Toshihiko Kuga

Stent graft treatment for abdominal pseudoaneurysm near the celiac artery

pledget-supported suture. We did not use this method because of suspected infection and the severely damaged PA wall. The histologic findings also support our decision. However, the PA wall was extensively abnormal, and the suture line was disrupted. Resuturing incorporating the pulmonary valve annulus caused mild residual stenosis that could not be tolerated in the presence of severe right ventricular dysfunction. Pulmonary root replacement can be a method of choice in such patients. Therefore, we believe that a pulmonary allograft should also be made available whenever possible and should be implanted during the initial operation, if necessary. The last problem was the timing of the operation. Emergency intervention was required in most reported patients with aortopulmonary fistulae and in this patient also, although the history of the present illness was rather long, and his general condition was fair

Left thoracotomy approach in reoperative off-pump coronary revascularization: bypass grafting from the left axillary artery or descending thoracic aorta.

OBJECTIVE Reoperative coronary bypass grafting is at high risk. Particularly in redo cases where the patent graft is running near the midline of the sternum, the graft may be exposed to injury by a median sternotomy and subsequent dissection. Whereas, off-pump bypass grafting from the left axillary artery or descending thoracic artery by a left thoracotomy approach is safe for preventing graft damage. METHODS From March 1998 to February 2002, we performed off-pump coronary artery bypass grafting by a left thoracotomy approach in 9 patients. The left axillary artery was used as the inflow vessel in 4 cases, and the descending thoracic aorta in 5. RESULTS The radial artery was anastomosed proximally to the axillary artery in 4 cases and the descending thoracic aorta in one case. The saphenous vein graft was anastomosed proximally to the descending thoracic aorta in 4 cases. Transdiaphragmatic minimally invasive bypass grafting for the right coronary artery was simultaneously performed in 3 cases. Postoperative cardiac events were ventricular arrhythmia in 6 cases and supraventricular arrhythmia in 3 cases. There was no damage to the patent grafts. Postoperative coronary angiography performed in 8 cases revealed all the grafts to be patent without stenosis. Cardiac symptoms were not found after the operation in any of the cases. CONCLUSIONS These procedures can prevent the injury to patent grafts caused by a median sternotomy, and will be one of the useful strategies for reoperative off-pump coronary artery bypass grafting.

Exposure of the coronary artery using an ultrasonic scalpel.

It has been reported that an ultrasonic scalpel (Harmonic Scalpel, dissecting-hook type; Ethicon Endo-Surgery, Cincinnati, Ohio) allows surgeons to exfoliate the internal thoracic artery without thermal injury to grafts and to collect skeletonized grafts that provide long-term patency. During coronary artery bypass surgery, exposure of native coronary arteries is occasionally a problem when they are buried in adipose tissue or myocardium. We verified that the ultrasonic scalpel can provide safe and rapid exposure of coronary arteries.