[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai

Publications in this journal

• Article: [Temporary use of left ventricle-to-pulmonary artery extracardiac conduit for the surgical repair of complete transposition of the great arteries with ventricular septal defect and left ventricular outflow tract obstruction].

  I Kashima, T Fukuda, T Suzuki, K Kimura
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  ABSTRACT: A 1.8-year-old boy was first admitted to our hospital at 12 days of age with the diagnosis of transposition of the great arteries (TGA), ventricular septal defect (VSD), and left ventricular outflow tract obstruction (LVOTO). Echocardiography and catheter examination at 10 months of age disclosed severe organic stenosis of left ventricular outflow tract (LVOT) with its diameter of 5.6 mm (50% of N) and the left to right ventricular (LV/RV) pressure ratio of 0.6. At 1.8 years of age, he underwent complete correction which comprised intraatrial switch (Senning procedure), direct closure of VSD, and removal of thickened endocardium at LVOT. Because of the residual LVOTO, evidenced by postoperative LV/RV pressure ratio of 1.4, placement of 14 mm PTFE graft extracardiac conduit was concomitantly performed. The conduit from the left ventricular apex to the main pulmonary artery effectively lowered the left ventricular pressure with LV/RV pressure ratio of 0.68. Repeat catheter examination at 2.10 years of age revealed further descent of LV/RV pressure ratio to 0.32. Based on the findings that balloon occlusion of the conduit elicited only a minimal elevation of the left ventricular pressure (from 30 to 34 mmHg), the conduit was removed at 3.6 years of age. The third catheter examination at the age of 3.9 years confirmed LV/RV pressure ratio of 0.43. The patient is leading a normal life. without medication 3 years after the operation. This experience draws us to conclude that placement of left ventricle-to-pulmonary artery conduit concomitantly with the intraatrial switch is a useful adjunctive procedure for the complete correction of TGA, small VSD, and LVOTO, and that, in a subset of the patients, this procedure may allow amelioration of LVOTO and secondary removal of the conduit.
  [Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 01/1998; 45(12):2021-5.
• Article: [Modification of the surgical strategy based on intraoperative echographic findings of atherosclerotic ascending aorta].

  S Hosaka, S Suzuki, J Kato, H Sasaki, N Fukuda, S Katahira, S Yoshii, K Kamiya, Y Tada
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  ABSTRACT: To prevent the atheroembolic complications such as brain infarction due to the manipulation of atherosclerotic ascending aorta during cardiac surgery, the ascending aorta of 55 patients including 6 emergencies (mean age: 67.7 +/- 6.9 years, valvular disease: n = 12, ischemic heart disease only or combined with valvular disease: n = 43) were evaluated with intraoperative echography as a routine, to enable a proper placement of the cannulae, clamp etc. Irregular elevated lesions into the aortic lumen from the intima were identified in 7 patients (13%, mean age: 71.0 +/- 6.9 years) of ischemic heart disease, which included 2 emergent cases. Arch cannulation was employed in 3 patients with wide-spread lesions on the posterior wall and femoral cannulation was done in 1 patient with wide-spread lesions on the anterior wall. Two of these patients received CABG with in situ arterial conduits under ventricular fibrillation, and the other 2 patients received CABG with aortic cross clamping at the lesion-free site during proximal anastomosis of vein grafts (single clamp technique). Two patients with localized lesion were done CABG with partial aortic clamping and one of them had cerebral infarction during the operation. We recognized that manipulation of the ascending aorta has to be done with a meticulous care and well away from the diseased site. In another patient with localized lesion, the arch cannulation and the single clamp technique were used 2 cm away from that lesion. The brain infarcted patient completely recovered without any sequelae and the others also had no atheroembolic complications. Although calcified lesions on CT were correlated with atheromatous lesions on echogram (p = 0.004), these atheromatous plaques were not detected by enhanced CT, except in only one patient. For screening of the atherosclerosis of ascending aorta, the CT examination was not so effective and the intraoperative echography was the most sensitive and could be easily accomplished. In conclusion, in order to prevent the atheroembolism that might occur due to the improper manipulation of the diseased ascending aorta during usual procedures, surgical strategies have to be modified according to the position, extent and quality of the atherosclerotic lesions, diagnosed by intraoperative echoscanning of the aorta.
  [Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 01/1998; 45(12):1916-21.
• Article: [A case report of one-stage repair for transposition of the great arteries with intact ventricular septum and coarctation of the aorta in neonate].

