Biomedical subjects
Publications and source records attributed to F Iwaya.
A rare case of right atrial thrombosis was observed in a 49-year-old woman. She had cyanotic ostium secundum atrial septal defect without pulmonary hypertension. By postoperative cardiac catheterization, she was diagnosed as having isolated right ventricular hypoplasia.
A patient who developed a foreign body granuloma three years after aortic valve replacement was surgically treated. Oxidized cellulose was suspected of its cause.
Hemodynamic measurements were performed before, during and after surgery of aneurysmal patients. Fifty non-ruptured infrarenal aneurysmal patients undergoing elective aortic reconstructions were studied. Patients who had no evidence of heart disease were divided into two groups by age. The older group consisted of 22 patients older than 70 years of age, and the younger group consisted of 28 patients younger than 70 years. The results may be summarized as follows: (1) Hemodynamics before surgery (volume loaded test): For 500 ml albumin infusion within 30 minutes, cardiac indices of the older group kept below 4.0 l/min/m2, whereas in the younger group there was an increase from 3.66 to 4.42 l/min/m2. (2) Hemodynamics during surgery: Peripheral resistance increased by cross-clamping of the aorta, and decreased after removal of the aorta, and decreased after removal of the cross clamp in both groups. Cardiac indices dropped during cross-clamping of the aorta. The older group dropped more noticeably compared with the younger group, for instance, at one minute after cross-clamping, the older group was 2.04 +/- 0.56, and the younger group was 2.44 +/- 0.56 l/min/m2. Mean pulmonary wedge pressure increased gradually during surgery in both groups. (3) Hemodynamics after surgery: The older group kept lower cardiac indices compared with the younger group, but not so noticeably. These results indicated that older patients have low cardiac function for preload and afterload change. We will be confronted by an increasing number of older patients in the near future. Hemodynamic managements of aortic reconstructions in the elderly might become important.
The patient was 63-year-old man, who underwent patch closure of VSP 37 days after onset. LVAD was required for weaning from CPB. Mediastinitis occurred after LVAD was removed. The mediastinum was irrigated using diluted antibiotics through the retrosternal drain. He discharged on 79th day postoperatively. False aortic aneurysm and marked AR was pointed out by cineangiography and enhanced CT scan two years after operation. AVR was performed through right thoracotomy, because false aortic aneurysm invaded the sternum. The aneurysmal wall was repaired with patch. Postoperatively, peritoneal dialysis was performed for two days. Flail chest made difficult weaning from the respirator. He died 11 days postoperatively due to respiratory failure. There remains the possibility that mediastinitis resulted in false aortic aneurysm and AR. It was esseutial to remove the foreign materials placed on the aorta for eradication of infection.
A case of 7-year-old boy with tetralogy of Fallot associated with DiGeorge syndrome was reported. He had been diagnosed as cardio-facial syndrome with hypoparathyroidism because of hypocalcemia, convulsion, cardiac defect and the characteristic face. But immunologic study showed hypofunction of cellular immunity and cardiac catheterization and angiogram revealed the Tetralogy of Fallot. So we diagnosed as DiGeorge syndrome and performed operation. The thymus was not found and we close the ventricular defect with patch and reconstructed right ventricular outflow tract with transannular patch. We often measured serum ionized calcium level and corrected with calcium gluconate intravenously. Peritoneal dialysis was done due to oliguria and much inotropic support was necessary.
A 55-year old man had complained shortness of breathing and an abnormal shadow at left hilus region had been pointed out on the chest X-ray film. Right heart catheterization and right ventriculography revealed pulmonary valve stenosis with pulmonary artery aneurysm-like. Utilizing cardiopulmonary bypass, aneurysmorrhaphy and valvotomy was performed. Postoperative course was good and he was discharged on the 29th postoperative day. It is considered that mild post-stenotic dilatation of pulmonary trunk due to pulmonary valvular stenosis might develop into the aneurysmal change because of some congenital structural deficiency in the pulmonary arterial wall.
A case (56 year-old, female) of the aneurysm of sinus of Valsalva due to infectious endocarditis with aortic stenosis and regurgitation was described. The patient was successfully operated upon by patch closure of the orifice of the aneurysm and aortic valve replacement with Medtronic Hall 23A. Post operative course was uneventful and discharged from the hospital at 37 post operative days in good condition.
A 20-year-old female of right aortic arch associated with subclavian steal syndrome is reported. She was admitted to our hospital for numbness of the left arm, headache and dysphagia. Division of the ligamentum arteriosum and left common carotid-left subclavian artery anastomosis were successfully performed.
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Twenty-seven calves were operated on in our institute for total artificial heart replacement. Thomasu hearts (made by the Thomasu Technical Company, Japan) were used in 21 calves from February 1980 to May 1983. Utah Jarvik 7 hearts were used for the first five calves and the 17th calf. The air-driven Thomasu heart, made of segmented polyurethane, has 95 ml and 85 ml of stroke volume in its left and right sides respectively and showed recognizable function curves in mock circulation systems. There were no satisfactory results in the first 19 cases but the 20th calf survived for 28 days. In 1982, we adopted a new surgical method in which, instead of suturing, a sutureless artificial graft with a stainless steel ring was inserted into the aorta and pulmonary truncus. Since then two out of six calves have survived for more than one month; one of these survived for 66 days. The causes of death after the Thomasu heart replacements were varied. Ten (48%) out of 21 cases had heart trouble and four calves (19%) died through thrombus formation at the inflow and outflow valves. Three calves (14%) died because of mechanical failure of the driving system, two (10%) due to surgical failure, one because of pneumonia, and one due to an abnormal reaction after donor blood transfusion. Our longest surviving calf died after 66 days, because of a broken left blood diaphram though, it remained in excellent condition until its death. There was no thrombus formation in either ventricle, no fibrin net formation and no calcium deposit on the surface of the diaphragm.(ABSTRACT TRUNCATED AT 250 WORDS)
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