Fumitaka Ando

Developmental changes in pharmacokinetics and pharmacodynamics of warfarin enantiomers in Japanese children

To clarify developmental changes in the pharmacokinetics and dynamics of warfarin enantiomers to establish rational pediatric dosage.

Postoperative Size of the Right Ventricular Outflow Tract and Optimal Age in Complete Repair of Tetralogy of Fallot

Abstract One hundred forty-three patients underwent complete repair of tetralogy of Fallot with an overall mortality of 14.7%. The mortality rate correlated with the preoperative pulmonary artery to aorta (PA/Ao) diameter ratio but not with age. A retrospective study revealed that for success, the postoperative pulmonary annulus should be over 1.75 cm 2 per square meter of body surface area (BSA) in patients with a BSA of less than 0.6 m 2 at operation. The younger the patient, the lower was the ratio of right ventricular to aortic systolic pressure, even when the cross-sectional area index (CSAI) of the pulmonary annulus was the same. Even with application of an outflow patch, pulmonary regurgitation was negligible when the CSAI was less than 2.6 cm 2 /m 2 . The pulmonary vascular response to increased blood flow was excellent in younger patients. Residual ventricular septal defect and recurrent pulmonary stenosis were unrelated to age. Thus, for symptomatic patients, even infants, we recommend that complete repair be attempted when the PA/Ao diameter ratio is over 0.3. For patients in whom this ratio is less than 0.3, operation should be undertaken when the average diameter index of the arterial pathway to the right upper lobe is above 4 mm/m 2 . Should this index be less than 4 mm/m 2 , a two-stage operation is recommended.

A brimmed valved conduit in repair of fibrous skeleton abscess

Aortomitral common annular involvement, which is not uncommon in infective endocarditis, necessitates deliberate surgical procedures. To repair fibrous skeleton abscess accompanied with annuloaortic ectasia, we used a brimmed valved conduit. Tension-free reconstruction of the aortic root and aortomitral common annulus was easily performed with this method.

New modification of the Damus-Kaye-Stansel operation

We report a successful modification of the Damus-Kaye-Stansel operation for transposition of the great arteries when the coronary arteries are unsuitable for transfer. The procedure includes creation of a neoaorta with end-to-end anastomosis of the proximal pulmonary artery to the distal ascending aorta and creation of an aortopulmonary window between the proximal great arteries. A valved conduit is interposed between the right ventricle and the distal pulmonary artery.

Ischemic Injury to the Cauda Equina following Operations for a Ruptured Abdominal Aortic Aneurysm

破裂性腹部大動脈瘤の術後に馬尾神経の虚血性損傷に基づく下肢不全麻痺および全知覚脱失をきたしたきわめてまれな症例を経験した.症例は61歳の男性.腹部大動脈分岐部直上に直径6cmの嚢状瘤を認め,大動脈-両外腸骨動脈間でY字人工血管置換術が行われた.L3～L5の腰動脈は瘤内から閉鎖し,下腸間膜動脈は結紮処理した.両総腸骨動脈の著明な硬化性変化および癒着のため,大動脈遮断が3時間におよんだ.術後の全身状態は良好であったが,左膝関節以下と右足関節以下の全知覚脱失が出現し,両下肢の弛緩性不全麻痺も認めた.左下肢の深部腱反射は消失し,Lasegue徴候陽性であった.血管造影では左総・内腸骨動脈が完全閉塞していた.患者は理学療法で歩行可能となったが,左下腿にパレステジーが残存した.臨床症状,筋電図,CT, MRIなどから馬尾神経の虚血性損傷と診断され,腰動脈閉鎖,長時間大動脈遮断,左総・内腸骨動脈閉塞がその発生要因と考えられた.