Tohru Sakurada

Long-Term Thrombosis after Transvenous Permanent Pacemaker Implantation

To assess the efficacy of prophylactic administration of anticoagulant and antiaggregant drugs to prevent venous thrombosis after long‐term transvenous permanent pacemaker implantation, venograms were performed in 100 consecutive patients at the elective replacement of the pacemaker. Mean follow‐up period after initial transvenous permanent pacemaker implantation was 6.0 years. The venograms demonstrated normal in 77 patients. The remaining 23 venograms showed venous stenosis in 11 patients and total obstruction in 12 patients. Twenty‐one of these 23 patients had venous collateral circulation. No difference was found in the incidence of venous abnormalities according to the route of entry, the lead insulation, the total number of the implanted leads, and anticoagulant and antiaggregant drugs. All these patients have remained asymptomatic. In conclusion, the incidence of venous thrombosis after long‐term transvenous pacing is 23% and the causes of venous thrombosis may be endothelial trauma and underlying venous stenosis. As this article describes a retrospective limited study, we cannot find the efficacy of prophylactic administration of anticoagulant and antiaggregant drugs to prevent venous thrombosis formation after transvenous permanent pacemaker implantation. Further prospective study will be needed to assess the efficacy of prophylactic administration of anticoagulant and antiaggregant drugs.

Surgical treatment of the coronary artery to pulmonary artery fistulas in adults.

Coronary artery to pulmonary artery fistula (CA-PAF) is a rare congenital anomaly. The purpose of this retrospective study was to analyze 11 adult patients with CA-PAFs treated surgically, and to evaluate the surgical management and long-term results. There were no surgical deaths and all patients survived the follow-up periods (mean 7.2 years). All symptomatic patients improved their New York Heart Association functional class. As surgical correction is safe and effective, with good long-term results, all the patients with CA-PAF in adults can be candidates for surgery to prevent life-threatening complications.

Venous aneurysm of the cephalic vein: Report of a case

We herein report the rare case of a 41-year-old Japanese woman in whom a venous aneurysm in the left cephalic vein was excised under local anesthesia. Histological examination revealed significant diminution in the number and size of muscle and elastic fibers in the aneurysm wall. Conceivably, a combination of endophlebohypertrophy and a congenital focal defect of the elastic and muscle fibers might have contributed to the development of this venous aneurysm.

A localized fibrous tumor (mesothelioma) in the mediastinum: Report of a case

We report herein the rare case of a 51-year-old Japanese woman who underwent thoracotomy for a mass in the mediastinum which was found to be a benign localized fibrous tumor, otherwise known as a mesothelioma. The clinical behavior of this tumor is thought to be unpredictable, and therefore we emphasize that long-term follow-up of patients with localized fibrous tumors in necessary, even if the histological features are benign.

Long-term results of primary closure for ventricular septal defects in the first year of life

The long-term results of primary closure for large ventricular septal defects (VSDs) in infants under 1 year of age with severe symptoms were studied over a period of more than 10 years. Between January, 1971 and March, 1982, 49 infants underwent primary closure of a VSD through a right ventriculotomy using complete cardiopulmonary bypass with mild hypothermia. There were four hospital deaths but no late deaths. Two of four infants with residual shunts had a left ventricular-right atrial shunt which necessitated reoperation. Surgical heart. block occurred in two infants who recovered sinus rhythm in the late period. The cardiothoracic ratio decreased from 60.5% preoperatively to 50.6% in the late postoperative period. Examination by cardiac catheterization revealed that the pulmonary-to-systemic pressure ratio (Pp/Ps) of 23 patients with a Pp/Ps of over 0.75 fell from 0.89 ± 0.09 preoperatively to 0.42 ± 0.12 by 1 month postoperatively, then to 0.27 ± 0.05 in the late postoperative period. The latest values for the cardiac index and left ventricular ejection fraction were 3.41 /min per m2 and 64.4%, respectively. More than 10 years after their operation, all the survivors were growing normally and maintaining a good quality of life, which supports our recommendation that primary repair should be performed in the first year of life for infants with large VSDs.

