ABSTRACT
A 62-year-old man with ischemic heart disease suffered from a poststernotomy wound trouble after coronary artery bypass grafting. We performed vacuum-assisted closure (VAC), minimally invasive treatment for difficult wounds, because he had severe heart failure and depressive disorder. This therapy assists in wound healing by applying localized negative pressure to the surface of the wound, and its effectiveness for poststernotomy mediastinitis has already been reported in several countries. It is, however, very difficult for us to obtain a manufactured device, the V. A. C.<i>®</i> system (KCI, San Antonio, Texas), which is not available in Japan yet. Therefore, we had to make a self-made system which combined RetractorPad<i>®</i> polyvinyl alcohol hydrofoam (Mondomed NV, Harmont, Belgium) and J-VAC<i>®</i> closed wound drainage system (Johnson & Johnson, Tokyo, Japan). This self-made system, without a vacuum pump machine, was small and light enough to be carried by the patient even in the early postoperative period. In this case, VAC resulted in complete healing of the wound in about 3 weeks with little pain, stress, effort and time, and with reasonable cost in comparison to conventional treatment. This is a useful and hopeful option in the treatment of not only sternum dehiscence but also mediastinitis after cardiac surgery, especially for high-risk patients.
ABSTRACT
Causative factors for thrombi formation in left atria of 38 patients with mitral stenosis who underwent mitral valve surgery (open mitral commissurotomy or mitral valve replacement) alone or in combination with other procedures were studied. There were 9 cases of left atrial thrombosis (LAT). Left atrial diameter was increased in LAT(+) group (6.1±1.6cm) compared with LAT(-) group (4.6±0.7cm). There was significant difference in the left atrial diameter between the two groups of patients (<i>p</i><0.01). Cardiac output was decreased in LAT(+) group (3.04±0.74<i>l</i>/min) compared with LAT(-) group (3.99±1.07<i>l</i>/min). Cardiac output of LAT (-) group was significantly larger than that of LAT(+) group (<i>p</i><0.05). Mean transition time of blood through left atrium (MTT<sub>LA</sub>) was calculated using left atrial volume and cardiac output. In LAT (+) group, MTT<sub>LA</sub> was significantly increased (6.2±3.9sec) compared with LAT(-) group (2.9±1.6sec). It is considered that, in mitral stenosis, prolongation of MTT<sub>LA</sub> is one of the risk factors for thrombi formation in the left atrium.