Kyobu geka. The Japanese journal of thoracic surgery
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Two patients with postoperative interstitial pneumonia are reported. Preoperative diagnosis was primary lung cancer without idiopathic interstitial pneumonia (IIP). ⋯ Steroid therapy was performed but one was dead. AIP is a fatal complication after pulmonary resection and steroid therapy may be useful in some cases of postoperative AIP.
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A 53-year-old female had undergone mitral valve replacement with Carpentier-Edwards (C-E) porcine bioprosthesis for mitral valve regurgitation at the other hospital in November, 1981. Postoperative clinical course was uneventful, since she was referred from the other hospital in 1990. In December, 1997, she had sudden complaint of shortness of breath on effort, and the chest X-ray showed pulmonary congestion and increase of cardio-thoracic ratio. ⋯ Combined mitral and aortic valve replacement was successfully performed with mechanical valves in February, 1998. The explanted C-E porcine bioprosthesis showed the commissural dehiscence from only one of the three stents without any leaflet perforation, commissural tear, pannus overgrowth, impaired leaflet mobility and leaflet deterioration or calcification. This case suggested the variety of malfunction of C-E porcine bioprosthesis and the limitation of its long-term durability.
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Papillary fibroelastoma is a rare cardiac tumour. We describe a patient with mitral valve regurgitation and aortic valve papillary fibroelastoma. The patient was 62-year-old woman. ⋯ Through the aortotomy, small tumors were found to be attached to each cusps of the aortic valve and they were successfully removed. The histopathologic diagnosis was papillary fibroelastoma of the aortic valve. The postoperative course was uneventful.
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Multicenter Study Clinical Trial
[Optimum anticoagulation control after bileaflet mechanical valve replacement: a prospective multi-institutional study].
This study was undertaken to assess optimum anticoagulation control after bileaflet mechanical valve replacement by using the international normalized ratio of prothrombin time (PT-INR). From January to December 1995, 261 patients (pts) underwent mechanical valve replacement in the aortic (n = 95), mitral (n = 126), aortomitral (n = 39) or isolated tricuspid (n = 1) valve position in 8 medical centers in Tokyo, Japan. The St. ⋯ The patients with bleeding events showed some increase of PT-INP or received anti-platelet agents. The 5 to 95 percentile of PT-INR at 6 months was 1.2 to 3.0 in the patients without valve-related events. These results suggested that optimum range of PT-INR might be between 1.2 and 3.0 after bileaflet mechanical valve replacement in patients without high risk of thromboembolism and between 2.0 and 3.0 in patients with the high risk.
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Case Reports
[Graft replacement from ascending aorta to descending aorta with endovascular stent graft under median sternotomy].
We reported a 62-year-old man with DeBakey IIIa dissecting aortic aneurysm involving distal aortic arch who underwent graft replacement from ascending to descending aorta using a endovascular stent graft. Median sternotomy was carried out, because of severe pleural adhesion. Endovascular stent graft composed of 30 mm Gianturco Z stent and 24 mm woven Dacron graft was inserted to descending aorta with the aid of hypothermia, systemic circulation arrest and selective cerebral perfusion. ⋯ And ascending and total aortic arch replacement was performed with four branched woven Dacron graft. Postoperative chest CT and aortography showed satisfactory reconstruction with the thrombosed false lumens. We think placement of stent graft to descending aorta through median sternotomy is useful method when left thoracotomy is impossible or distal anastomotic site is too far for the anastomosis.