Kyobu geka. The Japanese journal of thoracic surgery
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A 24-year-old male was brought to our hospital after being injured in a traffic accident. On arrival, his blood pressure was 70/44 mmHg and his pulse rate was 135/min and regular. Chest X-p revealed cardiomegaly but there was no pleural effusion or bone fracture. ⋯ Under midline sternotomy, right atrial rupture was repaired. The patient developed cardiac arrest lasting approximately 8 minutes during anesthetic induction, so he needed to be ventilated for 8 days. However his postoperative course was not so eventful and he was discharged 38 days after surgery without any neurophysiological disturbance.
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From 1981 to 1996, 48 consecutive patients, aged range 1 to 72 years, underwent surgical treatment for infective endocarditis. The infection was in the aortic valve in 10 patients, the mitral valve in 17, the aortic and mitral valves in 7, mixed aortic, mitral and tricuspid valves in one, the tricuspid valve in 9, the pulmonary valve in 3, and the other in 2, thirty-seven patients had native valve endocarditis (NVE) of which 22 cases were in the active stage. Seven cases had active prosthetic valve endocarditis (PVE) and 4 had VSD patch infection. ⋯ There were 2 late deaths caused by noncardiac disease. Thirty-nine of the total IE patients are now survived. These data demonstrate excellent results in patient with NVE undergoing the surgical treatment at the early phase, and support the premise that patients with active PVE should have also early surgical intervention.
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Recently, extended operation has been recommended for aortic dissection associated with Marfan syndrome. However, the operation for acute type A aortic dissection associated with Marfan syndrome is controversial. ⋯ CT examination on all patients, the survivors of the initial operation, revealed a gradually enlarged residual pseudolumen. 2 patients who underwent aortic root reconstruction and ascending aortic replacement for the initial operation eventually had to undergo aortic arch repair. From the results of this study and the improvements of intraoperative cerebral protection, we recommend aortic arch repair with aortic root reconstruction and ascending aortic replacement on initial emergency operation for acute type A aortic dissection associated with Marfan syndrome.
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Case Reports
[Emergency coronary artery bypass grafting under cardiopulmonary resuscitation: a successful case report].
A successful case of emergency coronary artery bypass grafting for a 69-year-old man with refractory cardiac arrest due to impending myocardial infarction was reported. Preoperative full resuscitation including external cardiac massage was required. The duration from cardiac arrest to cardiopulmonary bypass establishment was 24 minutes and aortic cross clamping time was 29 minutes for triple bypass grafting to the right, left circumflex and left anterior descending coronary artery.
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Case Reports
[A case of swallowed fish bone-induced esophageal perforation and mediastinitis treated with pedicled omental graft].
We experienced a case of 47-year-old man who suffered swallowed fish bone-induced esophageal perforation with purulent mediastinitis and underwent direct suture closure of the perforation and reinforcement with a pedicled parietal pleura four days after the onset. Postoperative esophageal suture insufficiency was occured and reoperation was performed two months after the first operation. ⋯ The postoperative course of the patient was uneventful and he discharged 45 days after the second operation. A reinforcement by pedicled omental graft for esophageal rupture accompanied with mediastinitis was considered to be a useful procedure.