  K Kurisu, K Yonenaga, N Furusho, K Nishimura, K Yatsunami
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  ABSTRACT: We report a neonatal case of one-stage repair for transposition of the great arteries with intact ventricular septum (TGA with IVS) and coarctation of the aorta (CoA). The surgery was performed at 27 days of age when the patient, a male, weighed 3408 g. Preoperative cardiac catheterization and angiography confirmed the diagnosis of TGA with IVS, CoA, atrial septal defect, patent ductus arteriosus, persistent left superior vena cava, left sided juxta-positioning of appendages and dextrocardia. The procedure was simultaneous subclavian flap aortoplasty through a left thoracotomy and an arterial switch operation through a median sternotomy. The patient's postoperative course was uneventful and he has grown well. Postoperative cardiac catheterization revealed mild pulmonary stenosis (pressure gradient of 19 mmHg between the right ventricle and the pulmonary artery) and mild aortic arch kinking from the arterial switch maneuver. One-stage repair, the combination of subclavian flap aortoplasty and arterial switch operation, provides a good clinical result in this complex malformation.
  [Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 01/1998; 45(12):1976-80.
• Article: [Five cases of peptic ulcer of gastric tube after radical esophagectomy for esophageal carcinoma and analysis of Helicobacter pylori infection at gastric tube].

  M Takemura, M Higashino, H Osugi, T Tokuhara, K Fujiwara, H Kinoshita
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  ABSTRACT: The peptic ulcer of gastric tube using for esophageal reconstruction is rare. We report herein five cases of peptic ulcer of gastric tube used for esophageal reconstruction after esophagectomy for esophageal carcinoma. The reconstructive route, in all cases, was posterior mediastinum. In one case, 10 days after esophagectomy, he had high grade fever and pneumonia of right lower lobe of lung. Endoscopic examination revealed a deep ulcerative lesion on anterior wall of gastric tube and fistula formation on membranous part of trachea. The partial resection of gastric tube was performed for closing to tracheo-gastro fistula. In other four cases, the location of ulcer was middle or lower third of gastric tube. One had multiple peptic ulcer and other had single. Two cases of four underwent post irradiation therapy. One case of then, the Helicobacter infection detected using by rapid urease test and histological examination. We analyzed of Helicobacter pylori infection and serum gastrin level of gastric tube in outpatients who have used gastric tube for esophageal reconstruction after radical esophagectomy. Helicobacter pylori infection was positive at 56% (9/16) of all patients. The serum gastrin level of patients who was positive of Helicobacter pylori infection is not significantly higher than that of patients who was negative. We consider that post operative irradiation therapy and Helicobacter infection might play in development of peptic ulcer of gastric tube.
  [Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 01/1998; 45(12):1992-7.
• Article: [A case of modified Fontan operation with reconstruction of the nonconfluent pulmonary artery].

  S Uchita, Y Imai, Y Takanashi, S Hoshino, M Terada, M Nagatsu
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  ABSTRACT: A three-year-old girl with complex cardiac anomalies and right isomerism successfully underwent a modified Fontan procedure and reconstruction of the nonconfluent pulmonary artery using autologous tissues. These cardiac anomalies included single right ventricle, atresia of the pulmonary trunk with nonconfluent pulmonary artery, atrial septal defect, common atrioventricular valve, bilateral PDAs, and bilateral SVCs. Preoperative cardiac catheterization showed elevated pulmonary artery pressure (mean pressure of 24 mmHg) and a small orifice of common pulmonary vein chamber. Pulmonary arteriographies showed balanced development of the branches. Indication for Fontan procedure was finally determined by measurement of the pulmonary artery and vein pressures and pulmonary vascular resistance before the cardiopulmonary bypass in the operation. Nonconfluent pulmonary artery was reconstructed by direct anastomosis of the right and left branches in the posterior aspect and enlarged with autologous pericardium patch. Intracardiac anomalies were repaired by enlargement of common pulmonary vein orifice (from 5 mm to 15 mm in diameter) and right atrial oblique partition. Furthermore, Fontan circulation was established by pulmonary artery angioplasty, direct anastomosis of left SVC to left pulmonary artery and direct anastomosis of right atrial appendage to pulmonary artery. Postoperative clinical course was uneventful, and cardiac catheterization showed mean right atrial pressure of 14 mmHg, cardiac index of 3.5 l/min/m2, and no pressure gradient at the site of reconstruction of the pulmonary artery.
  [Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 01/1998; 45(12):1986-91.
• Article: [Open heart surgery in a Jehovah's Witness boy--a case report of successful management of aortic regurgatation and aneurysm of sinus Valsalva due to infective endocarditis].

