[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai
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Nihon Kyobu Geka Gakkai Zasshi · Aug 1994
Case Reports[Thrombolytic therapy of thrombosed Björk-Shiley aortic valve prosthesis--report of four cases].
Prosthetic valve thrombosis is associated with high mortality. Thrombolytic therapy is a promising alternative to valve replacement in the management of prosthetic valve thrombosis. To determine the efficacy and safety of thrombolytic therapy for thrombosed Björk-Shiley aortic valve prosthesis, 4 patients who received urokinase intravenously for this disorder were analyzed. ⋯ A protocol for the safe treatment of thrombosed valve is urokinase in initially administered in the doses as 960,000 units for 24 hours, then followed by a maintenance infusion at the half dose every 24 or 48 hours later. Thrombolytic therapy should be continued for 1 week at least to prevent rethrombosis even normalization of valve function was documented clinically. Simultaneous heparin infusion of 10,000 units for 24 hours is then started to replaced by warfarin treatment adjusted to obtain optimal prothrombin times.(ABSTRACT TRUNCATED AT 250 WORDS)
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Nihon Kyobu Geka Gakkai Zasshi · Jul 1994
[Clinical study of continuous warm blood cardioplegia with normothermic cardiopulmonary bypass in coronary artery bypass surgery].
This study was undertaken to determine whether continuous warm blood cardioplegia (CWBCP) could be acceptable as an alternative method for myocardial preservation in cardiac surgery. Between December 1991 and June 1993, 100 consecutive patients underwent coronary artery bypass surgery. Four patients who received terminal warm blood cardioplegia were excluded in this study. ⋯ Group W patients were more likely to be hemodynamically stable after CPB discontinuing. Serum potassium levels during CPB was higher in Group W (max. 5.67 +/- 0.96 versus 4.39 +/- 0.50 mEq/l), so excessive potassium was eliminated using extracorporeal ultrafiltration. The major drawback of CWBCP was that continuous coronary perfusate occasionally obscured anastomosis site.(ABSTRACT TRUNCATED AT 250 WORDS)
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Nihon Kyobu Geka Gakkai Zasshi · Jul 1994
Case Reports[A two staged extending graft replacement for dissecting aortic aneurysm with Marfan's syndrome].
We experienced four cases of dissecting aortic aneurysms with Marfan's syndrome, in which two staged operations were performed with satisfactory results. The operations performed in the four patients were the replacement of the ascending aorta, transverse aortic arch and the entire descending thoracic aorta in DeBakey type I dissecting aortic aneurysm, replacement of the entire descending thoracic and abdominal aorta in type IIIb, replacement of the aortic valve, ascending aorta, transverse aortic arch, the entire descending thoracic and upper abdominal aorta in type I, and replacement of the total aorta including the aortic valve in type II + IIIb, respectively. ⋯ Dissecting aortic aneurysm with Marfan's syndrome must be observed carefully and corrected surgically, because the lesion is progressive and the residual dissecting aneurysm usually dilates eventually. In view of our clinical results, we conclude that the operation for dissecting aortic aneurysm with Marfan's syndrome should be performed as extensively as possible.
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Nihon Kyobu Geka Gakkai Zasshi · Jun 1994
Review[Surgical treatment of supravalvular aortic stenosis].
In the last 14 years, 7 consecutive patients with supravalvular aortic stenosis (SVAS) underwent surgical treatment for SVAS and/or for associated lesions. There were 5 male and 2 female patients ranging in age from 3 months to 12 years. Six of them had associated other cardiac anomalies; two had severe multiple peripheral pulmonary stenoses (PPS) and one each had ventricular septal defect (VSD), valvular pulmonary stenosis, coarctation of aorta with patent ductus arteriosus (PDA), total anomalous pulmonary venous return (TAPVR) with pulmonary branch stenosis, PPS and left lower pulmonary venous obstruction. ⋯ Four patients had undergone previous operations, which included repair of severe multiple PPS by extended peripheral pulmonary arterioplasty (case 4, 6), repair of coarctation of aorta and division of PDA (case 5), repair of TAPVR (Ia + IIa) and pulmonary branch stenosis (case 7). There was no operative death and one patient died late postoperatively (case 7) due to right heart failure in a follow up period of 3 to 14 years. In conclusion, it is important to select the appropriate surgical treatment according to the location and the severity of associated other cardiac anomalies as well as the severity of SVAS, and extended peripheral pulmonary arterioplasty is considered to be a recommended method for the relief of severe multiple PPS associated with SVAS.
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Nihon Kyobu Geka Gakkai Zasshi · Jun 1994
Case Reports[Cardiac herniation after right sleeve pneumonectomy with partial pericardiectomy].
A 63-year-old male underwent a sleeve pneumonectomy with partial pericardiectomy for a squamous cell carcinoma of the right upper bronchus invading the trachea. The pericardial defect was closed primarily. The initial postoperative course was uneventful until we performed endotracheal suction with bronchoscopy in that evening. ⋯ He recovered. The cardiac herniation after pneumonectomy is one of the fatal complications unless prompt diagnosis and surgical reduction should be done. Repair of the pericardial defect with strong prosthetic patches and careful postoperative management are indispensable for the prevention of the cardiac herniation after pneumonectomy.