Retrograde Cerebral and Coronary Perfusion for Acute Dissection of Stanford Type A with Destruction of the Right Coronary Ostia

Repair of acute aortic dissection with destruction of the right coronary ostia and aortic valve regurgitation is described. The patient was a 54 year-old female with Marfan syndrome, who was admitted to our hospital for acute dissection with annulo aortic ectasia, accompanied by myocardial ischemia of the inferior wall. Retrograde dissection to the aortic annulus and destruction of the right coronary ostia due to extended dissection were noted. Retrograde coronary infusion through the coronary sinus was conducted during replacement of aortic annulus by the Cabrol method in conjunction with supplementary vein grafting to the right coronary artery. Distal repair was carried out, supported by hypothermic circulatory arrest and retrograde cerebral perfusion through the superior vena caval cannula. Retrograde cerebral and coronary sinus perfusion have been shown to be quite effective for treating patients requiring complex reconstruction of the ascending aorta

Prevention of Limb Ischemia in Surgical Patients by Intra-aortic Balloon Pumping

Intra-aortic balloon pumping (IABP) was recently performed during the perioperative period in seven patients in whom balloon insertion was difficult because of vascular complication. Prophylactic measures for the prevention of limb ischemia were taken when the balloon was inserted. These measures included (1) balloon insertion through the femoral artery and continuous infusion of heparin into the femoral artery in three patients, (2) balloon insertion through the left femoral artery and femoro-femoral arterial crossover bypass in two patients, and (3) balloon insertion through the left common iliac artery and axillo-femoral bypass on the same side in two patients. Most patients recovered satisfactorily without any evidence of ischemia of the limbs either clinically or in serum biochemistry examination. One patient died of prolonged cardiac failure

WPW Syndrome Complicated by Another Cardiac Disorder

During the past 28 months, 16 cases of WPW syndrome were operated on at Hiroshima University Hospital. Two cases were complicated by other cardiac disorders which accelerated tachycardia, making diagnosis difficult. One of these cases showed serious mitral regurgitation, due to infective endocarditis and the patient suffered cardiac failure accompanied by paroxysmal tachycardia not responsive to medical therapy or cardioversion. A complex rhythm with atrial fibrillation and antegrade conduction rhythm through the accessory pathway made diagnosis and therapy quite difficult. The condition of the other patient was associated with myocardial bridging which caused angina pectoris during paroxysmal tachycardia. Myocardial scintigraphy showed myocardial ischemia in the antero-lateral area of the left ventricle. In the former case, mitral valve replacement and interruption of the accessory pathway were undergone simultaneously. In the latter case, myotomy of the muscle on segment 7 was conducted, following interruption of the accessory pathway

Comparative Study of Cerebral Protection during Surgery of Thoracic Aortic Aneurysm

During the past 5 years, 30 cases of thoracic aortic aneurysm were treated. Selective cerebral perfusion (SCP) and retrograde cerebral perfusion (RCP) were conducted for cerebral protection during aortic cross clamping. SCP was carried out in 5 cases of dissecting aneurysm (all Stanford type A, including a case of AAE) and 3 cases of arch aneurysm. RCP was conducted in 5 cases of dissecting aneurysm (4 Stanford type A; 1 Stanford type B with retrograde dissection) and 2 cases of aortic arch aneurysm. The mean cerebral perfusion time of SCP exceeded that of RCP (89 ± 26 min in SCP versus 61 ± 33 min in RCP p < 0.05). The hospital mortality rate was 38 % (SCP) and 29% (RCP). Neurological complications were prolonged unconsciousness (1/8 in SCP, 1/7 in RCP) and transient paralysis (0/8 in SCP, 1/7 in RCP). Although the mechanism for the cerebral protective effect of RCP is unknown, this perfusion method is easy and safe, requiring little time for ascending and/or arch aortic reconstruction