Ascending to Abdominal Aorta Extraanatomic Bypass for Descending Aortic Coarctation: A Reconstruction Technique without Laparotomy or Left Thoracotomy.

The descending aortic coarctation is often difficult to anatomically reconstruct. We report two cases of ascending aorta to abdominal aorta bypass without laparotomy or thoracotomy. This approach enabled us to avoid anastomosis close to the inflammatory lesion and left thoracotomy causing bleeding from the collateral vessels, and to allow concomitant cardiac procedures to be performed.

Comparison of medically versus surgically treated acute type a aortic dissection in patients <80 years old versus patients ≥80 years old.

Although recent progress in emergency surgery has resulted in an increase in the indication for older patients with acute type A aortic dissection (AAD), some patients remain who cannot undergo surgical treatment and little is known about the prognosis of patients with AAD who receive medical treatment, especially in elderly patients. Of the 82 patients with AAD who were admitted to our institution, 48 received medical therapy only. We retrospectively reviewed their clinical data and analyzed the prognostic value of the clinical characteristics in both younger and older patients.

[Traumatic aortic regurgitation complicating chronic bronchitis; report of a case].

A 61-year-old man with diabetes mellitus and chronic bronchitis was brought to the hospital after falling from a roof accidentally. He received blunt trauma to the left chest wall including left rib fractures, pneumothorax, hemothorax and a fracture of left scapula. After endotracheal intubation and chest drainage, he was transferred to the intensive care unit.

[Sequential bypass grafting with arterial grafts can be functioned? Assessment of evaluation for function of sequential bypass grafting from theoretical model].

As total arterial revascularization in coronary artery bypass grafting (CABG) has been recommended, a sequential bypass technique using arterial grafts has been induced. We evaluate whether a sequential bypass graft can be functioned or not by using a simple simulation model for coronary circulation analogous to the electrical circuit based on Ohm law. The ratio of flow between graft and native coronary artery was determined by the severity of stenosis in the bypassed vessels and the graft diameter.

Bypass balloon pumping: a newly developed device for mechanical circulatory support in heart failure.

Various types of assist devices have been developed for severe heart failures. Among them, intra-aortic balloon pumping (IABP) has achieved popularity, mainly in the treatment of patients with either severe cardiac infarction or low cardiac output syndrome (LOS) after open-heart surgery. However, IABP has a limitation in that although it acts as a pressure support, it cannot directly support flow volume.

[Pitfall in the choice of the in situ arterial grafts in OPCAB].

Flow capacity with arterial grafts which have been used in off-pump CABG has been discussed. To analyze the hypoperfusion syndrome when in situ arterial grafts are selected, we made the simple mathematical model which consisted of two vessels with in parallel. We speculated the flow capacity of the various grafts, and flow distribution in the distal coronary artery, based on Poiseuille's law.

Transplantation of the en bloc vascular system for coronary revascularization.

Objectives: Use of the free gastroepiploic artery graft for coronary revascularization has not been very popular because of its inclination toward vasospasm. We hypothesized that the cause of free gastroepiploic artery spasm was the graft damage caused by an interruption of venous drainage from the graft. To solve this problem, we developed a new method of free gastroepiploic artery grafting.

Transfusion-associated graft-versus-host disease with transfusion practice in cardiac surgery.

Background: Transfusion-associated graft-versus-host disease (TA-GVHD) in immunocompetent patients has still been underdiagnosed and underreported. Risk of TA-GVHD caused by transfusion practice in cardiac surgery should be appropriately recognized.

Methods: The correlation of TA-GVHD with transfusion practice in cardiac surgery was analyzed from our 17-year clinical experience.

Repair of leaking postinfarction ventricular septal defect under circulatory arrest via left thoracotomy.

We treated a 60-year-old woman for postinfarction ventricular septal defect (VSD) and closed it by the infarction exclusion method. Postoperatively she was complicated by Candida sternal mediastinitis and residual shunt of VSD. After her sternal infection came under control we repaired the leaking VSD via left thoracotomy under hypothermic circulatory arrest.

Theoretical analysis of right gastroepiploic artery grafting to right coronary artery.

Background: The right gastroepiploic artery (GEA) has been used as the second reliable arterial graft for coronary artery bypass grafting (CABG). However, concern regarding the flow competition with the recipient coronary artery has remained.

Methods: An application of in situ GEA grafting to the right coronary artery (RCA) was studied by using a theoretical model.

Partial maze procedure is effective treatment for chronic atrial fibrillation associated with valve disease.

