[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai
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Nihon Kyobu Geka Gakkai Zasshi · Apr 1993
Case Reports[Surgical treatment of ruptured sinus of Valsalva aneurysm].
We operated on 3 patients with ruptured sinus of Valsalva aneurysm (RSVA). According to the classification by Konno, 2 of them had type I RSVA where aneurysm originated from the right coronary sinus rupturing into the right ventricle, and another type IV where it arose from the non-coronary sinus draining into the right atrium. Both of the 2 with type I RSVA had accompanied ventricular septal defect (VSD) of Kirklin type I. ⋯ Another patient with type IV RSVA underwent a direct closure of right atrial wall where aneurysm protruded. All 3 patients are doing well without shunt and aortic regurgitation. In this paper, diagnosis, surgical treatment and outcome of RSVA were reviewed.
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Nihon Kyobu Geka Gakkai Zasshi · Apr 1993
[Growth of the pulmonary arteries and morphological assessment after Blalock-Taussig shunts].
Clinical and angiographic results were studied after 121 classic Blalock-Taussig shunts (CBT) and 74 modified Blalock-Taussig shunts (MBT) with polytetrafluoroethylene grafts. 1. The actuarial shunt patency rate in all 195 patients showed a significant difference in patency between CBT and MBT at six months after operation. (CBT = 91.6%, MBT = 98.6%, p < 0.05). The patency rate of 4-mm MBT grafts was lower than that of CBT of grafts. 2. ⋯ In contrast, MBT grafts sometimes narrowed along their entire length, causing deterioration of pulmonary artery growth. 3. The 60 patients in whom pre- and post-operative pulmonary artery sizes were able to be evaluated were studied for pulmonary artery growth. The development ratio (DR) was calculated as the ratio of postoperative to preoperative pulmonary artery index (post-PAI/pre-PAI). a) DR in patients with lower preoperative PAI was greater than that in patients with higher preoperative PAI. b) DR in patients under the age of 6 months was greater than that in older patients. c) There were no significant differences in DR between CBT and MBT or between pulmonary stenosis and pulmonary atresia. d) Relative to the BT shunt, the ipsilateral pulmonary artery grew to the same degree as the contralateral artery.(ABSTRACT TRUNCATED AT 250 WORDS)
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Nihon Kyobu Geka Gakkai Zasshi · Apr 1993
[Changes in cardiorespiratory function after radical esophagectomy by bilateral thoracotomy approach in dogs].
Eighteen dogs (8-21 kg) were anesthetized with pentobarbital sodium, buprenorphine and pancuronium bromide followed by endotracheal intubation in the supine position. Eighteen dogs were divided into two groups. Group 1 (n = 9) underwent thoracic esophagectomy with regional lymph nodes dissection under the right thoracotomy. ⋯ Significant differences were found in the PaO2, Qs/Qt, respiratory index (RI) and the dosage of Dextran 40 between Group 1 and Group 2. There are no significant differences in the tracheal ischemic changes between the two groups, but peripheral atelectasis in Group 2 seemed to be severe as compared to that in Group 1. From these results, extended radical esophagectomy by bilateral thoracotomy approach for clinical cases seems to be possible under the exact indication and intensive perioperative care.
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Nihon Kyobu Geka Gakkai Zasshi · Mar 1993
[Extravascular lung water in patients after cardiac surgery].
Extravascular lung water (EVLW) measured by a double indicator dilution method using thermal-dye indicator was evaluated in 204 patients after cardiac surgery during last 7 years. The measurement of EVLW was done at 2, 4, 8, 24 and 48 hours after extracorporeal circulation (ECC), EVLW showed no significant change except transient decrease at 4 hours after ECC, average of that was 7.62 +/- 3.58 ml/kg, EVLW of group I (MVR) and group III (AVR + MVR) were significantly higher than those of group II (AVR), group IV (noncyanotic congenital heart disease) and group V (A-C bypass). EVLW of 7 patients with postoperative pulmonary edema was 14.47 +/- 4.44 ml/kg, and that was significantly higher than those of others (7.54 +/- 3.06 ml/kg). ⋯ In the preoperative parameter, EVLW correlated with age, mPAP, mean pulmonary wedge pressure (mPAWP), PMV, serum BUN and serum creatinine, and showed inverse correlation with CI, %VC, FEV%, PSP test and creatinine clearance. We concluded that the patients with mitral valve disease who have high mPAP and LAP, respiratory and renal dysfunction and old aged preoperatively showed upward trend of EVLW. In perioperative management, care must be taken in such patients and membrane oxygenator was thought useful for prevention of pulmonary edema.(ABSTRACT TRUNCATED AT 250 WORDS)
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Nihon Kyobu Geka Gakkai Zasshi · Mar 1993
[Surgical repair in hearts with univentricular atrioventricular connection and subaortic stenosis].
Between 1986 and 1990, fourteen patients with univentricular atrioventricular connection and subaortic stenosis underwent surgical treatment. The patients consisted of 7 cases of double inlet left ventricle, 4 with double inlet right ventricle, 3 with tricuspid atresia. The palliative operation was performed in 6 infants ranging in age from 17 days to 6 months. ⋯ Young infants and neonates with severe subaortic stenosis can survive by the Norwood operation. Infants with mild subaortic stenosis, although can survive by pulmonary artery banding, should be closely followed for the development of subaortic stenosis. For relief of subaortic stenosis, enlargement of bulboventricular foramen may be effective in septation.(ABSTRACT TRUNCATED AT 250 WORDS)