Akira Ingu

Comparative Study of the Effect on Clinical Outcome of the Use of an Open Circuit and the Use of a Closed Circuit in Cardiopulmonary Bypass for a Graft Replacement of the Descending Thoracic or Thoracoabdominal Aorta

AbstractPurpose. We studied the benefits of reduced systemic heparinization in a heparin-coated cardiopulmonary bypass (CPB) system for graft replacement of the descending thoracic (TA) or thoracoabdominal aorta (TAA). Methods. Fifty-five patients were assigned to two groups: one group in which closed CPB circuits with reduced heparinization by elimination of the hard shell reservoir were used (group A, n = 36) and one group in which open circuits with full heparinization were used (group B, n = 19). Results. The transfusion requirement tended to be greater as the duration of CPB increased, even in group A. The incidences of renal dysfunction in two groups were not significantly different. Only the incidence of pulmonary dysfunction was significantly higher in group B. A reduction of systemic heparinization had no benefit for perioperative bleeding. In the TAA operation, the total amount of hemorrhaging in group A was greater than that in group B, but the difference was not significant. Conclusions. No beneficial effects of the use of heparin-coated CPB circuits on the amount of perioperative bleeding and postoperative organ damage, including renal dysfunction, were found in this study. However, our findings suggest that it may be better to avoid the use of closed CPB circuits in operations with a prolonged duration of CPB, such as a TAA operation.

Acute Occlusion of a Simple Aortic Coarctation Presenting as Abdominal Angina

A 9-year-old boy whose past history was remarkable for a heart murmur was diagnosed with abdominal angina due to acute occlusion of a simple coarctation of the aorta. Using a single cross-clamp, we accomplished an end-to-end anastomosis after resection of the coarctation. Paradoxical hypertension and abdominal angina were treated successfully with a continuous intravenous infusion of lipo-PGE-1 and nicardipine. Three years after his operation, the patient’s blood pressure was normal, with no stenosis at the site of the anastmosis.

The elephant trunk technique for type A dissection.

Abstract A modified elephant trunk technique that was used to treat acute type A dissection is described. This technique prevents leaks at the distal anastomosis and facilitates surgery on the aneurysmatic downstream aorta following total arch replacement. In addition, it allows closure of the primary intimal tear in patients with DeBakey type III retrograde dissection.

Right parasternal minithoracotomy for repair of atrial septal defect.

Abstract  Various surgical approaches for repair of atrial septal defect (ASD) have recently been introduced for superior cosmetic and less invasive results. A technique for repair of isolated ASD through a small right parasternal minithoracotomy is described. In spite of the smaller incision, there is no need to use femoral cannulation or video‐assisted endoscopy. This approach is simple, less invasive, and cosmetic. We believe that right parasternal minithoracotomy is a suitable alternative to a median sternotomy for ASD closure, especially in young male patients.

Immunosuppressive effects of FK506 inhalant on acute rejection in lung transplantation

reported with the administration of ATG although not in the context of lung allografts. Methods: Biopsy specimens of human lung allografts were assessed for the extent of septal capillary necrosis (SCN) and deposition of complement components, namely C1q, C4d, C3, and C5b-9. Serum from patients undergoing biopsies was evaluated for Factor VIII, a marker of endothelial cell damage, and soluble serum complement levels (C3 and C4). Findings: 49 consecutive patients underwent lung transplantation. The initial 25 and one additional did not receive ATG induction. 23 subsequent patients received ATG. Samples from 11 patients who received ATG (ATG) and 9 patients who did not receive induction therapy(NIT) were evaluated. Biopsies from ATG patients demonstrated a higher percent of SCN (60% -vs43%). Components of the classic complement pathway, C1q and C4d, were found in 65% and 78% respectively of ATG patients, versus 35% and 34% of NIT patients and as well exhibited a greater intensity of deposition in the ATG patients. C3 and C5-9, neither specific for classic omplement activation, were found in the following frequencies: ATG: C5-9 62%, C3 33%, and NIT C5-9 66% and C3 52%. Factor VIII was increased in ATG patients (328 vs274 ng/ml) C3 levels were similar in ATG patients and untreated patients. C4, however, showed a trend toward lower levels in ATG patients, with an average of 23.1 versus 30.6 in untreated patients. Conclusion: Pathologic and serologic evidence supports the activation of the classic complement pathway with the use of ATG as an immunosupression induction agent for lung transplant patients. One possible sequelae could be endothelial cell injury; long-term consequences remain to be defined.

Coronary Ostial Aneurysms After Composite Graft Replacement

Abstract Coronary ostial aneurysms after composite graft replacement of the ascending aorta and aortic valve is a rare complication. We report two patients with Marfan syndrome who developed coronary ostial aneurysms at the sites of the coronary anastomosies, presumably because of oversized windows made in the graft. They were successfully treated by redo composite graft replacement. To prevent this complication, it is important to consider that the hole made in the tube graft should not be larger than the diameter of the respective coronary ostium to avoid exposure of the diseased aortic wall to the circulating blood as much as possible, and that the suture used to anastomose the coronary buttons should pass through the rim of the ostium rather than through the aortic wall surrounding it. (J Card Surg 7999;14:301–305)