Kyobu geka. The Japanese journal of thoracic surgery
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A 30-year-old female with Marfan's syndrome underwent aortic root replacement for annuloaortic ectasia and mitral valve replacement for mitral regurgitation. She remained well until 16 months postoperatively when she had sudden onset of pain. Preoperative angiogram showed Stanford B aortic dissection. Thoracoabdominal aortic replacement was performed successfully under deep hypothermic bypass.
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We investigated effects of milrinone in twenty consecutive patients (6 adults, 1 child, and 3 early infants) during cardiac surgery requiring cardiopulmonary bypass (CPB). The operations were: CABG 5, CABG+mitral valve repair 2, MVR 2, redo-MVR 4, aortic surgery 3 (total arch replacement 2), VSD+pulmonary hypertension 2 (infants), Tetralogy of Fallot 1, and PDA aneurysm 1 (infant). Ten minutes after release of aortic cross-clamp, all patients received milrinone by loading dose (50 micrograms/kg, bolus), followed by a continuous infusion of 0.5 or 0.75 microgram/kg/min. ⋯ Milrinone administration did not cause significant changes in platelet number after CPB. No adverse effects attributable to this drug were found. Milrinone appears to be effective and safe in patients undergoing cardiac surgery of all kinds.
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Review Case Reports
[The case of left atrial myxoma originating from posterior leaflet of mitral valve].
We experienced the case of left atrial myxoma originating from posterior leaflet mitral valve. Mitral valve repair was performed in that case, because of the presence mitral leaflet defect due to removal of the myxoma. Transesophageal echocardiography was a useful tool for perioperative evaluation of the mitral valve and precise localization of the origin of the myxoma.
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Case Reports
[A case of an adult patient of tetralogy of Fallot having malignant hyperthermia during surgery].
An episode of malignant hyperthermia occurring in a 42-year-old man undergoing hypothermic cardiopulmonary bypass is reported. Malignant hyperthermia is a syndrome initiated by a hypermetabolic state of skeletal muscle. ⋯ And the disease of tetralogy of Fallot made the syndrome difficult to manage. Although the clinical diagnosis of malignant hyperthermia is difficult to be confirmed, when it is suspected, it is prudent for the case to be initially treated as malignant hyperthermia.
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Case Reports
[Surgical treatment of infective endocarditis associated with cerebral mycotic aneurysm].
We experienced two cases of infective endocarditis associated with cerebral mycotic aneurysm. Case 1: 58 year-old man underwent emergency aortic and mitral valve replacement due to active infective endocarditis and congestive heart failure diagnosed by transesophageal echocardiography. After the operation, he did not wake up and his bilateral pupils were dilated. ⋯ Infective endocarditis and mitral regurgitation were also diagnosed by echocardiography. He underwent cerebral mycotic aneurysmectomy after intensive antibiotics therapy, followed by successful mitral valve replacement. We review the literatures and discuss the problems of surgical management of infective endocarditis with cerebral mycotic aneurysm.