ABSTRACT
This study reports a 38-year-old man who suffered traumatic thoracic aorta injury due to a fall accident during mountain climbing, and was saved by swift helicopter transport and emergency surgery. Approximately 2 h after the accident, the subject was brought to the hospital by the emergency helicopter transport service. Contrast-enhanced CT of the thorax and abdomen revealed leakage of the contrast medium from the aortic isthmus and a hematoma in the surrounding area. Thus, traumatic thoracic aorta injury was diagnosed and emergency surgery was performed. The patient went into a state of shock after being given anesthesia. Further rupture was diagnosed and a left fourth intercostal thoracotomy was performed immediately in order to control the hemorrhage. Concurrently, a partial cardio-pulmonary bypass was used. A lacerated foramen was observed across 1/3 of the lesser curvature of the aortic isthmus ; the affected site was replaced by a prosthetic graft. The postoperative recovery was generally uneventful, and the patient was discharged from the hospital 30 days after the operation.
ABSTRACT
A 39-year-old woman was found to have a heart murmur by a medical examination at age 37. During a checkup at our hospital, echocardiography revealed mild aortic valve regurgitation (AR) and mild mitral valve regurgitation (MR). When she was 39 years old, echocardiography revealed severe MR and moderate AR. Based on preoperative examinations, antiphospholipid syndrome (APS) was diagnosed. Therefore, she received high-dose prednisolone therapy and underwent plasma exchange before the surgery. We performed double valve replacement using a bioprosthetic valve. On the first postoperative day (POD 1), the number of platelets suddenly decreased. We diagnosed catastrophic APS, and treated her with high-dose prednisolone, high-dose immunoglobulin and plasma exchange. Her blood platelet gradually increased on POD 3. Although she needed time for rehabilitation, she was discharged from our hospital on POD 88. APS can cause a catastrophic event triggered by an operation. Therefore, stringent pre- and postoperative management is necessary in patients with APS.
ABSTRACT
A 72-year-old man presented with abdominal aortic aneurysm (AAA) and was referred to our hospital by his physician. A computed tomography revealed a 95-mm AAA with three right renal arteries. The main right renal artery branched from the AAA, and two remaining arteries branched from the same level as the left renal artery. The patient underwent AAA repair and main right renal artery reconstruction without any renal protection. After the operation, renal function did not deteriorate. 3D-CT was useful for diagnosing renal artery branching, evaluation of renal blood perfusion, and determining the operation method.
ABSTRACT
Eight patients with Takayasu's disease underwent cardiac surgery between 1983 and 1998. All were women and the age at the time of operation ranged from 42 to 68 years (mean, 53.8 years). They were divided into two groups according to the coronary artery involvement: group A (<i>n</i>=3) had aortic regurgitation with an intact coronary artery and underwent aortic valve replacement (AVR); group B (<i>n</i>=5) had coronary artery lesion and underwent coronary artery bypass grafting (CABG) concomitant with or without AVR. All AVR procedures were performed using mechanical valves. At the CABG operation, saphenous veins alone were used in three cases and the left internal thoracic artery and saphenous veins in two. The actuarial survival rate was 65.6% at 5 years and 32.8% at 10 years. There were no early or late deaths in group A. On the contrary, there were one hospital death and two late deaths in group B. We discussed the timing of surgical intervention, the kind of prosthetic valve, the material of bypass graft and the procedure of CABG, the postoperative steroid use, and the surgical prognosis. The optimal timing of surgery for cardiac involvement is, needless to say, the inactive phase of inflammation. However, there are some patients who require operations during the active phase because of medically intractable or worsening symptoms. There is a consensus regarding the kind of prosthesis, and the mechanical valve is usually employed. There are still controversies regarding the material of grafts. We do not know the late results of saphenous vein graft in Takayasu's disease although saphenous vein is thought to be the choice of graft and several CABG procedures are advocated. The left internal thoracic artery might be used as a graft if the patient with Takayasu's disease had no subclavian artery lesions and was stable with an antiinflammatory regimen. We recommend the postoperative steroid therapy to control inflammation and also describe the antiinflammatory regimen after cardiac surgery in Takayasu's disease. It is essential that we have to meticulously follow up the patients with Takayasu's disease who underwent cardiac operations, paying especial attention to the side effects of steroid as well as the progression of inflammation.
ABSTRACT
This study was designed to clarify the usefulness and pitfalls of hypothermic management after Fontan's operation. Twenty-five patients who underwent Fontan's operation and received hypothermic management in an acute postoperative phase from 1974 to 1991 were divided into two groups; the alive (S) group and the dead (D) group. The lowest rectal temperature during the procedure was 32°C on average. There were no significant differences in preoperative indices of pulmonary circulation and renal function. After rewarming, PaO<sub>2</sub> and daily urinary output were increased and central venous pressure decreased significantly in the S group. In all S group patients, urinary output was increased during hypothermia irrespective of peritoneal dialysis. Anuria occurred 2 days on average after induction of hypothermia in D group. Urinary output in D group decreased significantly for 4 days compared to S group. On the other hand, it was possible to save two patients who underwent take-down of Fontan's operation within 6 hours after the onset of anuria. We conclude that hypothermic management is useful in serious cases after Fontan's operation and that daily urinary output in relation to body weight during hypothermia is most important as an index of post operative circulation.