Sakae Masuda

Left retroperitoneal approach using a retractor to repair abdominal aortic aneurysms: a comparison with the transperitoneal approach.

Abstract.Abstract.Purpose: The purpose of this study was to compare the effectiveness of the retroperitoneal approach (RP) using a Thompson retractor with the conventional transperitoneal approach (TP), to repair infrarenal abdominal aortic aneurysms (AAA).Methods: A total of 91 consecutive patients were divided into two groups; group A (n= 21) underwent surgery using the TP, and group B (n= 70) underwent surgery using the RP with a Thompson retractor.Results: There were no significant differences in the operation time, aortic cross-clamp time, incidence of postoperative cardiac events, or the development of wound complications; however, a significantly higher rate of postoperative respiratory complications and ileus was observed in group A. Moreover, oral feeding was commenced later and the hospital stay was prolonged in group A (P < 0.01).Conclusion: These findings clearly demonstrate that our RP method, especially when using a Thompson retractor, is a preferable alternative to TP for AAA surgery.

Aneurysm of the left sinus of valsalva causing aortic, mitral regurgitation and myocardial ischemia

An aneurysm of the left sinus of Valsalva producing aortic and mitral regurgitation with myocardial ischemia was treated successfully by reconstructing the left coronary sinus while preserving the aortic cusp combined with coronary artery bypass grafting. Aortic and mitral regurgitation occurred due to distortion of the left aortic cusp by a huge aneurysm that also compressed and obstructed the main trunk of the left coronary artery. The postoperative course was uneventful and follow-up showed aortic and mitral regurgitation to be absent and the coronary graft to be patent. Aortic valve-sparing surgery thus proved to be an appropriate procedure for this case.

Congenital aortic regurgitation caused by a rudimentary noncoronary cusp: Report of a case

A 14-year-old asymptomatic boy was admitted to our department for investigation of a diastolic murmur which had been discovered by his family doctor during a routine examination. Echocardiography showed aortic regurgitation with dilatation of the left ventricle. Inspection of the aortic valve at the time of operation revealed normal left and right cusps with a rudimentary noncoronary cusp. An aortic commissuro-plication was performed and a new bicuspid aortic valve successfully reconstructed. His postoperative course was uneventful and he has been well and leading an active life since his discharge from hospital.

The endoscopic removal of a foreign body in the pericardial cavity following cardiac surgery

We were able to successfully remove a needle and suture through a pericardial drain following cardiac surgery by means of a simple method using a bronchofiberscope without having to perform a re-median sternotomy. The technique of endoscopic removal of cardiac surgical misplacement is described.

Mitral Valve Replacement and Preservation of Subvalvular Apparatus Using Cox's Maze Operation

A 58-year-old female with mitral stenosis and atrial fibrillation underwent mitral valve replacement. The subvalvular apparatus was successfully preserved by the Coxs maze operation. The postoperative course was uneventful. One year postoperatively, she is doing well and remains in sinus rhythm. The combined operative techniques are discussed.