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Maintenance of High Blood Pressure and Early Establishment of Pulsatile Blood Flow to the Spinal Cord during Thoracoabdominal Aortic Repair

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World Journal of Cardiovascular Surgery 2018年第10期8卷 175-188页

作者： Koji Furukawa eisaku nakamura Masanori Nishimura Hirohito Ishii Kunihide nakamura Department of Cardiovascular Surgery Faculty of Medicine University of Miyazaki Miyazaki Japan Department of Cardiovascular Surgery Miyazaki Medical Association Hospital Miyazaki Japan

Objectives: Despite continuous advancements in the surgical treatments for thoracoabdominal aortic aneurysms (TAAA), paraplegia remains a devastating treatment-related complication. We aimed to summarize our experience with a novel surgical strategy involving maintenance of high blood pressure and early establishment of pulsatile blood flow to the spinal cord. Materials and Methods: Between August 2011 and October 2017, 29 patients (age, 67 ± 12 years) underwent open surgery for TAAA. According to the Crawford classification, two aneurysms were type I, eight were type II, 12 were type III, and seven were type IV. We used partial cardiopulmonary bypass under mild hypothermia in all patients except one. By maintaining distal aortic perfusion pressure at 60 - 80 mmHg and creating the distal aortic anastomosis before visceral branch reconstruction, we established early perfusion of the hypogastric arteries with native pulsatile flow. Intraoperative spinal monitoring and cerebrospinal fluid drainage were performed in 26 (90%) and 23 (79%) patients, respectively. Nineteen patients (66%) underwent reconstruction of the intercostal arteries. During perioperative management, the mean arterial pressure was kept >80 mmHg. Results: No in-hospital deaths or acute neurological complications occurred. One patient (3.4%) experienced delayed temporal paraplegia. During follow-up, aorta-related death occurred in only one patient, who developed prosthetic vascular graft infection but did not undergo repeat graft replacement. The 3-year freedom from aortic-related death was 95%. Conclusion: Our surgical strategy involving maintenance of high blood pressure and early establishment of pulsatile flow to the spinal cord was effective in preventing spinal cord injury following open surgery for TAAA.

关键词： Thoracoabdominal Aortic Aneurysm Open Surgery High-Blood-Pressure Maintenance Pulsatile Flow

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Left Ventricular Reconstruction and Mitral Valve Annuloplasty Combined with Papillary Muscle Relocation for Severe Ischemic Mitral Regurgitation

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World Journal of Cardiovascular Surgery 2017年第12期7卷 150-155页

作者： Koji Furukawa Mitsuhiro Yano eisaku nakamura Masakazu Matsuyama Masanori Nishimura Katsuya Kawagoe Kunihide nakamura Department of Cardiovascular Surgery Miyazaki Medical Association Hospital Miyazaki Japan Department of Cardiovascular Surgery Faculty of Medicine University of Miyazaki Miyazaki Japan

A 46-year-old man was referred to our hospital due to severe ischemic mitral regurgitation with severe bileaflet tethering and a dilated left ventricle. We performed left ventricular reconstruction and mitral valve annuloplasty combined with papillary muscle relocation. Although left ventricular continued remodeling occurred during follow-up, left ventricular reconstruction and mitral valve annuloplasty combined with papillary muscle relocation provided durable mitral repair, and his functional status was good. Thus, this combined surgical treatment may reduce mitral regurgitation recurrence after mitral valve annuloplasty.

关键词： Ischemic Mitral Regurgitation Left Ventricular Reconstruction Mitral Valve Annuloplasty Papillary Muscle Relocation

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Supraceliac Aortic Clamping for Repair of Ruptured Abdominal Aortic Aneurysm in Patients with Short Aortic Neck Length

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World Journal of Cardiovascular Surgery 2016年第1期6卷 5-13页

作者： Koji Furukawa Mitsuhiro Yano eisaku nakamura Masakazu Matsuyama Shuhei Sakaguchi Katsuya Kawagoe Kunihide nakamura Department of Cardiovascular Surgery Miyazaki Medical Association Hospital Miyazaki Japan Department of Cardiovascular Surgery University of Miyazaki Miyazaki Japan

Objective: Prompt bleeding control with proximal aortic clamping and subsequent aortic repair are very important for ruptured abdominal aortic aneurysm. However, unsuitable anatomy, such as short aortic neck length, not only disturbs the means to an expeditious repair, but may also increase morbidity and mortality. In the present study, we aimed to evaluate the efficacy of supraceliac aortic clamping for improving surgical outcomes for patients with ruptured abdominal aortic aneurysm, who have a short aortic neck length. Method: Between April 2010 and September 2015, eighteen patients underwent emergent open surgical repair of ruptured abdominal aortic aneurysm. Eight patients with a short aortic neck length underwent supraceliac aortic clamping, and 10 underwent infrarenal aortic clamping. Results: The mean supraceliac aortic clamping time was 30 ± 7 minutes. There was 1 operative death in the infrarenal aortic clamping group due to respiratory failure, and the overall operative mortality was 6%. There were no significant differences between the 2 groups with respect to postoperative complication rates or mortality. Furthermore, there were no significant differences in variables of renal function between the 2 groups, through-out the study period. Conclusion: Supraceliac aortic clamping was associated with minimal mortality and morbidity, but not with harmful effects on postoperative renal function. Thus, supraceliac aortic clamping can be safely applied for ruptured abdominal aortic aneurysm with short aortic neck length.

关键词： Ruptured Abdominal Aortic Aneurysm Short Aortic Neck Length Open Surgical Repair Supraceliac Aortic Clamping

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Right Atrial Blood Cyst Incidentally Detected by Computed Tomography for Metastatic Breast Cancer in an Adult Female Patient: A Case Report

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World Journal of Cardiovascular Surgery 2019年第5期9卷 47-51页

作者： Kazuhiro Higuchi Koji Furukawa eisaku nakamura Eriko nakamura Yujiro Asada Hiroshi Nakada Kunihide nakamura Department of Cardiovascular Surgery University of Miyazaki Hospital Miyazaki Japan Department of Pathology University of Miyazaki Hospital Miyazaki Japan Department of Radiology University of Miyazaki Hospital Miyazaki Japan

Cardiac blood cysts are benign congenital cardiovascular tumors that are rare in adults. A 70-year-old woman who underwent left mastectomy for left breast cancer 9 years ago was referred to our institution for a right atrial mass that measured 35 × 30 mm and was detected incidentally by computed tomography for metastatic breast cancer and transthoracic echocardiography. The mass was attached to the interatrial septum by a stalk. Although it was asymptomatic, surgical resection was performed because of the risk of pulmonary embolism. The mass contained blood, and histopathological findings were suggestive of a blood cyst. We described a rare case of a right atrial blood cyst incidentally found during evaluation for metastatic breast cancer in a woman.

关键词： Blood Cysts Cardiac Tumors Extracorporeal Circulation

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