation. Based on the results of cytodiagnosis of myeloaspiration specimen, the diagnosis of hemophagocytic syndrome (HPS) was made. Since an elevation of 2-5 oligo A synthetase (2-5 AS) levels was observed, the patient was diagnosed to suffer from virus-associated hemophagocytic syndrome (VAHS), and steroid was administered. The patient exhibited a good response to the treatment. The fever declined 3 days after the start of administration. Leukocyte counts were also increased gradually. The patient condition was improved and she was discharged from the hospital on day 28. At present, seven months after the operation, there is no evidence of recurrence and the patient's condition is still monitored.

[A case of congenital solitary tricuspid regurgitation treated with tricuspid valvular replacement].

A case of congenital solitary tricuspid regurgitation was reported. The patient was a 43-year-old male. The echocardiogram and ventriculography showed severe tricuspid regurgitation. The tricuspid valve was hypoplastic in each leaflet and chordae without torn chordae and papillary muscles. A tricuspid valve replacement was performed using St. Jude Medical 33 mm valve. As of June 1993 nine patients with this disease undergoing surgery were reported around the world.

[A case of localized fibrous tumor of the pleura with bloody pleural effusion].

A 25-year-old female came to our hospital with the chief complaint of right dorsal pain. On her initial chest X-ray, the tumor (5 x 3 cm) was recognized in the right lower lung field. The tumor grew rapidly during the three month period between the initial X-ray taken on her first visit and her getting admitted in the hospital. A preoperative diagnosis was done by percutaneous aspiration biopsy. Initial diagnosis of spindle cell tumor was made. Partial resection of right lower lobe with chest wall resection was carried out. There were about 500 ml of bloody pleural effusion. Macroscopically, the tumor was encapsulated, measuring 8.0 x 6.0 x 5.0 cm. The cross section was of a yellowish brown solid tumor. The histological diagnosis was of a low grade malignant fibrous mesothelioma. Only 14 cases of localized mesothelioma with pleural effusion including our case have been reported in Japan. She is still alive nine months after surgery. This patient should be carefully followed for the recurrence of the disease.

Effects of cilostazol on late lumen loss after Palmaz-Schatz stent implantation.

Cilostazol inhibits intimal hyperplasia after stent implantation into canine iliac arteries. To determine the antiproliferative effect of this agent, cilostazol or aspirin was randomly given for 6 mo to 36 patients treated with Palmaz-Schatz stent implantation. Initial success was obtained in 34 patients. Repeat angiography was performed in 33 patients, and the complete angiographic data were obtained in 22 lesions of the cilostazol group and in 21 lesions of the aspirin group. The reference diameter and minimal luminal diameter were similar in both groups before and immediately after stent implantation. At follow-up, minimal luminal diameters were significantly greater in the cilostazol group than in the aspirin group (P < 0.001). Late loss and loss index were significantly smaller in the cilostazol group than in the aspirin group (P < 0.001). These results suggest that cilostazol reduces angiographic late lumen loss and thereby may reduce the incidence of restenosis after Palmaz-Schatz stent implantation.