Rinsho kyobu geka = Japanese annals of thoracic surgery最新文献

IVOX was named as an acronym for intravascular oxygenator. The device does not need a blood pomp like an extracorporeal membrane oxygenator (ECMO), and performs intracorporeal gas exchange to be a small elongated, hollow fiber membrane oxygenator designed to lie within the subject's venae cavae so that circulating venous blood can flow freely over and around the external surfaces of the hollow fibers. The amount of gas exchange in IVOX is less than ECMO, however, the equipment is simple and there is no effect to hemodynamics and body temperature. IVOX has been utilized in the management of 165 clinical trials patients in 31 international critical care centers. Currently the gas transfer rate by means of the IVOX device constitutes 1/4 to 1/3 the total metabolic requirement of adult acute respiratory failure patients. Therefore, intentional hypoventilation to limit airway pressures (mild permissive hypercapnia) is recommended to improve CO2 removal with increasing mixed venous CO2 concentrations. In the future, improvements of design, function, and methods of utilization of IVOX device are expected to increase the amount of gas exchange and to enlarge the indications for its use.

Between January 1973 and June 1993, 157 patients had Bentall's operation and its modifications for the surgical treatment of annuloaortic ectasia and dissecting aneurysm in our institute. Reoperation for false aneurysms following Bentall technique were performed 10 patients. There were 8 males and 2 females. This ages ranged from 29 to 57 years with an average of 41. The interval between initial and subsequent operation was from 3.7 to 18.4 years (median, 8.2 years). Prior to a median sternotomy, femoro vein-femoral artery partial cardiopulmonary bypass was instituted occationaly. Operative technique of repair of coronary detachment were direct closure in 6 and interposition graft technique in 4 patients. There were 2 hospital death caused by rupture at median aternotomy and graft infection. The actuarial freedom from reoperation at 10 years according to technique of coronary reattachment, for the patients with one lane suture was 69%, for those with two lane suture was 95% (p < 0.01), and for those with interposition graft technique was 100%. In conclusions, it was very important for repair of false aneurysms following Bentall procedure to expose aneurysms safely through proper approach. Interposition graft technique was preferable to repair coronary detachment. Our recent surgical results of Bentall procedure improved by the modification of the coronary reimplantation method.

We performed mitral valve surgery in 5 patients using the combined superior-transseptal approach to the left atrium. Exposure of the mitral valve was excellent, and postoperative arrhythmias related to the operative procedures were not seen in all patients. The operative technique and indications are discussed in this paper.

We reoperated twenty-four times upon twenty cases of dissecting aortic aneurysm since 1983. Nine of them (45%) were Marfan patients. Reoperations on the same part of the aorta as the prior procedure was done 15 times upon 13 cases with six hospital deaths (40%). Reoperations on the different part of the aorta from the prior operation was done 9 times on 9 cases with one hospital death (11%). Over all hospital mortality rate was 29%. The hospital mortality rate for Marfan patients (8%) was significantly better than that for non-Marfan patients (50%).

The effects of subcutaneous administration of recombinant human erythropoietin (EPO) on harvesting autologous blood predonation (ABP) and decreasing homologous blood transfusion (HBT) in open-heart surgery were examined prospectively in 132 patients treated in a 32-institute multicenter study. Single doses of 6000, 12,000, 18,000 and 24,000 unit (IU) of EPO with intravenous iron (40 mg) were administered once a week for 3 weeks with ABP (400 ml/week) before surgery. ABP volume (ml), change of blood hemoglobin level (C-Hb), preoperative net blood hemoglobin increase (delta Hb [g/dl] including ABP, perioperative blood loss (ml), and HBT rate, were as follows; [table: see text] Preoperative reduction of Hb (C-Hb) was less in administration dose of 18,000 IU and 24,000 IU than 6000 IU (p < 0.05). The increase of delta Hb was highest in 18,000 IU and HBT rate was lowest in administration dose of 24,000 IU, however, there was no statistical difference. In conclusion, both 18,000 IU and 24,000 IU of EPO treatment is effective to minimize the progression of anemia according to ABP for open heart surgery.

