Implantation Technique of a Left Ventricular Assist System through a Small Right Parasternal Incision / 日本心臓血管外科学会雑誌

A 62-year-old man was transferred to our institution with ventricular fibrillation. Percutaneous cardiopulmonary support (PCPS) was established and he underwent successful percutaneous transluminal coronary angioplasty. Since his left ventricular function did not recover, he was placed on a left ventricular assist system (LVAS). Under general anesthesia, a 10-cm longitudinal incision was made on the right parasternum. The third and fourth cartilages were completely resected. The pericardium was incised longitudinally. At first, an inflow cannula was insected to the right side of the left atrium. The ascending aorta was then partially excluded and an outflow cannula with a 10mm Gore-Tex prosthesis was anastomosed end-to-side to the aorta with a continuous Gore-Tex suture. After the pump was established, PCPS was gradually discontinued. During 9 days of support, his left ventricular function recovered and subsequently he was weaned from LVAS. Unfortunately, he died two days after LVAS removal. We think this procedure is useful because it is easy to perform, reduces the bleeding, shortens the operating time.

Redo Coronary Artery Bypass Grafting via a Small Thoracotomy without Cardiopulmonary Bypass / 日本心臓血管外科学会雑誌

We report two cases the first was a 74-year-old woman who had received coronary artery bypass grafting [SVG-to-LAD, SVG-to-Cx, SVG-to-RCA, the left internal thoracic artery (LITA) was mobilized but was unsuitable for the graft] two years previously. Postoperative angiography revealed graft occlusion. Since repeated catheter intervention was not successful, reoperation was performed. A MIDCAB procedure with radial artery graft and proximal anastomosis was performed on the left axillary artery. The operation was successful and there were no complications. Two weeks after the operation, the graft patency was confirmed and she was discharged. The second case was a 64-year-old man who received coronary artery grafting (LITA-to-LAD, SVG-to-Cx and SVG-to-RCA). Two months after the operation, recurrent chest pain was caused by severe stenosis of the LITA anastomotic site. Percutaneous transluminal coronary angioplasty was performed but was unsuccessful. He received redo CABG in the same manner using the saphenous vein. The postoperative course was uneventful and he was discharged 6 days after the operation. This procedure is useful for the patients whose left internal thoracic artery has been used on a previous operation. Good early results were obtained in both patients.

A Combination of a Modification of Bentall's Procedure, the Elephant Trunk Method and Aortic Arch Replacement for Marfan's Syndrume Using Cardioplegia / 日本心臓血管外科学会雑誌

A 44-year-old woman with Marfan's syndrome presented complaining of severe back pain. Angiography revealed annulo aortic ectasia, aortic regurgitation, acute aoric dissection (DeBakey IIIb) and distal aortic arch aneurysm. One month after admission, she underwent cardiopulmonary bypass was established through the femoral artery, the superior and inferior vena cava. The heart was arrested by aortic cross clamping and retrograde cold (20°C) cardioplegia. At first, a modified Bentall's procedure was done in addition to a Carrel patch procedure. After this procedure, the heart was perfused continuously (300ml/min) with warm (37°C) blood until the end of the cardiopulmonary bypass. The heart recovered a sinus rhythm spontaneously. Subsequently, aortic arch replacement and the elephant trunk method was done with the aid of deep hypothermia and circulatory arrest. The patients is well 1 year after the operation. This technique is useful for patients who require prolonged aortic cross clamping time.

Left Ventricular Shape and Regional Wall Motion in Relation to the Prognosis of Ischemic Mitral Regurgitation / 日本心臓血管外科学会雑誌

Ischemic mitral regurgitation (IMR) is a serious and increasingly common clinical disorder, but at present, the relationship between left ventricular shape and IMR is not completely understood. Thirty patients with moderate or severe IMR who underwent mitral valve surgery combined with coronary artery bypass grafting were studied retrospectively. Left ventricular shape, left ventricular regional wall motion, hemodynamic index, condition of the coronary artery, severity of IMR and long term results were assessed using ventriculography and angiography. Left ventricular shape at end diastole and end systole were quantified based upon the ratio of the major-to-minor axis and the sphericity index. Hospital mortality rate was 13.3%, 5 years survival rates were 10.5%, and 5-year rate of freedom from congestive heart failure (CHF) were 7.8%. Significant difference between cardiac deaths (<i>n</i>=11) and survivors (<i>n</i>=19) included requiring intensive care admission, requiring intra-aortic balloon pumping, recurrent myocardial infarction, the ratio of the major-minor axis at end diastole, the sphericity index at diastole, and the sphericity index at end systole. Multivariable regression analyses were performed with the Cox proportional hazards model. Significant determinants of survival were the sphericity index at end systole and LV regional wall motion at the site of the anterobasal segment or apex. These findings indicate that the shape of the LV and LV regional wall motion in IMR may be important determinants of prognosis and suggest that surgical attention to shape may be helpful for mitral valve surgery.

EFFECT OF THIAMINE TETRAHYDROFURFURYL DISULFIDE (TTFD) ON PHYSICAL FITNESS CHIEFLY ON MUSCLE STRENGTH / 体力科学

The effect of TTFD chiefly on muscle strength in athletes, mainly track and field, in training camp was examined. The double-blind method was used. The test group (T-group) was given 150mg/day of TTFD while the control group (P-group) was given 3mg/day of TTFD. The duration of administration was two weeks. The following results were obtained.<BR>1) In the following test items, T-group (150mg/day) showed higher values than P-group (3mg/day) in a significant difference:<BR>sargent test (morning) at 5% level<BR>sargent test (evening) at 2.5% level<BR>left grip strength (evening) at 5% level<BR>right grip strength (morning) at 10% level<BR>No significant differences were found in other test items.<BR>2) In the P-group, difference between 2 week stage (non-treated period) and 4 week stage (treated period) was observed to have a trend for decline in the various test items. On the contrary, in the T-group, no decline was observed and a trend for a rise was found in all test items.<BR>3) No adverse effects attributable to TTFD were noted with administration of 3mg/ day nor 150mg/day for 2 weeks.<BR>4) The influence of administration of TTFD 150mg/day was discussed on effectiveness of training as shown by the increase of motor ability.