  Y Sawada, K Asada, N Matsuyama, S Hasegawa, S Sasaki
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  ABSTRACT: Jehovah's Witness who require operation represent a challenge to the physician because of the patients' refusal to accept blood transfusion. We report an 8-year-old male of Jehovah's Witness who underwent a surgical treatment of infective endocarditis. He was transferred to our hospital because of high fever and heart murmur. Echocardiogram revealed a developing vegetation of aortic cusps and an aneurysmal change of the non-coronary sinus Valsalva. On admission he was complicated by anemia, purulent meningitis and suppurative arthritis of left knee. There were no signs of cardiac failure. Erythropoietin (6000 U thrice weekly) and iron (60 mg daily) were given for 11 weeks prior to surgery, raising the hemoglobin level from 9.2 g/dl to 18.4 g/dl. Aortic valve replacement and plasty of the sinus Valsalva were then performed. Intraoperatively hemoglobin concentration dropped to 10.3 g/dl and it raised to 15 g/dl postoperatively. We also used Cell-Saver to reduce blood loss. The patient made an uncomplicated recovery. Erythropoietin therapy contributed substantially to the successful outcome of this case.
  [Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 01/1998; 45(12):2006-10.
• Article: [A case report of chronic dissecting aortic aneurysm (Stanford type A) with circumferential detachment of the intima].

  K Kodera, A Sakai, M Abe, Z B Lin, M Oosawa
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  ABSTRACT: A 57-year-old man underwent Bentall's procedure (Piehler's modification) and partial aortic arch replacement for Stanford type A chronic aortic dissection. Circumferential detachment of intima with intimal intussusception into the aortic arch was found at the time of operation. Preoperative findings did not show the intimal tear involving entire circumference of the ascending aorta. He was asymptomatic but coughing before consulting our hospital. He was discharged from the hospital 26 days after operation.
  [Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 01/1998; 45(12):2011-5.
• Article: [Mitral valve plasty and LV patch reconstruction for a left ventricular aneurysm with mitral regurgitation].

  H Naganuma, H Kurosawa, M Nakano, Y Sakamoto, F Saito
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  ABSTRACT: Three years after myocardial infarction, a 60-year-old man had congestive heart failure caused by left ventricular aneurysm with mitral regurgitation. He underwent the following concomitant operations: (1) patch reconstruction for a left ventricular aneurysm and (2) mitral plasty for a torn chordate and mitral regurgitation by using valvuloplasty, a shortening chordae and a prosthetic ring. A postoperative examination indicated that his cardiac function had markedly improved.
  [Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 01/1998; 45(12):2003-5.
• Article: [Pulmonary metastasis after resection of non-invasive thymoma: a case report--analysis of nuclear DNA pattern and pathological findings].

  T Noriyuki, S Yoshioka, T Kataoka, S Shibata, Y Miyata, K Dohi
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  ABSTRACT: After resection of a non-invasive thymoma, two metastatic lung tumors were found in the left upper lobe and the left lower lobe. There were differences in tumor doubling time (TDT) and invasion between the metastatic tumor in the lower lobe and the one in the upper lobe. The TDTs of the tumors were 834.1 days and 328.3 days, and the tumor of the left lower lobe invaded the left lateral basal segmental bronchus (B9). The differences in the two tumors were determined by pathological findings and nuclear DNA pattern. Pathologically, the resected thymoma and both of the metastatic tumors were mixed type, which consisted of epithelial cells and lymphocytes. But by epithelium form, the resected thymoma and the tumor in the lower lobe were classified as cortex type, and only the slow growing tumor in the upper lobe contained a spindle-cell component. The DNA pattern of the resected thymoma was aneuploid and the two metastatic tumors were diploid. As this case is very interesting clinically and pathologically, we reported it.
  [Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 01/1998; 45(12):1998-2002.
• Article: [A surgical case of aggressive fibromatosis].

