Kazuhiro Tani

Surgical repair of extracardiac unruptured acquired valsalva aneurysms

Two cases of extracardiac unruptured Valsalva aneurysms due to rare causes are reported. One patient had been suffering from hyper eosinophilic syndrome. Operative corrections consisted of total replacement of the aortic root. The other patient had an aneurysm of just noncoronary sinus of Valsalva and a dilated ascending aorta due to cystic mucoid degeneration. Replacement of the ascending aorta with patch closure for the aneurysm was successfully performed.

Clinical evaluation of a silicone coated hollow fiber oxygenator.

In this article, the clinical experience with a cardiopulmonary bypass (CPB) using a newly developed hollow fiber oxygenator with an ultra-thin layer of silicone is reported. A comparative study of biocompatibility between the new oxygenator and a heparin coated oxygenator is also described. The CPB was performed with a silicone coated oxygenator, Mera Excelung Binding Prim HPO 15 H-C (Group I, n = 6) or Binding Prim HPO 25 H-C (Group II, n = 10) (Senko Medical Instrument Mfg., Tokyo, Japan). Air could be vented through the silicone coated hollow fibers, and it was easy to prime the circuits. The CPB duration was 101 ± 37 min and 170 ± 64 min for Groups I and II, respectively. There were no deaths and no complications from CPB. Partial arterial pressure of O2 levels 60 minutes after the start of CPB were 529 ± 28 mm Hg and 529 ± 28 mmHg for Group I and II, respectively. of Co. levels 60 min after the start

Clinical Experience with the Nikkiso Centrifugal Pump

The Nikkiso HPM-15 is a minimally sized centrifugal pump. Preliminary results regarding clinical use of this pump for cardiopulmonary bypass (CPB) procedures have been reported previously. Recently, we have managed some additional cases using a newly developed controller. This article reports our clinical experiences with the use of this pump. We have managed 23 cases with a Nikkiso centrifugal pump. Twenty-two patients underwent CPB and 1 patient with fulminant viral myocarditis underwent percutaneous cardiopulmonary support (PCPS). With this pump, the circuit was extremely easy to prepare and deaeration was achieved readily. Hemodynamics during CPB and PCPS were stable in all cases. The increase in serum-free hemoglobin levels during CPB with this pump was as low as that seen in preliminary tests. A decrease in the platelet count was observed after the initiation of CPB with this pump; however, platelet counts returned to preoperative values 7 days after surgery. Moreover, urine output during CPB with this pump was as high as that seen in preliminary tests. No abnormalities in renal or liver function occurred during CPB. It appears that this new centrifugal pump is safe and easy to operate, and we conclude that it is useful for CPB and PCPS.

Blunt Injury of Duodenum with Avulsion of Papilla of Vater

In a 52-year-old man, there was a complete separation of the duodenum with avulsion of the papilla of Vater from the head of the pancreas due to blunt abdominal trauma. He was successfully treated by an anastomosis of the ampulla to the jejunum of a Roux-en Y limb, after removal of the entire duodenum and partial gastrectomy, followed by gastrojejunostomy of the Billroth II-type, instead of pancreaticoduodenectomy. The patient is well at 15 months after this surgery.

Isolated atrioventricular discordance with solitus viscera, inverted atria, D-loop ventricles, and solitus normally related great arteries: report of a rare case with successful surgical management.

tricular and concordant ventriculoarterial alignments (isolated atrioventricular discordance) is rare.1-3 Only 29 cases of this defect have been reported.4 We report the case of an infant with isolated atrioventricular discordance and complete common atrioventricular canal. To our knowledge, this case is the first successful surgical repair without atrioventricular block for isolated atrioventricular discordance with complete common atrioventricular canal.1 Clinical summary. The patient was an 8-month-old girl, weighing 3.7 kg, with poor physical development. She was a 2798-gm baby of a full-term pregnancy complicated by fetal bradycardia. Immediately after birth, she required pacemaker implantation because of sick sinus syndrome. Four months later she was noted to have congestive heart failure and was readmitted for treatment. Radiographic examination showed a left-sided stomach bubble, indicating visceral situs solitus, dextrocardia with marked cardiac enlargement, and increased vascular markings. Echocardiography showed isolated atrioventricular discordance and complete atrioventricular canal (Rastelli type A), with severe mitral and tricuspid valve regurgitation. Cardiac catheterization and angiography revealed interrupted inferior vena cava. The left-sided right atrium opened into the left-sided left ventricle and to the aorta. The left atrium was connected with a right-sided right ventricle. The pulmonary valve was leftward, anterior, and superior to the aortic valve; however, the left ventricle was anterior and to the left, with the right ventricle posterior and to the right. Systolic pressures were equal in both ventricles and in the aorta. There was a partial anomalous pulmonary The Journal of Thoracic and Cardiovascular Surgery Volume 117, Number 2 Brief communications 393

