Seiichiro Minohara

Descending branch of lateral femoral circumflex artery as a free graft for myocardial revascularization : A case report

The lateral femoral circumflex artery (LFCA) is one of the branches of the deep femoral artery. In the field of plastic and reconstructive surgery, the LFCA has been used to supply composite tissue of skin and/or muscle. 1-3 The LFCA has three major branches: the ascending, transverse, and descending branches. The descending branch of the LFCA passes downward through the intermuscular space between the rectus femoris muscle and the vastus lateralis muscle and finally terminates in the vastus muscle near the knee joint, The descending branches of the LFCA have a very large diameter (2 to 3 ram) and do not taper like those of the radial arteries. 3 The descending branch of the LFCA has an attractive caliber and length. We report the first case in which a descending branch of the LFCA was used as a graft for myocardial revascularization. A 77-year-old woman had a 7-month history of increasing angina on exertion. ElectrocardiOgraphic changes were consistent with effort angina. Cardiac catheterization revealed a 99% stenosis of the proximal right coronary artery and a 75% stenosis of the middle third of the left anterior descending coronary artery. For this patient, we had planned to perform coronary artery bypass grafting (CABG): a left internal thoracic artery (LITA) in situ to the left anterior descending coronary artery and a saphenous vein graft to the right coronary artery. However, the saphenous vein had varices and was unacceptably thin. We also decided to avoid grafting the right internal thoracic artery to the right coronary artery for this elderly woman because devascularization of the sternum suggested a greater risk of sternal wound infections with the use of bilateral internal thoracic artery grafts. We concluded that the descending branch of the LFCA could be used to bypass the right coronary artery. We had evaluated the descending branches of the LFCA bilaterally by means of a femoral arteriogram 5 days before this operation. The arteriogram showed a good qUality vessel Without stenosis (Fig. 1). The descending branch of the left LFCA was harvested

INDICATIONS AND PROBLEMS OF CORONARY ARTERY BYPASS GRAFTING WITHOUT CARDIOPULMONARY BYPASS

As an alternative method of myocardial protection and to obviate the inherent risks of cardiopulmonary bypass (CPB), we have been performing coronary artery bypass grafting (CABG) without CPB in carefully selected patients. Since the first such operation was successfully performed in Junuary 1995 on a patient with angina pectoris and lung cancer, four other patients have subsequently undergone this technique. This series of 5 patients, being 1 man and 4 women ranging in age from 68 to 80 years, is presented in this report. The reasons for the selection of this procedure were concomitant diseases including lung cancer, a calcified aorta, and myocardial infarction. The mean time of ischemia for each anastomosis was 15.3 ± 5.3min, and the maximum cardiac muscle creatine phosphokinase (CPK-MB) was less than 14 unit/l postoperatively. None of the patients required ventilatory support for longer than 24h postoperatively, and oral intake was started within 24h after extubation in all patients. Postoperative angiography confirmed graft patency and none of the patients developed any ischemic symptoms. All the patients were discharged between 1 and 2 months postoperatively. Thus, the off-pump technique is useful when concomitant diseases are present and will become an alternative method of treatment for coronary artery disease in selected patients.

A Case of Ruptured Abdominal Aortic Aneurysm with Intraoperative Cardiac Arrest

術中心停止となった破裂性腹部大動脈瘤の救命例を経験した.症例は4年前の冠動脈バイパス術(CABG)と7ヵ月前の胃全摘術の既往のある71歳男性で,破裂性腹部大動脈瘤に対し緊急手術を行った.開腹後心停止となり,左開胸心マッサージを開始した.胸腔内で用手的に大動脈を遮断し,腹部大動脈瘤を切開,瘤内から胸部下行大動脈へ閉塞用バルーンカテーテルを挿入し遮断後,腹部大動脈の剥離を行い,腎動脈下で遮断し直した.心停止から37分後に自己心拍が再開し,Y字人工血管で腎動脈下腹部大動脈を置換した.末梢吻合は両側とも大腿動脈で行った.下腸間膜動脈は再建しなかったが腸管に虚血所見を認めなかった.術後3日間の人工呼吸管理を必要としたが,心不全・腎不全は発症しなかった.神経学的異常は認めず,術後50日目に軽快退院された.開胸直接心マッサージ・胸腔内大動脈遮断・閉塞用バルーンカテーテルの使用が有効であった.

Myocardial Protection with Ryanodine and CoQ10 Against Post-ischemic Reperfusion Injury of Rabbit Heart

The effect of Ryanodine and CoQ10 on intracellular electrolyte alter¬ations of rabbit heart was investigated. Electrolyte concentrations in the contractile element (A band) of the myocardial cells (ventricular cells) were measured by X-ray microanalysis employing thin sections of freshly freeze-dried myocardium.