Hiroshi Osawa

Partial left ventriculectomy in a 3-year-old boy with dilated cardiomyopathy

A 3-year-old boy suffered severe heart failure 2 months after ventricular septal defect repair. The cardiothoracic ratio was 67% and the ejection fraction 13%. Echocardiography showed a dilated left ventricle and thin myocardium. After thorough study, we made a diagnosis of dilated cardiomyopathy. Because conventional therapy was unsuccessful, we conducted partial left ventriculectomy with Alfieri repair of the mitral valve. The postoperative cardiothoracic ratio was 57% at 1 year of follow-up and the ejection fraction 40%. The New York Heart Association functional class improved from IV to I. In conclusion, the role of partial left ventriculectomy is both as a bridge to transplantation and as a definitive repair in dilated cardiomyopathy during childhood.

Prevention of surgical site infection by antibiotic spraying in the operative field during cardiac surgery.

OBJECTIVE Despite the many procedures introduced to prevent surgical site infection during cardiothoracic surgery, serious infections still occur. We attempted to reduce surgical site infection by spraying antibiotic solution in the operative field--a procedure since introduced at 4 other Japanese institutions. METHODS In the latter half of 1990, we began spraying an antibiotic solution of cefazolin (1g) and gentamicin (40 mg)/40 ml of saline placed in a 50 ml syringe and dispensed through an 18 G needle bent at 60 to 80 degrees to clean the wound during surgery. RESULT No deep surgical site infections or deaths due to infection have occurred among the 502 patients undergoing cardiothoracic surgery under cardiopulmonary bypass at our hospital. This method was used in over 2,100 cases of similar procedures at 4 other institutions. There were 3 deaths due to severe surgical site infection (0.11%). At one institution treating over 1,000 cases a year, the incidence of death due to surgical site infection decreased significantly after this method was introduced. CONCLUSION These preliminary experiences show that spraying antibiotic solution in the operative field reduces the risk of surgical site infection in cardiothoracic surgery.

Saccular descending thoracic aortic aneurysm with dysphagia.

A 76 year old woman had suffered from chest pain, back pain, and dysphagia for 8 months. She was diagnosed as having a thoracic aortic aneurysm by chest X-ray and chest enhanced computed tomography. Simultaneously, severe dysphagia developed. Chest enhanced computed tomography and chest aortic aortography at our hospital demonstrated a saccular descending thoracic aortic aneurysm. Esophagography demonstrated that the esophagus was compressed by the aneurysm; therefore, a graft replacement for the saccular descending thoracic aortic aneurysm was performed on February 17th, 1998. A left sided 6th intercostal approach was made, and graft replacement for the aneurysm using a 22 mm Hemashield prosthetic graft was performed under temporary bypass from the thoracic aorta just distal to the left subclavian artery and to the left femoral artery. The postoperative course was uneventful, the severe dysphagia improved dramatically, but a pleural effusion of 1000 ml collected 3 weeks after the operation. Surgical cases of saccular descending thoracic aortic aneurysm with dysphagia are rare, and with this in mind, we report this case to the the medical literature.

Off-pump coronary artery bypass grafting with an aortic nonclamping technique may reduce the incidence of cerebral complications

PurposeCerebrovascular accidents after coronary artery bypass grafting (CABG) remain a complication despite the advancements in techniques. Aortic partial clamping should be avoided to prevent this cerebral complication. We use pedicle arterial grafts (bilateral internal-mammary arteries and the right gastroepiploic artery) and saphenous vein graft with a proximal anastomosis device for off-pump CABG without aortic partial clamping. We call this technique the aortic nonclamping technique.MethodsBetween 2001 and 2007, a total of 468 patients underwent coronary bypass operations; 8 who were operated on with cardiopulmonary bypass were excluded from this study. Altogether, 451 patients underwent off-pump CABG using the aortic nonclamping technique. Among the procedures, 354 were performed using pedicle arterial grafts alone, and 99 were done using a saphenous vein graft with a proximal anastomosis device. Nine were performed with aortic partial clamping for any reason. Postoperative cerebral complications, especially cerebral infarction, were analyzed.ResultsCerebral infarction occurred in two cases (0.47%) in the aortic nonclamping group. They were delayed in both cases, one occurring on the third day after operation and the other on the fourth day. One patient in the aortic clamping group had an intraoperative (early) cerebral infarction.ConclusionThe aortic nonclamping technique might reduce the incidence of cerebral complications and produce ideal bypass grafts using arterial grafts and saphenous vein grafts with a proximal anastomosis device.

Reinforced Edge‐to‐Edge Commissural Closure With Mitral Valvuloplasty

Abstract  A variety of techniques has been used to repair prolapse of the commissure of the mitral valve. However, the application of these techniques may be technically challenging. A simple edge‐to‐edge suture approximation of anterior and posterior mitral leaflets is an effective way of restoring mitral valve competence. We use this technique with “spaghetti” for reinforcement, and annuloplasty for repair of the prolapse. We have recognized it to be a simple, durable, and reproducible technique for repair of prolapse of the mitral valve commissure.

Surgical closure of adult patent ductus arteriosus using a pursestring suture.

A 52-year-old woman with patent ductus arteriosus underwent transpulmonary surgical closure through a median sternotomy. The procedure was performed under cardiopulmonary bypass with normothermia and a beating heart, using transductal balloon occlusion and a pursestring suture around the orifice of the ductus. The use of a pursestring suture allowed minimization of the risk of balloon breakage, obviated the need for profound hypothermia and circulatory arrest, and greatly increased the technical facility of the procedure.

Aneurysms in the ascending aorta adherent to the sternum after cardiac surgery

Sternotomy in a patient with an aneurysm in the ascending aorta adherent to the sternum after cardiac surgery can result in fatal hemorrhage or brain damage unless the distal ascending aorta can be identified and secured immediately. A left anterolateral thoracotomy was used in three patients with adherent aneurysms. The distal ascending aorta was isolated, and dissection was performed between the aneurysm and the sternum. There was no complication. This method was safe, and blood loss was minimized.