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žçŽ 代è¬ã®é¢ã§æããã«ããããDuring off-pump beating heart surgery, myocardial injury due to normothermic myocardial ischemia is concerned. The present study was performed to examine the effect of transient myocardial ischemia in an experimental model of coronary artery occlusion. In dogs, myocardial tissue oxygen saturation and hemoglobin plus myoglobin concentration were measured using near-infrared spectroscopy. Left ventricular function was measured by a conductance catheter and a tip-transducer in the left ventricle. Left ventricular function was assessed by left ventricular pressure-volume loops. Dogs were divided into two groups. In group 1, the left anterior descending coronary artery was occluded for 30 minutes and then was reperfused for 3 hours. In group 2, dogs received ischemic preconditioning by 3 episodes of 5-minute ischemia and subsequent 5-minute reperfusion and then received a 30-minute iechemia and 3-hour reperfusion. Myocardial tissue oxygen saturation was decreased by coronary occlusion and was increased by reperfusion. In group 2, myocardial tissue oxygen saturation was increased at the second and third reperfusion than that at the first reperfusion. Myocardial tissue oxygen saturation during 30-minute ischemia was increased than that at the first coronary occlusion. This phenomenon was recognized as so-called ischemic preconditioning. During 30-minute ischemia, left ventricular end-systolic and end-diastolic volumes were increased and stroke work was decreased. During 3-hour reperfusion, those parameters of the ventricular function were restored quickly in group 2 compared with group 1. Maximal systolic elastance of the left ventricle at 3-hour reperfusion was higher in group 2 than group 1.Measurement of myocardial oxygen saturation enable us to assess myocardial oxygen metabolism at coronary occlusion. The effect of ischemia preconditioning by transient myocardial ischemia and reperfusion was determined using near-infrared spectroscopy and left ventricular function.ç 究課é¡/é åçªå·:09671370, ç 究æé(幎床):1997 â 1998åºå
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Coronary artery bypass surgery with arterial grafts in familial hypercholesterolemia
AbstractObjective: Familial hypercholesterolemia is a dominantly inherited disorder caused by mutations at the locus for the low-density lipoprotein receptor and is frequently associated with premature coronary artery disease. This study was performed to determine whether arterial grafting was associated with long-term benefits for patients with familial hypercholesterolemia. Methods: During the past 18 years, 101 patients with heterozygous familial hypercholesterolemia underwent primary coronary artery bypass grafting, with one hospital death. Group 1 patients (n = 31) received only saphenous vein grafts. Group 2A patients (n = 47) received one internal thoracic artery graft and supplemental vein grafts, and group 2B patients (n = 23) had multiple arterial grafts. After operation, all patients received diet therapy and intensive cholesterol-lowering drug therapy. Thirteen patients received low-density lipoprotein apheresis. Results: During a mean follow-up period of 95 months, 8 patients died, 9 underwent reoperation, and 12 received catheter intervention. The overall survival was 82% (95% confidence limits, 65%-97%) at 18 years after operation. The survival in group 2 was higher than that found in group 1 (P = .01). The overall freedom from major cardiac events (myocardial infarction, cardiac death, reoperation, and catheter intervention) was 57% (95% confidence limits, 40%-74%) at 16 years after operation. The freedom from reoperation in group 2 was higher than that found in group 1 (P = .03). There was no difference in the survival or freedom from major cardiac events between groups 2A and 2B. Conclusion: Arterial grafting improved the long-term freedom from reoperation in patients with familial hypercholesterolemia. Additional benefit of multiple arterial grafting could not be identified. (J Thorac Cardiovasc Surg 2000;119:1008-14
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Electrocardiographic gated 99mTc-MIBI SPECT for functional assessment of patients after coronary artery bypass surgery: Comparison of wall thickening and wall motion analysis
é沢倧åŠå€§åŠé¢å»åŠç³»ç 究ç§Abnormal septal motion after coronary artery bypass graft surgery (CABG) is a common finding. This study was undertaken to investigate the change in various global and regional ventricular function parameters measured by gated myocardial perfusion SPECT after surgery and to determine which quantitative parameter of WT and WM is more appropriate for the evaluation of regional cardiac function, especially in the septum of patients with CABG. Methods: Before and 3 to 5 wk after CABG (all patients underwent at least 1 bypass grafting to the left anterior descending coronary artery), 35 patients (28 men, 7 women) underwent gated SPECT using 99mTc-methoxyisobutylisonitrile. Quantitative global and regional ventricular functional analysis was performed using quantitative gated SPECT software. Results: Global ejection fraction did not change (59.3% ± 16.0% to 60.5% ± 14.5%, P = 0.24). However, end-diastolic and end-systolic volumes lessened significantly after CABG (81.4 ± 37.3 mL to 68.9 ± 28.9 mL, P < 0.0001, and 38.1 ± 33.1 mL to 30.4 ± 23.0 mL, P < 0.005, respectively). As global function parameters, the changes in both total WM (r = 0.88) and WT (r = 0.86) correlated well with the change in ejection fraction after surgery. Segmental analysis showed a significant postoperative increase in relative tracer uptake in the anterior, anteroseptal, inferoseptal, and inferior walls and in the apex. Segmental wall motion (WM) deteriorated in the anteroseptal, inferoseptal, and mid anterior walls. On the other hand, anterolateral, inferolateral, and inferior WM increased. As a whole, these WM changes showed a reduction in septal motion associated with a concomitant increase in lateral motion after surgery. Segmental wall thickening, however, did not decrease in septal areas and did not increase in the lateral wall and correlated with percentage tracer uptake (r = 0.69) better than WM did (r = 0.30) after CABG. Conclusion: In patients with CABG, postoperative WM analysis by gated SPECT underestimated septal motion and overestimated lateral motion because of exaggerated systolic anteromedial cardiac translation. Therefore, wall thickening analysis would be recommended for the evaluation of postoperative cardiac functio
PDA Banding ã«ããæåœãããé«èºè¡æµè€éå¿å¥åœ¢ã®1äŸ
A patient with complex cardiac anomalies who developed severe respiratory insufficiency due to high pulmonary blood flow from a giant PDA was treated successfully by PDA banding. PDA-dependent heart disease causes a reduction in pulmonary blood flow in many patients and is often treated by palliative shunt operation. Although the present patient had PDA-dependent heart disease, heart failure occurred due to increased pulmonary blood flow through PDA and required surgical treatment. We performed PDA banding, because it is technically simple and allows adjustment of the postoperative pulmonary blood flow according to the degree of constriction. The degree of constriction was determined according to the PaO2 value. SO2 levels of 60-70% have been used as an index of the extent of banding, but PaO2 is considered to be equally appropriate
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é沢倧åŠå»è¬ä¿å¥ç 究åå»åŠç³»A new vein holder for a side-to-side anastomosis between a vein graft and the coronary artery is described. The holder is consisted of two nerve hooks, and those distance is adjusted. The technique for creating the diamond anastomosis is also described
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