Kazuhiko Katsuyama

Reconstruction of the aortic arch in invasive thymoma under retrograde cerebral perfusion

Extensive en-bloc resection of the aortic arch and anterior wall of the main pulmonary artery was performed in a 46-year-old man with invasive thymoma. The aortic arch was replaced with a Hemashield vascular graft under hypothermic circulatory arrest with retrograde cerebral perfusion. Patch plasty with Xenomedica was performed for the anterior wall of the main pulmonary artery under cardiopulmonary bypass. The patient was treated with postoperative radiotherapy and has remained asymptomatic for 15 months after the operation. An extensive operation is considered necessary to improve the prognosis of invasive thymoma.

Unruptured Aneurysm of the Sinus of Valsalva Into the Pulmonary Artery

Congenital aneurysms of the sinus of Valsalva are rare lesions. Because the aortic root is central, the aneurysm can rupture into any cardiac chamber, and virtually all combinations of sinus and chamber fistulas have been described. Rupture into the pulmonary artery, however, is very rare. We encountered a 14-year-old boy with conal ventricular septal defect and right coronary cusp prolapse with an unruptured aneurysm of the sinus of Valsalva into the pulmonary artery.

Myxoma of the aortic valve

Myxoma of the aortic valve is exceedingly uncommon. In this article, we report a 58-year-old man with myxoma arising from the aortic valve. Aortic valve replacement was performed, and postoperative histologic examination showed myxoma of aortic valve.

Supravalvular Stenotic Mitral Ring with Ventricular Septal Defect

Abstract Background: Supravalvular mitral ring is exceedingly uncommon. Methods: We report a 4‐year‐old girl with supravalvular stenotic mitral ring and ventricular septal defect (VSD). The VSD was closed by a Dacron patch and the supravalvular ring was excised. For treatment of supravalvular mitral ring with obstruction, surgical resection is commonly performed. Results: There are no reports of long‐term follow‐up after resecting the supravalvular mitral ring. Conclusion: In our case, no mitral stenosis was evident on postoperative echocardiogram performed 3 years after surgery.

Clinical significance of reverse redistribution phenomenon after coronary artery bypass grafting

The reverse redistribution (RR) phenomenon is a decrease in thallium 201 uptake during redistribution compared with 201Tl uptake immediately after exercise. We evaluated RR in 23 patients after coronary artery bypass grafting. Postoperative RR was present in 48% and was significantly more common in patients with a history of myocardial infarction (62%). The patients were classified according to the presence (+) or absence (-) of RR. An analysis of left ventricular wall motion showed significant improvement after coronary artery bypass grafting in the RR+ group (n = 12) but not in the RR- group (n = 11). Quantitative myocardial viability was evaluated using the defect volume ratio, mean defect severity, and defect severity index. The preoperative defect volume ratio was higher in the RR+ group than in the RR- group (p < 0.05). In the RR- group, no improvement in these indices was observed after operation. In contrast, the RR+ group showed significant improvement in all three indices (p < 0.05). These results indicate that after coronary artery bypass grafting, an adequate blood supply to the remaining myocardium may induce RR. This phenomenon, therefore, may be a significant indicator of postoperative myocardial viability.

Combined catheter embolization and femorofemoral bypass for pseudoaneurysm of the right external iliac artery: Report of a case

Performing direct surgery for postoperative hemorrhage caused by intraperitoneal arterial injury is very difficult. We report herein the case of a 52-year-old woman who developed sudden right lower abdominal pain after numerous laparotomies and radiotherapy for advanced uterine cancer. A diagnosis of pseudoaneurysm of the right external iliac artery was made, and an emergency catheter embolization and femorofemoral bypass was successfully performed under local anesthesia. The patient was able to walk the next day. To the best of our knowledge, this is the first report of such a combined procedure in the literature.

Thrombomodulin Concentration in Patient Undergoing Surgery for Abdominal Aortic Aneurysm.

近年, 血中トロンボモジュリンは血管内皮細胞の障害程度を示す新しい分子マーカーとして注目されている. われわれは腹部大動脈瘤手術中の血管内皮障害を調べる目的で血中トロンボモジュリンを測定したので報告する. 対象は腎動脈下の腹部大動脈瘤に待機的手術を施行した9例で, 性別は全例男性, 年齢は46～74歳 (平均64.9歳) であった. 血中トロンボモジュリンの測定は手術前, 大動脈遮断直前, 大動脈遮断解除直後, 大動脈遮断解除1時間後, 3時間後, 18時間後に, 一側の大腿静脈より採血し, EIA法にて行った. トロンボモジュリンは大動脈遮断直前には術前より有意に低下したが, 遮断解除3時間後に増加し, 術前値との有意差は消失し, 以後とくに有意な変化は認められなかった. これらの結果から, 腹部大動脈瘤手術中は血中トロンボモジュリン値が増加するような血管内皮障害は発生していないと考えられた.

Cardiac Rupture after Acute Myocardial Infarction in 6 Cases.

急性心筋梗塞 (AMI) の重篤なる合併症として心破裂は現在のところ予後不良な疾患の一つである. 当院における6例の心破裂症例について検討し, 心破裂の分類について文献的検討を加え報告した. 1995年3月までに6例のAMI後心破裂に対する手術を経験した. 6例はすべて男性であり, 年齢は59～76歳 (平均65.2歳) であった. AMI発症～心破裂まで8時間から4日 (平均2.6日), 破裂～緊急手術まで1時間から24時間 (平均11時間) であった. 6例のうち2例は術前ショック状態で, このうち1例はIABP, PCPSを使用下に手術室へ搬送した. 2例とも破裂孔は blowout type で Felt Sandwich 法で閉鎖したが出血をコントロールできず死亡した. 残りの4例は心嚢ドレナージ後, 循環動態の改善がみられ, その後手術を施行した. Blowout type の1例は出血にて死亡したが, 出血解離型の2例は Felt Sandwich 法で縫合し, oozing type の1例はフィブリン糊とコラーゲンシートにて止血を行い救命しえた. 出血解離型や oozing type の成績は良好であったが blowout type は不良であり, とくに出血のコントロールや愛護的操作など今後もその対策を検討する必要があると考えられた. 肉眼的病理所見と臨床経過の対応を検討すると blowout 型や Becker のI型は急性型に属し, 出血解離型と oozing type の一部が亜急性期に, oozing type の一部と仮性左室瘤形成型および左室瘤形成型が慢性期症例にあたるものと考えられた.

The Physical Effects of Body Movement on Axillary-to-Femoral Artery Graft.

われわれはEPTFE人工血管を用いた右腋窩-大腿動脈バイパス術後, 右肋骨弓の尾側で非吻合部の人工血管断裂をきたした症例を経験した. この発生原因の一つとして, 体幹運動による人工血管への物理的負荷を考慮し, 健常者において実験を行った. 直立基本肢位にて, 右鎖骨中央より右ソケイ靱帯中央までの距離を測定し, この距離を3等分するようにマーカーを描いたものを基本位モデルとした. 次に, 各部位の距離が最長となる体位をそれぞれの部位での伸展位モデル, 最短となる体位を同様に屈曲位モデルとし, 各モデル間での各部位の距離の変化率 (%) を算出し検討した. 伸展位では中部で有意に伸展しており, 屈曲位では下部が有意に短縮していた. 腋窩-大腿動脈術後のグラフトでは, 体幹運動により, 中部および下部にて伸展, 屈曲の物理的負荷がかかるものと考えられ, この負荷により遠隔期に人工血管の断裂をきたす可能性が疑われた.