Yoshiya Ishikura

Use of a new stapling instrument for permanent occlusion of the aorta in the surgical procedure for thromboexclusion

Permanent aortic occlusion is required in the surgical procedures for the flow reversal and thromboexclusion technique and also for the permanent exclusion of aneurysms of the thoracic aorta. We have designed a stapling instrument for the permanent occlusion of the aorta and have used it in 5 patients with aortic dissections and 2 patients with aneurysms of the thoracic aorta. This report describes our newly designed surgical stapler for the closure of the aorta with 2 case reports.

Left ventricular rupture following mitral valve replacement —A report of two cases—

Left ventricular rupture is a rare and usually fatal complication of mitral valve replacement, and we report herein, 2 successfully treated cases of type III left ventricular rupture. The laceration in the posterior ventricular wall was repaired by a wide buttressed mattress suture with teflon felt belts on either side, then covered with Oxycel and fibrin glue or a large patch and fibrin glue. Naturally, the operation must be performed carefully and gently, however, the most important etiologic factor of left ventricular rupture is the extremely friable myocardium due to aging and a long history of heart disease. Utilizing fibrin glue for successfully repairing the rupture proved very effective.

Surgical treatment of the aortic aneursysm

For 93 cases of thoracic and 118 cases of abdominal aneurysms, the over-all operative mortality rate was 24.7 per cent and 9.3 per cent, respectively. Although the over-all operative mortality rate for 37 patients with aneurysms of the ascending aorta or aortic arch had been 40.5 per cent, recent advances in surgical technique led to a higher survival rate so that since 1975 no death occurred among 14 consecutive surgery cases. Cardiopulmonary bypass with or without selective perfusion of the carotid arteries or temporary external bypass procedures were employed in these 14 cases.The over-all operative mortality rate for 56 patients with aneurysms of the descending thoracic aorta was 14.3 per cent. Temporary external bypass prodedures were employed in 49 cases.The operative mortality rate for 99 patients with unruptured abdominal aneurysms was five per cent, and that for 19 patients with ruptured aneurysms was 31.5 per cent.

An isolated aneurysm of the common iliac artery associated with an arterio-venous fistula: Autotransfusion technique and postoperative hemodynamic monitoring —A case report—

Isolated aneurysms of the common iliac artery occur less frequently than abdominal aortic aneurysms. Moreover, the rupture of an isolated iliac aneurysm into a systemic vein is considered to be very rare. The case reported herein is of a patient with a left common iliac aneurysm which ruptured into the iliac vein, who was successfully treated surgically, using Doty’s autotransfusion technique as a supportive measure. We describe our preoperative diagnosis, operative method, including the supportive measures, and the postoperative hemodynamic changes monitored by a Swan-Ganz catheter.

The surgical treatment of a thoracoabdominal aortic aneurysm with total preservation of the intercostal and lumbar arteries using a permanent bypass technique a case report

A 44 year old man underwent successful surgery for a thoracoabdominal aortic aneurysm using a permanent bypass graft and aneurysmoplasty. This technique reduces visceral ischemia to a minimum and the aneurysmoplasty, through total preservation of the intercostal and lumbar arteries, can avoid paraplegia caused by spinal cord ischemia. Our technique is recommended as it can be performed easily, safely, and effectively without heparinization, temporary shunts or bypass perfusion.

Cardiopulmonary bypass with selective cerebral perfusion - An experience of 20 cases.

昭和45年から63年までの脳分離体外循環症例20例を対象として,脳分離体外循環方法を中心に検討した.脳循環は,体循環と別のポンプを用いて左右別々に送血した.送血部位は,右は腕頭動脈(INA)もしくは右腋窩動脈(RAX)を,左は左総頸動脈(LCA)を用いた.各部位別の送血量は,INA: 6.4±0.6, RAX: 7.4±1.7, LCA: 5.7±1.5ml/kg/minで,温度は21～32 (26.7±2.5)℃であった.手術成績は手術死亡が5例(25%)で,follow upが可能であった13例のうち遠隔死亡はなかった.脳合併症は,CT scan上異常を認めたのは1例のみで,覚醒遅延は2例であった.最近は,送血カニューレの挿入も,弓部分枝にタバコ縫合をかけて,弓部分枝を遮断することなく行っており,中等度低体温下,送血量も,INA, RAX: 7ml/kg/min, LCA: 5ml/kg/minに統一し,脳合併症もなく,好結果を得ている.