Takamaro Suzuki

Surgical Treatment or Conservative Therapy for Stanford Type A Acute Aortic Dissection with a Thrombosed False Lumen

OBJECTIVES Optimum treatment for acute aortic dissection (AAD) with a thrombosed false lumen (thrombosed AAD) remains controversial. We evaluated the outcome of thrombosed AAD according to treatment strategy. MATERIALS AND METHODS We examined 280 patients with AAD, of which 30 had thrombosed AAD. We compared computed tomography findings, cardiac performance, and clinical course in 28 of these patients. Patients were divided into three groups for the comparison: Group E (emergency surgery), Group C (conservative therapy), and Group S (conservative therapy switched to emergency surgery). RESULTS In Group E (n = 13), one patient died and 12 survived. In Group C (n = 10), all patients were discharged, of which two died of cancer and two of the remaining eight survivors underwent subsequent elective surgery. In Group S (n = 5), one patient died and four survived following surgery. CONCLUSIONS It was hard to predict re-dissection or rupture following conservative treatment for thrombosed AAD. Basically, we should perform emergency surgery following the diagnosis of thrombosed AAD, particularly in complicated cases such as those with pericardial effusion, tamponade, and large aorta. Conservative therapy has a very limited application in patients with the initial stages of thrombosed AAD.

Traumatic left ventricular free-wall laceration by a gunshot: report of a case.

This report describes the case of a 47-year-old man who shot himself in the left side of the chest in an attempted suicide, and was transferred to the hospital. Two gunshot wounds were found in the left side of the chest and the back. CT scans revealed left hemopneumothorax, the accumulation of pericardial blood, and lacerations of the heart and the spleen. Emergency thoracotomy and laparotomy were performed. There was a contusion of the left lung and lacerations of the left ventricular free wall, the diaphragm, and the spleen. The laceration of the heart was repaired by 3 pairs of mattress sutures with felt strips, and covered with fibrin glue and a TachoComb® tissue sealing sheet without the use of cardiopulmonary bypass. The patient was discharged on foot on the 18th postoperative day. Such patients can only be saved with an efficient emergency medical-care system including quick transportation, and close cooperation of the hospital staff.

Use of an audible ultrasonic flowmeter to locate deeply buried coronary arteries for off-pump coronary artery bypass grafting

In patients with coronary arteries that are deeply buried in the myocardium and fat, it is difficult and sometimes risky to expose them for off-pump coronary artery bypass grafting (OPCAB), leading to unavoidable conversion to conventional coronary artery bypass grafting (C-CABG) to ensure their safety. We have developed a new search procedure for these coronary arteries using a dedicated ultrasonic flowmeter with a small tip probe for OPCAB. This technique enables the identification of intramuscular and intra-fat coronary arteries that are less diseased and thus more suited for bypass surgery instead of switching to C-CABG. We believe this procedure will not only improve the quality of OPCAB but also expand its indication.

Surgical Treatment for Angiosarcoma Occupying the Bilateral Atrial Cavities and the Atrial Septum

症例は喀血で発症した48歳の男性.胸部CT検査で,両側心房および心房中隔に発生した心臓悪性腫瘍とその肺転移と診断した.左房内腫瘍がきわめて大きく,心腔内閉塞による突然死の予防と病理診断を目的に手術を行った.腫瘍は右房から心房中隔を経て左房内を占有していた.肺静脈を含めた左房の一部を残し,残りの左房壁とほぼすべての心房中隔,右房壁を切除後,ウマ心膜で両側心房と心房中隔,上下大静脈を再建した.病理検査の結果は血管肉腫であった.術後第22病日に軽快退院し,その後,血液腫瘍内科に入院しInterleukin-2(IL-2)投与を行ったが,術後第107病日に死亡した.近年,血管肉腫に対する放射線療法やIL-2による治療の有用性が報告されている.自験例のように原発巣の完全切除が可能な症例は,可及的早期に原発巣を切除して病理診断を行い,術後に放射線療法やIL-2投与などを行うことで,治療の可能性が広がる.