Kyobu geka. The Japanese journal of thoracic surgery
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Case Reports
[Catamenial pneumothorax in a young patient diagnosed by thoracoscopic surgery; report of a case].
A 16-year-old woman presented with chest pain on 2 days before the onset of menstruation and was referred to our hospital because of a pneumothorax. She was diagnosed as spontaneous penumothorax and surgical treatment was performed. Thoracoscopy revealed the presence of multiple blueberry spots near central tendon of the diaphragm and little pleural effusion. ⋯ Histological findings of biopsied specimen did not contradict as an endometoriosis and catamenial pneumothorax was diagnosed. CA 125 level of the pleural effusion had increased to 99.2 U/ml. Because she was young, she did not receive a systemic hormonal therapy.
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To evaluate the long-term results of atriopulmonary Fontan connection, we reviewed the outcome of 20 consecutive patients (single ventricle 8, double outlet right ventricle 8, tricuspid atresia 3, mitral atresia 1; mean age, 13 +/- 11) who underwent this operation between 1981 and 1997 at our institution. Glenn shunt preceded Fontan operation in 1 patient. Four patients had a concomitant bidirectional Glenn anastomosis at the time of the Fontan operation. ⋯ Atrial tachyarrhythmias are most common complications, and occurred in 12 patients (5.0%/patient-year), resulting in 40 +/- 13% of the cumulative free rate at 15 years after the operation. Thus, failure of the atrioventricular valve closure and stenosis of APC were important early to intermediate complications after the atriopulmonary Fontan connection. On the other hand, atrial tachyarrhythmias were inevitable, and were most common late complications leading to intra-right atrial thrombosis, which was successfully resolved by conversion of the conventional atriopulmonary Fontan anastomosis to extracardiac conduit cavopulmonary connection.
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Comparative Study
[Lateral tunnel versus extracardiac cavopulmonary connections].
To examine the mid term outcome of the lateral tunnel Fontan and the result is to be compared to extracardiac Fontan operation. Between March 1991 and May 2002, 72 lateral tunnel (LT) and 28 extracardiac conduit (EC) total cavopulmonary connection (TCPC) were performed. Right atrium was incised parallel to the sulcus terminalis and LT was created by using autologous right atrial wall. ⋯ Supraventricular tachycardia was found in 1 patient with EC group and 4 in LT group (all heterotaxy syndrome). There were no differences in mortality and mobidity between LT and EC TCPC. Lateral tunnel TCPC is useful especially to small infants and children.
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In recent years, the outcome of the Fontan-type operation has markedly improved by the application of total cavopulmonary connection method, the staged strategy to reach Fontan operation and the application of fenestration. In this report, the histological aspect of the changes in the operative techniques and the long term outcome in our institution are described.
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Of 185 patients with single ventricle physiology, 59 patients who underwent Fontan type operations between April 1970 and May 2002 served as subjects. Subjects displayed a median age of 5.2 years and a median body weight of 11.4 kg. In the first 22 years (group 1), 34 patients underwent concomitant right atrium-pulmonary artery (RA-PA) anastomosis, Björk procedure and total cavopulmonary connection (TCPC), while in the last 8 years (group 2), 25 patients underwent staged TCPC, where bidirectional cavopulmonary shunt (BCPS) and obliteration of additional pulmonary blood flow was performed previously. ⋯ Early mortality was 6.8% (group 1:12%, group 2:0%, p = 0.10) and late mortality was 21%. The 5-year survival rate was 85.2 +/- 4.9% (group 1:80.0 +/- 6.8%, group 2:93.8 +/- 6.1%, p = NS), and the 10-year survival rate was 79.6 +/- 6.0%. Staged TCPC, precedent BCPS with obliteration of additional pulmonary blood flow, seems to be beneficial for accurate patient selection for Fontan candidate.