Terufumi Matsumoto

Modified Ultrafiltration May Improve Postoperative Pulmonary Function in Children with a Ventricular Septal Defect

Abstract To evaluate the effectiveness of modified ultrafiltration (MUF) on ventricular septal defect (VSD) repair in children, we retrospectively examined 10 patients who underwent VSD repair with MUF at the Kinki University School of Medicine hospital between June 1998, and December 1998 (MUF group). These patients were compared with 14 patients who underwent the same procedure without MUF (control group) between January 1997 and June 1998. Systolic blood pressure and hematocrit values increased significantly during MUF. By the time of postoperative transfer to the intensive care unit, PaO2 was higher in the MUF group than in the control group (503.3 ± 112.2 mmHg vs 376.3 ± 149.2 mmHg; P = 0.0491), whereas A-aDO2 was lower in the MUF group than in the control group (171.9 ± 109.2 mmHg vs 301.1 × 150.4 mmHg; P = 0.0449). These findings demonstrate that MUF had a beneficial effect on pulmonary function in children who underwent surgery to repair a VSD.

Antegrade selective cerebral perfusion with mild hypothermic systemic circulatory arrest during thoracic aortic surgery

Objective Antegrade selective cerebral perfusion (ASCP) and retrograde cerebral perfusion (RCP) have proven to be reliable methods of brain protection during aortic surgery. These techniques are usually accompanied by systemic circulatory arrest with moderate hypothermia (24–28°C) or deep hypothermia (18–24°C). However, hypothermia can lead to various problems. The present study therefore reports results for thoracic aorta replacement using ASCP with mild hypothermic systemic arrest (28–32°C). Design Between 1995 and 2003, 68 consecutive patients underwent repair of the ascending aorta and/or aortic arch. Mild hypothermic ASCP was utilized in 31 cases, moderate hypothermic ASCP in 20, and deep hypothermic RCP in 17. Various parameters were compared between the mild hypothermic ASCP, moderate hypothermic ASCP, and RCP. Results Hospital mortality was 10.3%, with no significant differences observed between any groups. Permanent neurological dysfunction was 8.8%, and no significant differences were observed between any groups. Mild hypothermic ASCP displayed significantly decreased transfusion volume, intubation time, and ICU stay. Conclusions Use of ASCP with mild hypothermic systemic circulatory arrest during aortic surgery resulted in acceptable hospital mortality and neurological outcomes. ASCP with mild hypothermic arrest allows decreased transfusion volume and reduced duration of intubation and ICU stay.

Total cavopulmonary connection using a pedicled pericardial conduit for a patient with apicocaval juxtaposition

A 5-year-old boy, with a double inlet solitary ventricle, pulmonary atresia, and apicocaval juxtaposition underwent an extracardiac total cavopulmonary connection. A pedicled pericardial conduit was placed behind the ventricle to make a straight pathway between the inferior vena cava and pulmonary artery. This report presents a solution for managing patients with complicated heart defects with apicocaval juxtaposition during the completion of a total cavopulmonary connection.

Reconstruction of Right Ventricular Outflow Tract by Pedicled Pericardial Valved Conduit

A modification of the Rastelli technique using a pedicled autologous pericardial valved conduit was performed on 3 patients aged 10 months to 3 years. Two patients in whom a prosthetic gusset was not used or was partially used showed good recovery during the follow-up period (3 months to 3 years). The pedicled autologous pericardial conduit may be expected to increase its diameter with physical growth.

An effective device to keep the sternum open.

Delayed sternal closure following cardiothoracic surgery facilitates the treatment of heart failure and arrythmias caused by sternal closure, and also allows access to treat uncontrollable bleeding. The present study examines the use of stents made from disposable syringes for keeping the sternum open. The syringes demonstrated good strength, as well as resistance to tapping during pulmonary physical therapy and stability against body movement necessary to prevent the formation of decubitus ulcers. Thus, the proposed stent provides an inexpensive, easy, and effective method for keeping the sternum open.

Septoplasty and Right Ventriculoplasty in a Pediatric Patient With Diffuse Hypertrophic Obstructive Cardiomyopathy

Our successful trans-right ventricular septal myectomy with septoplasty and patch reconstruction of the right ventricular outflow tract in a pediatric patient with diffuse hypertrophic obstructive cardiomyopathy indicates the usefulness of this procedure in such patients.

Refractoriness to Platelet Transfusion Following Double Valve Replacement in an ITP Patient Who Had Undergone Splenectomy

Abstract Reports of patients with idiopathic thrombocytopenic purpura (ITP) undergoing cardiac surgery are rare, and almost all of the reported cases required platelet transfusion. ITP patients, especially those having a history of splenectomy or a history of heavy bleeding, may have to undergo multiple platelet transfusions. Such transfusions may induce al‐loimmunization against the human leukocyte antigen (HLA) and result in refractoriness to subsequent platelet transfusions. We report a case of a 63‐year‐old female with ITP, with a history of splenectomy and multiple platelet transfusions, who underwent aortic and mitral valve replacement. Although corticosteroid administration, high‐dose immunoglobulin therapy, and repeated platelet transfusion led to a temporary increase in platelet count and successful hemostasis, refractoriness to platelet transfusion occurred postoperatively because of the presence of the anti‐HLA antibody. In addition, the patient showed complications of pyothorax. Corticosteroids might have exerted an inhibitory influence on the occurrence of pyothorax.