Operations for Descending Thoracic Aortic Aneurysms Utilizing the Antithrombotic Cardiopulmonary Bypass / 日本心臓血管外科学会雑誌

Fifteen consecutive patients with true or dissecting aneurysms of the thoracic descending aorta, and thoraco-abdominal aorta were operated upon under left thoracotomy with the support of partial cardiopulmonary bypass, equipment composed of a membrane oxygenator, centrifugal pump, and percutaneous thin wall cannulae which were all coated with covalently bonded heparin. The polyvinyl tube was coated with Biomate. The administration of systemic heparin was determined by an ACT of around 200 seconds. One perioperative death in a case treated by emergency operation for a ruptured descending aortic aneurysm occurred due to acute myocardial infarction. Other patients tolerated their operation well and are alive. No thromboembolic accident, bleeding tendency, nor organ failure were observed postoperatively in any other patients. In conclusion, the cardiopulmonary bypass using an antithrombotic circuit is safe and recommendable for thoracic descending or thoraco-abdominal aneurysm operations.

Cardiovascular Surgery with or without Extracorporeal Circulation in Patients Suffering from Renal Insufficiency / 日本心臓血管外科学会雑誌

From April 1987 to March 1990, we performed open heart surgery using extracorporeal circulation in 90 patients (average age, 51.8 years old) and vascular surgery (graft replacement of abdominal aortic aneurysm and surgery for ASO) in 29 patients (average age, 58.1 years old). Among there, 8 patients with open heart surgery (EEC group) and 9 patients with vascular surgery (vascular group) had suffered from renal insufficiency preoperatively. In the two groups, we compared operative mortality, complications and postoperative severity of renal failure. Preoperative renal insufficiency was defined as a serum creatinine level of more than 1.4mg/dl and postoperative renal failure was defined as 2.0mg/dl. There was no significant difference in operative mortality, in postoperative creatinine, Ccr, BUN and serum potassium and in effectiveness of hemodialysis in the two groups. In conclusion, it seems that we should not hesitate to perform cardiovascular surgery with extracorporeal circulation for patients with renal insufficiency or in hemodialized patients.

Surgical Treatment of Abdominal Aortic Aneurysm in Cases with Previous Laparotomies / 日本心臓血管外科学会雑誌

From January 1987 to October 1992, 60 consecutive patients operated on for infrarenal abdominal aortic aneurysm (AAA) were reviewed to evaluate the effect of previous laparotomies giving on the results of aneurysmal surgery. Eleven of 60 patients had previous laparotomies. Two of them required emergency operation for ruptured aneurysms. One of them died during surgery as a result of excessive hemorrhage prior to cross-clamping the aorta. Severe peritoneal adhesion had made if difficult to properly expose the aorta for cross-clamping to control hemorrhage. There were no statistical significance in mortality between the previous laparotomy and non-laparotomy groups. Excluding ruptured cases, we compared the previous laparotomy group (9 patients) and non-laparotomy group (37 patients) with reference to perioperative factors, including operation time, blood loss, non-oral feeding days, bed-ridden days, and hospital stay but there were no statistically significant differences. These results suggested that previous laparotomy is not a serious risk factor in operations for AAA.

Surgical Experience of Leiomyosarcoma of the Inferior Vena Cava. A Case Report of Successful Resection under Extracorporeal Circulation / 日本心臓血管外科学会雑誌

This is a case report of a 40-year-old man with leiomyosarcoma of the inferior vena cava. He had suffered from shortness of breath and edema on lower limbs over several months. Clinical examinations including UCG, CT and MRI revealed the mass in the right atrium. The stalk of mass was located near junction of the right atrium and inferior vena cava by cavography. He was operated upon using extracorporeal circulation. The tumor originated from inferior vena cava, measuring 8.5×5.5×4.8cm in size, 130g in weight, was successfully removed. Partial defect of anterior wall on the inferior vena cava was reconstructed using Gore-Tex patch. Histologically, the tumor was composed of the spindled cells with arranged bundles. Immunohistochemically, they were positive for Dessmin and Vimentin. Seven months after the surgery, he has been followed at OPD. In review of the Japanese literature to our knowledge, only 14 cases were reported including this case.