Shoichi Takahashi

A prostacyclin analogue reduces free radical generation in heart-lung transplantation

The mechanism by which prostacyclin acts to prevent in vivo reperfusion injury is still uncertain. This study was therefore undertaken to assess the effect of a stable prostacyclin analogue (OP 41483-alpha-CD [OP]) on oxygen-derived free radicals after heart-lung transplantation. OP was administered to the heart-lung graft through the pulmonary artery for 25 minutes encompassing the reperfusion process. Free radicals were directly measured by electron spin resonance spectroscopy. The radical intensities of pulmonary venous blood were significantly lower in the OP group than in the control group, suggesting that fewer free radicals were generated in the lungs of the OP group. The cardiac and respiratory function were better in the OP group than in the control group. The lung is the primary source of oxygen free radical attack, and the beneficial action of OP on free radical generation is almost exclusively restricted to the lung and does not apply to the heart. This result suggested that OP probably is effective in inhibiting free radical generation from the endothelium.

Stent graft treatment for abdominal pseudoaneurysm near the celiac artery

pledget-supported suture. We did not use this method because of suspected infection and the severely damaged PA wall. The histologic findings also support our decision. However, the PA wall was extensively abnormal, and the suture line was disrupted. Resuturing incorporating the pulmonary valve annulus caused mild residual stenosis that could not be tolerated in the presence of severe right ventricular dysfunction. Pulmonary root replacement can be a method of choice in such patients. Therefore, we believe that a pulmonary allograft should also be made available whenever possible and should be implanted during the initial operation, if necessary. The last problem was the timing of the operation. Emergency intervention was required in most reported patients with aortopulmonary fistulae and in this patient also, although the history of the present illness was rather long, and his general condition was fair

Direct Percutaneous Puncture Embolization of Type II Endoleaks Using a Coaxial Technique

Purpose To demonstrate a coaxial needle technique for direct percutaneous puncture embolization of type II endoleaks. Technique The technique is demonstrated in a 79-year-old woman and an 80-year-old man who developed type II endoleaks after endovascular repair of thoracic and internal iliac artery aneurysms, respectively. Expansion of the aneurysms required additional therapy. Fluoroscopy and cone-beam computed tomography–guided direct percutaneous endoleak sac embolization with n-butyl-2-cyanoacrylate (NBCA)-lipiodol was performed using the coaxial technique, which resulted in complete embolization of the endoleak sac. At 6 and 3 months after embolotherapy, respectively, the NBCA-lipiodol filled the endoleak sacs and the communicating channels up to the respective feeding arteries; no enlargement of the aneurysms was observed. Conclusion Direct percutaneous sac embolization using a coaxial technique for type II endoleaks is a feasible treatment and yields good short-term results. More experience with this technique and longer follow-up of these patients is needed.

Exposure of the coronary artery using an ultrasonic scalpel.

It has been reported that an ultrasonic scalpel (Harmonic Scalpel, dissecting-hook type; Ethicon Endo-Surgery, Cincinnati, Ohio) allows surgeons to exfoliate the internal thoracic artery without thermal injury to grafts and to collect skeletonized grafts that provide long-term patency. During coronary artery bypass surgery, exposure of native coronary arteries is occasionally a problem when they are buried in adipose tissue or myocardium. We verified that the ultrasonic scalpel can provide safe and rapid exposure of coronary arteries.

Intraoperative thrombectomy for occluded carotid arteries in patients with acute aortic dissection: report of two cases

The present study describes two cases in which intraoperative thrombectomy was performed for occluded or severely stenosed carotid arteries in patients with acute aortic dissection complicated by cerebral malperfusion. A Fogarty catheter was inserted into the true lumen of the occluded branch under hypothermic circulatory arrest, and thrombi within the false lumen were removed. The arch vessels were patent on subsequent computed tomographic imaging, and no neurological complications were found postoperatively. In these cases, the choice of appropriate management strategies took into consideration the brain ischemic time and the presence or absence of cerebral infarction. This technique represents a useful option for the management of this clinical scenario.

Reoperative coronary artery bypass grafting without cardiopulmonary bypass

Between October 1995 and February 1997, 2 men and 4 women aged 53 to 75 years (mean, 66.3) underwent reoperative coronary artery bypass grafting without cardiopulmonary bypass. Isolated reoperative circumflex or intermediate artery bypass was performed through a left thoracotomy (n = 2), reoperative bypass to the left anterior descending coronary artery was performed through a median sternotomy (n = 3), and bypass to the right coronary artery was performed through an upper median laparotomy (n = 1). Single coronary bypass grafting utilizing arterial grafts (left internal thoracic artery: 3, right gastroepiploic artery: 3) was performed in all cases. There were no operative deaths. All cases required neither cathecolamine nor intraaortic balloon pumping). Peri/post operative blood transfusion was necessary in only one case. Postoperative coronary angiography revealed that the 6 arterial grafts were patent. Reoperative coronary artery bypass grafting without cardiopulmonary bypass can be performed with low perioperative morbidity and mortality, easy postoperative management, satisfactory graft patency, and good symptomatic improvement.

Ultrashort-Segment Embolization of High-Flow Vessels Using a Coil Packing Technique in an Amplatzer Vascular Plug

Purpose: To report an experimental study and clinical case using a coil packing technique that hastens occlusion of an Amplatzer Vascular Plug 1 (AVP1) in short-segment embolization of high-flow target vessels. Technique: An experimental vascular stenosis model was made of 12-mm soft polyvinyl chloride tubing. Under continuous pulsatile flow, a 12-mm AVP1 was deployed in the 4-mm-diameter stenosis. Before detachment of the AVP1, a 2.2-F microcatheter was inserted into the AVP1 through its mesh via a 6-F delivery guiding sheath in parallel with the delivery wire. Hydrogel microcoils were deployed tightly in the AVP1 and the plug was detached. After the procedure, the pulsatile saline flow was nearly obliterated. In the first clinical case, a 64-year-old man with a thoracic aortic stent-graft and single vessel debranching for type B aortic dissection developed a residual type II endoleak via the left subclavian artery. This coil packing technique in an AVP1 was employed to successfully embolize the leak. Conclusion: Based on the experimental study and the first experience in vivo, tight coil packing of an AVP1 might be a robust technique for ultrashort-segment embolization.

A potential concomitance of papillary fibroelastoma in the case with cardiac myxoma

An 84-year-old woman was referred to our hospital with a suspected cardiac tumor detected by transthoracic echocardiography performed as a preoperative examination of gastric cancer. In addition to a tumor in the left atrium, we found on cardiac ultrasound a 15-mm mobile tumor that adhered to the aortic valve. Gross findings and histological examination confirmed that the tumor in the left atrium was a cardiac myxoma, and that the tumor adhered to the aortic valve was a papillary fibroelastoma. We experienced a rare case where preoperative examination before gastrectomy accidentally revealed concomitant cardiac tumors.

A Case of Buerger's Disease Associated with Angina Pectoris and Carotid Stenosis

症例は60歳,男性.40歳のときに足趾の皮膚潰瘍が出現し,血管造影でバージャー病と診断された.最近労作時の胸部圧迫感があり入院となった.冠動脈造影では前下行枝近位部の高度狭窄と右冠動脈の完全閉塞を認め,ほかに脳虚血を伴う左内頸動脈の高度狭窄を認めた.さらに下肢の動脈の分節的閉塞とコイル状の側副血行路を認めた.この症例に対して,頸動脈にステント留置術を施行し,その後に下肢血行再建と冠動脈バイパス術の同時手術を施行した.術後は合併症なく良好な経過であった.