The maze procedure may be performed in combination with valve operations to treat chronic atrial fibrillation associated with valve dysfunction. Although we initially used the modified Cox maze III procedure, a more limited partial maze procedure is now preferred because the left atrium might be considered as the electrical impetues for atrial fibrillation. In this study we compared the results of 30 patients (group I) who underwent the full biatrial modified Cox maze III and 20 (group II) patients the partial maze procedure.

Maintenance of blood heparin concentration rather than activated clotting time better preserves the coagulation system in hypothermic cardiopulmonary bypass.

In cardiopulmonary bypass (CPB), despite heparin regimens in which the activated clotting time (ACT) is kept at more than 400 s, there is biochemical evidence of thrombin generation indicating activation of the coagulation system and increased fibrinolytic activity. Therefore, to reduce the coagulant activation has been one of the main issues in the improvement of CPB. The purpose of this study was to compare the heparin concentration with the ACT and to evaluate the effect of keeping higher heparin concentration on the coagulation and fibrinolytic systems during hypothermic CPB, employing moderate hypothermia (MHT) or deep hypothermic circulatory arrest (DHT).

Effects of proximal ventricular septal pacing on hemodynamics and ventricular activation.

Recently the use of alternate site pacing to improve cardiac function in patients with bradyarrhythmias has increased. In the present study, hemodynamics of right ventricular septal pacing were studied in seven dogs. A bipolar screw-in lead and endocardial lead were placed in the proximal right ventricular septum and right ventricular apex, respectively.

Protective effects of ONO-5046*Na, a specific neutrophil elastase inhibitor, on postperfusion lung injury.

Background: Polymorphonuclear neutrophil elastase might contribute to postperfusion lung injury, so we evaluated the protective effect of ONO-5046*Na, a specific inhibitor of polymorphonuclear neutrophil elastase, against such an injury.

Methods: The study was done using 8 mongrel dogs that received ONO-5046*Na (15 mg/kg per hour) (group O) and 8 control dogs (group C), all of which had 1 hour of partial bypass and 5 hours of observation.

Results: The respiratory index showed no significant changes in group O, but increased significant in group C (1.

Transaortic approach for a closure of a residual ventricular septal defect of the tetralogy of Fallot.

Background: A residual ventricular septal defect as part of the tetralogy of Fallot (TOF) is often difficult to close when a long interval has elapsed after a radical operation or the position of the defect is problematic.

Methods: When an accurate diagnosis and closure of a residual ventricular septal defect (VSD) were not obtainable through right atriotomy and right ventriculotomy, the ascending aorta was opened. The smooth surface of the left ventricular septum makes it possible to find the position of the defect, and close it accurately and safely.

[The analysis for surgical procedures of coronary-artery bypass grafting: selection of graft materials].

We analyzed 222 patients undergoing coronary artery bypass grafting (CABG) in our institute. Our selection of graft materials consists of only one arterial conduit and one or more saphenous vein grafts (SVG). An arterial conduits (left internal thoracic artery (LITA) was mainly used for the left anterior descending coronary artery (LAD), while a SVG was used for coronary arterial branch.

Comparative clinical study between retrograde cerebral perfusion and selective cerebral perfusion in surgery for acute type A aortic dissection.

Objective: Selection of a brain protection method is a primary concern for aortic arch surgery. We performed a retrospective study to compare the respective advantages and disadvantages of retrograde cerebral perfusion (RCP) and selective cerebral perfusion (SCP) in patients who underwent surgery for acute type A aortic dissection.

Methods: The study reviewed 166 patients who underwent surgery at Nagoya University or its eight branch hospitals between January 1990 and August 1996.

[A case of aortic prosthetic valve endocarditis with aortic root aneurysm].

A 72-year-old male who underwent patch closure of atrial septal defect and aortic valve replacement (AVR) 10 years ago was diagnosed as aortic prosthetic valve endocarditis for recurrent fever, coexisting paravalvular leakage and aortic root aneurysm by transthoracic and transesophageal echocardiography. Operative findings showed mechanical prosthesis was dehiscenced in part and limited subannular aneurysm that was healed macroscopically. The hole of the aneurysm was closed by direct suture.

[Coronary artery bypass grafting in cases with poor left ventricular function].

From January 1987 through June 1992, 18 patients with poor left ventricular function (left ventricular ejection fraction [LVEF] less than 0.3) underwent elective isolated primary coronary artery bypass surgery. The mean age was 56.

[The investigation of surgical procedures for post infarcted ventricular septal defects: a comparison between Daggett and David method].

Post infarcted ventricular septal perforations (VSP) has diverse clinical and pathological manifestations and the surgical results in severe cases have not yet been satisfactory. In the past we had performed the procedure of Daggett. However since 1992 we have also introduced the procedure of infarction exclusion technique proposed by David which involves plastering the ventricular cavity in a large patch without infarcted myotomy.