Takayuki Nomimura

Transvenous mitral commissurotomy examined with transesophageal echocardiography

SummaryTransvenous mitral commissurotomy (TMC) was conducted with transesophageal echocardiography (TEE) in two patients with mitral stenosis. It was possible to see clearly not only the intracardiac structures to be examined by TMC, such as the right and left atria, interatrial septum, and mitral valve, but also the instruments used in TMC, such as the catheter, guidewire, and balloon. It was possible to determine the positional relation between the intracardiac structures and instruments. We could observe all procedures other than Brockenbroughs procedure by both TEE and fluoroscopy at the same time. Although safety and reliability cannot be confirmed from just the two present cases, TEE appears to be applicable to TMC.

Left Thoracotomy before Laparotomy for Ruptured Abdominal Aortic Aneurysm.

最近5年間に手術した腹部大動脈瘤56例のうち破裂性腹部大動脈瘤は12例 (21%) であった. 12例中9例が来院時にショック状態であり, うち3例に心マッサージを要した. 初期に手術した直接開腹群4例のうち, 大動脈遮断に至るまでに出血性ショックで臓器不全となり病院死3例 (75%) を経験した. 他の8例は小さな左前側方開胸を加えて下行大動脈遮断が可能な状態で開腹した. このうち術前ショック状態が重篤であった4例は下行大動脈遮断を平均21分行った. 病院死は8例中1例 (12.5%) に減少した. 動脈瘤の最大径は左開胸群と非開胸群との間で差はなく, 手術時間も差はなかった. 出血量は左開胸群が平均3,925mlに対し直接開腹群は平均7,193mlであった. 開胸の合併症として, 肺炎と黄疸を1例ずつ経験したが軽快した.