Yoshihito Irie

Trapdoor thoracotomy as a surgical approach for aortic arch aneurysm

Since 1991 ten patients, 9 male and 1 female, with aortic arch aneurysm underwent surgical therapy with trapdoor thoracotomy. The mean age was 67.4 +/- 9.1 (standard deviation) years at operation. In addition to the aortic arch repair, we also performed seven descending aortic replacements. We performed one partial arch replacement, one total arch replacement, and one aneurysmorrhaphy and wrapping of the aortic arch aneurysm. We experienced 1 case of paraplegia, no hospital death, and no long-term mortality.

Multiple papillary fibroelastoma of the left ventricle.

treatment of a brain infarction. The transesophageal echocardiography (TEE) showed a mobile, solitary, intracavitary tumor with a short pedicle arising from the left ventricular outfl ow just below the right coronary cusp (Figure 1). It was considered to be the cause of the brain infarction. To avoid any further embolization, the patient was transferred to our hospital for urgent operation. At surgery, the aortotomy was performed under cardiopulmonary bypass and a 5 mm in diameter video-assisted thoracoscope (Olympus, Japan) was introduced through the aortic valve for inspecting the left ventricular cavity. A tumor measuring IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY

Thyroid Hormone and Myocardial Metabolism after Heart Surgery in Dogs

Recent studies have demonstrated that thyroid hormone improves hemodynamics following open-heart surgery, through unknown mechanisms. The effect of triiodothyronine on myocardial metabolism was studied in dogs undergoing normothermic crystalloid cardioplegic arrest. Seven animals in group 0 served as controls, 8 in group 1 received 0.1μg·kg−1·min−1 triiodothyronine intravenously after aortic cross-clamping, and 3 dogs in group 2 received triiodothyronine 150 μg per day orally for 7 days preoperatively and intravenously (0.1 μg·kg−1·min−1) after aortic cross-clamping. Myocardial carbon dioxide production and the uptake of oxygen, lactate, glucose, and free fatty acids were determined before aortic cross-clamping and at 10, 30, 60, and 120 minutes after declamping. After aortic cross-clamping, increased myocardial uptake of oxygen, lactate, and glucose were observed in group 1 compared with group 0. Myocardial free fatty acid uptake decreased in all groups. Carbon dioxide production correlated with myocardial oxygen uptake. These findings suggest that intraoperative triiodothyronine supplementation improves myocardial metabolism but preoperative administration is ineffective.

Pulmonary artery sarcoma successfully treated by right pneumonectomy after definitive diagnosis

Pulmonary artery sarcoma (PAS) is a rare and lethal neoplasm that is usually diagnosed during surgery or autopsy. Early diagnosis and radical surgical resection offer the only chance for survival. However, making a preoperative histopathological diagnosis is quite difficult. We encountered a 57-year-old woman presenting a PAS that mimicked a pulmonary thromboembolism. After confirming a definitive diagnosis using a catheter suction biopsy, we successfully performed a right pneumonectomy via a median sternotomy without cardiopulmonary bypass. Eighteen months after surgery, no recurrence was observed.

Surgically cured paraneoplastic hypoglycemia associated with solitary fibrous tumor of the pleura: report of two cases

Hypoglycemia is seldom seen in association with insulinomas, rare autoimmune diseases, and paraneoplastic situations. Paraneoplastic hypoglycemia is known as nonislet cell tumor‐induced hypoglycemia (NICTH). It is also known that a solitary fibrous tumor of the pleura can cause NICTH and that surgical resection is crucial to the success of NICTH treatment.

