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1.
Article in Japanese | WPRIM | ID: wpr-366556

ABSTRACT

A 61-year-old man was admitted with acute cardiac failure associated with atypical aortic coarctation and severe left ventricular hypertrophy. Angiography and MRI showed that all branches from the aortic arch were occluded, and that cerebral circulation was supplied via collateral flow from small aortic branches either proximal or distal to the coarctation and by the right vertebral artery receiving retrograde flow from the right internal thoracic and right thoracodorsal arteries. Cerebral CT revealed massive cerebral infarction in the perfusion area of the right mid-cerebral artery. Aortitis syndrome was diagnosed from these findings, and ascending-abdominal aortic bypass grafting with aorto-right subclavian bypass was performed after successful conservative treatment for cardiac failure. Because of remarkable increase in the aortic blood pressure on partial clamping of the ascending aorta, proximal aortic anastomosis was performed under extracorporeal circulation. Near infrared spectroscopy (NIRS) was used to monitor the intraoperative cerebral circulation. The perfusion flow rate was maintained in order not to reduce the regional brain oxygen saturation below the critical level. No cerebral complication was encountered postoperatively. Cases of aortitis syndrome with occlusion of all arch branches are rare. NIRS was suggested to be useful to evaluate cerebral circulation during operation in such cases in which cerebral blood flow can be severely affected.

2.
Article in Japanese | WPRIM | ID: wpr-366626

ABSTRACT

A 53-year-old woman had dyspnea on effort since half a year previously and was categorized as NYHA II. She had suffered from chronic atrial fibrillation (AF) for three years. She had undergone aortic valve replacement using a Starr-Edwards ball valve (SEV) for aortic regurgitation and mitral commissurotomy for mitral stenosis 29 years previously. Echocardiography revealed mitral stenosis with an orifice area of 0.9cm<sup>2</sup> and neither dysfunction of the SEV nor abnormal findings on the valve itself. She underwent mitral valve replacement and left atrial maze procedure for AF. Because of the intraoperative findings of the cloth wear-covered SEV cage, redo aortic valve replacement was performed simultaneously. St. Jude Medical valves were used for valve prostheses. There was no complication and the ECG returned to sinus rhythm postoperatively. These has been no report of a patient with such a long period between SEV implantation and replacement in Japan. This experience made us realize again the importance of attention to the cloth wear covered cage during long term follow up for SEV.

3.
Article in Japanese | WPRIM | ID: wpr-366534

ABSTRACT

A 34-year-old woman was referred to us because of severe aortic regurgitation and annuloaortic ectasia. She also showed a high level of CRP and stenosis of cervical arteries and aortitis syndrome was diagnosed. A translocated Bentall's procedure was performed after administration of corticosteroid. An SJM valve prosthesis was translocated from 1cm above the distal end of the graft and this composite graft was anastomosed to the aortic annulus with buttress sutures reinforced with Dacron felt. Both coronary orifices were reconstructed with small sized Dacron grafts, interposed from the coronary orifices to the composite graft. There was not any complication postoperatively. This procedure is preferable in cases with aortitis syndrome, because it decreases risk of prosthetic detachment in the aortic valve position.

4.
Article in Japanese | WPRIM | ID: wpr-366437

ABSTRACT

Atrial fibrillation is common in adults with atrial septal defect. A right atrial separation procedure was performed for the ablation of atrial fibrillation during the concomitant repair of atrial septal defect. The operation was performed under cardiopulmonary bypass. A Y-shape incision was made in the right atrium, followed by cryoablation of the tricuspid annulus and the atrial septum. After the operation, all three patients recovered and maintained a normal sinus rhythm during follow-up periods of 12, 4, and 1 months. This is a simple and effective procedure for the elimination of chronic atrial fibrillation associated with atrial septal defects in adults.

5.
Article in Japanese | WPRIM | ID: wpr-366218

ABSTRACT

A 59-year-old male suffered dyspnea and ischemia of the lower limbs due to myocardial infarction (occlusion of the right coronary artery and 99% stenosis with delay in the left anterior descending artery) and juxtarenal aortic occlusion, respectively. Juxtarenal aorto-femoral bypass operation using a Y-shaped prosthesis and coronary arterial bypass grafting using the left internal thoracic artery (LITA) and right gastroepiploic artery (RGEA) were performed simultaneously. As the left internal thoracic artery was the route of collateral blood flow to the left lower limb, aorto-femoral bypass was initially made prior to aorto-coronary bypass operation. Because of complete obstruction of the abdominal aorta and juxtarenal lumbar arteries, neither hemodynamic changes nor bleeding occurred during the reconstruction of the abdominal aortic occlusion in spite of severe coronary disease. This procedure was useful for protection of limb ischemia and shortage of extracorporeal circulation time, in addition to producing a route for insertion of an intraaortic balloon pumping catheter.

