Shigeyoshi Gon

Venous drainage method for cardiopulmonary bypass in single-access minimally invasive cardiac surgery: siphon and vacuum-assisted drainage.

Vacuum-assisted venous drainage (VAVD) can facilitate venous drainage in single-access minimally invasive cardiac surgery (SAMICS). We retrospectively examined the use of VAVD in SAMICS in our hospital for this report. VAVD has been performed according to a VAVD protocol since 2000. Data from the 110 patients who underwent SAMICS in our institute from January 2000 to June 2002 were reviewed retrospectively. The total negative pressure was maintained at no greater than −90 mmHg. Indications for use of VAVD (protocol) were: insufficient venous return by siphon drainage alone, persistent elevation of the central venous pressure (CVP), and, insufficient venous drainage in the operative field. Of 110 patients, 97 (88.2%) underwent VAVD. The body surface area was significantly smaller in the group that did not require VAVD (the non-VAVD group) than in the group that did (VAVD group) (VAVD group versus non-VAVD group: 1.586 ± 0.175 versus 1.408 ± 0.153 m2, P < 0.001). Other factors such as cardiopulmonary bypass time, aortic cross-clamp time, postoperative maximum lactate dehydrogenase, postoperative maximum creatinine, postoperative maximum blood urea nitrogen were similar in the two groups. VAVD is necessary in SAMICS except for small patients. A VAVD total negative pressure of −90 mmHg did not hinder operative procedures or cause clinical problems.

Post-parturition infectious endocarditis in a patient with a normal mitral valve.

A 29-year-old woman with no history of heart disease was admitted for the treatment of congestive heart failure. Six months earlier, she had given birth, then 20 days later developed a fever and cardiac failure ensued. An echocardiogram demonstrated severe mitral valve regurgitation. Her blood cultures were positive, and we made a diagnosis of mitral valve regurgitation due to infectious endocarditis. Despite treatment for congestive heart failure and antibiotic therapy, resulting in negative blood cultures, her congestive heart failure did not improve, and vegetation on the mitral valve was observed by echocardiography. We successfully removed the infected tissue with mitral valve plasty.

Survey of Doctors Changed Their Clinical Specialty from Cardiac Surgery

第一線で活躍していた心臓外科医が，開業もしくは循環器内科，血管外科に転科するケースを目にする．心臓外科を離れた医師が，なぜ転科したのかを調査し，現在の心臓外科の環境改善に活用すべくアンケートを実施した．心臓外科を一度従事し，その後開業もしくは転科した医師（154名）を対象にアンケートを送付した．返答数56（回答率36%），心臓外科に従事していた平均年数15.4年，転科後の平均年数5.3年であり，35人（65%）が心臓血管外科専門医を取得していた．現在の職種は，一般内科・外科による開業（34%），循環器内科医（20%），血管外科医（16%），一般内科・外科による勤務医（14%），その他（16%）であった．転科した理由は，1．実家などが開業しており，跡を継ぐため（16%），2．経済的な理由（15%），3．人間関係（12%）などであった．75%の医師が「転科後，年収があがった」としている．心臓血管外科専門医を取得した医師の63%が「更新したいが，手術条件など事実上困難である」としている．自由記載では，「自己犠牲による労働が多く，実働にあった給料が支払われていない」「心臓血管外科専門医の更新条件の見直し」という意見が多かった．心臓血管外科専門医の更新に手術経験が必須であり，開業や転科後に更新が困難である．専門医として地域医療や後方支援，後身育成に貢献できる点を考慮すれば，更新条件の緩和は検討に値すると考える．また，心臓外科は厳しい労働環境下において実働に見合う評価がされないという意見が少なくない．心臓外科医の自己犠牲に依存した現況が続けば，術者育成以前に転科する医師が減らず，心臓外科の将来が危惧される．心臓外科医の取り巻く環境の早急な改善が望まれる．

Revascularization using satellite vein after radial artery harvested for coronary artery bypass grafting.

The radial artery has been increasingly used for coronary artery bypass grafting and has excellent long-term patency rates. Hand claudication is one of the adverse effects after radial artery harvest. We reconstructed a radial artery using the satellite vein to prevent hand claudication. Pulsating blood flow at 35 cm/sec was evaluated using color Doppler echocardiography three months after surgery. This method makes it possible to use a radial artery in patients with a positive Allen test.