Bilateral retroperitoneal approach to repairing a ruptured right iliac artery aneurysm in a patient who has undergone transperitoneal abdominal surgery.

An 84-year-old woman with a history of surgery for cholangiocarcinoma presented to Akita University Hospital with severe right lower abdominal pain, respiratory distress, and hypotension. Computed tomography scanning revealed a ruptured right common iliac artery aneurysm with a massive right retroperitoneal hematoma and a right internal iliac artery aneurysm. Under the bilateral retroperitoneal approach, we preformed an in-situ repair of an aneurysm rupture from the aorta to the left common and right external iliac arteries using a bifurcated knitted Dacron graft, and then we ligated the right internal iliac artery.

Aortic root reimplantation using a Valsalva graft for postoperative pseudoaneurysm after acute aortic dissection.

We report a reoperative case in which a Valsalva graft was utilized on a 64-year-old woman who had previously undergone emergency repair of a DeBakey type I acute aortic dissection. On follow-up computed tomography (CT), she was found to have pseudoaneurysms of both proximal and distal anastomoses. We performed valve-sparing aortic root replacement (VSRR) with the reimplantation technique and total arch replacement, since we felt that a graft with pseudosinuses helps to prevent torsion of the coronary arteries.

Ethnic differences in the VKORC1 gene polymorphism and an association with warfarin dosage requirements in cardiovascular surgery patients.

Objectives: Vitamin K epoxide reductase (VKORC1) is the drug target for inhibition by coumarin-based anticoagulant drugs such as warfarin. Warfarin therapy has been reported as a leading cause of drug-related hospitalization and there is therefore an urgent need to develop tests for better warfarin prescription. We report here the distribution of the intron 1 -136 T>C (1173 T>C intron) polymorphism of VKORC1, previously reported to be associated with warfarin maintenance dose in Caucasians and Japanese, in several ethnic populations from Japan and Israel, and describe its significance for warfarin dosage in Japanese cardiovascular surgery patients.

Three-dimensional spectral map of atrial fibrillation by a 64-channel magnetocardiogram.

We verified the significance of 3-dimensional (3D) spectral mapping during atrial fibrillation (AFIB) using a 64-channel magnetocardiogram (MCG). The study consisted of 16 patients with valvular heart disease who had chronic AFIB. All 16 patients had surgical pulmonary vein (PV) isolation followed by valvular repair.

Three-dimensional recovery time dispersion map by 64-channel magnetocardiography may demonstrate the location of a myocardial injury and heterogeneity of repolarization.

Background: QT dispersion reveals heterogeneities in the repolarization time in the three-dimensional (3D) structure of the ventricular myocardium. In this study, we report on a 3D function map of recovery time (RT) dispersions as measured by 64-channel magnetocardiography (MCG).

Methods: MCG were simultaneously recorded in 29 controls and 21 patients with previous myocardial infarction (MI).

[Surgical strategies for aortic valve disease in elderly patients].

Population of elderly people is increasing and aortic valve disease due to degeneration with aging process, especially aortic stenosis (AS) is increasing in elderly patients. With development and great use of non-invasive diagnostic techniques, particularly echocardiography, the diagnosis and evaluation of aortic valve disease are even safer in these patients. Aortic valve replacement (AVR) is effective treatment for symptomatic AS, however, generally has a higher risk in elderly patients, especially 80 years and over patients.

[Thrombus entrapped in a patent foramen ovale of the atrial septum].

A 59-year-old women was referred to our hospital due to severe dyspnea and shock status 12 days after intracranial hematoma evacuation for the hypertensive right putaminal hemorrhage. Transthoracic echocardiography revealed right ventricular dilatation and floating structures in the right atrium. Transesophageal echocardiography demonstrated a large, snake-like structure crossing her foramen ovale of the interatrial septum, and impending paradoxical embolism was diagnosed.

Changes in patterns of left ventricular hypertrophy after aortic valve replacement for aortic stenosis and regurgitation with St. Jude Medical cardiac valves.

In this study, we analyzed the extent and pattern of regression of left ventricular (LV) hypertrophy after aortic valve replacement in patients with aortic stenosis (AS) and compared the results with those of another group of patients with aortic regurgitation (AR). Seventy patients who underwent isolated aortic valve replacement were divided into 2 groups. Group 1 was comprised of 29 patients who underwent aortic valve replacement for aortic stenosis, and Group 2 of 41 patients who underwent aortic valve replacement for aortic regurgitation.

Cardioplegic strategies for calcium control: low Ca(2+), high Mg(2+), citrate, or Na(+)/H(+) exchange inhibitor HOE-642.

Background: Ca(2+) overload plays an important role in the pathogenesis of cardioplegic ischemia-reperfusion injury. The standard technique to control Ca(2+) overload has been to reduce Ca(2+) in the cardioplegic solution (CP). Recent reports suggest that Na(+)/H(+) exchange inhibitors can also prevent Ca(2+) overload.

The diagnosis and management of splanchnic artery aneurysms. Report of 8 cases.

The purpose of this report is to describe the clinical characteristics and surgical technique for splanchnic artery aneurysms. Over the past 10 years we have surgically resected 8 cases of splanchnic artery aneurysms including 2 cases involving the superior mesenteric artery, 3 involving the renal artery, 1 involving the hepatic artery and 2 involving the splenic artery. Diagnosis was established preoperatively in all patients by splanchnic angiography.

[Ruptured descending thoracic aortic aneurysm due to aortitis syndrome--a case report].

Ruptured fusiform descending thoracic aortic aneurysms due to aortitis syndrome are rare. A 29-year-old woman was readmitted to our hospital with a chief complaint of back pain and shock, and diagnosed as having rupture of a descending thoracic aortic aneurysm. She had a past history of aortitis syndrome beginning eight years ago.