Comparative Studies of Glycoprotein Ib in Heparin Coated and Nonheparin Coated Extracorporeal Circulation Circuits

Contact between blood and artificial materials has various effects on blood. Impairment of platelet function is an especially important and well known effect, but its precise mechanism is not clearly understood. The authors constructed a circulation model to investigate the effect of extracorporeal circulation on platelet membrane glycoproteins (GPs), especially GP Ib, and to compare the changes in GP Ib in heparin coated (group C) and nonheparin coated (group N) circuits. As determined by flow cytometry, GP Ib in both groups decreased on initiating circulation, but the decrease in group N was significantly larger than that in group C. There was no observed change in GP IIb/IIIa levels in either group. The extent of shear stress induced platelet aggregation significantly decreased during circulation in both groups. Decreases in the extent of shear stress induced platelet aggregation were significantly less with the use of heparin coated circuits. In addition, the amount of GP Ib in the high speed pellet decreased progressively during circulation in both groups. In contrast, the amount of GP Ib in the Triton insoluble (low speed) pellet increased dramatically during circulation. However, expression of GP Ib in the Triton soluble platelet fraction was low in both groups. From the results, it was concluded that the cause of the decrease in platelet function during extracorporeal circulation is attributable to the internalization of GP Ib from the platelet surface inside the platelet. It also can be said that a heparin coated circuit is one effective means of controlling this change.

Effect of ultrafiltration on priming solution with preserved blood for extracorporeal circulation in infants.

In pediatric cardiac surgery, the initial priming solutions of the extracorporeal circulation include preserved blood. In an effort to eliminate unfavorable effects of preserved blood on the circulation, the authors introduced the preserved blood to ultrafiltration (UF). Seventeen infants with congenital heart defects were included in this study. UF was performed with a polysulfone ultrafiltrator before extracorporeal circulation. The 1600 ml of fluid, consisting of saline, 5% glucose, and maltose, were added to 400 ml of preserved blood, and the same amount of fluid was removed by UF. The concentrations of potassium, NH3, and bradykinin in the priming blood decreased significantly after UF. In the UF group, water balance during extracorporeal circulation and max. Creatinine-phosphokinase levels after surgery were better than controls. These data suggest that UF is able to remove some substances and result in reduction of an unfavorable effect on the circulation.

Clinical Analysis of Mediastinal Tumors Associated with Lung Tumor.

教室では過去17年間に縦隔腫瘍症例を153例経験しており, うち肺腫瘍との合併症例は5例で, これらについて検討を加えた.男性2例, 女性3例, 年齢は35歳から76歳で, 診断は胸腺腫と肺癌症例2例, 縦隔嚢胞性腫瘍と肺癌症例2例, 胸腺腫と肺過誤腫症例1例であった.全例手術症例で, うち合併切除は3例であり, 70歳以上の高齢者2例は手術侵襲を少なくする目的で縦隔腫瘍は良性と判断し切除せず肺腫瘍のみ切除し, 術後, 縦隔腫瘍に変化はみられなかった.開胸方法は縦隔腫瘍と肺腫瘍のどちらの切除を重視するかで違いがあり, 胸骨正中切開法, 前側方切開第4肋間開胸法, 後側方切開第5肋骨床開胸法を施行した.この5例の検討により, 縦隔腫瘍に肺腫瘍を合併した症例では症例の背景因子, 術前診断, 腫瘍部位を考慮して手術術式を決定すべきであると考えられた.

Successful Repair of Left Ventricular Aneurysm Associated with Mitral Regurgitation Secondary to Spasm-Induced Myocardial Infarction—A Case Report

A sixty-four-year-old man was admitted with a severe feeling of chest oppres sion and loss of consciousness. An echocardiogram and a left ventriculogram revealed a left ventricular aneurysm with severe mitral regurgitation, and a selective coronary angiogram demonstrated normal coronary arteries. Spasm- induced posterior myocardial infarction was diagnosed, and the patient under went combined left ventricular aneurysmectomy and mitral valve replacement. Six years after the surgery the patient remains well, without angina or heart failure.