Hirokazu Kajiwara

Banding a Hemodialysis Arteriovenous Fistula to Decrease Blood Flow and Resolve High output Cardiac Failure: Report of a Case

We report herein the successful surgical treatment of a patient with high-output cardiac failure which developed from a high-flow hemodialysis arteriovenous fistula of the Brescia-Cimino type. Banding correction of the venous limb of the fistula with a woven Dacron prosthesis resulted in marked improvement of the cardiac failure. An ultrasonic study showed the fistula flow of 3.21/min to be as high as 40% of the resting cardiac output, or 5.01/min, before banding, while an intraoperative electromagnetic study was useful for controlling the degree of banding and showing the decrease of fistula flow from 3.71/min to 1.41/min.

Flow dynamics in internal thoracic artery grafts 10 years after coronary artery bypass grafting.

BACKGROUND Flow dynamics in internal thoracic artery grafts 10 years after surgery are not known. METHODS Doppler examination was performed in native internal thoracic arteries as a control (n = 8) and in internal thoracic artery grafts to the left anterior descending coronary artery 6 months postoperatively (group A, n = 25), at 5 years (group B, n = 14), and at 10 years (group C, n = 11). RESULTS Each graft group showed a diastolic to systolic peak velocity ratio of less than 1.0 at the proximal end, and more than 1.0 at the distal end, but the control group showed a ratio of less than 1.0 throughout the length of the artery. The diastolic peak velocity of the graft groups was significantly faster than that of the control group at the distal end (versus group A, p < 0.01; versus group B, p < 0.005; and versus group C, p < 0.05). The systolic peak velocity of the graft groups was significantly lower than that of the control at the proximal end (versus group A, p < 0.0001; versus group B, p < 0.005; and versus group C, p < 0.0005). There were no significant differences of flow velocities among the graft groups and graft diameter among the four groups. CONCLUSIONS Although the internal thoracic artery is systolic predominant, when native artery is used as graft, it changes its hemodynamics to diastolic predominance, especially at the distal end. Even after 10 years, graft flow dynamics are unchanged. This hemodynamic character may be one of the factors related to the superior long-term patency.

Chronic contained rupture of abdominal aortic aneurysm.

Computed tomography in a 74-year-old man with intermittent claudication revealed an abdominal aortic aneurysm, retroperitoneal hematoma, vertebral erosion, and total aortic occlusion. Surgery was delayed for 9 months after definitive diagnosis of contained rupture of the aortic aneurysm to allow treatment for ischemic heart disease and cardiac failure. After interposing a Y-shaped woven Dacron graft, the intermittent claudication was alleviated. The postoperative course was uneventful.

Late vasospasm of the inferior epigastric artery graft

We report a case of vasospasm of a free inferior epigastric artery graft at 5-year angiographic follow-up after coronary artery bypass grafting. Although the cause of spasm was not clear, the graft was viable and had a vasoconstrictor profile similar to a gastroepiploic artery graft at long-term follow-up.

Repairing of Infarcted Myocardium Using a Novel Cell Patch Therapy

A 54-year-old man underwent left anterior descending artery bypass grafting with cell patch therapy for myocardial infarction. We applied a novel approach to replicating the infarcted myocardium by anchoring polyglycolic acid felt seeded with autologous peripheral blood mononuclear cells in front of the infarcted area. The cell patch remained fixed to the myocardium for 1 month, and the infarcted myocardium was reperfused.

Surgical results of low-dose systemic heparinization (1 mg/kg, 100 IU/kg) in thoracic aortic operation combined with a heparin-coated cardiopulmonary bypass circuit: Is low-dose heparinization safe during deep hypothermic circulatory arrest?

Abstract Heparin-coated cardiopulmonary bypass circuits allow a reduction in the use of systemic heparin administered during cardiopulmonary bypass. This study was carried out to investigate safety during deep hypothermic circulatory arrest in this low-dose heparin group during thoracic aortic operation. Heparin-coated cardiopulmonary bypass circuits were used in 30 adult patients who underwent thoracic aortic operations that required deep hypothermic circulatory arrest. The patients were divided into two groups. Six patients received 300 IU/kg of heparin, and the remaining 24 patients received 100 IU/kg. Clinical outcomes (mortality, incidence of stroke, and transfusion volumes during operation) were examined. All devices remained functional throughout the procedures, and no systemic emboli were detected. Two deaths occurred in the high-dose heparin group, but no deaths occurred in the low-dose heparin group (P = 0.03). The percentage of patients requiring transfusion was similar in the two groups (66.7% vs. 70.8%), but the median exposure to allogenic blood products was greater in the high-dose heparin group than in the low-dose heparin group (9.8 ± 9.5 units vs. 5.5 ± 5.2 units; P = 0.09). Reduced systemic heparinization, combined with hepar-in-coated cardiopulmonary bypass circuits during deep hypothermic circulatory arrest, can be performed with acceptably low early mortality in thoracic aortic operations. Patients are not at increased risk for stroke.

Treatment of Acute Renal Failure Following Cardiovascular Operation Using Extracorporeal Circulation. Comparison between Continuous Peritoneal Dialysis(CPD) and Continuous Arterio-Venous Hemofiltration(CAVH).

体外循環による手術後1週間以内に急性腎不全 (ARF) に陥った症例のうち, 保存的治療が無効の16例に対し血液浄化療法として連続腹膜灌流 (CPD) および持続的血液濾過 (CAVH) を行った. CPDのみを行った7例をCPD群, CPD施行中にCAVHに移行した5例をCPD→CAVH移行群, 最初からCAVHを行った4例をCAVH群とした. 各群の離脱, 生存率をみると離脱率はCPD群33%, CPD→CAVH移行群20%, CAVH群67%で, 生存率はCPD群33%, CPD→CAVH移行群20%, CAVH群0%と不良であった. 除水量と血清カリウム値のコントロールに関しては両方法とも十分有効であった. クレアチニンクリアランス (Ccr) はCAVHがCPDに勝る傾向にあったが, CAVHのCcrも平均11.3ml/minと低値であり, 血清クレアチニン値, 血清尿素窒素値のコントロールは両方法とも不十分であった. 合併症はCPD施行例では12例中3例に低蛋白血症がみられたのに対してCAVH使用例にはより重篤な合併症である出血症状が9例中7例にみられた.