Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 22
Filter
Add filters








Year range
1.
Article in Japanese | WPRIM | ID: wpr-887103

ABSTRACT

A 67-year-old man developed the recurrence of postoperative constrictive pericarditis. He had two operation histories : the one was CABG for old myocardial infarction and the other was pericardiectomy for postoperative pericarditis at 57 and 59 years old respectively. Both operations were performed in our hospital. We used an ePTFE sheet for covering the heart in the pericardiectomy. The course post operation was good, but eight years after the pericardiectomy, he had abdominal distension and leg edema. Detailed studies revealed a recurrence of constrictive pericarditis, and reoperation was performed. The re-operative finding showed thickened sclerotic tissues on both sides of an ePTFE sheet which was applied to the cardiac surface during the previous surgery. No abnormal tissue was detected where the ePTFE sheet was not applied. The ePTFE sheet and the sclerotic tissues were removed under cardiopulmonary bypass support, and then diastolic dysfunction improved dramatically. His chest was closed without applying an ePTFE sheet. His post-operative course was uneventful and he was discharged on the 20th postoperative day. The ePTFE sheet was highly suspected as a cause of the recurrent constrictive pericarditis. An ePTFE sheet-induced constrictive pericarditis should be considered as one of the postoperative complications even in the mid and long-term period. The ePTFE sheet is useful for preventing heart or vascular injury when we perform resternotomy, but in rare cases, there is some possibility of association with a risk of pericarditis.

2.
Article in Japanese | WPRIM | ID: wpr-825923

ABSTRACT

Mitral valve surgeries for cases with mitral annular calcification (MAC) are challenging because of the operative complications. For a case of MS with MAC, we achieved mitral valve plasty by ultrasonic decalcification alone. An 82-year-old male with edema and dyspnea was diagnosed with AS and MS with MAC. MAC was so severe that MVR was challenging. There were calcifications at the anterior commissure and the anterior mitral leaflet (AML), and removal of them was expected to improve the valve function. Therefore, anterior commissurotomy and ultrasonic decalcification of the anterior commissural annulus was performed using cavitron ultrasonic surgical aspiration (CUSA). Following the resection of the aortic valve, we carried out decalcification of the AML through the aortic valve orifice. After AVR, a trans-esophageal echocardiogram showed MS was ameliorated. Two years after surgery, recurrence of MS was not recognized. Some mitral cases with MAC can be treated by only decalcification to avoid risky valve replacement.

3.
Article in Japanese | WPRIM | ID: wpr-378646

ABSTRACT

<p>A 79-year-old man, who had a history of intravesical instillations of bacillus Calmette-Guérin (BCG) therapy for urinary bladder cancer, developed bloody sputum 4 years after BCG therapy. BCG was detected from the sputum by detailed examination. Medical therapy for tuberculosis (TB) was started, but bloody sputum continued. Computed tomography (CT) for the chest was performed to evaluate the state of TB, and surprisingly, found impending rupture of tuberculosis mycotic thoracic aneurysm. He was emergently transferred to our hospital. CT revealed that the aneurysm made a lump with surrounding lung and lymph nodes. It seemed to be quite difficult to dissect and to be quite high risk to perform graft replacement with pneumonectomy. On the other hand, TB infection was controlled with antibiotic therapy. Thus we chose debranch TEVAR for this complicated situation. His bloody sputum regressed soon after the procedure and disappeared during his hospitalization. He was discharged home on POD 13 without serious complication and continued to have antibiotic therapy under the instruction of his primary physician.</p>

4.
Article in Japanese | WPRIM | ID: wpr-378632

ABSTRACT

<p>Endovascular treatment for chronic aortic dissection in patients with Marfan syndrome is still controversial. A 60-year-old man developed an extended chronic type B dissection involving the aortic arch and thoraco-abdominal aorta with a large entry at the distal aortic arch and patent false lumen. He had undergone David procedure for type A aortic dissection at age 42, and aortic valve replacement for recurrent aortic valve insufficiency at 58, which was complicated with mediastinitis. He also suffered drug-induced interstitial pneumonitis. Considering his complicated surgical history and impaired pulmonary function, conventional graft replacement of thoraco-abdominal aorta was thought to be quite a high risk. Thus, we chose debranch TEVAR with a staged approach. First, debranching and Zone 0 TEVAR with the chimney technique were performed. Then, 4 months later, abdominal debranching and TEVAR was performed. The patient tolerated both procedures well and was discharged home. Two years after last procedure, he is in good condition and computed tomography shows that complete entry closure and false lumen had thrombosed. This strategy may be worthy to be considered even for a patient with Marfan syndrome, in case the patient's condition is unsuitable for conventional surgery.</p>

5.
Article in English | WPRIM | ID: wpr-215553

ABSTRACT

Histiocytic sarcoma in the liver is an extremely rare hematological malignancy. Herein, we reported the case of a 68-year-old woman who presented with characteristic wedge-shaped abnormality bounded by hepatic veins on computed tomography and magnetic resonance imaging of the liver. In the wedge-shaped area, decreased portal flow and the deposition of iron were observed. These imaging findings are consistent with intrasinusoidal tumor cell infiltration. A liver biopsy was performed, and histiocytic sarcoma was confirmed histopathologically.


