Kyobu geka. The Japanese journal of thoracic surgery
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There has been no report that pulse dye-densitometry (PDD), a novel non-invasive modality for monitoring hepatic blood flow (HBF), was applied during cardio-pulmonary bypass (CPB). We investigated weather PDD was useful to measure HBF during thoracoabdominal aortic surgery using partial CPB. Furthermore, HBF and hepatic metabolism were assessed during selective visceral perfusion or shunt using PDD, hepatic venous oxygen saturation (ShO2), and analysis of hepatic metabolic products. ⋯ PDD proved to be a useful modality that enabled non-invasive monitoring of HBF even during partial CPB. Decreased HBF during selective visceral perfusion or shunt in thoracoabdominal aortic surgery was within physiological compensation, which led us conclude that it might be effective adjuncts, for visceral organ protection.
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A patient was a 65-year-old female who had a complaint of palpitation was diagnosed aortic valve stenosis due to congenital bicuspid aortic valve with pseudotendon by the echocardiographic examination. We suspected left single coronary artery by the aortography and the coronary artery angiography. Aortic valve replacement and resection of pseudotendon was performed with Carbomedics supra-annular aortic valve (21 A). ⋯ Ventricular fibrillation due to insufficient supply of cardioplegic solution at right coronary area frequently occurred after cardio-pulmonary bypass and percutaneous cardiopulmonary support was required. The patient was discharged 32 days after the operation. Preoperative and intraoperative evaluation was important in the case of aortic valvular disease.
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We carried out the surgery of thoracic aortic aneurysm in fifty-eight patients from June 1994 to February 1999 (including aortic dissection in twenty-six patients). The mean size of grafts were 28.1 mm in ascending graft replacement, 25.8 mm in both ascending and arch graft replacement and 23.8 mm in descending graft replacement. The grafts for ascending aortic aneurysm were significantly larger than those for descending aortic aneurysm. ⋯ Jude Medical valve and 28 mm Hemashield graft) and total arch replacement (30 mm Hemashield graft with two side branches). Case 2; A 64-year-female was diagnosed as chronic type II dissecting aneurysm combined with acute type I aortic dissection. Ascending aorta was replaced with a 26 mm Hemashield graft, and the aortic arch was replaced with a 24 mm Hemashield graft with three side branches.
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Case Reports
[Catastrophic pulmonary vasoconstriction associated with protamine reversal of heparin].
Administration of protamine intravenously to neutralize the anticoagulant effects of heparin may be associated with hypotension. These adverse cardiovascular responses to protamine fall into three distinct types: transient hypotension related to rapid drug administration; anaphylactic responses: and catastrophic pulmonary vasoconstriction. ⋯ The two patients were survived except one who was dead due to the cerebral ischemic damage which was introduced by delayed establishment of circulatory assist device. We conclude that meticulous longstanding observation of the hemodynamic condition is important after administration of protamine under the unremoved cannulations.
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Review Case Reports
[A case of tricuspid infective endocarditis in a drug addict].
This report describes a successful operative case of tricuspid infective endocarditis in a drug addict. A 24-year-old man with a history of drug addiction (6 months) complained of general fatigue and high fever. Echocardiography showed a large vegetation attached to the tricuspid valve and severe tricuspid regurgitation. ⋯ However, subsequent severe heart failure necessitated emergency operation. The tricuspid valve was replaced with Carpentier-Edwards bioprosthesis because of severe destruction of the tricuspid valve. The postoperative course was uneventful and he has remained free from endocarditis for 15 months after surgery.