2つの瘤を形成した冠動脈-肺動脈瘻に対する1手術例

症例は77歳男性.2ヶ月前より夜間の息苦しさと胸の締め付けを感じていた.冠動脈CTを施行したところ主肺動脈前面及び上行大動脈と主肺動脈の間に冠動脈・肺動脈瘻を伴った2個の瘤を認め,右冠動脈#2に90%狭窄を認めた.On pump beating下に瘤を切開し,冠動脈側からの入口部及び肺動脈瘻を閉鎖した.また,右冠動脈の狭窄病変に対して大伏在静脈をグラフトとして用い冠動脈バイパス術を行った.術後経過良好にて退院となった.今回我々は瘤を形成した冠動脈-肺動脈瘻に対して人工心肺下に手術を施行した1手術例を経験したので報告する.We will report on one surgically treated case of coronary-pulmonary artery fistula with two aneurysms. A 77-year-old male suffering from chest pain and respiratory discomfort underwent coronary CT and angiography. Both revealed a fistula between the coronary artery and the pulmonary artery along with two aneurysms. Surgery was performed utilizing the on-pump beating heart technique. We extracted all fistulous vessels and performed a coronary bypass to #3 segment using the great saphenous vein grafting. We believe, that for complete treatment in such a case direct inspection of the internal wall of the aneurysm through incision is necessary, as opposed to simple ligation of the feeding vessel

Successful recovery without any neurological complication after intraoperative cardiopulmonary resuscitation for an extended period of time in the lateral position: a case report

Abstract No successful resuscitation has ever been reported about intraoperative cardiopulmonary resuscitation (CPR) for an extended period of time in the lateral position. Here we report a case of successful resuscitation without any neurological complication after cardiac arrest due to massive hemorrhage and 25 min of CPR in the lateral position. The patient was a 65-year-old man. During open hemostasis for the postoperative hemorrhage, the patient’s rhythm changed sinus to ventricular fibrillation (VF), followed by asystole. We started CPR immediately with the patient in the left lateral position. Chest compression was performed by two practitioners, one pressing patient’s sternum and the other pressing simultaneously patient’s mid-thoracic spine from his back. During CPR, though the value of end-tidal CO2 (EtCO2) was significantly low (around 5–20 mmHg), the value of systolic arterial pressure was kept about 35–50 mmHg, and diastolic pressure about 20–30 mmHg. After the 25 min of lateral CPR, he achieved the return of spontaneous circulation (ROSC). He was hemodynamically stable after ROSC. He regained his consciousness at the next postoperative day. He was discharged from our hospital on the 60th day of operation without any cardiac and neurological complication. Successful neurological outcome suggests that we may expect satisfactory neurological outcome even in the case of lateral position and prolonged CPR if we perform effective CPR with the feedback of arterial blood pressure and EtCO2 and with the immediate intervention to culprit injuries