Subject(s)
Aged , Biopsy , Female , Hematologic Neoplasms , Hepatic Veins , Histiocytic Sarcoma , Humans , Iron , Liver , Magnetic Resonance Imaging
6.
Article in Japanese | WPRIM | ID: wpr-377173

ABSTRACT

A 74-year-old woman was referred to our unit with a chief complaint of dysphagia. Enhanced CT showed a Kommerell diverticulum with a maximum diameter of 46 mm, associated with a right-sided aortic arch and aberrant left subclavian artery. We performed two-staged operations : left subclavian-common carotid artery bypass followed by total arch, and descending aortic replacement by an antero-lateral thoracotomy with partial sternotomy (ALPS). The postoperative course was uneventful. Total arch and descending aortic replacement for a Kommerell diverticulum by an ALPS approach is rare. ALPS approach for Kommerell diverticulum achieves safe surgery with good exposure.

7.
Article in Japanese | WPRIM | ID: wpr-376112

ABSTRACT

PA-LA communication is a rare congenital heart disease consisting of direct communication between a branch of the PA and LA through an aneurysmal structure. This disease reveals the central cyanosis with clubbed fingers and surgical repair is needed when symptoms are apparent. Computed tomography is highly recommended for definitive diagnosis. Angiographic catheterization is also recommended to support the diagnosis and decide on the treatment. PA-LA communication is categorized into 4 types. Two types do not need cardiopulmonary bypass (CPB) when treated surgically, but the others need CPB. A 16-year-old girl with clubbed fingers was found to have PA-LA communication by 3DCT. She underwent surgery and was discharged in good condition. The surgical procedure was done through median sternotomy without CPB. The anomalous aneurysmal fistula was doubly ligated. No communication was found after ligation by TEE.

8.
Article in Japanese | WPRIM | ID: wpr-375640

ABSTRACT

An 80-year-old woman underwent lower and middle lobe resections of right lung in 1990 and 1998 because of lung cancers. There was no recurrence. In 2009, she presented with exertional dyspnea, and echocardiography showed grade III mitral regurgitation (MR). We diagnosed with congestive heart failure caused by MR. Her chest CT showed her mediastinum was shifted to the right and her heart was in the right thoracic cavity. We performed mitral valve plasty via right 7th intercostal thoracotomy. Post-operative respiratory condition was stable and she was extubated on the first postoperative day. Post-operative UCG showed trivial MR. She was discharged on the 14th day.

9.
Article in Japanese | WPRIM | ID: wpr-375437

ABSTRACT

Essential thrombocythemia (ET) is an uncommon type of myeloproliferative disorder, characterized by both thrombotic and hemorrhagic diatheses. No clear guidelines exist for the pre- or post-operative management of patients with ET undergoing cardiac surgery. Here, we present a rare case of a patient with essential thrombocythemia and severe aortic stenosis, who needed an aortic valve replacement on cardiopulmonary bypass and who suffered no complications.

10.
Article in Japanese | WPRIM | ID: wpr-361992

ABSTRACT

We described a patient with free wall rupture followed by papillary muscle rupture due to acute myocardial infarction. A 69-year-old man was transferred complaining of transient unconsciousness. His clinical history, electrocardiogram, and chest CT showed myocardial infarction with free wall rupture indicated that several days had passed since the onset. Coronary angiography showed occlusion of the right coronary artery and severe stenosis of the left anterior descending artery. Since cardiac rupture was at inferior wall and hemorrhage wasn't active, repair of the rupture using fibrin glue and fibrin sheet and coronary artery bypass grafting to the left anterior descending artery was performed without cardiopulmonary bypass. On the 10th postoperative day, his arterial oxygen saturation suddenly deteriorated. Transesophageal echocardiography revealed papillary muscle rupture and severe mitral regurgitation. Emergency mitral valve replacement was performed. After two emergency operations, he gradually recovered and were discharged to home. In three months after discharge, he was admitted again due to congestive heart failure with left ventricular aneurysm at inferior wall and recovered in response of conservative treatment. Surgical experience of double rupture is rare. Based on this case, it may be necessary to perform reperfusion therapy toward even this case of recent myocardial infarction, to prevent papillary muscle rupture. It also may be better to use a patch on free wall rupture to prevent cardiac aneurysm.

