Tomoya Yoshizaki

Verapamil and nitroglycerin improves the patency rate of radial artery grafts.

The best way to prevent spasm of the radial artery is still under investigation. We retrospectively compared the effectiveness of topical verapamil-nitroglycerin with papaverine in preventing graft spasm in 215 patients who underwent isolated conventional coronary artery bypass using a radial artery. Postoperative angiographic data were successfully collected in 116 patients. Perioperative radial artery graft spasm was observed in 2 patients in the papaverine group and 1 in the verapamil-nitroglycerin group; this difference was not considered significant. Complete or functional occlusion was detected by postoperative angiography in 13 grafts (10 in the papaverine group and 3 in the verapamil-nitroglycerin group). Multivariate regression analysis revealed that topical papaverine and grafting to the right coronary artery significantly increased the rate of occlusion of radial artery grafts. Although further studies are needed, our data support the view that topical verapamil-nitroglycerin reduces the incidence of radial artery graft occlusion.

A new multisuction cardiac positioner for multivessel off-pump coronary artery bypass grafting.

Objective To accomplish successful multivessel off-pump coronary artery bypass grafting, safe, reproducible, and effective exposure of all coronary territories is essential. For this purpose, we developed a new, simple, multisuction cardiac positioner. Methods This new cardiac positioner consists of 3 small independent suction cups and suction tubes made of silicone. Unlike an apical suction cardiac positioner, this positioner has no arm. The suction cups can be applied with negative pressure of 300 mm Hg to various surfaces of the ventricle, including not only the apex but also the lateral, inferior, and right ventricular walls, according to surgeon preference. We applied this positioner in 15 clinical multivessel off-pump coronary artery bypass procedures. Results In all cases, all target vessels including those on the lateral or inferior wall were successfully exposed and grafted without hemodynamic compromise. Surgical exposure, especially on the lateral and inferior walls, was quite similar to that of conventional coronary artery bypass graft procedures performed during cardiopulmonary bypass. Conclusions The multisuction cardiac positioner provided reproducible and easy access in multivessel off-pump coronary artery bypass surgery. This simple, variable, and inexpensive cardiac positioner may be used as a new tool to aid in the performance of successful multivessel off-pump coronary artery bypass surgery.

Retrograde ascending aortic dissection after thoracic endovascular aortic repair

Thoracic endovascular aortic repair is a valuable alternative treatment option for patients with thoracic aortic aneurysms and type B dissections. However, thoracic endovascular aortic repair is associated with the risk of previously unanticipated severe complications including retrograde ascending aortic dissection. We report the case of an 86-year-old man who developed retrograde ascending aortic dissection as a delayed complication of thoracic endovascular aortic repair. Open surgical repair resulted in a successful outcome.

A Case of Aortitis Syndrome with Annuloaortic Ectasia and Aortic Regurgitation Which Was Successfully Treated by Aortic Root Replacement with Freestyle Stentless Bioprosthesis.

症 例 は大 動 脈 炎症 候 群 の診 断 を受 けた34歳 の 女性. 出産 を強 く希 望 して お り, 術後 抗凝 固療 法 を必 要 と し ないFreestyle生 体 弁(Freestyle弁)を 用 いて大 動 脈 基部 置 換 を施 行 した1例 を報告 す る. 精 査 で 大 動脈 弁 輪径30mm, Valsalva洞 径43 mm, 大 動脈 弁 閉鎖不 全(Sellers III度), 上行 大動 脈瘤(最 大径50 mm) を認 め た. : Freestyle弁(29 mm)とHemashield人 工 血 管(30mm)を 用 い て大動 脈 基部 お よび 上 行 大 動 脈 を置 換 した. Valsalva洞 周 辺 は炎症 に よる癒着 が 強 く, 剥離 困難iであ るた め, 冠 動 脈 の再 建 はCabrol変 法 に準 じて行 った. 術 後 経過 は良好 で あ った. 大 動脈 炎 症候 群 に よる: Freestyle弁 に対 す る遠 隔 期 の影 響 は まだ不 明 だ が, 術 後 のQOLを 配 慮 し, Freestyle弁 の応 用 は重 要 な選 択 肢 の 一 つ だ と思 わ れ る. 日心 外 会 誌31巻4号: 308-310 (2002) :