Kyobu geka. The Japanese journal of thoracic surgery
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A 49-year-old man who had undergone AVR entered our hospital with congestive heart failure and continuing slight fever. By cardiac imaging, he was diagnosed prosthetic valve endocarditis with periannular pseudoaneurysm and perivalvular leakage. ⋯ Post operative course was uneventful. He recovered well after the operation.
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The patients underwent aortic arch replacement for aneurysmal disease from 1988 to 1993 using a simplified cardiopulmonary bypass (CPB) technique with single selective cerebral perfusion (single SCP). Recently cold cerebral perfusion technique was also used. In order to study the effect of this technique, we monitored bilateral carotid artery pressure, blood oxygen saturation of jugular vein and brain oxygenation by near infrared spectroscopy during CPB. ⋯ The cold single SCP was accomplished by perfusion to the right axillary artery using separate pump and separate heat exchanger (flow 10-15 ml/kg/min, pressure 40-60 mmHg, perfusion temperature under 12 degrees C) under the low CPB flow (1,000-1,500 ml/min), moderate systemic cooling (23-25 degrees C) and retro-grade cardioplegia. There were no strokes caused by this technique. This simplified technique of cold single SCP was simple and attractive method, provide satisfactory cerebral protection.
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Twenty patients with aneurysm or dissection of the aortic arch underwent surgical treatment using partial brachiocephalic perfusion (PBP). The right subclavian artery (SA) and common femoral artery were separately cannulated and perfused by individual pump heads. The flow to SA was 4.5-11 (9.9 +/- 1.4) ml/min/kg. ⋯ We applied this simplified method (PBP) to the 20 patients with aortic aneurysms. No neurological complication were seen in these 19 patients without one patient. These clinical studies suggest that the PBP under hypothermic CPB is a safe and reliable method of cerebral protection for replacement of the aortic arch.
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How to optimize cerebral perfusion pressure and flow during selective extracorporeal circulation is a crucial problem for cerebral protection in surgical repair of aortic arch aneurysm. Among 47 cases of aortic arch replacement between 1980 and 1992, extracorporeal circulation (ECC) for the first 17 cases [group-1] were hypothermic ECC with selective cerebral perfusion (SCP) and 8 cases [group-2] with hypothermic ECC with hypothermic cardiac arrest. For the latest 16 cases [group-3] we introduced continuous O2 saturation monitoring by oximetry catheter placed in internal jugular bulb (SIJVO2) and maintained SIJVO2 value above 90% to effectively adjust pump flow to optimize cerebral perfusion pressure and flow for cerebral protection. ⋯ The mortality was 35% (6 cases: group-1), 37% (3 cases: group-2) and 6% (1 case: group-3) respectively. Cerebral dysfunction which were diagnosed in immediate postoperative period were 23% (4 cases: group-1), 0% (0 case: group-2) and 6% (1 case: group-3) respectively. We conclude continuous monitoring of SIJVO2 during selective ECC in aortic arch replacement is useful to optimize cerebral perfusion pressure and flow thereby reducing postoperative cerebral damage by selective ECC.
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Case Reports
[A case report of aortic valve stenosis combined with complete A-V block during chronic hemodialysis].
A 52-year-old man treated by hemodialysis under the diagnosis of chronic renal failure admitted to our hospital due to aortic valve stenosis and complete A-V block. Aortic valve was severely calcified, and the cause of complete A-V block was considered caused by the progressive calcification invasing to conduction system. ⋯ The efficacy of simultaneous operation of aortic valve and pacemaker implantation was emphasized. However the generator implantation was recommended to perform in the several days after the operation because of destruction of the pacemaker function by counter shock for arrhythmia in the early post operative period.