Yasunori Watanabe

AUTOLOGOUS BLOOD TRANSFUSION WITH RECOMBINANT HUMAN ERYTHROPOIETIN IN HEART OPERATIONS

The effects of recombinant human erythropoietin (rHuEPO) on improving the anemia associated with autologous blood collection before open heart operations and on improving the postoperative anemia were studied. The study was carried out on 18 patients undergoing coronary artery bypass operations; 400 mL of autologous whole blood was taken from each patient 2 weeks before operation and was subsequently used in the operation, and rHuEPO (100 U.kg-1.day-1) was given intravenously for 2 weeks before operation and for 1 week after operation. The group in which iron preparations were also administered intravenously was designated as group I (10 patients), and the group in which rHuEPO was given alone was designated as group II (8 patients). In group III, as a control group, 11 past patients were used in whom 400 mL of autologous whole blood was collected 2 weeks before operation but neither rHuEPO nor iron preparations were given. After autologous blood collections, the hemoglobin levels improved in group I, group II, and group III, in that order, and with significant differences among them. It was shown that rHuEPO was effective in ameliorating the anemia associated with preoperative autologous blood collection, and the effect was further enhanced with intravenous supplementing iron preparations. After operation, the anemia markedly improved while rHuEPO was administered, but the hemoglobin levels decreased rapidly when the administration was terminated. Further studies are needed regarding the use of rHuEPO after operation.

Subcutaneous use of erythropoietin in heart surgery

The effect of subcutaneous administration of recombinant human erythropoietin (rHuEPO) in ameliorating anemia resulting from autologous blood donation was compared with intravenous administration of rHuEPO. Forty patients undergoing coronary artery bypass procedures were divided into three groups. Group I (12 patients) received intravenous administration of rHuEPO (100 U.kg-1.day-1) and intravenous iron preparations for 14 days before operation; group II (14 patients) had subcutaneous administration of rHuEPO (600 U/kg) on preoperative days 14 and 7 and oral iron preparations for 14 days; and group III (14 patients) received oral iron preparations alone and served as the controls. Each patient predonated 800 mL of blood in the 2 weeks before operation. The reticulocyte count increased significantly in groups I and II (p less than 0.01), but little in group III. The hemoglobin level just before operation was higher in groups I (p less than 0.01) and II (p less than 0.05) compared with group III. Four patients (29%) in group III required homologous blood transfusion versus none in groups I and II (p less than 0.05). Subcutaneous administration of rHuEPO once a week was as effective as daily intravenous administration. Preoperative autologous blood donation can be performed over a short period on an outpatient basis with subcutaneous administration of rHuEPO.

A case of Aortic Valve Endocarditis with Splenic Abscess.

脾膿瘍を合併した活動期大動脈弁感染性心内膜炎の1例を報告した. 症例は25歳, 男性. 抜歯後の発熱を主訴に来院. 血液培養で Streptococcus viridans を検出, 心臓超音波検査で大動脈弁に1cm大の疣贅と大動脈弁閉鎖不全を認めた. 多剤抗生剤治療にもかかわらず発熱は続いた. 左上腹部痛が出現したため腹部造影CTを行ったところ広範囲の脾梗塞像を認めた. 心不全が急激に悪化したため, 感染性心内膜炎の活動期に大動脈弁置換術と脾臓摘出術を同時に行った. 大動脈弁は2尖弁であった. 脾臓は菌塊による広範囲の塞栓, 膿瘍の所見であった. 術後経過は順調で現在2年が経過したが感染の再燃はない.

Perioperative Cerebral Infarction during or after Coronary Artery Bypass Grafting.

1982年より1991年までの間に当科で行った冠動脈再建術961例のうち, 周術期に脳梗塞を発症した12例を対象に周術期の脳梗塞について検討した. 症例の平均年齢は65±4歳, 術前の冠動脈危険因子は高血圧9例, 糖尿病7例, 高脂血症5例であった. 頭蓋内病変は多発性梗塞3例, 中大脳動脈領域の梗塞6例, 後大脳動脈領域の梗塞1例, 橋梗塞1例, 眼底動脈塞栓症1例であった. 脳梗塞の強く疑われる原因は上行大動脈の粥状硬化病変によると思われるもの7例, 術中の脳低灌流によるもの1例, 上室性不整脈により形成された遊離血栓によるもの2例, 左室壁在血栓の遊離によるもの1例, 不明1例であった. 予後は重症例6例のうち2例が10か月, 21か月に病院死亡, 1例が8か月後に死亡した.

Coronary Revascularization in a Patient with Calcified Aorta Using Ventricular Fibrillation without Aortic Cross-clamping.

上行大動脈に高度の石灰化病変がある54歳の女性症例に対して, 上行大動脈にまったく操作を加えずに冠動脈バイパス術を行った. 大腿動脈より送血カニューレを挿入して体外循環を行い, cardioplegia 液を使用せず大動脈非遮断低体温心室細動下に, 両側内胸動脈と右胃大網動脈の3本の動脈グラフトを使用して3枝バイパス術を施行した. 術後は脳合併症など起こすことなく順調に経過した. 上行大動脈の高度石灰化症例に対してはこの aortic no touch technique が安全かつ確実な手術方法と考えられた.

A Case Report of Coronary Artery Bypass Grafting with Idiopathic Interstitial Pneumonia.

72歳男性. 特発性間質性肺炎 (IIP) を伴う不安定狭心症の診断のもと冠動脈造影 (CAG) を施行し, LMTに90%の狭窄病変を認め, PTCAを施行したが約2か月後再び不安定狭心症となり, CAGでLMT 90%の再狭窄を認めたため, 冠動脈再建術 (CABG) を施行した. 術前, 胸部X線像では両側下肺野にびまん性細粒状影を認め, 聴診上も Velcro ラ音を聴取した. 手術は高齢者かつ肺機能低下例でもあることを考慮し, 短時間での血行再建を目標に伏在静脈を用いた2枝バイパスを行った. 体外循環終了後に一時的なPaO2の低下をみたが, 周術期は血行動態, 呼吸状態ともに安定しており, 第1病日に抜管した. 術後は特発性間質性肺炎の急性増悪もみられず29病日に退院した.