Toshiyasu Kugimiya

Genetic risk factor for abdominal aortic aneurysm: HLA-DR2(15), A Japanese study

PURPOSE Autoimmunity has been proposed to play a role in the pathogenesis of the abdominal aortic aneurysm (AAA). Several autoimmune diseases are associated with specific HLA DR alleles. These experiments were carried out to determine whether the same HLA DR types that have been reported to be associated with AAA in a mixed North American population are similarly associated with AAA in a more homogeneous group of patients in Japan. METHOD HLA DR typing was performed by a serologic method on samples of peripheral blood of patients with nonspecific infrarenal AAA in Nagasaki University Hospital in Japan. The frequencies of HLA DR antigens were compared with those of volunteers approximately matched for age and sex from the same referral area. RESULTS HLA DR haplotypes were determined in 46 Japanese patients with AAA and in 50 patients in a control group. The HLA-DR2(15) antigen was observed in 27 (58.7%) patients (29 alleles 31.5%) with AAA and in 14 (28%) subjects (16 alleles 26.0%) in the control group (p < 0.005). CONCLUSIONS The data suggest that HLA-DR2(15) has an important role as a genetic risk factor for AAA in Japanese patients, as previously reported in a mixed North American population.

Acute occlusion of an abdominal aortic aneurysm--case report and review of the literature.

Acute thrombosis of an abdominal aortic aneurysm (AAA) is a surgical emergency. Only 44 cases have been reported in the literature. The mechanism of the thrombosis has not been delineated. The proposed etiologies include propagation of thrombus from distal artery occlusion, cardiac thromboembolism, and dislodgment of a mural thrombus. Patients often present bilateral lower extremity ischemia, mimicking a saddle embolism. Systemic heparinization immediately after diagnosis and prompt surgical revasculariza tion can reduce the mortality rate. The authors present a patient with sudden throm bosis of an AAA who was successfully treated with an axillobifemoral bypass graft. All published cases of thrombosed AAAs are analyzed.

Coronary atherosclerosis with dual coronary artery fistulas.

Coronary artery fistula (CAF) is an uncommon congenital anomaly. Bilateral CAFs, arising from both right and left coronary arteries are rare. Myocardial infarction is by far a less frequent complication of CAF than angina pectoris. Ligation of CAF and coronary artery bypass graft were performed in the treatment of coronary artery stenosis with CAF.

Myocardial recovery during post-ischemic reperfusion: Optimal concentrations of Na+ and Ca2+ in the reperfusate and protective effects of amiloride added to cardioplegic solution

SummaryThe effects of Na+ and Ca2+ concentrations in the reperfusate on post-ischemic myocardial recovery were examined. Also, the myocardial protective effects of amiloride, an inhibitor of the Na+/Ca2+ and Na+/H+ exchange systems, added to cardioplegic solutions were assessed, using an isolated working rat heart perfusion system. Global myocardial ischemia was induced by 30-min normothermic cardioplegic arrest, using St. Thomas’ solution. The concentration of Na+ in the reperfusate varied, stepwise, from 75 to 145 mM/l, and that of Ca2+, from 0.1 to 2.5 mM/l. In this study post-ischemic functional recovery was best at 110 mM/l Na+ and 1.2–1.8 mM/l Ca2+ in the reperfusate. A significantly greater postischemic functional recovery and a lower creatine kinase release were observed when amiloride was added to the cardioplegic solution. Ca2+ overload via Na+/Ca2+ and Na+/H+ exchange systems would, thus, appear to be due, at least in part, to post-ischemic reperfusion injury.

Myonephropathic-metabolic syndrome as a complication of cardiopulmonary bypass

We encountered eight rare cases of myonephropathic metabolic syndrome (MNMS) which developed as a complication of the femoral arterial cannulation (FAC) during cardiopulmonary bypass (CPB). Seven were boys ranging in age from 4–17 years, and all had undergone open heart surgery using CPB with a hemodilution technique. These eight corresponded to 1.9 per cent of the 420 patients treated with CPB before June, 1974. The pump priming fluid used was either Ringer’s lactate solution alone or that containing a small amount of colloidal solution. Duration of CPB ranged from 52 min to 2 hrs and 42 min, but the FAC period was more than 3 hrs in each case. Acute renal failure occurred in 3 and 2 required peritoneal dialysis. Severe respiratory insufficiency occurred in 2 and one died 3 months after the operation. The most effective means to prevent the development of MNMS seems to be the local cooling of the cannulated limb during FAC. MNMS did not occur in 444 cases of CPB with FAC after July 1974, and here local cooling was applied in all cases.

Six-year survival after excision of cardiac malignant lymphoma

We report a patient with a postoperative survival period of 6 years after the surgical excision of a cardiac malignant lymphoma. A 35-year-old woman underwent total excision of the tumor arising from the left ventricular outflow tract. After the operation, she was treated with chemotherapy for 6 months. She has been doing well thereafter without any medication. To date there is no evidence of recurrence.

The role of low-density lipoprotein apheresis as postoperative care of bypass grafting for chronic arterial occlusion

Since November 1989, low-density lipoprotein apheresis has been applied to patients with intractable hyperlipidaemia following bypass grafting for chronic arterial occlusion of the lower extremities. The treatment group comprised six patients (four men, two women) with arteriosclerosis obliterans. In five patients, the ankle pressure index deteriorated and intermittent claudication recurred due to atherosclerotic progression. Results of low-density lipoprotein apheresis were dramatic; the deteriorated ankle pressure index and intermittent claudication improved significantly after several applications of low-density lipoprotein apheresis. Significant angiographic improvement was obtained in two patients. It is concluded that low-density lipoprotein apheresis appears to be an efficient method to preserve graft patency and treat postoperative patients with deteriorated ankle pressure index.

Atrial septal defect as an uncommon cardiovascular malformation with Turner’s syndrome

Cardiovascular malformations are frequently observed in Turners syndrome. Bicuspid aortic valve and coarctation of aorta are commonly associated with Turners syndrome while an atrial septal defect is unusual. Here report a rare case of atrial septal defect with Turners syndrome.

Subclavian Steal Syndrome Secondary to Isolated Innominate Artery Stenosis Possibly Due to Fibromuscular Dysplasia A Case Report

Subclavian steal syndrome is usually associated with proximal subclavian artery stenosis and is characterized by retrograde perfusion of the vertebral artery to the distal subclavian artery. We encountered an unusual case of transient ischemic attack associated with isolated proximal innominate artery stenosis and angiographic subclavian steal phenomenon. Web-like stenosis found in the innominate artery could represent fibromuscular dysplasia. The patient was treated with an aortoinnominate artery bypass, with successful symptomatic relief.

A Case of Perioperative Coronary Artery Spasm in Initial and Redo Open-Heart Surgery.

冠動脈に有意病変を有しない僧帽弁膜症患者で, 初回手術時, 再手術時の2回にわたり高度の術中冠攀縮を発生したまれな1例を経験した. 患者は56歳女性. 7年前 (49歳時) の僧帽弁交連切開術の際にも術中に強い冠攀縮をきたし, IABP駆動下にようやく救命できた. 再手術時には, 麻酔導入時から心電図上STの高度上昇を伴う徐脈と低血圧の発作が頻回に生じ, ニトログリセリン静注も効果が少なく, そのまま体外循環に移行して僧帽弁置換術を施行した. 人工心肺離脱後も冠攀縮発作が頻発したが, ニトログリセリン, ノルエピネフリン, IABPなどの併用により救命できた. 術中術後の全経過を通じて心筋逸脱酵素の上昇を認めなかった.