Hideo Okabe

Marked clinical improvement in patients with hepatocellular carcinoma by surgical removal of extended tumor mass in right atrium and pulmonary arteries

Two patients with advanced hepatocellular carcinoma presented severe exertional dyspnea because of extension of a tumor into the right side of the heart. Removable of the tumor thrombus by open-heart surgery ameliorated the symptoms in each case, but their subsequent courses differed considerably. One patient survived for as long as 8 months thanks to successive multidisciplinary treatments, whereas the other patient died suddenly 1 month after the surgery. The first patients hepatocellular carcinoma was more differentiated, and the dyspnea was caused by a low cardiac output due to the intracardiac tumor mass, not by pulmonary embolism as in the second patients case. We conclude that successive multidisciplinary treatments to control the growth of hepatocellular carcinoma is the most important approach and is indispensable for improving the prognosis.

Extracardiac cavopulmonary connection of fontan procedure with autologous pedicled pericardium without cardiopulmonary bypass.

cision. This tremor elimination and computer motion scaling overcome perhaps the most significant limitation of conventional endoscopic instruments. Although further chronic studies are necessary to fully validate the clinical utility of this robotic instrumentation, the current study provides encouraging preliminary results. Robotic assistance in the microsurgical environment may allow for the development of completely endoscopic CABG.

Pulmonary Atresia, Ventricular Septal Defect, and Coronary- Pulmonary Artery Fistula

We report 2 patients with pulmonary atresia, ventricular septal defect, and coronary-pulmonary fistula. The fistula originated from the left anterior descending artery in 1 patient, and from the right coronary artery in the other. Both patients survived staged correction in which right ventricular outflow was reconstructed with autologous fistula tissue. One patient with pulmonary hypertension suddenly died 9 months after surgery. Twenty-four patients with pulmonary atresia, ventricular septal defect, and coronary-pulmonary fistula have been reported previously.

Lay-open pulmonary arterioplasty for postoperative hilar pulmonary artery stenosis

OBJECTIVE Lay-open pulmonary arterioplasty, a novel surgical technique to enlarge postoperative stenosis at the hilar pulmonary artery, was evaluated. METHODS Lay-open arterioplasty, in which the enlarged hilar stenotic pulmonary artery is partially made up of previous surgical scar tissue instead of being covered by a patch, was performed on 10 patients whose ages ranged from 2.2 to 15.7 years. Surgical results were assessed by angiography. RESULTS All patients tolerated the procedure without bleeding or embolic complications associated with pulmonary arterioplasty. Nine patients underwent concomitant procedures including total repair (n = 5), central interposing shunt (n = 3), and right ventricular outflow tract reconstruction (n = 1). No deaths or life-threatening events occurred during the total follow-up period of 18 patient-years. The stenotic segment was significantly enlarged from the preoperative diameter of 0.9 +/- 1.1 mm (mean +/- standard deviation) to the postoperative diameter of 8.0 +/- 1.3 mm, values which correspond to 7.0% +/- 8.8% and 68.4% +/- 11.5% of the normative values, respectively. A follow-up angiogram (n = 5) revealed an increase in the pulmonary artery diameter balanced with somatic growth (initial value, 65.2% +/- 9.0% of normal; second value, 69.1% +/- 7.7% of normal). No aneurysms or clinically significant restenoses were seen on the angiograms. CONCLUSIONS Our initial midterm results with this method were promising. The pulmonary arteries subjected to this procedure grew in proportion to somatic growth.

Diagnosis of cardiac allograft rejection by the detection of circulating plasma cardiac myosin light chains

Twenty adult male Japanese monkeys of the species Macaca fuscata were randomly paired and subjected to heterotopic cardiac transplantation performed by the Ono-Lyndsey method. Without immunosuppression, graft survival ranged between 8 and 27 days, with a mean survival of 14 days. Plasma cardiac myosin light chains were measured by radio-immunoassay, which showed transient increases in myosin levels just following transplantation. Three hearts showed high values at this period and stopped beating when the myosin levels decreased (type 1). The other 7 hearts showed low myosin values after transient increases and 5 of them were rejected with a preceding reincrease in the myosin levels (type 2). Pathological study revealed myocardial necrosis, perivascular cuffing of mononuclear cells and/or neutrophils and/or plasma cells in the type 1 hearts. Measurement of the plasma myosin light chain level was therefore revealed to be of great value in the monitoring of cardiac allograft rejection.

Right ventricular obstruction by tricuspid pouch in simple ventricular septal defect.

Tricuspid pouch sometimes causes subpulmonary obstruction in association with transposition of the great arteries, but rarely does so without transposition. A 5-year-old girl with isolated ventricular septal defect exhibited dynamic right ventricular outflow tract obstruction caused by pouches in the anterior and septal tricuspid leaflets. Echocardiography clearly demonstrated features of the tricuspid pouches. Ventricular septal defect closure resulted in disappearance of the tricuspid pouches and resolution of subpulmonary obstruction.

Anastomosis of the left juxtaposed atrial appendages in a patient with tricuspid atresia.

A 9-month-old boy with left juxtaposition of the atrial appendages, tricuspid atresia, pulmonary atresia, and ventriculoarterial discordance underwent anastomosis between the atrial appendages after failure of balloon/blade atrial septostomy because of restrictive atrial septal defect. For surgical creation of atrial communication in patients with juxtaposed atrial appendages, anastomosis between the atrial appendages seemed to be safer, more effective, and less invasive than septectomy by Blalock-Hanlon technique or inflow occlusion technique.

Autologous blood transfusion system using cardiotomy reservoir BCR3538.

体外循環回路の貯血槽を用いて回路内残血およびその後のドレナージチューブより回収した血液の自己血返血システムを導入,これら回収血の各血液凝固因子活性を経時的に測定,本システムの有効性と問題点をおもに血液凝固学的側面より検討した.通常開心術症例24例を対象とした.本システムの使用により使用輸血量は平均輸血量250mlまでに減少し,無輸血症例も11例と増加した.体外循環終了後の各凝固因子活性は患者側動脈血では順調に回復を示した.一方,貯血槽内血液では体外循環終了後1時間では残存ヘパリンの影響が著明であり,3時間の回収血液ではフィブリノーゲン量のみがきわめて低値を示した以外はとくに内因系因子が著しい高値を示した.本研究により自己血返血システムは輸血量の節減効果のみではなく,体外循環終了後の止血という点でも有効であることが認められた.一方,フィブリングルーの使用によるシステム内凝固の発生や,回収血の高度溶血の問題が今後さらに改良される必要があると思われた.