11.
Article in Japanese | WPRIM | ID: wpr-361948

ABSTRACT

A 27-year-old woman was given a diagnosis of infectious endocarditis with severe tricuspid regurgitation. Despite adequate antibiotics therapy, her general condition did not improve, and moreover multiple pulmonary abscesses were detected by computed tomography. Therefore surgery was indicated. Surgery consisted of removal of vegetation and tricuspid valve plasty with autologous pericardial patch augmentation of the anterior leaflet. Tricuspid valve plasty was carried out without prosthetic materials. Her postoperative course was uneventful with only mild tricuspid regurgitation. One year after surgery, neither recurrence of infection nor worsening of tricuspid regurgitation was noted. This method could be a useful technique for young patients with severe infection.

12.
Article in Japanese | WPRIM | ID: wpr-361919

ABSTRACT

A 47-year-old man had suffered from high grade fever and dyspnea for 10 days. He was transferred to our hospital in a condition of shock. Echocardiography showed severe diffuse hypokinesis of left ventricle (EF 21%), and multiple mobile thrombi in the left ventricle. Under a diagnosis of LV thrombi due to acute myocarditis, transatrial removal of LV thrombi was performed using video-assisted cardioscopy. He was weaned from cardiopulmonary bypass under IABP support. Postoperatively, he suffered from thromboembolism of the cerebral and right brachial artery. Thrombectomy of the right brachial artery and anticoagulation therapy was performed. IABP was removed on POD 3, and he no longer needed respiratory control on POD 4. Echocardiography on POD 6 showed marked improvement of the LV contraction (EF 52%). After rehabilitation, he was discharged on POD 23 on foot. Video-assisted cardioscopy allowed transatrial removal of LV thrombi, and preserved left ventricular function by avoiding ventriculotomy. Perioperative thromboembolism must be taken care of for a patient with multiple LV thrombi.

13.
Article in Japanese | WPRIM | ID: wpr-367245

ABSTRACT

Right-sided infective endocarditis (IE) accounts for 5% to 10% of all IE. Compared with left-sided IE, antibiotic treatment is effective in about 70% of cases. The timing of surgical treatment for right-sided IE is therefor controversial. A 26-year-old woman had suffered from tricuspid valve endocarditis with DIC. There was no evidence of any previous cardiac event or dental treatment. Echocardiography showed a large vegetation attached to the anterior leaflet of tricuspid valve with moderate tricuspid regurgitation. We removed the vegetation with a part of the anterior leaflet and performed tricuspid valvuloplasty and annuloplasty. The patient had an uneventful postoperative course and received intravenous antibiotic treatment for a further 4 weeks.

14.
Saudi Medical Journal. 2007; 28 (6): 831-837
in English | IMEMR | ID: emr-163738

ABSTRACT

This article reviews the current status of local ablation therapy for hepatocellular carcinoma [HCC]. In the treatment of HCC, non-surgical treatments play important roles since only 20-30% of patients are candidates for surgery. Still worse, even after curative surgical resection, 80% of patients develop recurrence within 5 years. Among non-surgical treatments, image-guided local ablation therapies have been widely used for cases of small-number and small-size lesions, because they are potentially curative, minimally invasive, and easily repeatable. Although percutaneous ethanol injection has long been a standard therapy, there has been a drastic shift from ethanol injection to radiofrequency ablation in recent years. Randomized controlled trials proved that radiofrequency ablation is superior to ethanol injection in the treatment of HCC from the viewpoint of not only treatment response but also long-term survival. Radiofrequency ablation will play more important roles in the treatment of HCC

15.
Article in Japanese | WPRIM | ID: wpr-367118

ABSTRACT

Primary cardiac angiosarcoma is very rare and its prognosis was reported to be very poor (average survival period 7 months). A 46-year-old woman with angiosarcoma was admitted for recurrent symptoms of cardiac tamponade. Surgical excision of the tumor was performed 5 months after initial presentation and irradiation therapy was added. Thereafter, immunotherapy, and transcatheter arterial embolization were performed for liver metastasis. Despite this multidisciplinary therapy, she passed away 355 days after surgery. In our report, we described our multidisciplinary approach to this highly malignant tumor and the treatment strategy was discussed.

