Yoshiyasu Egawa

Primary Mitral Valve Sarcoma in Infancy

Abstract. Primary cardiac sarcoma is a rare tumor, found especially in children, particularly in the left side of the heart. This report describes a rare case of primary mitral valve sarcoma in a 7-month-old male infant with hemiparesis and heart murmur who underwent mitral valve replacement because of excessive invasion of the mitral valve by the tumor. The patient remains well, free of recurrence and cerebral metastasis, and without adjuvant therapy 18 months after the operation.

Complete but not partial thymectomy in early infancy reduces T-cell-mediated immune response: three-year tracing study after pediatric cardiac surgery.

OBJECTIVEnThymectomy is often performed to secure an operative field in surgery for congenital heart defects in early infancy. However, how neonatal thymectomy affects the subsequent development of the immune system in humans remains unclear. We monitored patients for 3 years from the time of thymectomy that was performed during cardiac surgery in early infancy.nnnMETHODSnFor up to 3 years, we monitored the number of circulating lymphocytes and the clinical course of the children who underwent complete (n = 17), partial, and no (n = 15) thymectomy during congenital heart defect surgery performed at less than 3 months of age. The titers of immunoglobulin-G produced in response to vaccinated viruses and phytohemagglutinin responses were also measured.nnnRESULTSnSix months after surgery, the number of T cells, including CD4(+) and CD8(+) subpopulations, decreased in patients with complete but not partial thymectomy. The reduction in T-cell number persisted for 3 years, whereas the number of B cells did not change. In patients with complete thymectomy, the titers of immunoglobulin-G produced in response to vaccinated measles and rubella viruses were reduced, whereas the phytohemagglutinin-induced proliferation of T cells was not impaired. In addition, hospitalization frequency associated with infectious diseases increased in patients with complete but not partial thymectomy.nnnCONCLUSIONSnThe results revealed that complete thymectomy in early infancy reduces the number of circulating T cells and T-cell-mediated immune responses for at least 3 years, suggesting that the thymus should be at least partially preserved during surgery in early infancy to maintain protective immunity.

Two Cases of Successful Treatment of Tracheo-Innominate Artery Fistula

気管腕頭動脈瘻は気管切開術後の希な合併症であるが,発症すると致命的である.われわれは2例を経験し比較的長期の生存が得られたが,一時止血方法や手術方法に若干の相違があり,利点や反省点につき検討した.症例1は,長めの気管切開カニューレと経口気管チューブを併用し,さらに気管切開孔周囲を圧迫して一時止血を得たのち,右総腸骨動脈-右腋窩動脈バイパス作製後に胸骨正中切開から腕頭動脈離断と気管瘻孔の直接閉鎖を行った.症例2は,長めの気管切開カニューレを気管切開孔から最大限押し込みカフを過膨張させて一時止血を得たが,手術室搬入時にカフがずれて再度大量出血をきたした.手術は胸骨正中切開からePTFEグラフトを用いた解剖学的腕頭動脈再建と自己心膜パッチによる気管瘻孔閉鎖を行った.気管腕頭動脈瘻の治療でもっとも重要な点は予防である.気管切開後に少量の新鮮血出血が持続するなど先行症状を認めた場合には,大量出血にいたる前に気管支鏡やCTなどで早期に発見し手術治療を考慮すべきと思われる.しかし,大量出血をきたした場合には,一時止血と気道の維持が問題となる.われわれの経験では,症例1では良好な一時止血が得られたものの症例2ではカニューレの長さが不足して止血が不確実であった.手術方法としては,術野の汚染がない場合には解剖学的な腕頭動脈への血行再建と気管痩孔の閉鎖が理想的と思われるが,大きな痩孔の存在など術野の汚染が考えられる場合には非解剖学的血行再建を選択せざるを得ない場合もあり,感染予防や遠隔期予後の点からも早期の発見,治療が重要と考えられた.

Newborn with congenital arteriovenous fistulas of the abdominal wall complicated by a ductus arteriosus aneurysm

A case of congestive heart failure in a neonate resulting from a congenital abdominal arteriovenous fistula is described; an aneurysm of the ductus arteriosus was also found in the patient. Abdominal aortography was performed and demonstrated dilated feeding arteries, including the hypogastric arteries, which communicated with a dilated umbilical vein. Ligation of the feeding arteries and the umbilical vein led to resolution of the heart failure. Transient liver dysfunction occurred, however. Symptoms improved dramatically upon removal of the ligature from the umbilical vein. Although there is one previous report of an arteriovenous fistula involving the umbilical vein, we know of no prior report of a congenital arteriovenous fistula in association with a ductus arteriosus aneurysm.

New operative method for tracheal compression in congenital heart disease

A new technique is described for repairing tracheal compression caused by ascending aorta associated with corrected transposition of the great arteries and pulmonary atresia in a 113-day-old infant. Surgical repair for the tracheal compression was accomplished by suspending the pericardium around the aortic arch to the underside of the sternum. This method seems to be useful for some patients with tracheal compression caused by the ascending aorta.

Arterial Reconstruction for Femoropopliteal Occlusive Disease Due to Arteriosclerosis. A Retrospective Comperative Study between Endarterectomy and Femoropopliteal Bypass.

1978年から1990年10月までに大腿膝窩動脈領域閉塞性動脈硬化症75症, 97肢に対して血行再建手術を施行した. Risk factor として喫煙歴と高血圧が高率で, 他に心臓, 脳, 腎臓に合併症を持つものも多く認められた. 手術は大腿膝窩動脈の血栓内膜摘除術 (TEA) 31肢, またはバイパス術 (バイパス) 66肢である. 累積開存率はTEAが5年および10年が72.6%, バイパスが5年48.1%, 10年36.1%と, TEAがバイパスに比し遠隔期において有意に良好で, TEAで閉塞した症例は全て1年以内であった.また, 近位部病変合併例においては近位部を解剖学的に再建した方が, 大腿膝窩動脈領域の開存率は良好であった. TEAには, 早期閉塞を防ぐための慎重な手術と術後の厳密な抗凝固療法が重要であるが, 良好な遠隔期の開存率からみて, 大腿膝窩動脈領域の血行再建術として優れた術式である.