Michihiro Koga

Ventricular Septal Defect Associated with Aortic Regurgitation

The effectiveness of aortic valvuloplasty and the indications for aortic valve replacement were examined in 76 patients with ventricular septal defect associated with aortic regurgitation. Results of this study indicate aortic regurgitation is associated with rapid deterioration and that aortic valvuloplasty should be performed as soon as aortic regurgitation is detected. The data also suggest that aortoplasty is indicated if aortic valvuloplasty alone is inadequate for coaptation of the aortic cusps with thickening.

Surgical Treatment of Double-Outlet Left Ventricle in Situs Inversus {I, D, D}

A case of double-outlet left ventricle [I,D,D] with a subaortic ventricular septal defect and pulmonary stenosis is reported. The diagnosis was made at operation and was reconfirmed postoperatively by two-dimensional echocardiography. Repair was achieved by patch closure of the ventricular septal defect and enlargement of the functional right ventricular outflow tract using a valved patch. The postoperative course was uneventful except for a transient complete heart block. To our knowledge, this represents the second instance of surgical treatment of double-outlet left ventricle [I,D,D] reported in the literature.

RHABDOMYOSARCOMA OF THE RIGHT VENTRICLE

A case of a 66‐year‐old male with rhabdomyosarcoma of the right ventricle who presented first with a pleuritic chest pain and later developed congestive heart failure with A‐V block is described. The total period of the disease was about 9 months. At autopsy the right ventricle and wall were found to be replaced by tumor tissue which was diagnosed histologically as rhabdomyosarcoma of the alveolar type. We described one case and 52 rhabdomyosarcomas of the heart from the literature; the ages ranged from 3 months to 92 years with 29 men and 23 women (unknown 1). The primary lesions were right ventricle 29%, right atrium 26%, left atrium 24%, left ventricle 6%, and others 15%.

Complete correction of the tetralogy of fallot in adults using separated extracorporeal circulation to block intrathoracic collateral circulation and improve perfusion of the renal vasculature

During the last 10 years, complete correction of the tetralogy of Fallot (TOF) has been performed on 28 adult patients using the “separated extracorporeal circulation” (separated ECC) technique developed by us. In addition to the usual ascending aortic and dual right arterial cannulations for ECC, the separated ECC also involved femoral arterial cannulation and the insertion of a catheter with two balloons via the other femoral artery. Flow via the ascending aorta and femoral artery were maintained separately during ECC. The urine output during separated ECC was significantly better than that during ordinary ECC (P<0.01) and the operative field for intracardiac correction was clearer as a result of blocking the collateral circulation. Thus we believe separated ECC to be a superior method for total correction of TOF in adults, which may enhance the operative outcome.

STUDY ON POSTOPERATIVE STATE AFTER PANCREATICODUODENECTOMY

当教室で施行した膵頭十二指腸切除術症例40例を対象として, 術後病態の検討を行った.特に問題となる残膵機能においては切除時断端膵の組織学的検索を行い, 線維化の程度と対比してみた.PS試験による外分泌機能の変動をみるに, 術後三因子共低下しており, 切除時膵の線維化の程度と相関する傾向を示したが, 消化吸収機能はPS試験による外分泌機能の低下にくらべ良好に保たれており, 膵の線維化とは必ずしも相関しなかった.内分泌機能は遠隔時, 血糖負荷試験により検索したが, 切除時膵の線維化の強いほど, また, 線維化の増強する因子 (例えば膵管閉塞など) があれば比較的早期に耐糖能障害が現われてくるものと思われた.

A study on drip-infusion cholangiography (II)

Cholangiography is not only indispensable to the diagnosis of bile duct lesions, but also as valuable as hypotonic duodenography and P-S test in the study of pancreatic lesions. Pathological findings of the lesions below the common bile duct include total occlusion or stenosis of the lower bile duct in malignancy cases, and subtotal occlusion, sclerotic wall of the pancreatic portion of the bile duct, and opacity due to bile stones in benign cases such as cholangiolithiasis and chronic panereatitis. The double filling technique of percutaneous transhepatic cholangiography differentiates malignancy from benign lesions and indicates the depth of the lesions. Since April 1963 we have performed percutaneous transhepatic cholangiography on 232 eases of which 83 recent cases will be discussed together with 132 cases of oral Biliptin-intravenous Biligraphine method and 15 cases of T-tube cholangiography to study correlation between eholangiograms and pathology of the lower bile duct. The subjects of the study were 154 benign and 25 malignant cases. Normal type was found in 83 cases or 46.9 per cent. Distal stenosis was found in 51 cases or 28.4 per cent, a common finding of common bile duct stone. Sclerotic straight line, 9 cases, and sclerotic tapering, 8 eases, were found in panereatitis patients, showing sclerotic straight contour at the pancreatic portion of the bile duct. U-shape, V-shape and horizontal shape were found in carcinoma of the bile duct or the pancreas head. Rat-tail shape was characteristic in pancreas head infiltration of stomach cancer. Double filling cholangiograms reveal poor dilatation of the bile duct wall, and no rhythmic movement of the bile duet is demonstrated on cineroentgenography. Malignancy was preoperatively confirmed in all adenocarcinoma on the smear of the bile obtained at pereutaneours transhepatic cholangiography. Cineroentgenography is useful to study the function of the bile duct. The lower bile duct contracts rhythmically in benign lesions, whereas the movement disappears in malignant lesions. Pancreatitis is rarely present in those cases which show peristaltic flow of the contrast dediiam toward the duodenum without being trapped in the pancreas duct.