Takao Togo

Aortic arch aneurysm repair using selective cerebral perfusion

Seventy-seven patients underwent aortic arch aneurysm repair using selective cerebral perfusion from January 1987 to August 1992. Early and long-term results and preoperative and postoperative cerebral function were evaluated. Cerebral function was assessed by the mini mental state-Himeji test and the Wechsler adult intelligence scale. Thirty-six patients had true aneurysms, and 41 had dissection. Hospital mortality for true and dissecting aneurysms was 19.4% and 7.3%, respectively. The 5-year actuarial survival rates for true and dissecting aneurysms were 59.0% and 65.3%, respectively (not significant). There were no significant differences in test scores before or after operation. Repair or replacement of the aortic arch using selective cerebral perfusion is a safe procedure with acceptable hospital mortality.

Effects of Cardiac Surgery on Intellectual Function in Infants and Children

Intellectual function was evaluated by Gesells developmental quotient (DQ) and Binets intelligence quotient (IQ) in 161 infants and children (61 ventricular septal defects, 49 tetralogies of Fallot, 15 transpositions of the great arteries, seven atrial septal defects, five complete atrioventricular canals, five double outlet right ventricles and 19 shunt cases; average age 3.6 years) before and after cardiac surgery. There were no significant differences in preoperative DQs and IQs among the patient groups. Although average DQ scores in 21 infants with hypothermic (13–24°C) total circulatory arrest (36-70min) were not significantly different from the preoperative values, 13 patients with an arrest time >50 min showed a significant decrease in DQ scores. The postoperative DQ and IQ scores in patients without circulatory arrest or in shunt cases were not significantly impaired after surgery. It was concluded that cardiac surgery did not impair intellectual function in infants and children. although cerebral dysfunction might occur if circulatory arrest was >50 min. Copyright

Effects of cardiac surgery on intellectual in and children

Abstract Intellectual function was evaluated by Gesells developmental quotient (DQ) and Binets intelligence quotient (IQ) in 161 infants and children (61 ventricular septal defects, 49 tetralogies of Fallot, 15 transpositions of the great arteries, seven atrial septal defects, five complete atrioventricular canals, five double outlet right ventricles and 19 shunt cases; average age 3.6 years) before and after cardiac surgery. There were no significant differences in preoperative DQs and IQs among the patient groups. Although average DQ scores in 21 infants with hypothermic (13–24 °C) total circulatory arrest (36–70 min) were not significantly different from the preoperative values, 13 patients with an arrest time >50 min showed a significant decrease in DQ scores. The postoperative DQ and IQ scores in patients without circulatory arrest or in shunt cases were not significantly impaired after surgery. It was concluded that cardiac surgery did not impair intellectual function in infants and children, although cerebral dysfunction might occur if circulatory arrest was >50 min.

ANEURYSM OF A PATENT DUCTUS ARTERIOSUS IN AN ADULT

An adult patient with a spontaneous aneurysm of a patent ductus arteriosus was successfully treated. The lumen of the aneurysm communicated with the distal aortic arch and the pulmonary artery. Closure of the pulmonary arterial orifice of the ductus arteriosus and replacement of the inferior wall of the distal aortic arch and proximal descending aorta with prosthetic graft were performed under partial cardiopulmonary bypass using a centrifugal pump. The postoperative recovery was uneventful.

Cardiac dilatation after cardiopulmonary bypass: Ceramic plate technique for sternal splinting

Intraoperative sternal closure after cardiopulmonary bypass in patients with cardiac dilatation and dysfunction may cause fatal deterioration of their hemodynamics. To avoid this complication, a ceramic plate made from methyl methacrylate was used for sternal splinting. This simple splint can avoid chest wall compression to the overdilated heart, maintaining stable hemodynamics after cardiopulmonary bypass without postoperative respiratory complications or mediastinal infection.

Looped device for inferior vena cava taping through a right parasternal approach

In small adults and infants, inferior vena caval taping through the right parasternal approach for minimally invasive cardiac operations is often difficult with conventional methods. We present a new convenient method to simplify this critical step.