Shigetaka Kasuya

Adventitial cystic disease of the femoral vein: report of a case.

Adventitial cystic disease (ACD) of the veins is a rare phenomenon, and ACD of the femoral vein is particularly difficult to diagnose due to the similarity in symptoms to those of deep vein thrombosis. We report a case of ACD of the femoral vein, which was initially misdiagnosed as deep vein thrombosis, in a 48-year-old woman who presented with a painless swelling in her right lower leg. The extensive cystic involvement of the femoral vein was completely resected and reconstructed with an 8-mm ringed polytetrafluoroethylene vascular graft with good results.

The long-term survival rates of patients after repair of abdominal aortic aneurysms

This study was undertaken to examine the longterm survival rates of patients following abdominal aortic aneurysm (AAA) repair in comparison with an age-matched normal population, and to determine by multivariate analysis the factors influencing long-term survival. Of 125 patients who underwent AAA repair prior to July 1986, 13 died during hospitalization. Of these 13 patients, 6 who suffered aneurysmal rupture all died within 30 days. The survival rate of patients with ruptured aortic aneurysms was significantly lower than that of those with nonruptured aneurysms. Of the 112 patients surviving hospitalization, 85 died within 0.48 to 24 years after their operation. The long-term survival rate of patients who had suffered a preoperative cardiovascular event was significantly lower than that of those who had not suffered a preoperative cardiovascular event. The actual survival rate was significantly lower than the expected survival rate. According to a multivariate analysis, the significant predictors of late survival were age, aneurysmal rupture, and chronic renal failure in all the patients, and age, chronic renal failure, and pre- and postoperative cardiovascular events in patients who did not die in hospital. These findings indicate the importance of improving immediate perioperative management of ruptured AAA and that cardiovascular events should be prevented, or treated during long-term follow-up.

Right atrial thrombosis: Association with constrictive pericarditis

We report a 73-year-old man with right atrial thrombosis associated with both constrictive pericarditis and persistent sinus rhythms of the heart who successfully underwent thrombectomy and pericardiectomy.

Reviews of corrective surgery in 126 csses of tetralogy of Fallot

One hundred and twenty-six cases , 68 male and 58 female, with tetralogy of Fallot (TF) were operated upon in this period, and 19 patients were less than 5 years of age, 52 being between 6 and 10 years of age, 37 being between 11 and 15 years of age and 18 being older than 16 years of age (Table 1). The Blalock-Taussigs systemic-pulmonary-artery anastomosis had been previously performed in 39 patients who were distributed in all age groups. Almost a l l patients but 12 showed cyanosis at rest and/or i n exercise. Of 126 cases, 17 demonstrated hemoglobin-levels were below 15 g/100 mL, 69 from 15 to 18 g/ 100 ml. and 40 more than 18 g/100 ml., respectively (Table 2). In all patients, a median sternotomy was used. A disc oxygenator was u~ed for the first 75 cases, but since 1969, cardiopulmonary bypass has been accomplished with a disposable bubble oxygenator and roller pumps utilizing the hemodilution technique. Flow rate was usually about 2.2 L/Min/M 2 and mild hypothermia from 33 to 29 degrees centigrade was applied. A transverse or a longitudinal right ventriculotomy was used according to the anatomical findings on t h e right ventricular outflow-tract, described later, and the course of the right coronary artery branches. Infundibular stenosis was removed by division and resection of the hypertrophied muscles and dilatation of the pulmonary annulus with a Tubbs-type dilator. Valvular stenosis was routinely corrected through the ventriculotomy by careful commissurotomy: However, the patients with a small pulmonary annulus and/or a hypoplastic pulmonary trunk received various types of the outflow patch, including the small Teflon fabric patch, the small or large pericardial patch and the valve retaining homoor heterologous pulmonary artery patch 2 (Fig. 1). A large ventricular septal defect was closed with a Teflon fabric patch fixed by interrupted and buttressed mattress-sutures and a specially designed clamp 5 was

A Case of Popliteal Artery Entrapment Precisely Imaged by Multi-Scan Computed Tomography

症例は16歳,男性,高校ボクシング部選手.平成17年4月より300m走で下肢に痛みが出現する間歇性跛行のため当科を紹介受診した.ABIは右1.23,左0.99で,足部の動脈拍動は触知できた.しかし,足関節を背屈すると触知できなくなり,膝窩動脈捕捉症候群を疑った.64列マルチスライスCT(MSCT)により左膝窩動脈の内側偏位と高度狭窄,および腓腹筋内側頭による膝窩動脈の圧排を認め,左膝窩動脈捕捉症候群Delaney分類II型と診断した.手術所見では,膝窩動脈自体の器質的変化は認めず,異常筋束の切断のみで動脈の圧排は解除された.術後症状は改善し,左ABIは1.11と改善,背屈しても1.22と低下しなくなった.画像診断を中心に報告する.

