An occluder which intermittently became stuck in the open position with concomitant aortic regurgitation was encountered in a patient subjected to an aortic valve replacement with a 23 Omniscience prosthetic valve. The patient was intermittently aware of the complete momentary disappearances of the valve sounds, the etiology of which could not be discerned. During fluoroscopic examination, the occluder became stuck for a few cardiac cycles in what appeared to be the fully open position before finally moving. Prosthetic valve malfunction was thus diagnosed. The emergency operation was successful. Operative findings revealed that a thin thrombus had developed in a curtain-like fashion on the left ventricular face of the prosthesis with mild tissue overgrowth along the perimeter of the valve. The Omniscience prosthesis was replaced with a 19-mm St. Jude Medical prosthesis, and the patient's postoperative course has been uneventful.

Adult↗

PubMed1987

Traumatic combined valve lesions with aneurysm of the sinus of Valsalva causing late onset of heart failure.

A 23 year old man was operated on because severe incompetence of the aortic, mitral, and tricuspid valve caused congestive heart failure five months after a violent steering wheel injury. The following abnormalities were found at operation: a disrupted right coronary cusp, a torn chorda of the anterior mitral leaflet, a dilated tricuspid annulus, and an intimal tear on the aortic root near the right coronary ostium that had developed into an aneurysm of the sinus of Valsalva.

Accidents, Traffic↗

PubMed1987

Pulmonary artery connection in the Fontan procedure. Flexible polytetrafluoroethylene conduit for expansion.

From clinical experiences with the Fontan operation in six cases, a few practical contrivances and operative steps are described. We stress that meticulous care should be taken not to cause any stenotic complication in the outflow tract toward the pulmonary artery, particularly by traction of the right atrial appendage only to achieve a direct anastomosis. Conduit repair would be necessitated by cases in order to expand the indicative criteria vertically as well as horizontally. For conduit material, we used consecutively nonvalved polytetrafluoroethylene that was reinforced by handmade stainless steel wire ring (Gore-Tex, Inc) or by spirally built-in stent (IMPRA, Inc). The latter was eventually useful in obtaining natural curving of the conduit without kinking or compression. Some contrivances in anastomosing a conduit were also proposed to achieve an excellent result. We believe these practical contrivances will serve for expansion of the indicative criteria and promise improved operative outcome.

Adolescent↗

PubMed1987

Serial evaluation of cardiac function with aortic regurgitation caused by serious aortic lesions. A preliminary comparative study with isolated chronic aortic incompetence.

Clinical and hemodynamic appearances of aortic regurgitation caused by serious aortic lesions (AR-Ao-group) seemed more deteriorated than those with isolated chronic aortic regurgitation (AR-group). Often postoperative course and operative outcome are smooth and satisfactory in the AR-Ao-group. To support this observation, serial changes of left ventricular (LV) function and LV sphericity were evaluated before and after operation in ten cases in the AR-Ao-group and compared with those in the AR-group. Before operation, there were no significant differences in LV function between the two groups. Postoperative improvement of LV sphericity and LV function were statistically better in the AR-Ao-group. The LV function reserve was considered sufficiently retained in the AR-Ao-group. Results with this study supported that clinical observation. Therefore, the total correction, at the same time of aortic incompetence and aortic lesions is recommended.

Adult↗

PubMed1987

Echocardiographic prediction of postoperative low cardiac output syndrome in patients with mitral stenosis.

Thirty-eight patients were operated on for mitral stenosis between March 1979 and September 1981. Thirty-six of them were examined as to their age, symptom duration, chest roentgenograms, electrocardiograms and echocardiograms to obtain various indices of left ventricular function. The usefulness of these indices as preoperative risk factors for predicting postoperative low cardiac output syndrome (LOS) was investigated. Cases which had values of ejection fraction, cardiac index, percent fiber shortening or mean velocity of circumferential fiber shortening less than 0.45, 2.0 l/min/m2, 25% and 0.80 circ/sec, respectively, in the preoperative echocardiographic examination were associated with a greater chance of postoperative LOS. Each of these factors was independently useful as a risk factor in cardiac surgery for mitral stenosis. Moreover, it was revealed that the combination of a preoperative percent fractional shortening (%FS) of less than 30% and a cardiac index smaller than 2.0 l/min/m2 indicated a strong predisposition toward postoperative LOS.

Adult↗

PubMed1987

[Adenocarcinoma of an extraperitoneal rectum in a 17-year-old female].

A 17-year-old female with an adenocarcinoma of the extraperitoneal rectum, which was diagnosed correctly by preoperative intrarectal ultrasonography as being in Dukes' A stage, was operated on, this surgery performed adhering to function preserving procedures. Histologically, the tumor uncovered was found to be a well differentiated adenocarcinoma and, as had been expected, in Dukes' A stage. An absolute curative operation was achieved. The operative procedure for juvenile rectal cancer must be planned to achieve both tumor removal and bodily function preservation to assure the best possible quality of postoperative life. We recommend intrarectal ultrasonography at the preoperative stage, the results to be used in deciding on the operative procedure.

Adenocarcinoma↗

PubMed1987