[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai
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Nihon Kyobu Geka Gakkai Zasshi · Jan 1989
Comparative Study[Surgical treatment of postinfarction ventricular septal perforation--the difference between a cardiogenic shock group and a congestive heart failure group].
Twelve patients with postinfarction ventricular septal perforation (VSP) were divided into 2 groups based upon the preoperative status and the time interval between the operation and the occurrence of VSP after acute myocardial infarction (AMI). Group I were in cardiogenic shock unresponsive to either pharmacologic supports or IABP, and needed an emergency repair of VSP. The other group (group II) were in congestive heart failure responding to some extent to pharmacologic supports and IABP, and VSP of this group was repaired on the elective or semiemergency basis. ⋯ In group I, the right heart failure remained and was prolonged even after surgery reflected by the RAP/LAP ratio over 1 and finally resulting in MOF. To improve surgical results in group I, the operation should be undertaken on the emergency basis before MOF is completed, and patch reconstruction of the left ventricular free wall is recommended in patients with a wide AMI and a high positioned anterior septal perforation. When RV failure is dominant, not only a LV assist device but also a RV assist device may also improve the results.
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Nihon Kyobu Geka Gakkai Zasshi · Jan 1989
[Postoperative bronchopleural fistula--diagnostic significance of masked cases and results of early re-operation].
We studied recent-day cases of postoperative bronchopleural fistula from 1982 to 1985. And in 1985, postoperative chest X-ray films were intensively compared with previous ones. Radiological signs for bronchopleural fistula and/or alveolar fistula such as increases in air content and/or falls in air-fluid level of pleural space were seen in 11 (7.1%) of 155 pulmonary resection cases in 1985. ⋯ On the bronchoscopic examination, bronchopleural fistulas were mainly located at the side of the residual lobe on the stump. Bronchopleural fistula cases which were re-operated for re-amputation, re-suture, and coverage of the stump within 48 hours, were all cured. So we concluded early re-operation is the best choice for bronchopleural fistula patient, because of short administration, no cosmetical problems and no disadvantage for lung function.