Preoperative Risk Factors for Residual Aortic Regurgitation after Valve Re-Suspension Procedure in Acute Type A Aortic Dissection

Stanford A型急性大動脈解離における術後大動脈弁閉鎖不全(AR)残存症例について,中枢側解離形態,術前AR評価などを中心に非残存例と比較検討した.大動脈中枢側断端形成術を行い,術前後心エコー検査でARの評価が可能であった38例を対象とした.術後AR II度以上をAR群(n=6),I度以下をno AR群(n=32)とした.両群間に年齢,性差,術前併存症に有意差はなかった.術前ショック状態は50%,18.7%とAR群がより重症の傾向であった.術前心エコー検査によるARは2.25±1.17度,0.69±0.91度(p<0.001)であった.とくに術前AR III度以上はそれぞれ66.7%,0%と有意にAR群で高度であった(p<0.001).術前CT検査のSTJ levelの解離率は0.90±0.20,0.68±0.26と有意差は認めなかったがAR群で解離率が高い傾向であった.上行大動脈にエントリーを認めたものは66.7%,37.5%とAR群でより中枢側の解離例が多かった(p<0.05).今回解析した大動脈中枢側断端形成38例ではII度以上のAR残存例は6例(15.8%)であったが,AR III度以上は3例(7.9%)とほぼ満足のいく結果であった.術前AR III度以上,上行大動脈にエントリーがあるものに,術後AR残存の可能性が高いことが示唆された.

Acute Coronary Insufficiency after Aortic Valvular Surgery.

大動脈弁手術203例で, 術後急性冠灌流不全を右冠動脈5例, 左冠動脈2例, 両冠動脈1例の8例 (4%) に経験した. 主症状は, 右冠動脈灌流不全では, 体外循環離脱困難な右心不全3例, 下壁梗塞による左心不全2例, 左冠動脈灌流不全では, 広範梗塞による左心ポンプ不全1例, 心室停止2例であった. 発症直後CABGを追加施行した4症例は全例救命された. Cabrol 手術1例, Piehler 法と弓部置換の同時手術1例の死亡2例では左冠動脈口に縫着した人工血管の血栓閉塞を認めた. 救命6例は術後冠動脈造影で新たな冠動脈病変は認めなかった. 発症原因として, 冠動脈 spasm と拡張障害を伴った左室肥大心における周術期冠予備量の不足が推測された. Piehler 法や Cabrol 手術では冠動脈吻合グラフトの圧迫や吻合部狭窄も示唆された. 救命措置は灌流不全の冠動脈に速やかにCABGを追加する方法が確実であった. 予防対策として適切な手術時間の決定と, 逆行性冠灌流法を含む確実な心筋保護法の応用が考慮された.

Prediction of preserved flow to the infarct area based on admission electrocardiogram in anterior wall acute myocardial infarction

To determine whether preserved flow to the infarct area could be predicted from the admission electrocardiogram and to define the effect of preserved flow on the late results after reperfusion, 20 anterior myocardial infarction patients who were successfully reperfused were studied. Patients were divided into 3 groups: (1) no-flow group (8 patients), with an occluded infarct-related artery and no easily visible collaterals; (2) intact collateral group (6 patients); and (3) subtotal obstruction group (6 patients). From the admission electrocardiogram, the sum of ST-segment elevation (sigma ST), the sum of R-wave amplitude (sigma R) in leads V1 through V6 and the ratio of these (sigma R/sigma ST) were measured. There was no significant difference in sigma R among the 3 groups. The no-flow group had significantly lower sigma R/sigma ST and higher sigma ST than the intact collateral group or subtotal obstruction group. All patients (6 of 6) with subtotal obstruction and all except 1 patient (5 of 6) with intact collateral showed sigma R/sigma ST greater than 2.5 or sigma ST less than 2.0 mV. All patients (8 of 8) with no flow showed sigma R/sigma ST less than or equal to 2.5 and all except 1 patient with no flow (7 of 8) showed sigma ST greater than or equal to 2.0 mV. The regional wall motion was assessed by the radial method at 4 weeks. The mean percentage systolic shortening in the anterior and apical regions was significantly correlated with sigma R/sigma ST (r = 0.75, p less than 0.001) and sigma ST (r = -0.65, p less than 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

Successful Resection of an Ascending Aortic Aneurysm under Cardiopulmonary Bypass Associated with Carotid and Coronary Perfusion

Successful resection of an ascending aortic aneurysm under cardiopulmonary bypass associated with auxiliary carotid and coronary perfusion is reported. The advantages of the cardiopulmonary bypass such as the present method in surgery of aneurysms of the ascending aorta and aortic arch are discussed.