Search

The determinations of cardiac troponin T provide the highest diagnostic efficiency for the detection of myocardial cell necrosis. To assess perioperative myocardial infarction, serum levels of cardiac troponin T were determined in 14 patients undergoing coronary artery bypass grafting (CABG). The patients were divided into two groups: group I (n = 9), those whose troponin T was less than 1.00 ng/ml on the first postoperative day; group II (n = 5), those whose troponin T was more than 1.00 ng/ml on the first postoperative day. Troponin T levels in group II patients were significantly higher than in group I from the second to the seventh postoperative day. Two patients in group II had specific changes on the electrocardiogram detecting perioperative myocardial infarction as a new Q wave and R wave reduction. These results suggest that troponin T is a valuable marker of perioperative myocardial infarction following CABG.

Coronary artery bypass surgery was performed in 55-year-old male with angina pectoris and Basedow's disease. His thyroid function was controlled in hypothyroid state, in order to avoid thyroid crisis perioperatively. At the start of the extra-corporeal circulation (ECC), values of T4, free-T4, T3 and free-T3 decreased progressively below the lower limits and remained depressed during ECC. The values returned almost to the pre-ECC levels at 2 hours after ECC. However, thereafter a gradual fall was seen up to 3 days after ECC. On the other hand, postoperative concentration of reverse-T3 progressively increased. Perioperative course was uneventful. The patient remains free of angina pectoris with optimal anti-thyroid drug therapy.

A 11-year-old girl diagnosed as having pulmonary atresia with uncommon systemic-pulmonary artery underwent on March 6, 1991. The collateral artery was derived from the left subclavian artery and divided from the descending aorta. Right ventricular outflow reconstruction was performed using a non-valved conduit of the autologous pericardium, and anastomosis of the conduit and pulmonary artery was successfully performed prior to extracorporeal circulation, because of the conduit's flexibility. Thus, we could reduce extracorporeal circulation time. Postoperative course was excellent, and patient is free from the morbidity associated with prosthetic valve. It is considered that a non-valved conduit of the autologous pericardium may be effective, but will require a long term follow-up.

A 14-year-old woman was admitted to our hospital due to heart murmur. Loud systolic murmur at the forth intercostal space was altered its intensity by patient's posture. The chest roentgenogram showed normal cardiovascular silhouette. The electrocardiogram revealed normal sinus rhythm without right bundle branch block. The echocardiography and cineangio-cardiography proved a tumor in the right ventricle. Right heart catheterization showed pressure gradient for 35 mmHg between the right ventricle and the pulmonary artery. At surgery, the tumor was excised with the full thickness of the anterior right ventricular wall. The tumor was cardiac myxoma with 15 g of weight. The patient's postoperative course was uneventful.

We report on a 14-year-old girl with tetralogy of Fallot and the non-confluent main pulmonary artery with the left pulmonary artery after a left Blalock-Taussig shunt. She underwent a left-sided classic Blalock-Taussig shunt at the age of one. However, she showed repeated dyspnea and increasing cyanosis, and cardioangiography showed the non-confluent main pulmonary artery with the left pulmonary artery. Corrective surgery of tetralogy of Fallot was done by a two-staged operation. In the first stage, a EPTFE prosthesis was grafted between the main pulmonary artery and the left pulmonary artery, and in the second stage, intracardiac operation was performed. The late postoperative status and hemodynamic results were satisfactory and we emphasize the rational for this approach.

Long term graft patency after aorto-coronary (A-C) bypass surgery has been reported in the West and the data shows a lower patency rate in saphenous vein grafts (SVG) than internal mammary artery grafts. We studied the long term SVG patency in cases of Japanese patients at our institute, and we have compared our results with those in the West. The subjects, including children, were 211 cases who received A-C bypass surgery using at least one SVG from Jan., 1975 to Sept., 1989. 182 of these cases (examination rate: 86%) received a postoperative angiography one or three months after surgery. The postoperative study took the form of either a selective coronary angiography or a digital subtraction angiography. In 81 cases, using the same two methods, graft patency was reconfirmed from one to eleven years after surgery. Early graft patency including children was 95%. Long term graft patency in the adult cases was 89% from 1 to 2 years (mean: 1.3 years), 94% from 2 to 5 years (mean: 3.2 years), 88% from 6 to 11 years (mean: 7.1 years) following the operation. Six patients died during the post operative follow up period. Two cases were sudden death, one resulted from a reoperation for recurrent angina, two were caused by malignant neoplasm and other was the result of a cerebro-vascular accident. The results correlating the long term graft patency using a SVG and long term mortality were not as negative at our institute as they have been in studies done in the West.

A 17-year-old male with tricuspid atresia who underwent a modified Fontan procedure died due to heart failure 4 years and 6 months after operation. At autopsy a thrombus was found in the right atrial appendage. From the experience, it might be recommended to excise the appendage when the modified Fontan procedure leaving the appendage was employed. In addition, anticoagulation therapy as well as regular echocardiographic examination for detecting thrombus formation should be considered after the operation.

A 72-year-old man with ruptured aneurysms of the sinus of Valsalva and a bicuspid aortic valve was operated. Ruptured aneurysms were found in the noncoronary sinus region, and they were opened to the commissure between the anterior cusp and septal cusp of the tricuspid valve. The tissue around the aneurysm was very weak, so closure of the ruptured hole was carried out from the inside of both aorta and right atrium. Ruptured aneurysm of Valsalva is very rare in a aged patient. In this case, it is considered that the bicuspid aortic valve associated with malformations of the aortic cusp caused a weakness of the sinus wall, and this region gradually became aneurysmal.