Thirty-four patients with congenital cardiac disease were studied to evaluated the role of ultrafiltration after cardiopulmonary bypass without homologous blood transfusion. We used either polypropylene microporous hollow fiber hemoconcentrator (HC-30M or 100M) or polyacrylonitrile microporous hollow fiber hemoconcentrator (PHC-500). Ultrafiltration was useful in the reduction of fluid overloading after cardiopulmonary bypass with extreme hemodilution. Thirty-two patients tolerated the procedure uneventfully without donor blood transfusion and were discharged from the hospital. The values of hematocrit, serum protein and free hemoglobin increased significantly after ultrafiltration with either type of hemoconcentrator. However the degree of concentration of blood components was significantly higher with polyacrylonitrile hemoconcentrator than those with polypropylene hemoconcentrator. These results indicated that ultrafiltration was useful for maintaining water balance after cardiopulmonary bypass without homologous blood transfusion in pediatric cardiac surgery and that polyacrylonitrile microporous hollow fiber hemoconcentrator should be employed in patients with shorter bypass time and less hemolysis.

An 80-year-old man was transferred to our hospital because of blunt traumatic aortic arch injury caused by a fall. Computed tomography (CT) revealed a pseudoaneurysm and mediastinal hematoma around the aortic arch, right hemothorax, left hemopneumothorax, lung contusion and spine fractures. His hemodynamic condition was stable but he required mechanical ventilation because of severe hypoxemia. Surgery was postponed until twelve days after the injury, when his lung function improved and active bleeding decreased. During surgery we found that the intimal disruption extended to half of the circumference of the aortic arch, and thus performed total arch replacement under deep hypothermic circulatory arrest and selective cerebral perfusion. The patient suffered respiratory failure and pneumonia postoperatively as well as multiple cerebral infarctions. He was referred to a rehabilitation center on postoperative day 130.

Transcatheter embolization of 25 aortopulmonary collateral arteries (7 bronchial arteries and 18 intercostal arteries) was attempted prior to intracardiac repair in 7 patients. The underlying disease was tetralogy of Fallot in 3 patients, pulmonary atresia with ventricular septal defect in 2, double-outlet right ventricle with ventricular septal defect and pulmonary stenosis in 1 and tricuspid stenosis with pulmonary atresia in 1. The intervals between embolization and intracardiac repair ranged from 0 to 17 days (mean 4.5 days). Embolization resulted in total occlusion in 7 bronchial arteries and 17 intercostal arteries, with an overall success rate of 96%. Complications included a coil dislodgement from a collateral artery into the aorta in one patient, necessitating surgical removal of the dislodged coil from the femoral artery, an exacerbation of cyanosis and dyspnea on exercise in 5, and slight fever in 2. In one patient with tetralogy of Fallot, who had 5 collateral vessels, transcatheter embolization caused hypoxemia, bradycardia and hypotension and therefore intracardiac repair was performed immediately after embolization. Aortopulmonary collateral arteries in patients with congenital heart disease can be effectively treated by transcatheter embolization. Embolization should be performed just before intracardiac repair because an excessive decrease in arterial oxygen saturation after embolization may require an emergency operation.

Background: In abdominal aortic aneurysm (AAA) repair, European and the United States' guidelines recommend performing proximal anastomosis as close to the renal arteries as possible. A long infrarenal residual aorta (IRA) raises concern about the risk of enlargement and aneurysmal formation in the future. There are no descriptions of proximal anastomosis in Japanese guidelines. Objective: To investigate the relationship between the length of the IRA and its long-term enlargement. Subjects: 100 patients who underwent open repair for AAA at our hospital between June 2002 and November 2016 were included. The mean age was 70.2±8.2 (SD) years, and the mean observation period was 8.5±3.3 years. Group S (n=24) consisted of patients whose IRAs were less than 2 cm in length, and Group L (n=76) consisted of patients whose IRAs were more than 2 cm in length. The preoperative diameter of the infrarenal aorta and the length and diameter of IRA in the immediately after surgery, in the early postoperative period (within 1 year), in the mid-term (2 to 9 years), and in the remote period (after 10 years) were measured. Results: There was no significant change in IRA diameter between preoperative and immediate postoperative periods. The preoperative diameter of the infrarenal aorta were 23.0 [21.0-26.0] mm in group S and 22.0 [20.0-24.5] mm in group L. There was no significant difference of the preoperative IRA diameter between the two groups. The IRA diameters in the postoperative period and thereafter were 22.0 [20.0-26.0] mm, 23.0 [21.0-27.0] mm, 24.0 [22.0-28.0] mm, 26.0 [23.3-32.8] mm in group L, showing a significant dilatation immediately after operation (p<0.01). In addition, although there was no statistically significant difference, the group with a preoperative infrarenal aorta diameter of 26 mm or greater showed a larger dilatation after the midterm postoperative period. Conclusions: An association was found between IRA length (≥2 cm) and postoperative IRA dilatation.