  S Yoshida, H Kimura, N Iwai, K Yasufuku, Y Yamaguchi, Y Takahara
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  ABSTRACT: A case of "aggressive fibromatosis" which appeared in posterior mediastinum is reported. A 50-year-old woman was admitted to our hospital with right shoulder pain. The tumor surrounded the right vertebral artery and infiltrated into the right sympathetic nerve, brachial plexus and muscle tissue. It was suspected of neurogenic tumor by percutaneous needle biopsy. Removal of the tumor and partial resection of the invaded vertebral artery and brachial plexus were made in Aug. 10, 1996. In postoperative examination, the tumor was 6.2 x 6.5 x 4.5 cm in size and diagnosed pathologically as "aggressive fibromatosis". Postoperative course was uneventful, but Horner's symptoms and motor disturbances of IV, V, fingers of the right hand were slightly occurred. Radiotherapy of 60 Gy was done after operation. There is no recurrence to date 17 months after surgery. As for the character of this disease, it seldom metastasizes, but grows infiltratively and the recurrence after operation is an important problem. In particular, the neck and the head are important because surgical margin is not provided enough, anatomically. Therefore, chemotherapy or radiotherapy after operation is needed. In this case, radiotherapy was done after operation. So, there is not the recurrence and passes to date 17 months after surgery. But, follow-up of long terms is necessary because it may recur after postoperative therapies.
  [Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 01/1998; 45(12):2016-20.
• Article: [Beneficial effect of a stable PGI2 analogue (ONO-1301) on prostanoid release after reperfusion in canine left single lung allotransplantation model].

  K Minamoto
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  ABSTRACT: Recently much interests have focused on the imbalance between the release of thromboxane A2 (TXA2) and prostaglandin I2 (PGI2), which may contribute to the development of pulmonary vascular injury. TXB2 has potents of platelet aggregation and vasoconstriction, while PGI2 has against in its activities. We investigated the effect of new PGI2 analogue (ONO-1301), which is a novel prostacyclin mimetic with inhibitory activity against thromboxane synthetase, on the early graft function in canine left single lung allotransplantation model. 19 donor dogs were divided into three groups. Seven dogs were comprised control group and received heparin administration (400 Unit/kg) before pulmonary arterial flushing with 50 ml/kg of 4 degrees C low potassium dextran glucose (LPDG) solution. Each six dogs were comprised I2-10 and I2-50 groups respectively, with receiving a 10-minute infusion of ONO-1301 (10 micrograms/kg/min) before flushing. The pulmonary cold preservation was performed with LPDG solution at 4 degrees C for 18 hours. After left single lung transplantation, in control group, saline solution was administered to the recipient for 10 minutes encompassing the reperfusion process (starting from 5 minutes prior to reperfusion). In I2-10 group, the ONO-1301 (10 micrograms/kg/min) was administered in the same manner. In I2-50 group, the ONO-1301 was administered from the same timing as I2-10 group, but for 50 minutes. The recipient dogs were observed for 6 hours after ligation of the right pulmonary artery and bronchus. We measured the transplanted lung function, including arterial blood gas and pulmonary hemodynamics, and plasma 6-keto-PGF1 alpha, TXB2 and lipid peroxide levels of left atrial blood. Pulmonary histological investigation was performed after preservation and sacrifice the recipient dog. All recipient dogs were survived for observation period. I2 groups provided significantly better gas exchange and pulmonary hemodynamics than control group. The 6-keto-PGF alpha levels in control group peaked after an early rise in TXB2 levels, and reached maximum at one hour after contra-lateral ligations. These prostanoid release levels rose again at 6 hours. While in I2 groups, the levels of them were significantly lower compared with control group. Histological examination of the transplanted lung after assessment, revealed disruption of alveoli forced by pulmonary edema in control group. In contrast, there was minimal fluid extravasation without alveolar disruption in both I2-10 and I2-50 groups. There were no significant differences between I2-10 and I2-50 groups. Although it dose not protect the implanted lung completely from developing edema, the ONO-1301 administration (10 micrograms/kg/min) to the donor and the recipient resulted in prevention of TXA2 and PGI2 release and improvement of the respiratory function and pulmonary hemodynamics after reperfusion. We conclude that it seems beneficial to administer the ONO-1301 to the donor and the recipient in order to regulate the prostanoid release and maintain the early graft function.
  [Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 01/1998; 45(12):1931-42.
• Article: [The temperature dependency of the protective properties of the St. Thomas' Hospital cardioplegic solution, the University of Wisconsin solution, and Bretschneider buffered solution].

