Yurio Kobayashi

Multiple free (aorta-coronary) gastroepiploic artery grafting

The use of in situ gastroepiploic artery grafts has been reported recently. In the present case, the in situ gastroepiploic artery was too short to graft both the diagonal and the obtuse marginal branches of the coronary arteries in a patient with diffuse coronary artery disease. The free (aorta-coronary) gastroepiploic artery graft was anastomosed to both arteries to form a Y graft.

Angiographic Follow-up of Internal Thoracic Artery for Free Bypass Grafting

BACKGROUND The use of free internal thoracic artery (ITA) grafts in patients with smaller body surface areas has been questioned because of technical difficulties and inadequate graft flow. METHODS To evaluate postoperative changes in the diameter of free ITA grafts, we performed coronary angiography immediately after coronary artery bypass grafting and then again at a mean of 42 +/- 6 months later. In 20 consecutively treated patients, 21 free ITAs were used as bypass conduits. Two ITA grafts that were patent at the time of the first angiography had closed at the second angiography. Postoperative changes in ITA graft diameter were measured in the 19 patent ITA grafts. RESULTS At the first angiography, the mean diameters of the proximal, middle, and distal ITA grafts were 2.28 +/- 0.45 mm, 2.34 +/- 0.39 mm, and 2.12 +/- 0.38 mm, respectively. At the second angiography, the mean diameters of the proximal, middle, and distal ITA grafts were 2.85 +/- 0.50 mm, 2.89 +/- 0.53 mm, and 2.72 +/- 0.53 mm, respectively. All segments of the ITA grafts had dilated significantly between the first and second angiographic evaluations (p < 0.01). The percentage change in graft diameter was greater when the initial ITA diameter was less than 2.3 mm (32.0% +/- 28.0%) than when it was 2.3 mm or more (18.8% +/- 11.3%) (p < 0.05). CONCLUSIONS The postoperative increase in free ITA graft diameter depends on coronary blood flow requirements.

Unroofed coronary sinus demonstrated by two-dimensional echocardiography

Fig. 2. Left panel, Two-dimensional echocardiogram in parasternal, long-axis view demonstrates a mass (T) in the left atrium (LA). Right panel, The left atrium is shown at necropsy with thrombus (T), measuring 3 cm in length and 1 cm in width, attached to the interatrial septum. AV = aortic valve; FO = foramen ovale; LVFW = left ventricular free wall; MV = anterior leaflet of mitral valve; VS = ventricular septum.

Bilateral axillary artery aneurysms after Bentall procedure in Marfan syndrome.

A man with Marfan syndrome underwent a Bentall procedure for annuloaortic ectasia and severe aortic regurgitation at 43 years of age. Twenty-eight years after the Bentall procedure, he developed bilateral axillary artery aneurysms (length × diameter: right: 80 × 39 mm; left: 103 × 45 mm). Aneurysmectomy and reconstruction of the axillary artery were performed using an artificial vascular graft. Histological examination revealed cystic medial necrosis. The postoperative course was uneventful, but long-term follow-up is necessary.

Structural valve deterioration of a mitral Carpentier-Edwards pericardial bioprosthesis in an 87-year-old woman 16 years after its implantation

The second-generation pericardial valve, the Carpentier-Edwards perimount bioprosthetic (CEP) valve, shows dramatically improved durability as compared to the first-generation pericardial valve, and excellent performance has been obtained, in both the aortic and mitral positions. Especially in elderly patients with an implanted CEP valve, reoperation due to structural valve deterioration (SVD) is rarely required. Here, we report the case of an 87-year-old woman with an explanted CEP valve in the mitral position due to SVD, 16 years after its implantation.

