[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai
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Nihon Kyobu Geka Gakkai Zasshi · Sep 1995
Case Reports[Hiatal hernia incarceration during cardiopulmonary bypass in patient with acute aortic dissection--a case report].
A 67-year-old woman was admitted to our hospital under diagnosis of Stanford type A acute aortic dissection. Chest CT showed aortic dissection from the ascending to descending aorta, and large hiatal hernia. Operation was undergone under cardiopulmonary bypass and circulatory arrest with retrograde cerebral perfusion. ⋯ Her postoperative course was uneventful except for acute renal failure, and she was discharged 60 days after the operation. The incarceration of hiatal hernia was thought to be caused by tissue edema and small bleeding during cardiopulmonary bypass. This is the first reported case with the incarceration of hiatal hernia which occurred during cardiopulmonary bypass.
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Nihon Kyobu Geka Gakkai Zasshi · Sep 1995
Clinical Trial[Fontan procedure after pulmonary artery banding--surgical results and new anatomical repair for tricuspid atresia].
We examined our surgical experiences to determine the appropriate condition of pulmonary artery banding (PAB) for the Fontan procedure. From 1974 through 1992, thirteen patients underwent Fontan procedure following PAB at Tokyo Women's Medical College. Of these 6 had tricuspid atresia (TA), 5 had single ventricle, or 2 had other complex malformations. ⋯ Hemodynamic data before Fontan operation showed a tendency of higher PA pressure (17.5 vs 31.5 mmHg), and pulmonary vascular resistance (2.4 vs 5.5 Wood Unit) in non-survivors than in survivors. For patients with tricuspid atresia and high pulmonary vascular resistance, a new operation "Anatomical Repair" utilizing hypoplastic right ventricle with the translocation of pulmonary or aortic valve in tricuspid position was developed and successfully applied in three patients. In conclusion, initial tight PAB during early infancy and often repeated palliative surgery for development of adequate pulmonary vascular bed is the most important for maximizing the chance of subsequent successful Fontan procedure.