Kyobu geka. The Japanese journal of thoracic surgery
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We report results of surgical treatment in 30 patients with acute type A aortic dissection. The average age of the 25 patients without the Marfan syndrome was 59.2 (range 51-76), and male/female ratio was 11/14. The average age of the five patients with the Marfan syndrome was 36.8 (range 27-48), and male/female ratio was 2/3. ⋯ Cumulative cardiovascular event-free rate was 89% at one year, 85% at three years, 77% at five years. Early and long-term results of surgical treatment for acute type A aortic dissection was satisfactory. This seems to result from the use of deep hypothermic circulatory arrest and selective cerebral perfusion as an adjunct and application of aortic arch replacement when the aortic arch is dilated or intimal tear is located in the aortic arch or more distally.
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Objective of this study is to evaluate influence of acute aortic dissection on long-term results of aortic root reconstruction in patients with Marfan's syndrome. 19 patients who underwent consecutive aortic root reconstruction between 1985 May to 1998 February were retrospectively reviewed. Patients who associated acute aortic dissection at the time of operation (group D, n = 7) were compared long-term results with those who did not (group non-D, n = 12). Mean follow-up period was 5.1 +/- 3.2 years and longest follow-up term was 12.5 years. ⋯ On the other hand, excellent long-term results after aortic root reconstruction were found in non-dissection Marfan's syndrome. Considering high incidence of late dilatation of residual aorta, simultaneous total arch replacement with aortic root reconstruction is recommended in acute dissecting Marfan's syndrome. Whereas, preventive simultaneous arch replacement is not required in non-dissecting Marfan's syndrome because of less postoperative vascular events.
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After right heart bypass operation, dopamine was continuously infused at 5 micrograms/kg/min. The patients had a stable hemodynamic status but relatively low SvO2, low urine output and peripheral insufficiency. Amrinone was continuously infused at 10 micrograms/kg/min in 5 patients (Group A), or milrinone was continuously infused at 0.5 microgram/kg/min in 5 patients (Group M). ⋯ These patients treated using temporary antiarrhythmia drug or temporary pacing. When the patients discharged, they recovered the normal sinus rhythm. In conclusion, after right heart bypass operation in infants, infusion of amrinone or milrinone appears to be effective and safe combining with dopamine.