[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai
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Nihon Kyobu Geka Gakkai Zasshi · Apr 1997
[Surgical treatment of type A acute aortic dissection--experience of hypothermic circulatory arrest associated with the cerebroplegia].
From 1992 to July 1996, 19 patients (aged 39 to 78 years) were operated on for type A acute aortic dissection. Our operative strategy is that all patients in whom aortic dissection involves the segment of transverse aortic arch should undergo simultaneous replacement or repair of the aortic arch and ascending aorta. Among these 19 patients, 17 were operated on within 24 hours after onset. ⋯ One patient died of graft versus host disease (GVHD), another patient died of acute epidural hemorrhage which was undetected until the repair was completed. During the postoperative course, in all but two patients, the false lumens of the aortic arch and/or descending thoracic aorta were confirmed to be totally thrombosed by the examination of CT scan and/or aortography. It is concluded that the surgical treatment of type A acute aortic dissection can be successfully performed, even if the graft replacement extended to the transverse aortic arch.
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Nihon Kyobu Geka Gakkai Zasshi · Apr 1997
Case Reports[Two cases of annulo-aortic ectasia with type A aortic dissection reconstructed by reimplantation of the aortic valve].
We performed aortic valve sparing operation in two cases of annulo-aortic ectasia combined with Type A aortic dissection. Marfan syndrome was found in one case and the dissection was acutely evolving in another case. ⋯ No aortic regurgitation was found in the acute case but slight regurgitation was checked out in the Marfan case at the discharge. The aortic valve preserving operation for annulo-aortic ectasia was considered much effective in cases with aortic dissection in order to expect the thrombolization in the pseudo lumen.
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Nihon Kyobu Geka Gakkai Zasshi · Apr 1997
Case Reports[A successful surgical case report of impending rupture of the true thoraco-abdominal aortic aneurysm induced by thrombosed-type acute aortic dissection (Stanford type A)].
Impending rupture of the true aneurysm of the thoraco-abdominal aorta induced by acute aortic dissection (Stanford type A) is very rare, and decision making of the therapeutic plain is difficult. A 88-year-old woman manifested severe back pain with hypotension. ⋯ Under the diagnosis of impending rupture of the thoraco-abdominal aortic aneurysm induced by acute aortic dissection (Stanford type A), graft replacement of the thoraco-abdominal aortic aneurysm and pericardial drainage were successfully performed. Two months later, computed tomographic examination revealed disappearance of the thrombosed false lumen in the ascending aorta.
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Nihon Kyobu Geka Gakkai Zasshi · Jan 1997
[Effectiveness of continuous pulmonary perfusion during total cardiopulmonary bypass to prevent lung reperfusion injury].
The oxygen free radicals and the interaction between neutrophils and endothelium have been implicated in the pathogenesis of lung injury associated with cardiopulmonary bypass (CPB), and in the setting of total CPB, the ischemia-reperfusion injury has been suspected as the mechanism of lung injury. To prevent this reperfusion induced lung injury, we performed continuous pulmonary perfusion during total CPB. We studied 26 infants less than 1 year of age who underwent patch closure of ventricular septal defect. ⋯ PaO2/FiO2 ratio of group P at 3, 6, and 12 hours after CPB were higher than those of group N, although there were no significant difference When analysis was made on the infants with high pulmonary vascular resistance (preoperative Rp/Rs ratio > or = 0.1), PaO2/FiO2 ratio of group P (n = 6) at 3, 6 and 12 hours after CPB were higher than those of group N (n = 11), and the difference was statistically significant at 12 hours after CPB (291.1 +/- 15.5 versus 199.6 +/- 27.0, p = 0.027. These results implicate that young age, low body weight and especially high pulmonary vascular resistance were incremental risk factor of lung injury after CPB and, furthermore, ischemia reperfusion injury can be the initiating factor of lung injury. The results also suggest that continuous pulmonary perfusion during total CPB is an effective mean to prevent lung injury particularly for the infants with high pulmonary vascular resistance.