Kouichi Yoshimura

Sequential bypass for multisegmental occlusive disease

We evaluated the effectiveness of a sequential bypass for multisegmental occlusive disease. Forty-seven multiple bypass grafts were performed on 43 patients ranging in age from 55 to 83 years (mean: 70 years). The indications for operation included incapacitating claudication in 20 limbs, resting pain in 15, and nonhealing ulcers in 12. An anatomical arterial bypass was performed on 36 limbs, consisting of an aorto-femoro-popliteal bypass in 21 limbs, a femoro-popliteal-posterior tibial bypass in 8, an ilio-femoro-popliteal bypass in 4, an ilio-femoro-posterior tibial bypass in 2, and a femoro-popliteal-plantar bypass in 1. Similarly, an extra-anatomical arterial bypass was performed on 11 limbs, consisting of an axillo-femoro-popliteal bypass in 6, a crossover femoro-femoro-popliteal bypass in 3, an axillo-femoro-posterior tibial bypass in 1, and a crossover femoro-femoro-anterior tibial bypass in 1. The follow-up period ranged from 3 to 77 months (mean: 23 months). Twelve graft failures occurred, and 2 of them required major amputations. The cumulative graft patency rate was 85% at one year and 65% at 3 years. Arterial Doppler examination revealed a mean preoperative ankle-brachial index of 0.29±0.25. The early and late mean postoperative ankle-brachial indices, however, increased to 0.97±0.19 and 0.84±0.25, respectively. Midterm results have indicated that such multiple sequential bypass grafts are effective.

OBSTRUCTION OF THE RIGHT VENTRICLE OUTFLOW TRACT DURING RIGHT CARDIAC PROLAPSE

We observed cardiac prolapse following right pneumonectomy in which the patient experienced a 90 degree rotation of the heart and compression of right ventricular outflow tract from behind by the aorta, which led to an increase in right atrial pressure and a decrease of pulmonary artery pressure and cardiac output. Compression of the right ventricular outflow tract by the base of the aorta was observed as an additional shock inducing factor in right cardiac prolapse.

A Case of Descending Aortic Aneurysm Associated with Coarctation of the Aorta.

管前型大動脈縮窄症は心奇形を合併することが多く予後不良である. そのため, 管前型の成人症例は非常に少ないとされている. 最近, われわれは管前型大動脈縮窄症を伴った胸部下行大動脈瘤の症例を経験した. 症例は, 49歳女性. 左鎖骨下動脈分岐部より末梢側の下行大動脈に約5cmにわたる狭窄を認め, その末梢側が後狭窄性拡張となっていた. 瘤切除および人工血管置換術を行った. 大動脈瘤の成因として, 血流ジェットが影響し瘤が発生したと推測できた. 術後経過は良好である.