[Recurrent intrathoracic dissemination of thymoma with myasthenia gravis: a case report].

A 48-year-old man was readmitted to our hospital with a chief complaint of left anterior chest mass. He had a past history of thymo-thymomectomy six years earlier. On chest CT examination, multiple tumor shadows were noted within the left thoracic cavity.

[Long-term results of emergency coronary artery bypass grafting].

During a 20-year period, 364 patients underwent coronary artery bypass grafting (CABG) for the treatment of ischemic heart disease. Among these patients, 28 underwent emergency surgery. The reasons for performing emergency CABG were unstable angina in 15 patients, impending myocardial infarction in 12 patients, and congestive heart failure in 1 patient.

Long-term results of emergency coronary artery bypass grafting.

During a 20-year period, 364 patients underwent coronary artery bypass grafting (CABG) for the treatment of ischemic heart disease. Among these patients, 28 underwent emergency surgery. The reasons for performing emergency CABG were unstable angina in 15 patients, impending myocardial infarction in 12 patients and congestive heart failure in 1 patient.

[Underlying cardiac disease in infective endocarditis].

Underlying cardiac lesions in 39 adult cases with infective endocarditis were studied. 18 cases (46%) of the patients had no evidence of preexisting cardiac disease and infection frequently involved aortic valve. The patients without preexisting cardiac disease and 4 patients with an intracardiac substitute including pacemaker lead and aortic valve prosthesis required a surgery during an active infective endocarditis.

[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 esophageal fistula was plugged with a pedicled omental graft successfully.

[The experimental study of myocardial protection for warm myocardial ischemia in an isolated rat heart: the effect of a calcium antagonist].

Although the protective effects of the calcium antagonists on ischemic and reperfused myocardium have been investigated, there have been only a few reports regarding their efficacy in relation to the degree of ischemic myocardium. This study was undertaken to investigate the efficacy of diltiazem, a calcium antagonist, in relation to the degree of ischemic myocardial injury in an isolated working rat heart. Three different models of ischemic injury were designed; Group A: 30 min global ischemia with a single dose infusion of St.

In vitro and in vivo testing of an implantable motor-driven left ventricular assist device.

A totally implantable motor-driven left ventricular assist device (LVAD) has been developed and tested. The performance of this LVAD was tested in a mock circulatory system. This pump provided 8 L/min of output against a mean afterload of 120 mm Hg with a filling pressure of 20 mm Hg when the pump was operated in the fill/empty mode.

[Surgical correction of total anomalous pulmonary venous drainage: an adult case of successful repair].

Total anomalous pulmonary venous drainage (TAPVD) is a rare congenital cardiac anomaly. It occurs in only 1.5% of children born with congenital heart defects.

[A case of thymic squamous cell carcinoma successfully treated with curative resection].

A case of rare thymic squamous cell carcinoma was reported. A 46-year-old female was admitted to our hospital because of an abnormal shadow on chest X-ray. Chest CT showed anterior mediastinal tumor and histological diagnosis of squamous cell carcinoma was made by needle biopsy under CT guide.

[A case of primary mediastinal germ cell tumor, successfully treated with chemotherapy and curative resection].

A 20-year-old man was admitted to our hospital because of an abnormal shadow on chest X-ray Laboratory data revealed a high serum alpha-fetoprotein (AFP) and LDH level. Percutaneous needle biopsy of the tumor suggested primary mediastinal germ cell tumor. Curative resection was performed after three courses of combination chemotherapy (cis-platinum, VP-16, bleomycin and adriamycin).

[Reoperation after open mitral commissurotomy for mitral stenosis].

Between 1975 and 1993, 16 of 95 patients who received open mitral commissurotomy for mitral stenosis required reoperation for recurrent mitral lesions with a mean duration of 11 years after the initial operation at Kawasaki Medical School Hospital. The mitral lesions necessitating reoperation involved restenosis in eight, stenoinsufficiency in six and regurgitation in two. In 13 patients, mitral commissure was well separated, and the mitral restenosis and regurgitation were caused by progressions of valvular and subvalvular lesions.

[A case of hypertrophic obstructive cardiomyopathy (HOCM) complicated by infective endocarditis (IE) and mitral regurgitation (MR)].

The case of a 56-year-old man who underwent mitral valve replacement due to HOCM complicated by IE and MR is reported. Preoperative 2D echocardiographic assessment of the mitral valve revealed systole anterior motion (SAM) and vegetation, and color flow Doppler echocardiographic examination revealed severe mitral regurgitation. The left ventricular out-flow tract gradient decreased from 140 mmHg preoperatively to 60 mmHg postoperatively.

[A case of acute retrograde type I dissecting aneurysm of aorta underwent three operations].

A 54-year-old man with an acute retrograde type I dissecting aneurysm of the aorta underwent three operations for four years. The first operation was by the Collins method, the second was a graft replacement of the descending aorta, and the third involved a graft replacement of the ascending aorta and aortic arch, revascularization of the aortic branches and replacement of the aortic valve. In operations on acute retrograde type I dissecting aneurysms of the aorta, the methods of Koster or Collins are in appropriate in cases where sufficient entry treatment is impossible, and graft replacement of the ascending aorta at least is considered to be necessary.

[Coronary reoperation--report of 16 cases].

Between January 1975 and July 1992, coronary artery reoperation was performed in 16 of 333 patients who had undergone primary bypass grafting. The interval between the operations ranged from 2 to 147 months. Reoperation was done within one year in two patients, within one to five years in five patients and after more than five years in nine patients.