[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai
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Nihon Kyobu Geka Gakkai Zasshi · Mar 1994
Case Reports[A case of staged operation for a dissecting aneurysm (DeBakey type IIIb+II) with Marfan's syndrome].
A 34-year-old woman with Marfan's syndrome had severe heart failure due to annulo-aortic ectasia and aortic insufficiency, which was accompanied also by a dissecting aneurysm (DeBakey type IIIb) that was demonstrated by aortography. 4 days before the operation, sudden progression of the aneurysm to a DeBakey type II, and finally DeBakey type I dissecting aneurysm was seen. The first operation was an extended aortic resection with replacement from the aortic valve to the descending thoracic aorta (level of the 7th thoracic vertebra) using selective cerebral perfusion. ⋯ The postoperative course of the patient was uneventful. Dissecting aneurysm with Marfan's syndrome should be operated as extensively as possible if necessary.
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Nihon Kyobu Geka Gakkai Zasshi · Mar 1994
[Sarcoplasmic reticular calcium release and myocardial protection--effect of ryanodine on myocardial ischemia and reperfusion-induced injury].
Calcium release from sarcoplasmic reticulum (SR) may contribute to the intracellular calcium overload observed during myocardial ischemia and reperfusion. We have therefore investigated the ability of ryanodine to enhance myocardial protection when given before ischemia or during reperfusion in the isolated working rat heart. Hearts (n = 6-9/group) from male Wistar rats were aerobically (37 degrees C) perfused (20 min) with bicarbonate buffer (Ca2+ = 2.4 mM). ⋯ Creatine kinase (CK) leakage during Langendorff reperfusion was reduced in the 1.75 nM group but was similar to control in all other groups. In the second series of studies, 3 min of cardioplegia without ryanodine and 38 min of ischemia (37 degrees C) were followed by 15 min of Langendorff reperfusion with 0, 0.09, 0.18, 0.88 or 1.75 nM ryanodine, %AF was 59.3 +/- 3.3%, 54.7 +/- 3.3, 53.8 +/- 3.5, 38.4 +/- 8.9 (p < 0.05) and 33.3 +/- 5.8 (p < 0.05)% in the 0, 0.09, 0.18, 0.88 and 1.75 nM ryanodine groups, respectively. CK leakage tended to increase dose-dependently.(ABSTRACT TRUNCATED AT 250 WORDS)
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Nihon Kyobu Geka Gakkai Zasshi · Feb 1994
Case Reports[A concomitant operation of Damus-Kaye-Stansel procedure, atrioventricular valvuloplasty and total cavopulmonary connection].
A 2-year-old girl with single ventricle and coarctation of aorta, who received subclavian flap aortoplasty and pulmonary artery banding at 30 days of age, developed subaortic stenosis and atrioventricular valve regurgitation. At the age of 2 years and 10 months, physiologic correction with atrioventricular valvuloplasty, Damus-Kaye-Stansel procedure, and total cavopulmonary connection were performed concomitantly. She showed uneventful convalescence, and postoperative cardiac catheterization revealed trivial atrioventricular valve regurgitation with a mild pressure gradient between the left ventricle and aorta.
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Nihon Kyobu Geka Gakkai Zasshi · Feb 1994
Review Case Reports[Aortic valve replacement in a patient with chronic idiopathic thrombocytopenic purpura].
We reported a case of aortic valve replacement in a patient with chronic idiopathic thrombocytopenic purpura (ITP). We used high-dose intravenous gammaglobulin therapy (400 mg/kg/day) for five days to increase the platelet prior to the operation. The number of platelet was 8-10 x 10(4)/microliters at admission and it was increased to 23 x 10(4)/microliters before surgery. ⋯ The platelet was transfused after the bypass. Perioperative hemorrhage was moderate and postoperative course was uneventful. We believe that high-dose intravenous gammaglobulin therapy for ITP is effective to minimize perioperative hemorrhage for open heart surgery.
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Nihon Kyobu Geka Gakkai Zasshi · Feb 1994
[Experimental studies of pulsatile retrograde cerebral perfusion].
This study was investigated for the effects of pulsatile flow on retrograde cerebral perfusion under profound hypothermic circulatory arrest. Fifteen adult mongrel dogs were placed cardiopulmonary bypass and induced profound hypothermia of 20 degrees C at nasopharyngeal temperature. Five dogs were performed non-pulsatile retrograde cerebral perfusion (NP-RCP) and 5 were pulsatile retrograde cerebral perfusion (P-RCP) for 60 minutes each group. ⋯ CSFP and ATP concentration in both of NP-RCP and P-RCP were significantly higher than those of HCA. Water content of cerebral tissue in P-RCP were significantly lower than those of NP-RCP. We concluded that retrograde cerebral perfusion for 60 minutes protects the brain as the assistances of circulatory arrest and retrograde cerebral perfusion with pulsatile flow has the possibility to control brain edema as compared with non-pulsatile flow in dogs.