Osamu Oba

Coil embolization of a patent ductus venosus in a 52-day-old girl with congenital heart disease

We present the case of 52-day-old girl with a common atrioventricular canal. Severe liver dysfunction persisted following complete repair of the cardiac defect. A patent ductus venosus appeared to be the source of the hemodynamic disturbance responsible for hepatic dysfunction. Given her critical condition, coil embolization of the ductus venosus was performed, after which the patient improved rapidly. The ductus venosus should be tested for patency when liver dysfunction persists after the corrective cardiac surgery, and coil embolization is the treatment of choice in gravely ill children.

Operative results of the anterolateral thoracotomy with partial sternotomy approach for chronic-type B aortic dissection involving the aortic arch

Objectives There are various treatment strategies for chronic-type B aortic dissection involving the aortic arch. Our aim was to review our surgical experience in the anterolateral thoracotomy with the partial sternotomy approach for chronic-type B aortic dissection involving the aortic arch. Methods From January 2000 to October 2015, 39 patients underwent the single-stage open surgery for chronic-type B aortic dissection involving the aortic arch using the anterolateral thoracotomy with partial sternotomy approach. Results Among the 39 patients, 32 were men (82.1%; mean age at surgery, 61.3 ± 11.9 years), with a mean dissecting aortic aneurysm diameter of 50.21 ± 12.20 mm; 28 patients (71.8%) had patent false lumens of the descending aorta. The median interval from dissection occurrence until surgery was 34.05 ± 52.34 months. Twenty-one patients underwent descending aortic replacement plus total aortic arch replacement and 18 underwent descending aortic replacement (plus partial aortic arch replacement). Overall in-hospital mortality and postoperative stroke rates were 5.1% (2 patients) and 10.3% (4 patients), respectively. Survival rates at 1, 3 and 5 years were 94.7%, 94.7% and 90.2%, respectively. Aortic event-free rates at 1, 3 and 5 years were 90.9%, 90.9% and 80.2%, respectively. Conclusions The anterolateral thoracotomy with partial sternotomy approach is a useful surgical procedure with acceptable outcomes for chronic-type B aortic dissection cases involving the aortic arch, when aortic remodelling using thoracic endovascular aortic repair cannot be performed.

Coronary Artery Bypass Grafting with Left Inferior Epigastric Artery as Collateral

We report a case of co-existent coronary and peripheral vascular disease with collaterals to the lower extremities in a 72-year-old female. The patient had triple-vessel coronary artery disease, an occlusion of the bilateral iliac arteries, and the left internal mammary-inferior epigastric artery collateral pathway was a major route to the lower extremities. Coronary artery bypass grafting and right axillo-bifemoral bypass were performed. The well-developed left inferior epigastric artery was used as a conduit to the circumflex artery.

Successful arterial switch operation for post-Mustard pulmonary venous obstruction and secondary pulmonary hypertension

A 16-year-old girl presented with dyspnea 15 years after the Mustard operation for transposition of the great arteries with intact ventricular septum. An echocardiogram revealed secondary pulmonary hypertension due to pulmonary venous obstruction. Cardiac catheterization showed the left (pulmonary) ventricular pressure was over the systemic level. We performed a successful one-stage switch conversion. The patient is doing well 1 year after the switch conversion.

Risk factors reducing blood transfusion requirements in pediatric open heart surgery after introduction of vacuum assisted circuits

OBJECTIVES Open heart surgery without homologous blood transfusion remains difficult in children. The introduction of vacuum-assisted cardiopulmonary bypass circuits to reduce priming volume for pediatric patients has improved the percentage of transfusion-free operations. We retrospectively analyzed blood transfusion risk factors to further reduce blood transfusion requirements after vacuum-assisted circuit introduction. METHODS From March 1995 to June 1996, 49 patients weighing between 5 and 20 kg underwent cardiac surgery with cardiopulmonary bypass at our institution, excluding hospital deaths. We retrospectively analyzed risk factors influencing blood use in 37 patients with no blood priming in cardiopulmonary bypass after introducing a vacuum-assisted system. Factors selected for univariate analysis were age, body weight, cyanosis, preoperative Hb, operation time, cardiopulmonary bypass time, aortic cross-clamping time, and intraoperative and postoperative bleeding volume. Correlation between total bleeding volume/body weight and cardiopulmonary bypass time was studied by regression analysis. RESULTS As risk factors, univariate analysis identified cyanotic disease, longer operation time (> 210 minutes), longer cardiopulmonary bypass time (> 90 minutes), longer aortic cross-clamping time (> 45 minutes), greater intraoperative bleeding volume/body weight (> 4 ml/kg), and greater postoperative bleeding volume/body weight (> 15 ml/kg). Regression analysis showed a significant positive correlation between total bleeding volume/body weight and cardiopulmonary bypass time. CONCLUSIONS Cyanotic disease and long bypass time are risk factors in reducing blood transfusion requirements in pediatric open heart surgery after introduction of vacuum-assisted circuits. Further efforts are needed, however, to reduce blood transfusion requirements, particularly in these children.

One-stage Surgery in Patients with Ischemic Heart Combined with Occlusive Peripheral Vascular Disease.

1991年1月より5年間に10例のCABGと動脈硬化性閉塞病変の同時手術を施行した (AAA合併例は除く). 手術時年齢は平均65.8歳で, 冠動脈グラフト本数は平均2.2本で, 動脈硬化性病変の術式は内頸動脈のTEA2例, 大動脈-鎖骨下動脈バイパス2例, 大動脈-両側総腸骨動脈バイパス1例, 総腸骨動脈 interposition 1例, 大動脈-外腸骨動脈バイパス1例, F-Pバイパス3例 (4本), F-Tバイパス1例であり, 手術時間は平均428分, 体外循環時間は平均121分, 大動脈遮断時間は平均61分であった. 無輸血は4例であった. 手術死亡はPMI合併後緊急IABP挿入肢のMNMSの1例であった. 同時期に施行した待期的CABG単独施行183例と比較検討した. 手術時間, 出血量は同時手術例で多かったが, 手術死亡率, 無輸血率, 挿管日数, 術後入院日数は有意差を認めず, 手術は安全に行われた.