Shugo Koga

Safety and Efficacy of Low-Dose Continuous Infusion of Landiolol, an Ultra-Short-Acting β-blocker, in Cardiac Surgery

Introduction: Landiolol hydrochloride is an ultra‐short‐acting β‐blocker that is administered intravenously and has many advantages in cardiac surgery. This study was performed to examine the safety and efficacy of low‐dose landiolol continuous infusion in cardiac surgery.

Repair of a pseudoaneurysm compressing the right coronary artery in a patient with Takayasu's arteritis

Aortic pseudoaneurysms may occur following the replacement of the ascending aorta and arch in patientswith connective tissue, congenital, or atherosclerotic disease. Patients with Takayasus arteritis may also develop pseudoaneurysms due to calcification of aortic tissue. We present images of a patient with Takayasus arteritis who developed a giant pseudoaneurysm compressing the right coronary artery (RCA) following aortic arch replacement. A 57-year-old female with Takayasus arteritis, who had undergone replacement of the descending aorta and total arch replacement 21 and 10 years previously, presented with chest pain. At the time of the total arch replacement, a Hemashield graft (Maquet Cardiovascular, San Jose, CA) was placed from the sinotubular junction to just beyond the takeoff of the left subclavian artery, and each arch vessel was individually reconstructed. A chest computed tomography (CT) showed a 80 × 70-mm pseudoaneurysm at the site of the proximal graft anastomosis compressing the RCA (Figures 1A and 1B), which had not been seen on a previous surveillance CT scan 6 months earlier. The patient had elevated Creactive protein levels and was receiving prednisone, 15 mg orally each day for active Takayasus arteritis. At the time of surgery, prior to a repeat median sternotomy, cardiopulmonary bypass was established with femoral arterial and venous cannulation. A resternotomy was then performed and the heart was arrested with cold, crystalloid cardioplegia. A 50 × 30-mm pseudoaneurysmwas found at the proximal suture line of the previous graft with the native ascending aorta. The pseudoaneurysm was completely resected and the defect was repaired with a polyethylene terephthalate “J graft” patch (Japan Lifesciences, Inc., Tokyo, Japan), reinforced posteriorly with bovine pericardium (Figures 1C and 1D). Sutures were placed through the previous graft superiorly as well as the native aorta inferiorly. This patch was reinforced with another “J graft” bovine pericardial patch. The cardiopulmonary bypass time and arrest time were 161 and 40min, respectively. Thepatient tolerated theprocedurewell and apostoperativeCT scan showed no evidence of a recurrent pseudoaneurysm or any RCA compression (Figures 2A and 2B). Specimens from the previous graft and the native aorta showed evidence of aortitis but no infection. The patient has remained asymptomatic on steroids for 5 yearswithout any recurrent pseudoaneurysm formation on a recent follow-up CT scan (Figure 2C).

Extensive resection and double-patch reconstruction for left atrial myxoma.

The efficacy and safety of surgical intervention for atrial myxoma are established, but the operative approach to tumor resection and atrial reconstruction are controversial. A biatrial approach is generally used for excision of atrial myxoma and has many advantages. In contrast, there are a few reports about the method of double-patch reconstruction, and the right and left atrium are individually reconstructed with the two patches. We found it to be effective in the case reported here. We suggest that this method can be applied to atrial myxoma in which extensive resection is necessary.

Aortic valve replacement with smaller valve size.

The occurrence of prosthesis-patient mismatch after aortic valve replacement with a small valve size was evaluated in 249 patients, focusing on echocardiographic data. Aortic valve pathology included regurgitation in 174 patients and stenosis in 75. Echocardiography was performed in the early and late postoperative periods. A projected effective orifice area index < 0.85 cm2ċm−2 was noted in 56 patients; values ≥ 0.85 cm2ċm−2 were found in 128. Postoperative changes in ejection fraction, left ventricular mass regression, and peak transprosthetic gradient were similar in both groups. Small prostheses (≤ 19 mm) were used in 43 patients who had significantly higher postoperative transprosthetic gradients in both the early and late periods, compared to those with larger prostheses. Our findings show that the occurrence of prosthesis-patient mismatch after aortic valve replacement is rare. Left ventricular mass regression occurred in most patients, with acceptable transprosthetic gradients.

Surgical Treatment for a Trauma-Caused Cardiac Rupture

鈍的外傷による心破裂の救命率は低い.救命率の向上のためには診断,治療方針を明確にする必要がある.われわれは鈍的外傷による心破裂例8例を経験した.来院時,全例経胸壁心エコーにより心嚢液貯留を認め,心タンポナーデの状態であった.受傷から来院までの平均時間は186±185分,来院から手術室搬入までの平均時間は82±49分.術前に心嚢ドレナージを行ったのは2例,経皮的心肺補助装置を使用したのは2例であった.破裂部位は,右房3例,右房-下大静脈1例,右室2例,左房1例,左室1例であった.4例に体外循環を用い損傷部位を修復した.8例中6例を救命することができた(救命率75%).診断において経胸壁心エコーが簡便かつ有効であった.多発外傷例が多いが,心タンポナーデによるショック状態を呈している場合,早急に手術室へ搬送すべきである.手術までの循環維持が重要であり,心嚢ドレナージ,PCPSが有効である.