Nobuyuki Akasaka

A Case of a Short-Coupled Variant of Torsades De Pointes with Electrical Storm

TAKEUCHI, T., et al.: A Case of a Short‐Coupled Variant of Torsades De Pointes with Electrical Storm. This case report describes a short‐coupled variant of Torsades de Pointes with a characteristic ECG pattern consisting of a prominent J wave in leads V3–V6, in which an electrical storm was evoked with autonomic receptor stimulation and a blockade test. The patients frequent VF attacks were triggered by short‐coupled premature ventricular contractions with a right bundle branch block morphology and left‐axis deviation, and were suppressed by deep sedation followed by a combination therapy using verapamil and mexiletine. Interestingly, with the use of those drugs, the prominent J wave diminished. The mechanism underlying this syndrome is discussed. (PACE 2003; 26[Pt. I]:632–636)

Vacuum-Assisted Closure for Pediatric Post-Sternotomy Mediastinitis: Are Low Negative Pressures Sufficient?

We present 3 cases of pediatric post-sternotomy mediastinitis treated by a vacuum-assisted closure (VAC). The patients 2 girls, aged 6 months and 10 months, and a 2-year-old boy. The onset of infection was at 9, 14, and 32 postoperative days. The culture examination detected coagulase-negative Staphylococci strains in 2 cases, and Staphylococcus aureus in 1 case. A VAC was performed at -50 mm Hg for 10, 12, and 7 days. The wounds were closed without vascularized soft tissue. A VAC under a low negative pressure is a useful and safe procedure for the management of pediatric post-sternotomy mediastinitis.

Combined distal venous arterialization and free flap for patients with extensive tissue loss.

BACKGROUND We evaluated the mid-term outcome of distal venous arterialization (DVA) and the role of a combined free flap as a bridgehead for blood supply. METHODS In the past 5 years, nine patients with extensive tissue loss and lacking graftable distal arteries underwent DVA. These consisted of four primary DVAs, three combined DVA and free flap procedures, and two adjuvant DVAs for hemodynamically failed distal bypasses. After nine primary DVAs, three redo DVAs were performed for early failure. Etiologies were four Buerger disease and five arteriosclerosis obliterans, including three dialysis patients. RESULTS Among the nine DVA cases, there were five primary failures: two underwent amputation, two had successful redo DVA, and the remaining one did not require redo DVA. Primary patency, secondary patency, and limb salvage rates were 44.4%, 55.6%, and 77.8%, respectively. The postoperative period was 1-36 months (median 12). Angiography demonstrated DVA was effective in the early period, and development of collaterals or a capillary network from the free flap replaced the DVA function in the intermediate period. CONCLUSION DVA can be effective as a procedure for limb salvage in patients without graftable distal arteries, and a combined free flap is effective and functions as a bridgehead for blood supply to the ischemic zone.

Ruptured aneurysm of coronary artery-to-pulmonary artery fistula

A 69-year-old lady was discovered unconscious. Computed tomography showed pericardial effusion and a coronary artery aneurysm of 25 mm in diameter in front of the main pulmonary artery. Emergency surgery revealed a coronary-pulmonary artery fistula and coronary aneurysm surrounded by a large hematoma. The inflow and outflow of the fistula were closed, and no cardioplegic leakage was noted. Postoperative angiography showed residual fistulas that were successfully closed by transcatheter embolization.

Correction of tetralogy of Fallot in an adult using a stented bioprosthetic valved conduit

A 55-year-old man with tetralogy of Fallot successfully underwent correction using a valved conduit. He was diagnosed as having congenital heart disease during childhood, but no surgical intervention was performed. Cyanosis and dyspnea on effort had progressed gradually. Catheterization showed a left ventricular end diastolic volume of 126 ml, and the pulmonary arteries had sufficient diameters. To prevent postoperative pulmonary regurgitation, we planned to use a bioprosthetic valved conduit for right ventricular outflow tract reconstruction. At 4.5 years after the operation he is in New York Heart Association functional class I. The catheterization performed 1.5 years after the surgery showed no pressure gradient between the right ventricle and the pulmonary artery. Thus, total correction of tetralogy of Fallot in an adult can be achieved safely, and the use of a bioprosthetic stented valved conduit can be beneficial.