Clinical and Thermographic Findings in the Late Postoperative Period after Coronary Artery Bypass Surgery Using the Radial Artery / 日本心臓血管外科学会雑誌

We evaluated the relation of changes in skin temperature, measured by thermography, to clinical symptoms and findings in patients who underwent coronary artery bypass surgery using the radial artery. All had a negative Allen test before operation. Ten consecutive patients who underwent surgery at least 3 months prior to the study were selected. Left radial artery grafts were harvested in all patients. Skin temperature was measured twice, before and after exercise. Two patients had a cold sensation at the arterial harvest site at rest. Three, including these two, complained of pain along the harvest site after exercise. No differences in temperature were observed before and after exercise in the ulnar aspects of the palm or forearm on either the left or right side. On the other hand, the increase in radial aspect temperature on the left side was smaller than that on the right. Skin temperature was clearly decreased after loaded exercise in 3 patients. We believe that the indications of grafting should be carefully considered because patients can show findings associated with circulatory disturbance at arterial harvest sites.

A Case of Marfan's Syndrome with Repeated Occurrence of Acute Aortic Dissection during Treatment / 日本心臓血管外科学会雑誌

A 26-year-old man with Marfan's syndrome suffered aortic dissection repeatedly during hospitalization. He was admitted with a diagnosis of annuloaortic ectasia with severe aortic regurgitation. A type A aortic dissection occurred after diagnostic angiography. Three weeks after the onset of the dissection, an aortic root replacement in combination with a total arch replacement was performed. Eight months later, residual dissection in the descending thoracic aorta was replaced with distal perfusion by a temporary bypass from the left subclavian artery to the descending thoracic aorta. At the termination of the operation, abdominal aortic dissection occurred with acute bilateral limb ischemia, which was treated with abdominal aortic intimal fenestration. He recovered uneventfully and was discharged 3 weeks after operation. In light of our experience, because of vascular fragility, great care should be taken in treating patients with Marfan's syndrome to avoid iatrogenic aortic dissection.

Re-do Cases and Histidine Buffered Cardioplegia / 日本心臓血管外科学会雑誌

Re-do open cardiac surgery may sometimes require complete ablation around the pericardium for the 2 major reasons of attaining better myocardial protection and obtaining effective DC cardioversion. However, this ablation may increase postoperative hemorrhage which may require blood transfusion. Hypothermia is based on the concept of myocardial protection during open heart surgery by suppressing myocardial metabolism, but recently the approach has been changed to maintaining myocardial metabolism with aerobic or anaerobic energy production. We have already reported that histidine-buffered cardioplegia which promote anaerobic glycolysis, provided an excellent functional recovery of myocardium post-ischemia with lower inotropic requirements in a range from 10°C to 37°C of myocardial temperature. Based on our theoretical background and clinical data, we tested the efficacy of this type of cardioplegia in patients receiving multiple surgical procedures with minimum ablation after sternotomy. First case, who had undergone a Bentall procedure for annulo-aortic ectasia 14 years previously had a thrombotic valve and mitral regurgitation. Aortic valve plasty and mitral valve replacement (MVR) was performed. The second case who had undergone MVR 15 years previously had malfunction of the prosthetic valve and underwent re-MVR. The third and fourth cases had ventricular septal defect (VSD) which were closed using Teflon patches. The third case had patch closure during second operation for residual shunt. The fourth case received tricuspid valve replacement (TVR) for tricuspid regurgitation due to a pacemaker lead implanted into the right ventricle through the left subclavian vein. The fifth case received coronary artery bypass surgery in a second operation for restenosis of the graft and progressing atherosclerosis. All hearts started beating spontaneously without DC cardioversion after the aortic unclamp. Ventricular fibrillation occurred in the first case while the patient was weaned from cardiopulmonary bypass and treatment was performed by aortic cross clamp, infusion of the cardioplegia followed by aortic unclamp to start own beat again. Two of 3 patients who were able to donate their own blood preoperatively did not require homologous blood transfusion. Due to advantages such as excellent myocardial protection under hypothermic or normothermic condition, ease of use and relatively lower potassium concentration, histidine-buffered cardioplegia can be an excellent candidate for myocardial protection in re-do cases with less ablation technique.

A Case of Jaundiced Constrictive Pericarditis / 日本心臓血管外科学会雑誌

We treated a constrictive pericarditis patients that developed jaundice. The 28-year-old male complained chiefly of dyspnea on exertion. In addition to hyperbilirubinemia, his chest X-ray showed calcification of the pericardium. Cardiac catheterization found increased central venous pressure (24mmHg), a dip and plateau of the right and left ventricular pressure, and a patent foramen ovale (PFO). Surgery to excise the pericardium and close the PFO was performed under extracorporeal circulation. Hypertrophic pericardium had expanded throughout the right atrium to the free wall of the right ventricle and was partially calcified. Surgery restored the patient's cardiac and liver functions and allowed him to resume normal social activity.