Urgent surgical treatment for a huge metastatic tumor of the right lung via plastron thoracotomy: A case report

For an extremely large intrathoracic tumor, which almost occupies a unilateral thoracic cavity, it is likely that salvage surgery would provide benefit. Nevertheless, the operative risk of such salvage surgery is very high, plus the surgery itself often becomes challenging. The choice of surgical approach presents another problem, as the presence of a large tumor mass often makes it difficult to secure a workable surgical field. Our patient was a 63-year old man with a huge right lung metastasis from a left crural myxofibrosarcoma. We performed an urgent salvage surgery: a right pneumonectomy with assisted circulation via plastron thoracotomy. The patient lived a year and two months after the operation. We believe that plastron thoracotomy can be one of the available choices for surgical approach for resection of a giant thoracic tumor. Correspondence to: Ryuta Fukai, Department of General Thoracic Surgery, Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura, Kanagawa, 247-8533, Japan, Tel: +81 467 46 1717; Fax: +81 467 47 8243; E-mail: ryuta.f@ hotmail.co.jp

Obturator foramen bypass for infective groin caused by closure device.

A 69-year-old man underwent carotid artery stenting through the right femoral artery with a percutaneous vascular closure device for hemostasis. Eleven days later, an infective femoral artery pseudoaneurysm was diagnosed by computed tomography. At surgery, a defect in the femoral artery was observed, corresponding to the remnants of the closure device. Removal of the foreign material, debridement, wound irrigation, and arterial patch plasty were performed, but the infection and leg ischemia did not improve. After several failed attempts to revascularize and control the infection, obturator foramen bypass was performed. The postoperative course was uneventful, indicating the usefulness of this procedure.

Usefulness of Lower Ministernotomy in Aortic Valve Replacement (AVR) by Minimary Invasive Cardiac Surgery (MICS)

Minimary invasive cardiac surgery (MICS)による大動脈弁置換術(AVR)においては一般的にupper ministernotomyが選択されることが多い.しかし,retograde cardioplegia cannulaが挿入できないことなどがある.当科でCTをもとに検討したところ日本人の大動脈弁の位置はlower ministernotomyでも手術可能な場合が多いことがわかった.そこでこの2種のアプローチの有用性について検討した.1997年1月から2002年3月までに大動脈弁疾患に対しMICSによるAVRを施行した68症例を対象としupper ministernotomy施行症例をU群,lower ministernotomy施行症例をL群とした.Retrograde cardioplegiaは一般にAVRでの心筋保護法として頻用されている.L群は心筋保護および術野確保の点でもfull sternotomyへの移行した症例はなく有効であった.L群ではMAZE手術も施行でき大動脈遮断時間,人工心肺時間,手術時間,出血量,そのほかの因子でも有意差を認めなかった.Lower ministernotomyはupper ministernotomyと比較しMICS AVRにおいてretrograde cardioplegiaによる心筋保護および術野確保に有効であった.

Staged Surgery for Treatment of Three-Channeled Aortic Dissection

Dissection of the wall of an aortic dissection results in a three-channeled aorta. This particular entity creates many problems in the diagnosis and surgical treatment. A 42-year-old male with this lesion underwent successful surgical repair. Fenestration of the abdominal aorta below the renal arteries using a Y-graft was undertaken as the first step, without bypass. This was followed by total replacement of the thoracoabdominal aorta. The patient recovered satisfactorily and remains well. The technique of reconstruction of the splanchnic arteries and the artery to the spinal cord is described.

Anigioplasty of Isolated Left Coronary Ostial Stenosis-A Case Report.

症例は49歳の女性で冠動脈硬化症の危険因子は高血圧症のみであった. 狭心症発症より3か月で心内膜下梗塞の疑いにて近医に緊急入院し, 不安定狭心症のため当院へ転院した. 冠動脈造影検査の結果左冠動脈入口部の90%の孤立性狭窄が認められた. 手術は心停止下に大動脈前壁を左冠動脈口に向って斜切開し左冠動脈主幹に約8mm切開を延長した. 大伏在静脈パッチを6-0 monofilament 糸の連続縫合にて冠動脈切開部と大動脈切開部に縫合し入口部拡大を行った. 術後経過は順調で狭心症は消失した. 術後造影では左冠動脈入口部はよく拡大されていた. 術後約1年の経過観察で狭心痛の再発を認めていない.