Ryuichiro Shibata

The cervical aortic arch with aneurysm formation.

An asymptomatic 59-year-old man was admitted with an initial suspicion of mediastinal tumor. He was diagnosed as having a left-sided cervical aortic arch (Haughton type D) with arch aneurysm by using contrast-enhanced CT and angiography. The arch aneurysm was surgically removed. This is the 20th reported case of cervical aortic arch with aneurysm formation.

Surgical treatment for cervical aortic arch with aneurysm formation

Cervical aortic arch is an unusual malformation. Cervical aortic arch with aneurysm formation is very rare. We report a case of cervical aortic arch associated with a saccular aneurysm in a 59-year-old Japanese man. The aneurysm protruded caudally and was located between the left common carotid and left subclavian arteries. Cardiopulmonary bypass and deep hypothermic circulatory arrest was applied as adjunct methods. A Dacron graft was sutured just distal to the left common carotid artery, with the patient in the Trendelenburg position. The proximal site was left open while oxygen-saturated venous blood was supplied in a retrograde manner to perfuse the lower body during occlusion of the descending aorta. Distal anastomosis to the descending aorta was performed during rewarming. The left subclavian artery was reconstructed by using a branch of the graft. This procedure is simple and useful for distal arch operations, especially in patients with Haughton D type aneurysms.

Myocardial recovery during post-ischemic reperfusion: Optimal concentrations of Na+ and Ca2+ in the reperfusate and protective effects of amiloride added to cardioplegic solution

SummaryThe effects of Na+ and Ca2+ concentrations in the reperfusate on post-ischemic myocardial recovery were examined. Also, the myocardial protective effects of amiloride, an inhibitor of the Na+/Ca2+ and Na+/H+ exchange systems, added to cardioplegic solutions were assessed, using an isolated working rat heart perfusion system. Global myocardial ischemia was induced by 30-min normothermic cardioplegic arrest, using St. Thomas’ solution. The concentration of Na+ in the reperfusate varied, stepwise, from 75 to 145 mM/l, and that of Ca2+, from 0.1 to 2.5 mM/l. In this study post-ischemic functional recovery was best at 110 mM/l Na+ and 1.2–1.8 mM/l Ca2+ in the reperfusate. A significantly greater postischemic functional recovery and a lower creatine kinase release were observed when amiloride was added to the cardioplegic solution. Ca2+ overload via Na+/Ca2+ and Na+/H+ exchange systems would, thus, appear to be due, at least in part, to post-ischemic reperfusion injury.

The role of low-density lipoprotein apheresis as postoperative care of bypass grafting for chronic arterial occlusion

Since November 1989, low-density lipoprotein apheresis has been applied to patients with intractable hyperlipidaemia following bypass grafting for chronic arterial occlusion of the lower extremities. The treatment group comprised six patients (four men, two women) with arteriosclerosis obliterans. In five patients, the ankle pressure index deteriorated and intermittent claudication recurred due to atherosclerotic progression. Results of low-density lipoprotein apheresis were dramatic; the deteriorated ankle pressure index and intermittent claudication improved significantly after several applications of low-density lipoprotein apheresis. Significant angiographic improvement was obtained in two patients. It is concluded that low-density lipoprotein apheresis appears to be an efficient method to preserve graft patency and treat postoperative patients with deteriorated ankle pressure index.

Aortic valve replacement with 17-mm St. Jude Medical Regent prosthetic valves for a small calcified aortic annulus in elderly patients.

PurposeThe aim of this study was to investigate the outcome of aortic valve replacement (AVR) performed with a 17-mm St. Jude Medical Regent prosthetic valve (17SJMR) for an aortic annulus ≤19 mm in elderly patients aged ≥65 years.MethodsSix female patients (age 73.0 ± 5.1 years, body surface area 1.43 ± 0.07 m2) underwent AVR between October 2005 and February 2008.ResultsPeak transaortic pressure gradient, which was 80.8 ± 31.0 mmHg preoperatively, decreased to 31.0 ± 4.2 mmHg postoperatively (P < 0.01) and to 21.7 ± 1.5 mmHg long term (P < 0.01). The left ventricular mass index, which was 112.1 ± 10.6 g/m2 preoperatively, also significantly decreased to 101.4 ± 15.0 g/m2 postoperatively and to 88.3 ± 14.8 g/m2 long term (P < 0.01). Subjective symptoms diminished in all patients, and neither mortality nor hemorrhagic complications occurred. The postoperative mean effective orifice area index was 0.91 ± 0.04 cm2/m2.ConclusionA favorable outcome was obtained by aortic valve replacement with the 17SJMR. Patients showed improved postoperative hemodynamic performance without valve-related complications.

