[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai
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Nihon Kyobu Geka Gakkai Zasshi · Sep 1994
Case Reports[A case of aortic and mitral regurgitation with two aneurysms in the mitral valve].
A 59-year-old male was found to have two aneurysms in the mitral valve, mitral regurgitation, and aortic regurgitation by the echocardiographic examination. The patient had a previous history of infectious endocarditis by streptococcus at the age of 24. Under the diagnosis of mitral aneurysms developed after infectious endocarditis, surgery was undertaken. ⋯ Patients with a history of infectious endocarditis have to be followed up for a long period of time. Transesophageal echocardiogram is useful in those patients. Considering high prevalence of aortic valvular diseases in those with a mitral aneurysm after infectious endocarditis, aortic valves should be carefully evaluated.
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Nihon Kyobu Geka Gakkai Zasshi · Sep 1994
Case Reports[Successful repair of acute traumatic rupture of the thoracic aorta].
We report four male patients (from 18 to 36 years in age) with acute traumatic rupture of the aortic isthmus due to blunt chest trauma caused by motor vehicle accident in three patients and a full in one patient. Of these patients, 3 underwent segmental replacements of the descending thoracic aorta with vascular prosthesis using cardiopulmonary bypass, and an additional patient underwent the same procedure using left heart bypass. All patients survived without the development of any serious complications. ⋯ However, cardiopulmonary bypass requires systemic heparinization, which predisposes the patients with associated multiple injuries to a tendency of bleeding. Thus, a thorough investigation of the preoperative status, including the severity of multiple injuries, should be undertaken, and appropriate therapeutic measures instituted before the start of cardiopulmonary bypass. The determination of the timing of operation is crucial to success in the treatment of acute traumatic ruptures of the thoracic aorta.
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Nihon Kyobu Geka Gakkai Zasshi · Sep 1994
[Experimental study of optimal perfusion pressure during retrograde cerebral perfusion].
The effects of retrograde perfusion pressure on the brain was experimentally investigated during profound hypothermic circulatory arrest. Fifteen adult mongrel dogs were placed cardiopulmonary bypass and induced profound hypothermia of 20 degrees C at nasopharyngeal temperature. Retrograde cerebral perfusion (RCP) with perfusion pressure of 10 mmHg (RCP10; n = 5), 20 mmHg (RCP20; n = 5), 30 mmHg (RCP30; n = 5) underwent for 60 minutes. ⋯ In the RCP30 group, the water content of cerebral tissue was significantly higher than those in the other groups. In the RCP20 group, the excess lactate was maintained in a negative range, and ATP concentration was significantly higher than in the RCP10 group. In conclusion, RCP may provide metabolically adequate support for the brain and a perfusion pressure of 20 mmHg was appropriate for RCP in dogs.
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Nihon Kyobu Geka Gakkai Zasshi · Aug 1994
Review Case Reports[2 cases of the tension pneumopericardium following blunt chest trauma resulting in the cardiac tamponade].
A 63-year-old man (case 1) was brought to our emergency unit following a high speed collision. He developed fatal cardiopulmonary arrest shortly after arrival despite resuscitation efforts. Tension pneumopericardium was revealed by chest X-ray and CT examination. ⋯ In a patient with traumatic pneumopericardium who requires mechanical ventilatory support, continuous pericardial drainage should be considered. In addition, tension pneumopericardium may occur in patients with breathing spontaneously as in our cases. In these cases, careful observation and immediate subxiphoid pericardial drainage are required.
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Nihon Kyobu Geka Gakkai Zasshi · Aug 1994
Case Reports[Mitral valve replacement secondary to resection of mycotic cerebral aneurysm in acute phase of bacterial endocarditis--a case report].
We report a case of mitral valve replacement after ruptured mycotic aneurysm resection in acute phase of bacterial endocarditis. We have experienced a 68-year-old man with vegetation at the anterior leaflet of mitral valve and multiple systemic embolization. ⋯ Mitral valve was replaced three days after successfully. If there was no heart failure preoperatively, valve replacement operation is recommended in acute phase of infected endocarditis or few days after cerebral aneurysmectomy.