Twenty seven cases of surgically excised pulmonary hamartomas were reviewed. Patient's ages varied from twenty eight year-old to seventy seven year-old with an average of fifty three year-old. Of twenty seven cases, seventeen cases were man, seventeen cases has mass on right lung, and twenty six cases has solitary mass. While twenty five cases were asymptomatic, one case had cough, and the other cases had a history of hemoptysis (Case 3). Medical treatment for pulmonary tuberculosis had been continued unless the confirmed diagnosis on two cases. On one case followed as tuberculosis for twelve years, size of tumor shadow grew to two times bigger on chest X-ray films (Case 1). One of 27 cases showed multiple mass (Case 2). Histopathologically, twenty six cases were chondromatous hamartoma, and one case was non-chondromatous hamartoma. Pulmonary hamartoma is a benign tumor, and majority of cases are asymptomatic and not growing. On cases with presumed pulmonary hamartoma, less invasive thoracoscopic surgery seemed valuable for both therapeutic and diagnostic purpose to avoid continuous non-rational treatment and mental pressure of patient by prolonged follow up with unconfirmed diagnosis since complete differentiation from malignant neoplasm should not satisfactory on many cases.

We experienced 8 cases who required reoperations, including 2 re-redo operations, after repairs of infrarenal abdominal aortic aneurysms. Of 8 patients, one patient developed a new aneurysm due to atherosclerosis in thoraco-abdominal aorta involving all visceral arteries and other 7 patients had aneurysmal formations at proximal anastomotic sites, including 3 suprarenal, 2 juxtarenal and 2 infrarenal aortic lesions. Etiology at initial operation in patients who subsequently developed anastomotic aneurysms included vasculo-Behçet disease in 4, atherosclerosis in 2 and dissecting aortic aneurysms type III due to Marfan syndrome in 1. At reoperation, all who had vasculo-Behçet disease had ruptures of anastomotic sites and 2 patients underwent repairs of dehiscent patch, 1 extra-anatomic bypass between ascending and abdominal aorta and 1 interposition of graft. One patient who had graft infection after repair of abdominal aortic aneurysm required axillo-femoral bypass with removal of infected graft. A patient who had dehiscence of proximal anastomosis after repair of aortoiliac occlusive disease required interposition of graft. Two patients, Marfan syndrome and aneurysm in thoraco-abdominal aorta, underwent graft replacement of thoraco-abdominal aorta concomitant with reconstruction of all visceral arteries. There were 8 patients who required reoperations for aneurysms at distal anastomotic sites after repairs of abdominal aortic aneurysms. Five patients underwent repairs of new aneurysms, including replacement of total arch in 3, descending aorta in 1 and iliac artery in 1. In all cases, no hospital death was noted, however, late deaths were occurred in vasculo-Behçet disease, Marfan syndrome and graft infection. Thus, late result depends on etiology of disease. Although patients who requires reoperation after repair of abdominal aortic aneurysms have higher operative risk factors, early and late results are satisfactory compared to initial operations.

Between March 1986 and December 1993 we had 233 heart transplant patients who were 218 males and 15 females and had a mean age of 50.9 years (range, 2 to 65 years). We analyzed the actuarial survival for these patients and investigated the status of rehabilitation and return-to-work from the view point of quality of life after heart transplant. Actuarial survival (Kaplan-Meier) was 81.7% at 1 year, 76.3% at 3 years, and 72.2% at 5 years. In 57 dead patients 24 patients (42%) died in 1 month after heart transplant. In 176 living patients 165 patients (53%) returned to life. In 129 patients except 76 retired patients only 69 patients (53%) returned to work. In 60 patients, who didn't return to work, 38 patients (63%) were physically able to work.

A successful surgical repair was experienced for a 75 year old female patient with ruptured dissecting aneurysm at the descending aorta. She presented with severe chest pain and advancing anemia. CT scan showed haemorrhage from the descending aorta into the pleural cavity. Diffused and circumferrential thickening of the descending aorta was shown but those area was not enhanced by dye injection. An "ulcer like formation" was shown at the descending aorta by aortogram done before surgery. Surgical repair was done subsequently by left thoracotomy with cardiopulmonary bypass. Only a small intimal wall leakage at the bottom of the crater with size of 20 mm and organized (old) thrombi were seen by intraoperative observation. Other part of intima was thickened but had no damage. Replacement was done for the descending aorta by 8 cm length with woven dacron graft successfully. Microscopic finding of resected aortic tissue showed severe atherosclerotic change. In this case, dissection was initiated from the part of crater which had most severe degeneration by atherosclerotic change and oozing started there, too. Atherosclerotic change, dissection, and oozing rupture were occurred at the same part in this patient, which is quite instructive.