Choken Oyama

Aortocoronary bypass grafting in a child with coronary artery obstruction due to mucocutaneous lymphnode syndrome: report of a case.

A four-year-old boy with a myocardial infarct and total occlusion of the right coronary and the left anterior descending coronary arteries due to mucocoutaneous lymphnode syndrome (MCLS). confirmed by selective coronary arteriography, underwent successful double aortocoronary bypass grafting. Patency of the grafts was demonstrated by graft angiography and the improvement of the contractile pattern of the left ventricle was reflected by the increase in ejection fraction from 0.45 to 0.61. This is the first patient successfully treated by aortocoronary bypass grafting for coronary artery obstructive lesions due to MCLS. This experience has demonstrated the feasibility of surgical management in a child with coronary artery obstruction due to MCLS. However, there are unanswered questions regarding the fate of the saphenous vein graft in relation to the growth of a child. Long-term clinical and angiographic follow-ups are mandatory to determine the significance of this mode of surgical treatment for the sequela of MCLS.

Coronary Sinus Blood Flow and Myocardial Oxygen Consumption after Valve Replacement for Aortic Insufficiency

Seven cases are reviewed in which the aortic valve was replaced with a Björk-Shiley tilting disk valve to treat aortic insufficiency. Comparative studies were made to determine coronary sinus blood flow (CSF) and myocardial oxygen consumption (MVO2) by using a continuous thermodilution method both before and after the operation. Additionally, indexes of left ventricular function were obtained by catheterization of the right and left heart and by left ventriculography. Postoperative total CSF decreased significantly compared with the preoperative value (p less than 0.02). However, in all cases, the postoperative CSF per 100 g of left ventricle (LV) increased compared with the preoperative measurement (p less than 0.001). The CSF per beat per 100 g LV also increased postoperatively (p less than 0.001). Total MVO2 decreased postoperatively (p less than 0.02). However, the MVO2 per unit mass tended to increase postoperatively; these increases were not significant. Postoperatively the left ventricular mass and left ventricular wall stress decreased considerably. The left ventricular ejection fraction (EF) and the mean velocity of circumferential fiber shortening (mVCF) remained at normal levels, whereas the left ventricular function improved markedly. In short, the total CSF decreased, along with LVM and left ventricular wall stress. However, because CSF per unit mass increased and EF and mVCF remained at normal values, it is assumed that the increase in CSF is associated with improvement in postoperative contractility.

Valvotomy in Young Patients with Rheumatic Mitral Stenosis

Twenty-nine patients younger than 18 years of age with mitral stenosis were operated upon in the Osaka University Hospital. Five patients who underwent operation in the early period of this study died postoperatively. Follow-up study was made in 20 of the surviving patients for a period of 6 to 20 years. Three died during the follow-up period. Twelve of the survivors were in NYHA Functional Class I, 4 were in Class II, and 1 was in Class III. Reactivation of rheumatic disease did not occur after mitral valvotomy.