  Y Kumada, F Yamamoto, T Ishikawa, K Kagisaki, Y Shimada, T Ohashi, H Yamamoto, H Hirose
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  ABSTRACT: We studied three preservation solutions such as St. Thomas' hospital cardioplegic solution No. 2 (ST), the University of Wisconsin solution (UW) and Bretschneider's solution (BR) for protective properties, especially in terms of temperature dependence during the preservation. Rat hearts were studied and divided into three groups; ST. UW and BR. In each group, six hearts were carried out perfusion, cardioplegic infusion, ischemia and reperfusion for four different conditions. Using an isolated working rat heart model, the hearts were subjected to 5 minutes Langendorff perfusion followed by 20 minutes working perfusion. During this working period, cardiac functions such as aortic and coronary flow, aortic pressure, and heart rates were measured every 5 minutes. After working perfusion, 3 minutes of cardioplegic infusion was carried out either with UW, ST, and BR at 37, 20, 4, 1 degree C. The hearts were subjected to either 35 min at 37 degrees C, 120 min at 20 degrees C, 300 min at 4 degrees C, or 450 min at 1 degree C. The hearts were immersed in the same solution during ischemia. The hearts were reperfused at 37 degrees C, initially in the Langendorff mode for 15 min. Coronary effluent was collected for the measurement of CK leakage during reperfusion. The heart were then converted to the working mode for 20 minutes. During working reperfusion period, the variables of cardiac function were again measured and expressed as a percentage of their individual preischemic control values. Under conditions of 37 degrees C ischemia, % recovery of cardiac output (%CO) in ST group is 62.8 +/- 2.8%, although the hearts preserved with UW and BR were not recovered. Under conditions of 20 degrees C ischemia, %CO in UW, ST and BR were 46.8 +/- 2.7, 82.0 +/- 3.1 and 41.4 +/- 2.6%, respectively. Under conditions of 4 degrees C ischemia, %CO in UW, ST and BR were 66.2 +/- 8.0, 68.6 +/- 2.3 and 47.2 +/- 2.9%, respectively. Under conditions of 1 degrees C ischemia, %CO in UW, ST and BR were 70.6 +/- 3.3, 56.5 +/- 1.6 and 43.0 +/- 2.5%, respectively. In conclusions, ST revealed the best protective properties for the heart preservation between 37 degrees C and 20 degrees C ischemia. The properties of ST was similar to that of UW under conditions of 4 degrees C, although UW showed most excellent protective properties under conditions of 1 degrees C ischemia. These results suggested that, protective ability of preservation solution might be changed by the temperature during preservation period.
  [Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 01/1998; 45(12):1954-60.
• Article: [Invasive thymoma with pericardial tamponade as initial manifestation].

  T Tanaka, H Katakura, S Matsumoto, K Maezato
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  ABSTRACT: A 68-year-old man presented to another hospital with progressive shortness of breath, dry cough, and systemic edema. A chest X-ray, echocardiogram, and chest CT showed a mediastinal mass and massive pericardial effusion. His symptoms improved after the treatment for heart failure. The pericardial effusion was bloody. In that, malignant cell wasn't proved. Thoracotomy was performed to diagnose the mediastinal tumor and to extirpate it. Pathological diagnosis after operation was thymoma with direct invasion to pericardium and tunica externa of aorta. Thymomas are routinely asymptomatic for prolonged periods of time. Symptomatic pericardial tamponade as initial manifestation due to a thymoma with a massive pericardial effusion is uncommon.
  [Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 01/1998; 45(12):1968-71.
• Article: [A case report of thoracic outlet syndrome with acute arterial obstruction caused by abnormal first rib].

  H Iida, H Mori, Y Mochizuki, Y Okamura, S Nagai, K Shimada
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  ABSTRACT: A 33-year-old male was transferred to our hospital because of coldness, numbness and pain in his right arm. Chest X-ray showed abnormal first ribs on both sides that were attached to the second ribs below the clavicles. Angiogram revealed an aneurysm of right subclavian artery, thrombus in the aneurysm and embolism to the brachial artery. Thrombectomy using a Fogarty catheter was done and the radial pulse recovered. Surgical resection of the abnormal first rib and thrombectomy was performed, because ischemic symptoms recurred in spite of anticoagulation and antiplatelet therapy. Acute arterial occlusion in patients with thoracic outlet syndrome is rare. The literature on arterial complications of thoracic outlet syndrome is reviewed.
  [Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 01/1998; 45(12):2026-9.
• Article: [Treatment strategies for lung cancer brain metastases].

