Hirokazu Minamimura

Echocardiography-guided pericardiocentesis with a needle attached to a probe

Pericardiocentesis with a needle attached to a probe was performed under two-dimensional echocardiographic guidance in 9 patients with pericardial effusion after cardiac operations. The first 5 mm of the tip of a puncture needle for percutaneous transhepatic cholangiodrainage is scratched with a scalpel to give the tip high echo intensity. When the probe is placed on the skin, the direction of puncture at that probe angle appears automatically on the monitor.

Aortocoronary Saphenous Vein Graft Aneurysm in Redo Coronary Artery Bypass Grafting:Report of a Case

We report herein the case of an 80-year-old woman who underwent successful redo coronary artery bypass grafting (CABG) for a saphenous vein graft aneurysm found 10 years after her initial operation. On presentation, coronary angiography (CAG) revealed aneurysmal dilatation of the saphenous vein graft and severe stenosis of the left main trunk (LMT). A percutaneous transluminal coronary angioplasty (PTCA) of the LMT lesion was performed; however, a CAG after the PTCA revealed restenosis and the patient developed anginal chest pain at rest. Thus, repeat CABG was urgently carried out, which was followed by a good outcome. Histological examination of the aneurysmal dilatation showed a true aneurysm. Only 15 other cases of redo CABG for this indication have been reported, the features of which are also discussed.

Acute pulmonary thromboembolism with a floating right-heart thrombus. 4 surgical cases.

Objective: We determined the efficacy of surgery for acute pulmonary thromboembolism with a floating right-heart thrombus.Methods and Results: Thrombi were diagnosed by transthoracic echocardiography and electron beam computed tomography in 4 patients with acute pulmonary thromboembolism with a floating right-heart thrombus, and thromboembolectomy was done in all patients. Surgical procedure included intermittent deep hypothermic circulatory arrest. One patient died of endobronchial hemorrhage and 3 survived.Conclusion: Because acute pulmonary thromboembolism with a right-heart thrombus is life-threatening, immediate thromboembolectomy is required to decrease mortality.

Revascularization of the Superior Mesenteric Artery in an Intestinal Angina

Revascularization of the Superior Mesenteric Artery in an Intestinal Angina Masanori Sakaguchi, Tadahiro Murakami, Takumi Ishikawa and Hirokazu Minamimura(Department of Cardiovascular Surgery, Bell Land General Hospital, Sakai, Japan) A 69-year-old woman suffered from postprandial abdominal pain and hematochezia. Colonoscopy suggested ischemic colitis, and intestinal angina was diagnosed by multirow-detector computed tomography(CT), which showed occlusion of the superior mesenteric artery(SMA). On enhanced CT, there was extensive calcification on the aortic wall and aortic expansion and several mural thrombi in the thoracoabdominal and abdominal aorta, as well as severe stenoses in the bilateral common iliac arteries. A bypass from the right renal artery, which was the only artery without significant stenosis of the major branches of the abdominal artery, to the SMA, was created using a saphenous vein graft. Postoperatively, the postprandial abdominal pain disappeared, and the patient was discharged after a good postoperative course. Jpn. J. Cardiovasc. Surg. 44 : 108-111(2015)

Extensive thoracoabdominal aortic aneurysm repair using deep hypothermic bypass and circulatory arrest.

We sought to evaluate the safety and usefulness of deep hypothermic cardiopulmonary bypass with intervals of circulatory arrest for extensive thoracoabdominal aortic aneurysms. Between March 1994 and December 2002, 17 patients with Crawford type I and II were reviewed retrospectively. The patients were divided into two groups: group H (hypothermic circulatory arrest, n = 8) and group N (normothermic cardiopulmonary bypass, n = 9). In group H, in-hospital mortality was 12.5%, and that in group N was 11.1%. Operation times were similar between the two groups though the cardiopulmonary bypass time was significantly shorter in group N than in group H (p < 0.05). Postoperative paraplegia occurred in 1 patient of group N. Postoperative renal dysfunction occurred in none of group H except in 1 preoperative dialysis case, whilst it occurred in 6 patients of group N. Postoperative creatinine levels were significantly higher in group N than in group H. Three cases in group H required tracheostomy. Our experience with hypothermic cardiopulmonary bypass and circulatory arrest for diffuse type thoracoabdominal aortic aneurysm confirms the safety and efficacy of this technique. Although respiratory complications remain a problem, the technique is considered to be effective for renal protection.

Surgical Treatment for Cardiac Myxomas. 20 Years' Experience in Consecutive 17 Cases.

今回われわれは当科において過去20年間に経験した心臓粘液腫連続17例の臨床像・手術術式・手術成績について検討を加えた. 男性5例・女性12例, 年齢は22～78歳 (平均55歳), 発生部位は左房13例・右房2例・右室1例・多発例1例であった. 左房粘液腫摘出術は2例を除き, 両心房縦切開を用いた心房中隔合併切除・腫瘍摘出術を標準術式とし, うち2例に僧帽弁輪縫縮術を追加した. 摘出した粘液腫の重量は6～310g (平均54g) であった. 手術・病院死亡はなかったが, 術後9年目に再発1例 (多発例・他院にて再手術) を認めた. おもな術後合併症は洞不全症候群 (ペースメーカー植え込み術) を1例, 術後一過性心房細動を2例, 術後急性肺水腫 (右室粘液腫摘出術直後) を1例認めた. 長期遠隔成績は追跡率100%, 平均観察期間約7年1カ月で, 17例中2例を非心臓死で失い, 10年累積生存率は75% (n=6) であった. 左房粘液腫に対しては発生母地を直視下に観察でき腫瘍を en bloc に摘出できる両心房縦切開を用いた心房中隔合併切除・腫瘍摘出術は有用であると思われる.

Successful Repair of a Proximal Descending Aortic Aneurysm under Hypothermic Circulatory Arrest via Left Thoracotomy after Coronary Artery Bypass Grafting

冠動脈バイパス術 (CABG) 後の遠隔期に発症した近位下行大動脈瘤に対し手術を施行した. 症例は61歳, 男性. CABG後8年を経過し, 冠動脈造影で静脈グラフトの閉塞を認め, 左前下行枝に吻合された左内胸動脈のみが開存していた. 瘤は左鎖骨下動脈分岐部直下に存在し, 瘤の中枢側遮断を要する手術手技は, 左内胸動脈の血流を障害するため不適当と判断した. そこで, 瘤への到達は前回手術の癒着を避けるために左第4肋間開胸で行い, 補助手段として中枢側大動脈遮断を要しない超低体温循環停止法を用いた. 大腿動静脈から送脱血管を挿入した体外循環下に全身冷却を行い, 脳波が平担化した時点 (直腸温24℃) で循環停止とし, 人工血管置換術を行った. 循環停止は17分, 体外循環時間は139分であった. 体外循環からの離脱は容易で, 術後の覚醒遅延もなく経過は良好であった.