Ikuko Kosugi

Efficacy and safety of on-pump beating heart surgery for valvular disease

BACKGROUND This study was conducted to assess the efficacy and applicability of on-pump beating heart valvular operations using retrograde coronary sinus perfusion. METHODS A prospective, randomized study was conducted. A total of 50 patients participated in this study after having been allocated to one of two groups. On-pump beating heart valvular operations using retrograde coronary sinus perfusion as myocardial protection were performed in 25 patients (beating heart procedure group: aortic = 8 patients, mitral = 15 patients, double = 2 patients). Twenty-five patients underwent conventional valvular operation using retrograde continuous warm blood cardioplegia (conventional procedure group: aortic = 9 patients; mitral = 13 patients; double = 3 patients). The remaining operative variables and early outcomes of these procedures were compared. In the beating heart procedure group, myocardial tissue oxygen was measured by near infrared spectroscopy, and partial oxygen pressure of coronary sinus perfusion was also measured. RESULTS The visual field of the on-pump beating heart was equal to that of conventional valvular operation, and technical accuracy was not compromised. In the beating heart procedure group, tissue oxygen saturation was maintained at 79% +/- 2%, and partial oxygen pressure of coronary sinus perfusion blood and returned blood were maintained at 383 +/- 29 mm Hg and 38 +/- 2 mm Hg, respectively. Postoperative peak creatine kinase-MB (measured every 3 hours postoperatively) and peak troponin T concentrations were significantly lower than those of conventional procedures (17.5 +/- 7.8 vs 32.1 +/- 9.3 IU/L and 0.12 +/- 0.04 vs 0.21 +/- 0.06 ng/mL, respectively; p < 0.05). There was no operative mortality and no major complications. CONCLUSIONS On-pump beating heart valvular operation is a good surgical option, and has advantages because conditions for the heart are more physiologic with beating tonus than with cardioplegia.

Mediastinal Bronchial Artery Aneurysm Treated with a Stent-Graft

Purpose: To report a rare case of mediastinal bronchial artery aneurysm successfully treated with an endovascular stent-graft. Case Report: A 79-year-old man with a history of tuberculosis was admitted to our hospital complaining of worsening hoarseness. Examination revealed a large mediastinal bronchial artery aneurysm located near the origin of the artery. Since neither surgical intervention nor transcatheter embolization was feasible, an endovascular stent-graft repair was performed using a newly developed stent-graft constructed from a nitinol stent and a thin membrane of polyester. Postprocedural angiography showed satisfactory exclusion of the aneurysm. The patient made an uneventful recovery. The 18-month computed tomographic scan documented continued exclusion of the aneurysm, with no evidence of endoleak, graft thrombosis, or migration. Conclusions: When conventional procedures are too complicated for bronchial artery aneurysms, endovascular stent-graft repair can be a useful approach.

Larynx‐preserving resection of the cervical esophagus for cervical esophageal carcinoma limited to the submucosal layer

This report describes the surgical procedure consisting of larynx‐preserving resection of the cervical esophagus and satisfactory lymphadenectomy. The sternum was split at the level of the 3rd intercostal space, which allowed an upper‐mediastinal lymphadenectomy to be performed easily. The cervical esophagus was reconstructed using a free jejunal autograft. The stump of the thoracic esophagus and the caudad stump of the jejunal graft were anastomosed using a circular stapling instrument. The posterior part of the cephalad esophagojejunostomy was completed in two layers using the Lembert stitch. The wall of the cervical esophagus was opened to determine the oral cut line considering the safety margin from the carcinoma. After cervical esophagectomy was completed, suturing of the anterior wall was performed in one layer. The left cervical transverse artery and the internal jugular vein were employed for recipient vessels. This procedure is acceptable for high cervical esophageal carcinoma limited to the submucosal layer. J. Surg. Oncol. 1998;69:113–116.© 1998 Wiley‐Liss, Inc.

Distortion of the radial artery by a mucinous cyst. Case reports.

Three cases of mucinous cyst situated close to the radial artery are reported. The patients complained of pain, a throbbing mass, or both at the wrist. Colour Doppler sonography showed distortion of the radial artery by the cyst in all three patients. In one patient the cyst was connected to a synovial sac by a pedicle, in another it was adherent to the radial artery but was identified histopathologically as a simple ganglion, and in the last patient a branch of the radial artery was involved in the cyst, which was identified histopathologically as an adventitial cyst. Mucinous cysts enlarge when subjected to mechanical stress. Excision is recommended for cysts that distort the radial artery.

Hybrid revascularization feasibility in minimally invasive direct coronary artery bypass grafting combined with percutaneous transluminal coronary angioplasty in patients with acute coronary syndrome and multivessel disease

OBJECTIVES We reviewed early and midterm outcome of 11 multivessel-disease acute coronary syndrome patients treated by hybrid revascularization, i.e., initial coronary angioplasty followed by minimally invasive direct coronary artery bypass grafting. We evaluated procedural efficacy and applicability. METHODS Beginning in August 1997, hybrid revascularization was conducted in 11 multivessel-disease acute coronary syndrome patients--9 men and 2 women with a mean age of 70.3 +/- 9.3 years. Occlusion or stenosis of the target coronary artery was treated by interventional cardiologic techniques and minimally invasive direct coronary artery bypass grafting, and the early and midterm outcome evaluated. Coronary angiography was conducted in all cases at 2 weeks, 6 months, 1 and 3 years postoperatively to evaluate anastomosis and restenosis in treated coronary vessels. RESULTS Initial intervention succeeded in patients with minimal residual stenosis. Subsequent minimally invasive direct coronary artery bypass grafting involved no complications. Coronary angiography early postoperatively, 6 months, 1 and 3 years later showed grafts patent without stenosis. Percutaneous transluminal coronary angioplasty was reconducted on restenotic lesions in 3 patients, 1 of whom required 3 procedures. CONCLUSIONS Hybrid revascularization appears safe and effective in coronary revascularization, at least over the short term. Several patients underwent angioplasty for restenosis within 3 years after initial procedure. Overall acceptance of this hybrid method depends on long-term functional success of the 2 procedures. Its major limitation is restenosis of angioplasty sites and the need for repeat procedures.