Kyobu geka. The Japanese journal of thoracic surgery
-
A 68-year-old female with heart failure was admitted on the probable diagnosis of patent ductus arteriosus. Coronary arteriography revealed the coronary-pulmonary artery fistulae which originated the bilateral coronary arteries. Excision of coronary artery fistulae was performed without cardiopulmonary bypass. ⋯ Coronary pulmonary artery fistula is commonly a meanders long and flowing into the pulmonary artery as one influx artery. We presume the surgical intervention without cardiopulmonary bypass would be adopted for the treatment of this type. Multidetector-row computed tomography (MD CT) is useful in verification to detect the perioperative fistulae.
-
Case Reports
[Emergent coronary artery bypass grafting in a survivor of out-of-hospital cardiac arrest].
We report a case of emergent coronary artery bypass grafting (CABG) in a survivor of an out-of-hospital cardiac arrest. A 64-year-old male driver lost consciousness and collapsed in a rice paddy field. A bystander placed him in a car and immediately started cardiopulmonary resuscitation after confirming the presence of pulselessness and apnea. ⋯ Coronary angiography revealed a thrombus in the left main trunk (LMT), total occlusion of the left anterior descending artery (LAD) and the right coronary artery (RCA), and 90% stenosis of the left circumflex artery (Cx). Since the patient recovered consciousness 1 hour after admission and did not undergo any critical trauma, an on-pump CABG was performed for 3 vessels. He was discharged on the postoperative day 23, and he resumed a normal life.
-
Case Reports
[Off-pump coronary artery bypass grafting for single coronary artery; report of a case].
A 55-year-old male with single coronary artery complicated by angina pectoris was referred to our department for coronary artery bypass grafting (CABG). Coronary arteriography could not identify the left coronary orifice. ⋯ Other findings included 90% stenosis in #4 posterior descending (PD) of RCA. Off-pump CABG was successfully performed to D1 with the left internal thoracic artery graft and to #4PD with the radial artery graft.
-
We present a case of Leriche syndrome, requiring coronary revascularization and both lower extremities. Leriche syndrome shows high aortic occlusion, which has occasionally large collateral pathways from the internal thoracic artery (ITA) to the femoral artery via superior and inferior epigastric arteries. ⋯ H-graft minimally invasive direct coronary artery bypass (MIDCAB), which puts arterial graft horizontally between in situ left ITA (LITA) and left anterior descending (LAD) through small incision approach, enables surgical LAD revascularization and keeps blood supply to lower extremities. H-graft MIDCAB contributed to two-stage surgery in a patient with Leriche syndrome complicated with coronary artery disease.
-
The diagnosis of malignant pleural mesothelioma (MPM) is challenging although MPM is highly aggressive tumor. The current diagnostic gold standard is principally based on light microscopic examination of hematoxylin-eosin and immunohistochemical stains of large tissue sections. However, pathological diagnosis of MPM and classification of histological findings into 1 of the 3 subtypes (epithelial, sarcomatoid, biphasic) are difficult. ⋯ In 6 cases (28.6%) , initial diagnosis of MPM were not confirmed because of missing malignant tissue (1 case) and relatively small and sarcomatous element (5). In 2 cases examined by closed biopsy and in 3 examined by thoracoscopy under local anesthesia, initial diagnosis of MPM were not confirmed. To get the accurate diagnosis of MPM, obtaining large tissue samples in the initial examination by less invasive thoracoscopy is recommended.