16.
Article in Japanese | WPRIM | ID: wpr-367034

ABSTRACT

The operation for constrictive pericarditis after coronary artery bypass grafting (CABG) needs complete pericardiectomy without injury to the bypass graft. A 60-year-old man had pleural effusion a month after CABG. Right atrial pressure (RAP), right ventricular pressure (RVP), and pulmonary capillary wedge pressure (PCWP) were elevated and RVP showed a dip and plateau sign on cardiac catheterization. We diagnosed heart failure due to constrictive pericarditis following CABG. Pericardiectomy was performed using a cardiopulmonary bypass through a median sternotomy. The Harmonic Scalpel was useful for dissecting the pericardium. After the operation, it took a month for the patient to improve. RAP, RVP and PCWP were decreasing, and the dip and plateau sign of RVP was improved. The pleural effusion disappeared and the patient was discharged on the 73rd postoperative day.

17.
Article in Japanese | WPRIM | ID: wpr-367014

ABSTRACT

We report mitral valve replacement (MVR) in a patient who had undergone left pneumonectomy for thoracic empyema 8 years previously. A 75-year-old man had heart failure due to mitral valve regurgitation and medication therapy was initiated. Although the heart had shifted to the right side, MVR was performed using a SJM valve with primary median sternotomy. The tracheal intubation tube was removed 17h after the operation, and the patient was discharged on the 43rd postoperative day. Careful preoperative assessment, preoperative control of heart failure, and careful attention to perioperative fluid management are important components of successful clinical management.

18.
Article in Japanese | WPRIM | ID: wpr-367004

ABSTRACT

A 31-year-old woman had an aneurysm of the brachiocephalic artery and aortic regurgitation due to aortitis syndrome. As C-reactive protein (CRP) levels were high (27.5mg/dl), steroid therapy was initiated. After CRP became negative, the brachiocephalic aneurysm was repaired using a GELWEAVE<sup>®</sup> Y-graft, and the aortic valve was replaced with an ATS<sup>®</sup> mechanical valve. Regional cerebral oxygenation (rSO<sub>2</sub>) was monitored during the operative period. The level of rSO<sub>2</sub> did not change during the period when the brachiocephalic artery was clamped, resulting in no cerebral damage after the operation. Homer's syndrome appeared after the operation but the symptoms gradually improved spontaneously. A mechanical valve was chosen because the patient did not want to undergo a reoperation. No cerebrovascular event occurred after the operation and the patient was discharged on the 28th postoperative day.

19.
Article in Japanese | WPRIM | ID: wpr-366946

ABSTRACT

A 77-year-old woman was given general anesthesia for an ascending aortic aneurysm operation and went into anaphylactic shock. The operation was canceled. Vecuronium, pancuronium, protamine and famotidine revealed positive prick test reactions. Ascending aortic replacement underwent under minimum dose of heparin for cardiopulmonary bypass (CPB). Heparin was injected immediately before CPB (2.5mg/kg) and nafamostat mesilate was injected continuously during CPB (2mg/kg/h). The ACT value was over 1, 400sec during CPB. However, protamine was not used after CPB. The operation time was 4h and 30min. CPB time was 1h and 26min. After the patient returned to the ICU, bleeding from the chest drainage tubes increased temporarily. The bleeding decreased gradually after administration of FFP and MAP.

20.
Article in Japanese | WPRIM | ID: wpr-366760

ABSTRACT

The valvular function after aortic valve replacement was examined using Doppler echocardiography and changes in serum lactate dehydrogenase (LDH) and free hemoglobin levels were assessed. Data for the ATS Medical open pivot prosthetic valve were compared with those of the St. Jude's Medical prosthetic (SJM) valve, a similar bileaflet valve. These have been used in the past 5 years. There were 23 patients with ATS valves (13 men and 10 women, with a mean age of 60.4±13.8 years) and 16 patients with SJM valves (10 men and 6 women, with a mean age of 61.4±8.7 years). The left ventricular diastolic diameter index (LVDdI), left ventricular systolic diameter index (LVDsI), % fractional shortening (%FS) and left ventricular mass index (LVMI) were determined by echocardiography. The peak pressure gradients of the aortic prosthetic valves were calculated by a simplified Bernoulli equation. Postoperative LVDdI, LVDsI and LVMI were not significantly different in the ATS group and the SJM group. However, the %FS of the ATS group was significantly higher than that of the SJM group with aortic stenosis. The pressure gradients at the aortic prosthetic valve position were not significantly different between ATS and SJM valve in the 19-mm, 21-mm and 23-mm size. Postoperative improvement or recovery of the serum LDH level was observed significantly more frequently in the ATS group than the SJM group (<i>p</i><0.005). The free hemoglobin level of the ATS group was also lower than that of the SJM group (<i>p</i><0.005). We demonstrated satisfactory valvular function of the ATS valve compared with the SJM valve. Postoperative improvement of hemolysis was observed significantly more frequently and more rapidly in the ATS valves.

SELECTION OF CITATIONS
SEARCH DETAIL