Cabrol, Technique Performed on a Patient with Corrected Transposition of the Great Arteries, Complicated by Annuloaortic Ectasia and Aortic Regurgitation / 日本心臓血管外科学会雑誌

Cabrol's technique was performed on a patient with corrected transposition of the great arteries (SLL), complicated by annuloaortic ectasia (AAE) and aortic regurgitation (AR). The patient, a 52-year-old male, complained mainly of dyspnea on physical exertion. In 1983, he underwent implantation of a pacemaker to treat advanced atrioventricular block. In 1994, his cardiac function deteriorated to NYHA III. Cardiac catheter examinations exhibited 2nd degree Seller's aortic valve insufficiency and 2nd degree insufficient closure of the left atrioventricular valve. The patient was Cardell classification B3, with a Shaher Type 4 coronary artery. A composite graft was made using a 27mm St. Jude Medical valve and a 30mm woven Dacron graft. The left atrioventricular valve had three leaflets, accessible from the right atrium using the septal approach. Kay's method was used to suture the posterior leaflet and reduce regurgitation. The patient has made favorable progress during the two-year follow-up period.

Simultaneous Surgical Treatment for Atrial Fibrillation and Mitral Valve Disease / 日本心臓血管外科学会雑誌

We performed surgery for atrial fibrillation and mitral valve disease on 3 patients along with atrial mapping. Macroreentrant circuits were found in 2 patients and the other patient showed a preexcitation ectopic focus in the left atrium. Right atrial excitation was chaotic in all three patients. Of the two patients with reentry circuits, one patient underwent biatrial incisions and the other patient had only a left atrial incision. In the patient with a preexcitation ectopic focus, we performed cryoablation of that focus and made a left atrial incision in order to prevent the reoccurrence of atrial fibrillation after surgery. Following surgery, one patient experienced transient atrial fibrillation, however, continuous atrial fibrillation was resolved by this procedure and all patients returned to a normal sinus rhythm.

Type B Acute Aortic Dissection: The Prognosis and Fate of the Dissected Lumen of Nonsurgical Treated Patients / 日本心臓血管外科学会雑誌

From March 1981 to March 1990, 61 patients with Stanford type B acute aortic dissection were initially treated by conservative therapy. Among these 61 patients, the dissected lumen became occluded due to thrombosis early after diagnosis in 25 patients (Group T) and remained patent in 36 patients (Group P). Twentythree patients in Group T (92%) and 22 patients in Group P (61%) were discharged without major complications related to acute aortic dissection. However, 2 patients in Group T (8%) and 14 patients in Group P (39%) required additional surgical therapy or died during hospitalization. The mean aortic diameter at the time of admission in Group T was smaller than that of Group P (38±3mm vs 43±7mm, <i>p</i><0.05). During the observation period, there was a tendency for the diameter of the dissected aorta in Group T to decrease, but to increase in Group P. Long-term survival appeared to be better in Group T than in Group P, but there was no significant difference in the overall survival curve. Large aortic diameter at the time of admission and the presence of a true thoracic aortic aneurysm were major contributing factors influencing the prognosis. A long-term follow-up study showed that the dissected lumen reduced or disappeared in 14 of 23 patients in Group T (61%) but only 2 of 16 patients in Group P (12.5%). We concluded that the patients with small dissected aortas and thrombosed dissected lumens (Group T) can recuperate only with conservative therapy. However, patients with large dissected aortas and patent dissected lumen (Group P) may require surgical therapy even in Stanford type B aortic dissection.

The Surgical Treatment of Endocardial Fibroelastosis and Endomyocardial Fibrosis / 日本心臓血管外科学会雑誌

We performed mitral valvuloplasty for 25 months old infant with endocardial fibroelastosis (EFE) and 21 months old infant with endomyocardial fibrosis (EMF). These two patients showing good post operative cause, have been followed up during 10 and 1 years respectively. The EFE and EMF are severe and progressive restrictive cardiomyopathy of unknown etiology. Most of cases with EFE and EMF have an enlarged left ventricle with incompetent atrioventricular valve. The prognosis of these patient is usually poor. We believe that the surgical treatment in early phase may be able to improve heart failure and also to protect the progression of these disease. This case with EMF is the first report of successfull surgical treatment for the patients with severe congestive heart failure whithin one year after birth in Japan.