Left ventricular motion after bypass operation for coronary artery disease with collaterals

Left ventricular ejection changes obtained from left ventricle roentgenograms were analyzed before and after coronary artery bypass grafting in 22 consecutive patients with chronic obstructive left anterior descending coronary artery disease receiving collaterals before surgical revascularization. The collateral vessels all disappeared after surgical revascularization. After operation, ejection changes of anterobasal, anterolateral and apical walls supplied by the left anterior descending coronary artery improved from 43.6% +/- 9.7% to 48.5% +/- 8.6% (p < 0.05), from 35.2% +/- 10.9% to 39.4% +/- 9.5% (p < 0.05), and from 46.0% +/- 10.6% to 50.0% +/- 8.7% (p < 0.05), respectively. The improvement in left ventricular wall motion did not appear to be related to the extent of preoperative collateralization. Thus, left ventricular wall motion was impaired in the area supplied by collaterals and was improved by myocardial revascularization. These results suggest that coronary blood flow, even through well-developed collaterals, may not be sufficient, which may produce chronic active ischemia and impaired left ventricular wall motion.

False aneurysm formation after ventricular rupture associated with reinfarction following successful thrombolysis.

SummaryA 69-year-old woman underwent successful thrombolysis for total occlusion in the right coronary artery using urokinase. One week later, the patient developed reinfarction in the area supplied by the right coronary artery, followed by ventricular rupture. She was resuscitated with drainage of the pericardial effusion. Cardiac catheterization confirmed that the site of the right coronary artery reocclusion was identical to that in the acute phase. A false aneurysm developed over the true aneurysm located in the inferior portion of the left ventricle as demonstrated by a ventriculogram at the convalescent stage and at surgery. The orifice of the false aneurysm has closed by suture.

Rapidly progressing left atrial hemangiopericytoma.

Cardiac hemangiopericytoma is a rare soft tissue tumor. We describe a case of hemangiopericytoma in the left atrium, which was diagnosed as myxoma preoperatively. A 70-year-old woman was admitted with heart failure. An echocardiogram showed a large myxoma-like mass in the left atrium, herniating into the left ventricle; therefore, an emergency operation was performed. Histological examination revealed a malignant hemangiopericytoma. The patient’s postoperative course was uneventful, but she died due to a local recurrence 4 months after the operation.

Correction of Severe Ebstein's Anomaly in a Neonate with Pulmonary Atresia

新生児期発症の解剖学的肺動脈閉鎖を伴った重症Ebstein奇形の1手術例を経験したので報告する.症例は生後8日の女児,39週4日自然分娩で出生,生直後より心雑音,チアノーゼを認め,心エコーでEbstein奇形,肺動脈閉鎖と診断された.LipoPGE 1を投与し動脈管を開存させ,肺血流を確保しつつ心不全治療を行ったが,心不全が増強するため出生後8日目に手術を行った.手術は体外循環下に三尖弁口閉鎖,心房間交通作製,右房縫縮を行った.生後60日目にBlalock-Taussig変法を行ったが,心不全のため強心剤からの離脱ができなかった.生後10ヵ月目に両方向性Glenn手術を行い,軽快退院した.2歳6ヵ月時にtotal cavopulmonary connection (TCPC)を行った.術後18ヵ月の現在も元気に日常生活を送っている.

Successful Surgical Treatment of Ruptured Abdominal Aortic Aneurysm Following Stanford Type B Acute Aortic Dissection

症例は72歳,男性.突然の腰背部痛で発症した.発症から3日後の胸腹部CTにて,Stanford B型急性大動脈解離と動脈硬化性腹部大動脈瘤が合併し,後腹膜に破裂していると診断された.腹部大動脈瘤は最大径60mmであった.全身状態が落ち着いていることから降圧療法を行い厳重に経過観察を行った.発症45日目に腹部大動脈瘤に対して人工血管置換術を行った.解離は腹部大動脈瘤に及び,後腹膜には血腫が存在した.腹部分枝はすべて真腔から分岐していたが,吻合部より中枢側での解離に伴う破裂を予防する目的で中枢側吻合は開窓して行った.今回われわれは既存の腹部大動脈瘤に解離性大動脈瘤を合併し,破裂した希な症例を経験したが,慢性期に人工血管置換術を施行し,経過順調であったので報告する.