Surgical Treatment of Acquired Tricuspid Regurgitation with Carpentier\u27s Ring

Between 1976 and 1982, nine patients underwent tricuspid annuloplasty with use of CARPENTIER\u27s ring for acquired tricuspid regurgitation associated with mitral valvular diseases or ruptured aneurysm of the sinus VALSALVA. Of these, one patient died of low cardiac output and respiratory failure. Postoperative cardiac functions were evaluated on remaining eight patients by physical examinations, findings of roentgenogram and contrast echogram. No postoperative regurgitation of the tricuspid valve was detected by contrast echogram in any of the five patients who received this examination after operation. In six of the eight patients, postoperative physical activity improved to grade I of the classification of NYHA, whereas the improvement was limited to grade II in two other patients in whom some forms of the left side cardiac lesions (e. g. mitral regurgitation) still seemed to remain

Instrumental Perforation of the Esophagus A Case Report and Review of Literature

Thanks to the improvement of the types of the endoscope and the progress of its techniques, the incidence of esophageal perforation has been decreasing recently. It should be pointed out, however, that esophageal perforation is a very serious iatrogenic disease requiring an early diagnosis and an adequate drainage in order to save the lives of patients. A woman at the age of 68 received gastrofiberscopical examination under suspicion of gastric ulcer, but immediately after the inspection, the patient had severe epigastric pain and dyspnea, and in five hours subcutaneous pneumatosis appeared on her neck. Chest X-ray pictures revealed mediastinal pneumatosis in high degree and pneumothorax on the left, and blood gas analysis showed the decrease in PO2 and the rise in PCO2. Since the patient fell into the state of shock, esophagography and esophagoscopy were not performed, but operation was given immediately. Hematoma was found at a site immediately above the diaphragm and on the left posterior wall, and abscess was formed in the mediastinum. We did not suture the injured region, but drinage of the mediastinum and the left thoracic cavity was given. After the operation, tracheostomy was performed, and her respiration was managed with a ventilator, simultaneously placing the nasogastric tube within the stomach to reduce the pressure inside it. In 15 days after operation, food intake was resumed, and in 46 days the patient was discharged in good health. Thus, it is important for esophageal perforation to give drainage as early as possible at a most appropriate position, which will enable us to same the patient in dyspnea and shock in esophageal perforation

Spontaneous regression of mediastinal seminoma

A 27-year-old man was transferred to our hospital with the complaint of facial edema and diagnosis of giant anterior mediastinal tumor. But soon after admission, the size of the tumor decreased remarkably, although he had no particular treatment. As the tumor was not completely regressed, surgical resection was performed subsequently, and examination of the specimen showed small foci of seminoma within the area of dense fibrous scar tissue, originated from the thymus. While regression of germ cell tumors are well recognized in cases of nonseminomatous germ cell tumors, this phenomenon of primary mediastinal seminoma was not reported previously

Effects of Histamine Receptor Blockers and the Rate of Administration of Morphine on Cardiovascular System

Blood pressure reduction during the high dose morphine anesthesia was investigated from the point of view of histamine receptor blockers and the rate of morphine administration. It was found as the results that blood pressure reduction was prevented by the administration of the histamine receptor blockers, and the effect was almost equivalent to that caused by morphine with the rate of infusion at 2 mg/min. Safer anesthesia may be performed in term of blood pressure reduction when H1 and H2 receptor blockers and a slow infusion of morphine with small divided doses are given

Temporary Division of the Superior Vena Cava For Extended Left Atriotomy ; Left-sided Atrioventricular Valve Repair in Corrected Transposition of the Great Arteries

The extended left atriotomy which combines the standard approach with the superior approach by concomitant temporary division of the superior vena cava (SVC) is a safe and useful method in the case of a small atrium. The approach used here is a modification of that which was reported by Selle and Kyger. This technique made it possible to sufficiently expose the laterally situated small left atrium in the case of corrected transposition of the great arteries (cTGA) which requires repair of the left-sided atrioventricular valve (tricuspid valve). In recent mitral surgery, median sternotomy is used with cannulation of the ascending aorta and both venae cavae to establish cardiopulmonary bypass. Although there are some approaches for left atriotomy, the standard procedure is to use vertical left atriotomy immediately posterior and parallel to interatrial sulcus. And in the case of combined mitral with tricuspid valve surgery, a right atriotomy with incision of interatrial septum has been employed to allow excellent exposure of the left atrium and mitral and tricuspid valve including subvalvular supporting structures. Surgical exposure of the mitral valve is often difficult by the conventional approach, especially in the patient with a small left atrium and a deep chest. In the case of cTGA too, sufficient exposure of the left atrium can not be obtained under median sternotomy on accout of anatomical abnormality. We performed prosthetic valve implantaion to the left-sided atrioventricular valve which is tricuspid valve in structure in the case of cTGA by means of new approach with the incision of the lateral to superior wall of the left atrium combined with division of the SVC temporarily. This technique was introduced by Selle 1) in a recent article