Behçet’ Disease (‘Silk Route Disease’) and Mitral Valve Prolapse

Dear Sir, I read with interest the article on cardiac involvement in Behçet’s disease by Morelli et al. [1]. The finding of a high incidence of mitral valve prolapse in 50% of their patients is not surprising. The association of mitral valve prolapse and Behçet’s disease was first reported from China [2]. Shen et al. [3] from Shanghai reported in 1985 also a 50% incidence of mitral valve prolapse in their patients with Behçet’s disease. Behçet’s disease occurs most frequently in Japan and the Mediterranean countries but also in the population linking these two areas to each other [4]. It occurs most frequently between latitudes 30° and 45° north, in Asian and Eurasian populations. This area coincides with the old Silk Route. Thus, Behçet’s disease is sometimes also called ‘Silk Route disease’ [2, 4]. OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO

A Case of Buerger's Disease Associated with Angina Pectoris and Carotid Stenosis

症例は60歳,男性.40歳のときに足趾の皮膚潰瘍が出現し,血管造影でバージャー病と診断された.最近労作時の胸部圧迫感があり入院となった.冠動脈造影では前下行枝近位部の高度狭窄と右冠動脈の完全閉塞を認め,ほかに脳虚血を伴う左内頸動脈の高度狭窄を認めた.さらに下肢の動脈の分節的閉塞とコイル状の側副血行路を認めた.この症例に対して,頸動脈にステント留置術を施行し,その後に下肢血行再建と冠動脈バイパス術の同時手術を施行した.術後は合併症なく良好な経過であった.

Arteriosclerosis Obliterans with Huge Multiple Leg Ulcers in a Patient with X-linked Ichthyosis.

症例は有痛性多発性左下腿潰瘍を主訴とした65歳, 男性である. 四肢, 体幹に魚鱗様の紋理を認め, 同様の魚鱗癬を有する男子が家系内に6名いること, ステロイドサルファターゼが10pmol/DHEA/mg・protein/hr未満で, 本酵素の欠損と考えられたことより, 伴性遺伝性魚鱗癬と診断された. 下肢動脈造影では左腸骨動脈, 両浅大腿動脈の閉塞, 右腸骨動脈に狭窄を認めた. 以上より, 伴性遺伝性魚鱗癬に発症した閉塞性動脈硬化症による下腿潰瘍と診断した. 腹膜外アプローチにて Gelseal®人工血管 (直径8mm) による腹部大動脈-左総大腿動脈バイパス, 自家静脈による左大腿動脈-膝窩動脈バイパス術を行った. 術後経過は良好で, 前脛骨部潰瘍の治癒は遷延したが, その他の潰瘍はほぼ1か月にて治癒した. 伴性遺伝性魚鱗癬では, 皮膚潰瘍の治癒機転はほぼ正常と考えられ, 潰瘍を有する閉塞性動脈硬化症でも通常人と同様に対処してよいものと考えられた.

Clinical Study on Peripheral and Visceral Aneurysms.

1975年から1990年までに外科治療を行った四肢および腹部臓器の末梢動脈瘤症例は34例であった. 動脈瘤の発生部位は, ほぼ全身にわたっていたが, 下肢が最も多かった. その成因としては動脈硬化が半数以上を占め, 次いで医原性が24%のほか, 外傷, Behcet 病, aortitis などがあった. 動脈硬化性のものは左右両側に発生する多発例が多かった. 全体の破裂の頻度が26%と高率であるのと, 体表から深い位置にある腹部臓器動脈瘤や内腸骨動脈瘤などが激しい突発症状で発症するのが診断上の問題であった. 末梢動脈瘤の手術成績は良好であるが, 遠隔期に心血管系の続発症が多いので, 術後も注意深い経過観察が必要である.