Simplified Negative Pressure Wound Therapy for Pediatric Mediastinitis after Cardiac Surgery / 日本心臓血管外科学会雑誌

<b>Objectives</b> : Mediastinitis results in significant morbidity in pediatric patients after cardiac surgery. The management of mediastinitis is not well established in the pediatric population. Our strategy for pediatric mediastinitis after cardiac surgery consists of rapid introduction of simple vacuum-assisted drainage system and sternal closure without plombage under aseptic conditions. The efficacy of our strategy was examined. <b>Methods</b> : The records of 7 pediatric patients with mediastinitis after cardiac surgery managed with this drainage system from May 2006 to May 2013 were retrospectively reviewed. The median age of the patients was 20.5 months and median body weight was 9.7 kg. Mediastinitis occurred 1-3 weeks after surgery. The mediastinum was re-explored immediately under general anesthesia after the diagnosis was made, and continuous drainage was used after extensive debridement was performed. We developed a simple vacuum-assisted drainage system consisting of conventional polyurethane foam, surgical drape containing povidone-iodine, and 1 to 3 silicone drainage tubes connected to a drain aspirator (-99 cmH₂O). Patients were allowed oral intake and resumption of daily activity after extubation. The components of the drainage system were exchanged every 2-3 days. The sternum was closed without the use of the omentum or muscle for plombage of the mediastinum after two negative topical swab cultures were obtained. <b>Results</b> : Negative topical swab cultures were obtained in all cases (3-12 days after the drainage commencement) and the sternum was closed 7-19 days after the drainage commencement. The median duration of hospital stay was 31 days (range, 14-47). Although one patient with prenatal infection died of aortic rupture, the remaining six children survived and did not experience recurrence after hospital discharge. <b>Conclusion</b> : The simple vacuum-assisted drainage system enabled rapid control of wound bacterial infection and sternal closure in postoperative pediatric mediastinitis without the need for special, and expensive devices.

Successful Operation for Multiple Giant Aneurysms with Congenital Coronary Artery Fistula in an Adult / 日本心臓血管外科学会雑誌

We report a case of successful operation for multiple giant aneurysms with a right coronary artery fistula from the right coronary artery to the left atrium. A 35-years-old woman was found to have a right coronary artery aneurysm with a maximum diameter of 85mm, and two other coronary artery aneurysms with maximum diameters of 40 mm along the coronary fistula, which arose from the proximal right coronary artery, traversed the root of the left atrium, and drained into the left atrium. Surgical treatment was indicated to relieve symptoms and to prevent possible rupture of the aneurysms. She underwent resection of coronary artery aneurysms, closure of orifices of the fistula and coronary bypass grafting to the right coronary artery with cardiopulmonary bypass. Her postoperative course was uneventful, and she was discharged in good condition.

Indications and Evaluation of Coronary Artery Bypass Grafting with Myocardial Single Photon Emission Tomography Using 123I-BMIPP, a New Tracer of Myocardial Metabolism of Fatty Acid / 日本心臓血管外科学会雑誌

To evaluate viability and severity of ischemically damaged myocardium, myocardial single emission tomography (SPECT) using 123I-BMIPP (BMIPP), a new tracer of myocardial metabolism of fatty acid, was performed before and after coronary artery bypass grafting (CABG). 201Tl myocardial SPECT (Tl) and left ventriculography (LVG) were also used. Thirty-three revascularized areas in eight patients were investigated. (1) Areas showing good redistribution on Tl and normal uptake on BMIPP indicated good viability and simple ischemic myocardium. Postoperative uptake of both tracers returned to normal levels. (2) Areas showing good redistribution on Tl and severely decreased uptake on BMIPP indicated jeopardized myocardium with severe ischemia. All such areas were seen in patients with unstable angina. Postoperative uptake of both tracers returned to normal levels. (3) Areas showing poor redistributionor severely decreased uptake on Tl and slight uptake on BMIPP indicating hibernating areas. Postoperative uptake became normal or better than preoperative uptake on Tl necrosis. However on BMIPP, the uptake was unchanged or recovered slightly. (4) Areas showing complete defect in Tl and BMIPP indicated necrosis and had no viability. Postoperatively the defect in both tracers were unchanged. Therefore, these areas required no revascularization. The ischemic state of myocardium could be assessed by evaluation of uptake patterns of BMIPP and Tl using myocardial SPECT. Therefore, using this new tracer of myocardial fatty acid metabolism “BMIPP”is useful for deciding culprit and viable lesions requiring coronary revascularization and evaluating therapeutical effects.

Intermediate Results of Translocation of the Aortic Valve for Periannular Abscess Due to Active Infective Endocarditis and Introduction of a Sutureless Translocation Technique / 日本心臓血管外科学会雑誌

Periannular abscess and mycotic aneurysm due to infective endocarditis are very difficult conditions to treat surgically. Beginning in 1983, we introduced a translocation technique on 9 such cases. In particular, 7 patients who underwent a new sutureless translocation technique all showed an uneventful course and were discharged. There was no hospital death, but four patients died in the late period (2 heart failure, 1 ventricular tachycardia and 1 thrombotic valve). The sutureless translocation method consists of insertion of a composite valve into the ascending aorta (a ring was detached from an intraluminal ringed graft and a prosthetic valve was sutured to it at that point) and coronary artery bypass grafting to the right and left coronary arteries. Our new technique was simple, required only a short aortic clamping time (mean 173.9min) and there was no significant bleeding. This new translocation technique provides a solution for the treatment of periannular abscess and mycotic aneurysm due to infective endocarditis.