The Japanese journal of thoracic and cardiovascular surgery : official publication of the Japanese Association for Thoracic Surgery = Nihon Kyōbu Geka Gakkai zasshi
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Jpn. J. Thorac. Cardiovasc. Surg. · Jan 1998
Case Reports[A case of total arch replacement for redissected impending rupture of early thrombosed aortic dissection without intimal tear detectable at operation].
A 51-year-old suddenly developed severe chest and back pains. The diagnosis was acute aortic dissection of Stanford type A, but the dissecting space was not observed by enhanced CT scan. Medical treatment was started as early thrombosed aortic dissection. ⋯ Therefore total arch replacement was needed to resect the wall which may be responsible for the dissection and to reduce the residual dissecting space. The patient recovered without complications. Postoperative CT scan revealed no residual false lumen in the distal descending aorta.
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Jpn. J. Thorac. Cardiovasc. Surg. · Jan 1998
Case Reports[A successful valve repair case of isolated tricuspid regurgitation due to traumatic lacerated papillary muscle of the tricuspid valve].
A case of tricuspid valve regurgitation due to a non-penetrating chest trauma was presented. This case involves a 20-year-old man, who was admitted to a nearby hospital because of rib fracture, mandibular fracture, and hemorrhage of the left hemopneumothorax, caused by a traffic accident. Palpitation and chest discomfort were observed at admission time, but there was no follow-up. ⋯ Absence of the left pericardium was observed during the operation. We reported valve repair of traumatic tricuspid regurgitation which with papillary muscle rupture. Due to its rarity and the fact that there has been no reported cases of papillary muscle repair for traumatic tricuspid regurgitation in Japan, we used researched information on the subject.
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Jpn. J. Thorac. Cardiovasc. Surg. · Jan 1998
Case Reports[Repair of intrathoracic visceral damage using video-assisted thoracoscopic surgery for blunt chest trauma and rib fixation at the site of mini-thoracotomy].
We treated three patients with intrathoracic visceral damage caused by severely dislocated fractured ribs resulting from blunt trauma by using video-assisted thoracoscopic surgery (VATS) and rib fixation through a mini-thoracotomy. Under general anesthesia and unilateral respiration, the thoracic cavity was inspected with a thoracic video scope through the port inserted through the thoracic drainage opening which was made upon arrival at hospital. As the visceral damage seemed restorable under VATS, a mini-thoracotomy was positioned just above the rib fracture. ⋯ The rib fixation and bone regeneration were excellent after this procedure. The advantages of this method are the visceral restoration under VATS through a mini-thoracotomy and the ability to perform rib fixation without injuries to the intercostal muscle, artery, vein or nerve. This operative procedure is recommended for intrathoracic visceral damage caused by severely dislocated rib fracture.
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Jpn. J. Thorac. Cardiovasc. Surg. · Jan 1998
[The effect of pump flow on cerebral oxygen metabolism during cardiopulmonary bypass].
We evaluated effects of pump flow on cerebral metabolism using transcranial Doppler (TCD) during cardiopulmonary bypass (CPB) in 22 adult patients undergoing coronary artery bypass grafting. All the patients were anesthetized with high dose fentanyl. The pump flow was controlled with non-pulsatile roller pump at 2.2-2.5 L/min/m2 in group L and 2.7-3.0 L/min/m2 in group H under alpha-stat acid-base regulation. ⋯ Especially, rCMRO2 right after CPB discontinued was increased 1.7 times in L group and 2.0 times in group H as much as that of steady state of CPB. It is suggested that cerebral metabolism should be decreased during cooling to 31 degrees C of pharyngeal temperature, 2.2-2.5 l/min/m2 of pump flow was adequate to keep SjO2 stable. On the other hand, it is necessary to increase pump flow to 2.7-3.0 l/min/m2 during rewarming period as cerebral oxygen metabolic demand becomes greater.
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Jpn. J. Thorac. Cardiovasc. Surg. · Jan 1998
[Blood flow velocity in the ophthalmic artery measured by Doppler ultrasonography during cardiopulmonary bypass--usefulness for cerebral perfusion monitor].
Brain blood flow is supplied from the internal carotid artery, and the ophthalmic artery is the first branch of the internal carotid artery. We studied how blood flow velocity in the ophthalmic artery (OAV) changes during cardiopulmonary bypass (CPB) and investigated whether it can be used to monitor brain blood flow during CPB. In 13 open heart surgeries in adults, OAV and blood flow velocity in the common carotid artery (CAV) were measured with Doppler ultrasonography, and blood flow volume in the brachiocephalic artery (BA flow) was measured simultaneously with an electromagnetic flow meter. ⋯ Our results indicate that OAVmax more accurately reflects changes in pump flow than does CAVmax and BA flow. Because vessel resistance in the ophthalmic artery was small during CPB, OAVmax was thought to be determined mainly by CPB pump flow. OAVmax was useful for monitoring brain blood flow during CPB.