[Our method and concept concerning the activated clotting time (ACT) during cardiopulmonary bypass].
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Biomedical subjects
Publications and source records attributed to Y Iyomasa.
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With the widespread use of intravenous polyethylene or silicone elastomer catheters for continuous infusion of fluids and drugs and monitoring central venous pressure, loss of catheter fragments into the central circulation has become an increasing problem. These catheter fragments have been removed from all areas of the right side circulatory system by various techniques not requiring thoracotomy. Many kinds of instruments for nonsurgical removal of these fragments have been utilized. The majority of them have been accomplished using a loop snare or a helical basket. As with loop snares and baskets, a free end of fragments is necessary for fragment entrapment. In this report the authors describe four cases with catheter fragments in the heart or the great vessels and a new nonsurgical technique using a "forceps with three or two grasping prongs for endoscope" for their removal. In the first case, we could remove the embolized catheter fragment without accessible free ends in the pulmonary artery by this method. This special forceps with two grasping prongs was applicable even for the infant and could be inserted through a No. 8 French Cordis catheter introducer. This method is extremely promising for removal of catheter fragments in the central circulatory system.
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A technique facilitating intraoperative assessment of the degree of mitral regurgitation during mitral reconstructive procedures is reported. During open heart procedure using cardioplegia, a cardioplegic cannula in the aortic root was inserted into the left ventricle, filling the left ventricle with cold saline, and competence of the mitral valve was assessed. This assessment of mitral regurgitation during open heart procedure was compared with the degree of mitral regurgitation by the postoperative left ventriculography. This technique was expedient, safe and helpful.
A case undergoing conduit procedure for tetralogy of Fallot with pulmonary atresia was complicated postoperatively by bacteremia due to non-fermentative Gram-negative rods and by disseminated intravascular coagulation. He was able to be cured without any sequela. The patient was a 16-year-old male, who had undergone Blalock-Taussig anastomosis in his infancy. The present operation was carried out as follows: ventricular septal defect was closed with a Teflon-patch and discontinuity between the right ventricle and the pulmonary artery was corrected using a Hancock's valved conduit. Two weeks after the operation, pleural effusion in the right chest cavity was shown by a chest X-ray film. On the 32nd postoperative day, high fever with chills occurred, and subsequently developed pulmonary edema, shock and hemorrhagic tendencies with petechia. Pseudomonas aeruginosa, Flavobacterium and Alcaligenes faecalis were detected by the culture of pleural effusion. The platelet count decreased to about 10,000/microliters. Carbenicillin, tobramycin and minocycline were administered for the infection, and heparin and aprotinin were used for disseminated intravascular coagulation. By these treatments for about 6 months, the patient became well and was discharged without any sequela.
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The concentration of sulbenicillin in the serum and myocardial tissue of 13 patients were determined at cardiac surgery. About 100 mg/kg of sulbenicillin were administered intravenously for 60 minutes. Right auricle resected at the vena caval cannuration was examined for myocardial tissue. The serum concentration was also examined every 30 minutes after injection, 30 minutes, 60 minutes, 90 minutes, 120 minutes and 150 minutes. Mean values of serum concentration were 213.6 micrograms/ml, 432.5 micrograms/ml, 181.6 micrograms/ml, 236.3 micrograms/ml and 101 micrograms/ml, respectively. The values determined in myocardial tissue were 146.5 micrograms/g (60 minutes), 39.2 micrograms/g (90 minutes), 66.0 micrograms/g (120 minutes) and 23.5 micrograms/g (150 minutes). The mean value of concentration ratio of sulbenicillin in myocardial tissue was 0.23 of serum concentration. The high myocardial tissue levels of sulbenicillin suggests that its use at cardiovascular surgery would protect the myocardial tissue from the bacterial infections.
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Two hundred and seventy-eight patients with atrial septal defect of secundum type were operated on surgical closure of the defect. The patients were divided into 5 groups according to age at surgery, and preoperative complaints and laboratory findings were analyzed to evaluate natural history. As year passed, incidence of complaints increased. Cardiothoracic ratio (CTR), systolic pressure of the right ventricle (PRVS), end-diastolic pressure of the right ventricle (RVEDP), mean pressure of the right atrium (PRAm), ratio of pulmonary to systemic systolic pressure (PPA/PS), right ventricular dimension (RVD) and left atrial dimension (LAD) increased significantly, while frontal axis of the QRS complex, RV1, SV1 +RV5 and LVD decreased. No chronological changes were seen in ratio of pulmonary to systemic blood flow (QPA/QS) and ratio of pulmonary to systemic vascular resistance (RPA/RS). The first and second decades of life were considered to be stable stages of the disease. Postoperatively, changes in the above-mentioned parameters were compared in each age group, and effects of surgical repair on natural history were evaluated. Of 265 survivors, 168 were followed-up for more than one year, the longest period being 22 years. CTR, frontal axis, RV1, PRVS, RVEDP, PPA/PS and RVD decreased significantly, while SV1 + RV5, RPA/RS and LVD increased. No changes were seen in LAD. Surgical effects appeared most significantly in the first decade and least in the fifth or more. From these findings it would be concluded that corrective surgery should be best carried out in the first decade, at latest in the second, though not to be contraindicated by age alone. Otherwise, postoperative improvement of parameters delays or hemodynamical abnormalities may persist regardless of considerable clinical improvement.
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