Ruptured Dacron Prosthesis by Blunt Trauma 8 Years after Implantation for Axillo-femoral Bypass / 日本心臓血管外科学会雑誌

A case of a 77-year-old man is reported, who developed late rupture of the knitted Darcon velour graft by blunt trauma 8 years after implantation for axillo-femoral bypass. Dacron fiber deterioration, which led the graft to fragility, might have played a main role in the clinical setting. This case clearly emphasizes that with its possibility to be deteriorated life-long care and follow up should be taken for the patients who undergo arterial reconstructive surgery using Dacron prostheses.

Cystic Adventitial Disease of the Popliteal Artery - A Case Report / 日本心臓血管外科学会雑誌

Cystic adventitial disease of the popliteal artery is an uncommon disorder. 58-year-old male complained of left intermittent calf claudication and couldn't sit straight. He preferred playing baseball and jogging. Digital subtraction angiograms revealed a smooth extrinsic compression on the proximal left popliteal artery. Surgical procedure was performed with posterior approach. The left popliteal artery was confirmed to be surrounded by two adventitial cysts at operation. After the evacuation and removal of these cystic wall, peripheral popliteal artery pulse was improved. Postoperative course was smooth and calf claudication was completely disappeared, post operative angiogram showed no stenosis. Histological examination of the resected specimen showed degenerated elastic fiber and inflammatory granulation. We have found 40 cases previously reported in Japan and the present case was 2nd one in our institute.

A Case of Common Hepatic Aneurysm with Anomalous Origin from the Aorta / 日本心臓血管外科学会雑誌

We describe a 52 year old woman who had an aneurysm involving the common hepatic artery directly originating from the aorta. It was successfully treated by aneurysmectomy without needing the arterial reconstruction. An aneurysm of the common hepatic artery that has an anomalous origin from the aorta is very rare and only 4 cases including the present case were reported in Japanese literature on our survey. The features and management of hepatic aneurysm are discussed.

An operative case of aneurysm of peripheral pulmonary artery / 日本心臓血管外科学会雑誌

Aneurysm of peripheral pulmonary artery was rarely reported. A 51-year-old man who was pointed out a coin lesion at the right hilus region on the chest X-ray film complained back chest pain. Selective pulmonary arteriography revealed the peripheral pulmonary aneurysm of saccular dilatation running into the middle lobe. Aneurysmectomy was performed successfully and the patient returned to social work. Pathologic specimen revealed partly necrosis of medial cell. Eleven surgical cases including this case were reported in Japan. A brief review of the literature was made.

A case report of surgical correction of partial anomalous pulmonary venous drainage of entire left lung without other cardiac anomaly / 日本心臓血管外科学会雑誌

Congenital heart disease of partial anomalous pulmonary venous drainage of entire left lung without other cardiac anomaly was very rare. 21-year-old man, who was pointed out heart disease 6 months ago, was diagnosed as partial anomalous pulmonary venous drainage of entire left lung without other cardiac anomaly by cardiac catheterization and angiography. The patient underwent surgery through the left forth intercostal incision without cardiopulmonary bypass. The end-to-side anastomosis was made between the vertical vein and the left atrial appendage following ligation of the vertical vein near the innominate vein. Surgical treatment was satisfactory in the postoperative angiography which was shown widely patent anastomosis. He was discharged with uneventful postoperative course and returned to full activity.

Antitumor Activity of a Hot Water Extract of <I>Flammulina velutipes</I> Sing / 日本農村医学会雑誌

A hot water extract of <I>Flammulina velutipes</I> Sing.(FEH-1) showed a markedly high antitumor effect against sarcoma 180 in ICR mice. FEH-1 (10mg/kg) was administered intraperitoneally for consecutive 21 days before and after the subcutaneous inoculation of sarcoma 180 (4.1X10<SUP>6</SUP> cells) to the mice. Animals were sacrificed on the 24th day after the inoculation of sarcoma 180 and tumor weight was determined. The highest tumor inhibition ratio was 98.5%, when FEH-1 was administered at the dose of 10mg/kg.<BR>Cytotoxicity of FEH-1 was denied by the following two tests:(1) after mixed-culture of Vx2 tumor cells with FEH-1 for 7 days <I>in vitro</I>, number of Vx2 cells was counted by dye-exclusion technique, and (2) after contact of Vx2 cells with FEH-1 for 1 hour, the cell mixture was inoculated subcutaneously to the rabbits. It was suggested that antitumor effect of FEH-1 was host-mediated.