6.
Article in Japanese | WPRIM | ID: wpr-366262

ABSTRACT

A 51-year-old man was admitted with symptoms of sudden back pain and abdominal pain. Echocardiography and aortagraphy demonstrated enlargement of the aortic annulus, aortic regurgitation and Stanford type B aortic dissection. Since an entry of the aortic dissection was located at the root of the left subclavian artery, a one-stage operation consisting of aortic root replacement and total arch replacement was scheduled. The aortic root replacement using Piehler's modification was first performed followed by total arch replacement combining with the closure of the entry in the distal aortic arch was followed under selective cerebral perfusion. All procedures were complished through median sternotomy. The postoperative course was uneventful and aortography showed good reconstruction of the coronary arteries and the cervical arteries and thrombo-exclusion of the false lumen in the descending aorta. This method was useful for in this case of annulo aortic ectasia with Stanford type B aortic dissection.

7.
Article in Japanese | WPRIM | ID: wpr-366026

ABSTRACT

Twelve cases of ruptured abdominal aortic aneurysm (RAAA) were treated during 5 years. Nine showed severe hypotension (systolic pressure below 70mmHg) and three required cardiac massage prior to operation. At the beginning of this study, direct laparotomy was conducted on 4 cases but mortality was high mortality (75%). Left thoracotomy with antero-lateral incision through the 7th intercostal space was carried out to access the thoracic aorta for clamping before laparotomy, since the major mortality of this disease is due to abrupt bleeding following anesthesia and operation. Left thoracotomy before laparotomy was conducted on 8 cases, half of whom required aortic clamping during operation (clamping time 21min). Operative mortality following thoracotomy decreased (12.5%). The aneurysm size and the time of operation for the groups with or without thoracotomy were the same, though the degree of bleeding significantly differed (3, 925ml in the group with thoracotomy, 7, 193ml in the group without thoracotomy). Left thoracotomy befor laparotomy obtained good results in case of RAAA.

8.
Article in Japanese | WPRIM | ID: wpr-366063

ABSTRACT

We have operated upon 17 cases of distal arch aneurysm, including 3 cases of rupture, during the past 6 years. Operative adjuncts during aortic cross clamping were left heart bypass with a centrifugal pump (LHB, 6 cases), retrograde cerebral perfusion (RCP, 5 cases) and selective cerebral perfusion (SCP, 6 cases). LHB was applied to localized, the aneurysm apart from the left subclavian artery. It was safely performed during operation, but cerebral embolism happened in 2 cases with aortic cross clamping. RCP was performed in emergency cases of rupture or impending rupture. Recently 3 cases were operated by left thoracotomy under RCP. One case, an 85-year-old female, was perfused for 100min by RCP, became unconsciousness and died by multiple organ failure. Although this method was simple and easy to prepare, the efficacy of cerebral perfusion is unclear and a perfusion time of less than 90min is thought to be safe. SCP was performed in 6 cases of large aneurysm, including four cases of total arch replacement. There was one operative death, but minimum complications in the survivors. Distal arch aneurysm varies in shape, location and size. Operative adjunct must be selected based on the condition of the aneurysm.

9.
Article in Japanese | WPRIM | ID: wpr-365880

ABSTRACT

Two cases of blue toe syndrome were effectively treated by PGE1. Case 1 was an 80-year-old man who had an ulcer lesion of the 5th toe. Angiography indicated the symptoms were caused by microemboli from an extended lesion of the aorta and iliac artery. The wound was healed by lipo PGE1 (10μg×30 days). Case 2 was a 54-year-old man who had dull pain and skin color change of the 3rd and 4th fingers. A thrombus could not be detected by transthoracic echocardiography, but was found by transesophageal echocardiography. The symptoms improved by PGE1 (60μg×20days). Blue toe syndrome is induced by a microembolism in the peripheral arteries, and thus the conventional treatment has been the administration of fibrinolysins and anticoagulants. PGE1 was used in this study for the first time in consideration of its vasodilating effect on the collateral circulation and to prevent a secondary thrombus by inhibiting platelet aggregation.

10.
Article in Japanese | WPRIM | ID: wpr-365901

ABSTRACT

Patients who underwent the bypass operation during 5 years from 1987 to 1992 in the 1st Department of Surgery, Hiroshima University School of Medicine, were divided into 2 groups; AIOD group (51 cases) had lesions in the aorta and iliac artery, and FPOD group (46 cases) had lesions in the femoral artery and popliteal artery. A comparative study of these two groups was made. There was no significant difference in age, sex, symptom severity, smoking history, serum cholesterol level, serum triglyceride level. The complication rate of peripheral lesions of the AIOD group was 24% and of the FPOD group was 57%. The cumulative patency rate for 5 years of the AIDO group was 100% and of the FPOD group was 61%. The AIOD group exhibited better patency. In addition to the lower complication rate of peripheral lesions, all the AIOD group had underwent reconstruction operation for peripheral lesions simultaneously. The run-off state of the peripheral region may thus possibly be related to patency.