  M Nakade, K Kohno, H Watanabe
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  ABSTRACT: Forty-one patients suffered initial relapses with brain metastasis after surgery for non-small lung cancer at our hospital between 1978 and 1995. These patients were a total of 8.4% of all cases of surgical removal, and had an average relapse period of 8.6 months +/- 8.0 months after surgery on the primary lesions. Of these, surgical removal of metastasized lesions was performed on 18 patients (43%), in which the 5-year post-operative survival rate was 35.7%, and the median survival time was good at 28 months. It was found that the survival period was significantly extended in the group whose relapse period was less than one year after surgery on the primary lesions, and in the group who received cranial irradiation post-operatively on the metastasized brain lesion. Following surgery on the metastasized lesion, second relapses occurred in nine patients, and six patients suffered from second relapses in the brain, of which four did not receive cranial irradiation post-operatively. Cases of radiotherapy in patients of 70 years of age or more frequently manifested post-radiotherapy subacute neuropathy. From the above, it is thought that the following procedures should be adopted: 1. Periodic examination for brain metastasis during the 24 months following surgery for non-small cell lung carcinoma for purposes of early detection; 2. in cases where brain metastasis is detected, if no metastasis is identified in other organs, a policy of surgical removal should be adopted where possible; and, 3. in cases of 70 years of age or less following surgery on the metastasized lesion, cranial irradiation should be considered.
  [Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 01/1998; 45(12):1911-5.
• Article: [Surgical treatment of double outlet left ventricle].

  T Sakamoto, Y Imai, Y Takanashi, S Hoshino, K Seo, M Terada, M Aoki, F Suetsugu
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  ABSTRACT: Double outlet left ventricle (DOLV) is an uncommon congenital cardiac defect which was first reported by Sakakibara and associates. We studied anatomical aspects relevant to surgical repair in our 4 cases and additional 28 cases which had been reported on the literatures. The locations of ventricular septal defect (VSD) were subaortic in 20 cases, subpulmonary in 7, doubly-committed in 2 and unknown in 2. The positions of the aorta relative to the pulmonary artery were right or left anterior oblique in 11 cases, right or left side-by-side in 9, right or left posterior oblique in 10 and unknown in 3. The definitive surgery included Rastelli type operation in 18 cases, right ventricular outflow tract repair with closure of VSD in 6, intraventricular conduit repair in 4 and Fontan type operation in 4. In regard to the selection of the procedure, the size of right ventricle, the presence of pulmonary stenosis, the location of VSD and the relationship of the great arteries are very important. Although most of the patients underwent the Rastelli type operation, the right ventricular outflow tract reconstruction or intraventricular conduit repair could be adopted particularly in patients with posterior oblique position of the aorta relative to the pulmonary artery or subpulmonary VSD.
  [Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 01/1998; 45(12):1922-30.
• Article: [Thoracoscopic resection of mediastinal parathyroid adenoma with cyst and hyperparathyroidism--a case report].

  M Shimizu, H Akamatsu, T Yoshizaki, H Tanaka, T Sakamoto, M Sunamori
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  ABSTRACT: A 51-year-old woman was admitted because of general fatigue assumed to be due to climacteric disturbance. Laboratory examinations suggested a diagnosis of hyperparathyroidism based on high serum levels of Ca, intact PTH, and high-sensitivity PTH. No abnormalities were found in the cervix. Chest X-ray films and CT scans showed a mass measuring 4 cm in the right postero-upper mediastinum. The tumor was positive on a parathyroid scintigram, and was diagnosed as a mediastinal parathyroid adenoma with hyperparathyroidism. Operative findings showed a tumor surrounded by the superior vena cava, vagus nerve, azygos vein, and brachiocephalic artery. Careful resection of the hypervascular tumor from surrounding tissues was performed using a thoracoscopic technique alone. The postoperative course was uneventful. Serum values of Ca, intact PTH, and high-sensitivity PTH decreased to within normal ranges. after surgery. Pathohistological study confirmed the diagnosis of parathyroid adenoma including a cyst caused by degeneration of the tumor.
  [Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 01/1998; 45(12):1972-5.
• Article: [The waffle procedure (multiple incision of epicardium) with pericardiectomy for constrictive pericarditis].