Ruptured thoracic descending aortic aneurysm coexisting with DeBakey type IIIb aortic dissection

We have encountered a rare case of ruptured true thoracic aortic aneurysm coexisting with DeBakey type IIIb aortic dissection. The patient was a 67-year-old woman who had a past history of hypertension and cerebral infarction. She experienced DeBakey type IIIb acute aortic dissection, and initially conservative medical treatment was carried out. However, the patient suddenly went into shock, and emergency contrast-enhanced computed tomography revealed the presence of a ruptured true thoracic aortic aneurysm coexisting with the type IIIb dissection. Replacement of the descending aorta was performed through a left thoracotomy using circulatory arrest and deep hypothermia. The rupture site and intimal tear were located in the middle of the aneurysm. Open proximal and distal anastomoses were carried out using a 22 × 10 mm gelatin-covered Dacron graft. The patient was discharged from our hospital uneventfully on the 33rd postoperative day.

A Case of Surgical Repair of Ruptured Aneurysm of the Sinus of Valsalva with a Congenitally Bicuspid Aortic Valve.

先天性大動脈二尖弁を伴ったバルサルバ洞動脈瘤破裂の1例に対し手術を行い,良好な結果を得たので文献的考察を加え自験例を報告する.症例は50歳の女性で,比較的急速に出現した心不全症状の精査目的に入院.動脈瘤は大動脈二尖弁の前バルサルバ洞より発生し右室流出路へ破裂していた.破裂部位は大動脈側から直接縫合閉鎖を行った.術前より合併していた心エコー上2度の大動脈弁閉鎖不全に対しては,大動脈弁の石灰化,弁尖自由縁の肥厚短縮が強く,弁置換術を行う必要があった.その治療にさいしては術後に大動脈弁閉鎖不全を残さない点が,遠隔期の良好な成績を得るために重要である.

A Case of Perioperative Coronary Artery Spasm in Initial and Redo Open-Heart Surgery.

冠動脈に有意病変を有しない僧帽弁膜症患者で, 初回手術時, 再手術時の2回にわたり高度の術中冠攀縮を発生したまれな1例を経験した. 患者は56歳女性. 7年前 (49歳時) の僧帽弁交連切開術の際にも術中に強い冠攀縮をきたし, IABP駆動下にようやく救命できた. 再手術時には, 麻酔導入時から心電図上STの高度上昇を伴う徐脈と低血圧の発作が頻回に生じ, ニトログリセリン静注も効果が少なく, そのまま体外循環に移行して僧帽弁置換術を施行した. 人工心肺離脱後も冠攀縮発作が頻発したが, ニトログリセリン, ノルエピネフリン, IABPなどの併用により救命できた. 術中術後の全経過を通じて心筋逸脱酵素の上昇を認めなかった.

Counterplans to reduce the incidence of non-A, non-B hepatitis after open-heart surgery.

After December 1982, the new criteria for blood donor selection to reduce the incidence of non-A, non-B hepatitis was established. This criteria consists in (1) GPT≤20 KA unit (2) serum Guanase≤2.9 unit for the recipients under 50 year old.Our former criteria for blood donor was GPT≤35 KA unit only. We compared the incidence of non-A, non-B hepatitis between the patients group belong to former and new criteria. The total number of both group are 307. (former criteria group: 176 pts, new criteria group: 131).The incidence of non-A, non-B hepatitis with the criteria of GPT≤20 KA unit was 12.2% lesser than 21% with former criteria of GPT≤35 KA unit. (p≤0.05).When Guanase check (≤2.9 unit) add to this criteria of GPT≤20 KA unit, the incidence of non-A, non-B hepatitis was 10.4% lesser than 18.1% without Guanase check. (N. S.)It is our conclusion that new criteria of GPT limitation under 20 KA unit is effective to reduce the incidence of non-A, non-B hepatitis.