11.
Article in Japanese | WPRIM | ID: wpr-365959

ABSTRACT

Fifty-one cases which underwent surgery for arteriosclerosis obliterans in the aorta and iliac artery at the First Department of Surgery, Hiroshima University School of Medicine were divided into two groups. The EAB group (18 cases) underwent extra-anatomic bypass operation, and the AB group (33 cases) underwent anatomic bypass operation. A comparative study showed the mean age of the EAB group to be 10 years higher than that of the AB group, and the former group exhibited severer symptoms. Renal and pulmonary function declined in the EAB group, and the occurrence rate of complications such as cerebral infarction was also higher At operation, the following approaches were employed; long-term administration of PGE-1 before and after operation, operation with a better visual field under light general anesthesia, simultaneous reconstructive operation in peripheral lesions, artificial vessels of externally supported velour knitted Dacron. There was no case of obstruction in the past 5 years. Extra-anatomic bypass operation therefore provides as good postoperative patency as anatomic operation.

12.
Article in Japanese | WPRIM | ID: wpr-365961

ABSTRACT

A 74-year-old man presented with swelling in both lower limbs and fatigue. Venography indicated nozzle-like stenosis of the inferior <i>vena cava</i> that appeared during the inspiratory phase but disappeared during the expiratory phase. A large pressure gradient between the upper and lower portion of the stenosis was observed during the expiratory phase. Stenosis during the inspiratory phase was relieved by percutaneous transluminal angioplasty, and symptoms and signs disappeared. Although stenosis occurred only during the inspiratory phase, our patient exhibited symptoms characteristic of Budd-Chiari syndrome. We believe that this patient originally had stenosis of the diaphragmatic portion of the inferior <i>vena cava</i>, and that his symptoms derived from the formation of a parietal thrombus.

13.
Article in Japanese | WPRIM | ID: wpr-365977

ABSTRACT

This is a rare case of abdominal apoplexy encountered in a 50-year-old man who had aortic and mitral valve replacement due to dominant regurgitation resulting from infective eneocarditis. On the 4th day after the operation, retroperitoneal bleeding, probably due to rupture of the splenic artery aneurysm, occurred and he developed shock. On the 28th day, there was bleeding in the digestive tract and blood pressure was low, probably due to rupture of the microaneurysm of the small artery distributing to the ileum. Rupture of an abdominal vessel without a recognizable external cause is called abdominal apoplexy, and our case was caused by mycotic aneurysm caused by infective endocarditis. Angiography facilitated the accurate diagnosis.

14.
Article in Japanese | WPRIM | ID: wpr-365992

ABSTRACT

Between 1988 and 1992, we experienced 4 cases of removal of renal or hepatic cell carcinoma tumor thrombi extending into the inferior <i>vena cava</i> and the right atrium, under cardiopulmonary bypass. We operated on 3 cases using profound hypothermia and circulatory arrest, and 1 case using moderate hypothermia and the Pringle maneuver. One case developed acute massive pulmonary embolism followed by cardiac arrest during the procedure of freeing the inferior <i>vena cava</i> and died on the second postoperative day due to low output syndrome. The postoperative courses of the other 3 cases were uneventful, and there was no major complication due to surgery. They were discharged and enjoyed normal daily lives. Two cases died due to recurrence of the tumor, 6 and 7 months after the operation, respectively. The merits and demerits of these two surgical methods were discussed. Appropriate selection of these methods and subjects allows safe and complete excision of tumor thrombi with satisfactory operative results.

15.
Article in Japanese | WPRIM | ID: wpr-365848

ABSTRACT

The authors encountered 2 rare cases of adventitial cystic disease of the popliteal artery. Case 1 was a 51-year-old woman with dull pain in the lower limbs during walking. Case 2 was a 34-year-old man with numbness in the lower limbs on bending his knees. In both cases, angiography showed crescent stenosis, and computed tomography (CT) showed cyst-like lesions about the artery. Magnetic resonance imaging (MRI) indicated the lesions to have high density at T 2 imaging. With a diagnosis of adventitial cystic disease, cystectomy was conducted with satisfactory results. Adventitial cystic disease is rare and only 43 cases have so far been reported in this country. All of these were reviewed to clarify the characteristics of this disease. Its clinical symptoms often resemble those of arteriosclerosis obliterans (ASO) as intermittent claudication, but it differs from ASO in that it is usually achieved cure by cystectomy alone and seldomly required bypass operation. In the case of intermittent claudication in young patients, adventitial cystic disease should be diferrentiated from ASO.

16.
Article in Japanese | WPRIM | ID: wpr-365865

ABSTRACT

A 78-year-old man consulted our hospital with complaint of abdominal mass. Blood examination indicated a inflammatory reaction. An abdominal aortic aneurysm, 5.5cm in size, was found by CT scanning examination. Its wall quite thick (mantle sign), and enhanced by contrast medium. Y graft replacement was carried out. Microscopic hiatological examination of the aneurysmal wall indicated severe inflammation being assisted of chronic inflammatory cells, like lymphocytes and plasma cells at the adventitia. Ten cases of inflammatory abdominal aortic aneurysm reported in Japan so far are reviewed and features of this disease are discussed.

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