  H Tsukui, K Ohara, T Akimoto, M Mukaida, K Abe
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  ABSTRACT: Pericardiectomy is the only effective surgical procedure for constrictive pericarditis, but we have often experienced a lack of significant improvement of hemodynamic parameters, this being attributed to the presence of residual constriction. We have had two patients with constrictive pericarditis. In these patients, we decorticated the pericardium as usual, anterior to the bilateral phrenic nerves without cardiopulmonary bypass, and then, multiple longitudinal and transverse incisions were carefully made in the fibrous epicardium, avoiding the predicted course of major coronary branches and the myocardium. At the end of the procedure, the epicardial fibrous surface acquired a waffle-like appearance. With this maneuver, relief of constriction was achieved and the myocardium was able to reexpand, thus obtaining an adequate hemodynamic response. Our two patients recovered fully, and were discharged on the 18th and 19th postoperative day. They are presently free of clinical symptoms.
  [Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 01/1998; 45(12):1981-5.
• Article: [Assessment of left ventricular function by pressure-volume loop in VSD and TOF before and after operation].

  S Shimizu, H Kurosawa, M Nakano, K Hashimoto, K Suzuki, M Yamagishi, H Okuyama, K Nomura
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  ABSTRACT: This study estimates the perioperative left ventricular function of VSD and TOF by using Pressure-Volume (PV) loop. The most characteristic hemodynamic change of VSD is a decreased volume load. Although ejection fraction significantly decreased after the operation, this change did not mean a deteriorated left ventricular contractility. Emax, which is an index of left ventricular contractility on PV loop, improved and pressure-volume area (PVA) which is correlated with 02 consumption of left ventricule was reduced. Mechanical efficiency of left ventricular energetic state did not significantly change. Left ventricular volume and ejection fraction in TOF slightly increased after the operation. Increased ejection fraction reflected a compensation to volume overload after surgery. Emax slightly decreased and PVA increased. Meanwhile mechanical efficiency increased after the operation indicating well preserved ventricular contractility. In particular, the shape of PV loop of both VSD and TOF eventually became usual square after operation due to recover of the isovolumic contraction and relaxation phase. These characteristics had better to be concerned for improvement of surgical techniques as in conotruncal repair, particularly in TOF in the setting of better quality of life with low atrial pressure.
  [Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 01/1998; 45(12):1961-7.
• Article: [Verapamil pretreatment extended the viability of non-beating donor hearts in situ].

  K Iijima
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  ABSTRACT: An animal study was designed to examine whether the viability of asphyxiated cadaver hearts in situ could be extended by the verapamil pretreatment. Verapamil was administered separately at a dose of 0.1 (n = 9), 1.0 (n = 9), or 10 mg/kg (n = 16) to male adult Sprague-Dawley rats (440-500 g) 15 minutes prior to asphyxiation to death. Verapamil was not administered in control rats (n = 9). All dead rats were left at room temperature for 30 minutes followed by excision of their hearts and washout of coronary vascular beds with a cold University of Wisconsin solution. After simple cold storage for 30 minutes, hearts were reperfused on an isolated working rat heart apparatus in a nonworking mode with modified Krebs-Henseleit buffer for 60 minutes. After 30 minutes of the subsequent working mode, hemodynamics were measured and the hearts were perfused with 3% glutaraldehyde for the ultrastructural examination using electron microscopy. The hearts of the 10 mg/kg group were irreversibly contracted (0/16 vs. 8/9 in control hearts, p < 0.0001) during reperfusion, and most of them could make a pressure enough to keep a working mode (14/16 vs. 1/9 in control hearts, p = 0.0003). Satisfactory results were not found with 0.1 and 1.0 mg/kg verapamil groups. In ultrastructural examination, coronary vessels after preservation were dilated in the 10 mg/kg group, whereas were not dilated enough to washout of the red blood cells by the solution in controls. Irreversible changes of myocytes after reperfusion such as contraction bands and amorphous densities were presented in controls, but not in the 10 mg/kg group. Verapamil pretreatment before cardiac arrest may contribute to preserve cadaver hearts with dilating the coronary vessels and probably preventing the calcium influx into cardiomyocytes during ischemia and reperfusion. Verapamil provides dose-dependent extension of viability of non-beating donor hearts in situ.
  [Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 12/1997; 45(12):1943-53.