[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai
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Nihon Kyobu Geka Gakkai Zasshi · Sep 1995
Case Reports[Hiatal hernia incarceration during cardiopulmonary bypass in patient with acute aortic dissection--a case report].
A 67-year-old woman was admitted to our hospital under diagnosis of Stanford type A acute aortic dissection. Chest CT showed aortic dissection from the ascending to descending aorta, and large hiatal hernia. Operation was undergone under cardiopulmonary bypass and circulatory arrest with retrograde cerebral perfusion. ⋯ Her postoperative course was uneventful except for acute renal failure, and she was discharged 60 days after the operation. The incarceration of hiatal hernia was thought to be caused by tissue edema and small bleeding during cardiopulmonary bypass. This is the first reported case with the incarceration of hiatal hernia which occurred during cardiopulmonary bypass.
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Nihon Kyobu Geka Gakkai Zasshi · Sep 1995
Clinical Trial[Fontan procedure after pulmonary artery banding--surgical results and new anatomical repair for tricuspid atresia].
We examined our surgical experiences to determine the appropriate condition of pulmonary artery banding (PAB) for the Fontan procedure. From 1974 through 1992, thirteen patients underwent Fontan procedure following PAB at Tokyo Women's Medical College. Of these 6 had tricuspid atresia (TA), 5 had single ventricle, or 2 had other complex malformations. ⋯ Hemodynamic data before Fontan operation showed a tendency of higher PA pressure (17.5 vs 31.5 mmHg), and pulmonary vascular resistance (2.4 vs 5.5 Wood Unit) in non-survivors than in survivors. For patients with tricuspid atresia and high pulmonary vascular resistance, a new operation "Anatomical Repair" utilizing hypoplastic right ventricle with the translocation of pulmonary or aortic valve in tricuspid position was developed and successfully applied in three patients. In conclusion, initial tight PAB during early infancy and often repeated palliative surgery for development of adequate pulmonary vascular bed is the most important for maximizing the chance of subsequent successful Fontan procedure.
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Nihon Kyobu Geka Gakkai Zasshi · Aug 1995
Clinical Trial[Composite arterial conduits with internal thoracic artery and inferior epigastric artery for a myocardial revascularization].
From November 1992 to February 1995, 10 patients were submitted to myocardial revascularization using composite arterial conduit with internal thoracic artery (ITA) and inferior epigastric artery (IEA). The age ranged from 48 to 68 years (mean age, 60.3 years); all patients were male. All patients had double-or triple vessel disease. ⋯ There was no operative mortality and fetal complication. Early postoperative angiographic controls demonstrated 100% patency of composite grafts in 9 of 10 patients. The composite arterial graft using ITAs and IEAs is feasible and the anastomoses so performed are completely safe.
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Nihon Kyobu Geka Gakkai Zasshi · Aug 1995
Case Reports[Simultaneous operation for annulo-aortic ectasia, mitral regurgitation, and tricuspid regurgitation in a patient with Marfan syndrome--report of a case].
A 57-year-old man with manifestations of Marfan syndrome was referred for detail examination of cardiac murmur to our hospital. Cardioangiography showed moderate aortic valve regurgitation (2/4), and severe mitral valve regurgitation (3/4), in addition to aneurysmal dilatation of the aortic root. Moderate tricuspid valve regurgitation (2/4) was also detected by Doppler echocardiography. ⋯ Jude Medical valve, and repair of the tricuspid valve with the bicuspidalization technique were simultaneously performed in this patient. His postoperative recovery was uneventful. In this study, we discuss about the indications of simultaneous aortic root replacement and mitral valve replacement in a patient with Marfan syndrome.
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Nihon Kyobu Geka Gakkai Zasshi · Jul 1995
Case Reports[A case of massive air embolism during cardiopulmonary bypass].
Massive air embolism during cardiopulmonary bypass is one of the most serious complications in open heart surgery. We report such an accident, which was managed by temporary retrograde perfusion through the superior vena cava. A 59-year-old woman with severe mitral stenosis underwent mitral valve replacement. ⋯ When the accident was discovered, and until the end of the operation, deep anesthesia was induced with pentobarbital for protection of the brain. Mitral valve replacement and tricuspid annuoplasty were done in the usual way thereafter. Postoperatively, the patient had no neurologic sequelae except for transient generalized convulsions, and has returned to normal daily activities.