For the "sandwich technique" via a right ventricular approach to treat post-infarction VSD, the choice of patch size according to VSD size is an important variable for reducing major residual leak.
akayasu's arteritis is a primary, chronic, progressive, vascular inflammatory disease that causes stenosis and/or aneurysmal dilatation of the aorta and aortic arch branches, and in 50-80% of cases the pulmonary arteries as well. 1 However, isolated pulmonary Takayasu's arteritis is very uncommon. We present a case of isolated pulmonary Takayasu's arteritis and describe the successful surgical treatment of this rare condition. Case ReportA 67-year-old woman with a 6-month history of progressive exertional dyspnea was referred in January 2003. Laboratory examination showed an erythrocyte sedimentation rate (ESR) of 36 mm at 1 h and 70 mm at 2 h; C-reactive protein, 0.8 mg/dl; white blood cells, 9,800 / l; platelets, 42×10 4 / l. Rheumatoid factor, antinuclear antibody and Wasserman reaction were all negative. Human leucocyte antigens (HLA) were B52, A24 and DR2.Pulmonary perfusion scintigraphy revealed complete absence of perfusate in the left lung and no defects in the right lung. Magnetic resonance imaging revealed remarkable wall thickness of the pulmonary trunk and proximal right pulmonary artery ( Fig 1A). Magnetic resonance angiography (MRA) demonstrated severe stenosis of the right main pulmonary artery and obstruction of the left main pulmonary artery (Fig 1B). The aortic arch and its primary branches were normal. Cardiac catheterization showed that the systolic pressure of the main pulmonary artery was 85 mmHg and 25 mmHg in the right pulmonary artery, and the arterial pressure gradient was 60 mmHg. There was no stenosis of the coronary arteries and no incompetence of the aortic valves. A diagnosis of Takayasu's arteritis based on the angiographic findings was confirmed by the laboratory, although the inflammatory response was mild.In March 2003, the patient underwent surgical treatment. Exposure was obtained through a median sternotomy and total cardiopulmonary bypass, involving cannulation of the superior and inferior vena cava through the right atrium and of the ascending aorta, was instituted. Inflamed tissues were found in close contact with both the aorta and right pulmonary artery. Under cardioplegic cardiac arrest, the main trunk and bifurcation of the pulmonary artery were Circ J 2005; 69: 500 -502 (Received February 16, 2004; revised manuscript received May 21, 2004; accepted June 2, 2004 CASE REPORTS
The advantage of completely closing the pericardium after a coronary artery bypass grafting is the avoidance of injury of the heart and grafts during a re-operation. However, it would obviously be counterproductive to close the pericardium with a substitute that is predisposed to infection. This study was designed to evaluate the safety of ePTFE surgical membrane in comparison to native pericardium or autologous tissue. Between January 1992 to March 2003, 695 coronary artery bypass graftings were performed. The hearts and grafts were covered with ePTFE surgical membrane (474 cases: ePTFE group), or autologous pericardium and/or other autologous tissue (221 cases: non-ePTFE group). Often, a bilateral dissection of the internal thoracic artery was performed, which lengthened the surgery, the cardiopulmonary bypass, and the aortic clamp, in the ePTFE group. But there was no difference between the ePTFE group (2.1%) and the non-ePTFE group (3.2%) in the development of postoperative mediastinitis. There was also no difference between the two groups in the organism type of the infection. Methicillin resistant Staphylococcus aureus (MRSA) is the most common organism cultured from sternal wound infections; there were five cases in the ePTFE group, and four cases in the non-ePTFE group. In the ePTFE group, the hospital mortality due to postoperative mediastinitis was zero, and there was also no significant difference between the ePTFE group and the non-ePTFE group in time from the drainage operation to discharge; 74.3 days in the ePTFE group, and 81.0 days in the non-ePTFE group. The clinical use of ePTFE surgical membrane for a coronary artery bypass grafting does not appear to be a risk factor for mediastinitis.
Midterm observation of endovascular surgery using a fabric-covered stent graft for thoracic aortic aneurysms is discussed with postoperative follow-up findings based on regularly performed thoracic computed tomography (CT). From 1996 to 1999, 20 patients with thoracic aortic aneurysm underwent stent-graft placement in our hospital. One year follow-up CT results after placement were obtained for 17 patients. The CT scans found that there were both thrombosis and size reduction of aneurysm in 8 patients (46%), thrombosis without size reduction in 2 (13%), a new ulcerlike projection (ULP) in 3 (19%), persistent minor endoleakage in 2 (13%), a new endoleak in 1 (6%), and a recurrent endoleak from intercostal arteries in 1 (6%). The new ULP formation seemed to be a peculiar problem stemming from an intimal injury caused by edges of the stent. Therefore, we recently adopted a new spiral stent instead of the previous stent to avoid the injury. The new endoleak suggested that aneurysmal thrombosis without size reduction could cause the aneurysm to develop recurrent endoleaks. From these findings, we concluded that midterm observation of stent-graft repair for thoracic aortic aneurysms did not give satisfactory results. In order to improve the results of endovascular surgery using stent-grafts, we need to develop safer stent grafts with a reliable design to prevent endoleaks and to avoid intimal injury of the aorta. We also hope to develop effective technologies that can accelerate organization of thrombus in the aortic aneurysm after stent-graft placement.
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