During past 4 years, 15 patients over 50 years of age with secundum atrial septal defect underwent surgery in our hospital. The ages ranged from 50 to 70 years with a mean of 59.7 years. Before operation, 8 were in functional class II, 7 in class III (New York Heart Associasion classification). Thirteen patients had pulmonary hypertension, 8 had right-to-left shunt and 6 had atrial fibrillation. Pulmonary function test showed decreased %VC and FEV_1.0% with a mean of 74% and 65%, respectively. Cardiothoracic ratio ranged from 48 to 77 with a meam of 60%. Preoperative laboratory data showed significant inverse correlations between CTR and %VC and between pulmonary arterial pressure and %VC. The defects were closed directly in 6 patients and closed using patches in 9. All patients survived the operation. Postoperatively, antithrombotic agents were administered to the patients with patch closure. After operation, all but one improved to functional class I and no patients had embolic episode.

The purpose of this study is to clarify the effects and limitation of high-dose therapy with dopamine (DOP) and dobutamine (DOB) for the patients with severe low cardiac output syndrome (LOS) after coronary artery bypass grafting (CABG). Among the patients who underwent CABG in Sendai Tokusyukai Hospital between 1986 and 1991, two groups were selected: More than 20μg/kg/min of both DOP and DOB were administered within 48 hours after CABG in “high-dose group” patients (n=6); Less than 5μg/kg/min of DOP and DOB were administered in the same period in “low-dose group” patients (n=9). All patients in the high-dose group had episodes of acute myocardial infarction in the pre- or intra-operative period. The operative mortality rate of this group was 34% (2/6). Significant stenoses of the left main trunk were observed preoperatively in both dead cases. The postoperative changes of cardiac index, heart rate, serum CPK-MB, dose of lidocaine given, urine output, total peripheral resistance and incidence of cardiac arrhythmia within 48 hours after CABG were compared between the two groups. There were no significant differences in all parameters except cardiac index, heart rate and total dose of lidocaine. However the maximal value of the mean heart rate in high-dose group was less than 120beats/min and lidocaine was effective in all patients with premature ventricular contraction. We conclude that high-dose therapy with DOP and DOB is useful for the selected patients with severe LOS after CABG when side effects caused by these drugs are carefully managed.

During past 7 years, 43 patients less than 2 years of age underwent closure of the ventricular septal defect. Durations of postoperative use of a respirator were 3 days or less in 30 patients (short-period group) and over 3 days in remaining 13 patients (long-period group). There was no operative death. Pre-, intra- and postoperative factors affecting prolonged respiratory care were analyzed between two groups. Results were as follows: There were statistically significant differences between short- and long-period groups on age (9.7 versus 6.5 months), body weight (6.3 versus 5.2kg) at surgery, necessity of preoperative respiratory care on respirator (0/30 versus 4/13), duration of cardiopulmonary bypass (108 versus 132min.), aortic clamp time (56 versus 70min.) and respiratory index at the first postoperative day (1.1 versus 1.7). These results revealed the necessity of far earlier surgical intervention in symptomatic patients before respiratory distress develops. Furthermore, shorter cardiopulmonary bypass and aortic clamp times should always be in mind for attaining smooth postoperative course.

In the past 13 years, 17 patients underwent reoperation after intracardiac repair, including reconstruction of the right ventricular outflow tract. Primary diagnoses of the cardic anomalies were tetralogy of Fallot (TOF) (8 patients), extreme type (TOF) (4 patients), TOF with absent pulmonary valve (1 patient), double outlet right ventricle (DORV) (2 patients), truncus arteriosus (1 patient) and transposition of the great arteries (TGA) (1 patient). Patients were divided into 4 groups based on the surgical procedures for reconstruction of the right ventricular outflow tract as follows: Group A, porcine valved conduit; Group B, autologous pericardial valve bearing tube graft; Group C, transannular patch; Group D, outflow patch with pulmomary valvotomy. The main reason for reoperation in groups A and B was pulmonary stenosis due to calcification of the porcine valve or shrinkage of the pericardial tube graft. Average periods between corrective surgery and reoperation were 7 and 13 years in groups A and B, respectively. Reoperation was performed for massive tricuspid regurgitation and residual shunt, 15 and 24 years after previous operations in groups C and D, respectively. Low cardiac output syndrome, proconged right heart and respiratory failure were major postoperative complications in groups A, B and C. Furthermore, one patient in group A and one other in group C died in the long-term period after reoperation. Both patients had had markedly dilated hearts associated with frequent PVCs. In conclusion, earlier reoperation for progressive and/or residual lesions should be performed to obtain better surgical outcome and quality of life of the patients.

We evaluated the efficacy of combined antegrade and retrograde intermittent cold cardioplegia for patients with prolonged aortic cross-clamping. Thirty patients with cross-clamping time of more than 4h were divided into three groups according to the method of cardioplegia. Antegrade crystalloid cardioplegia was performed in 9 cases, combined antegrade and retrograde crystalloid cardioplegia was performed in 5 cases, and combined antegrade and retrograde cold blood cardioplegia was performed in 16 cases. There was no statistical difference in mean aortic cross-clamping time among the three groups. The hospital mortality was 33% in the antegrade crystalloid group, 20% in the combined crystalloid group, and 0% in the combined blood group. There was a significant statistical difference in the hospital mortality between the antegrade crystalloid and combined blood group. The incidence of low cardiac output syndrome (LOS) was 67% in the antegrade crystalloid group, 20% in the combined crystalloid group, and 6% in the combined blood group. There was a significant difference in the incidence of LOS between antegrade crystalloid and combined blood groups. The recovery rate of spontaneous rhythm after the release of the cross-clamp was also significantly greater in the combined blood group than in the antegrade crystalloid group. In conclusion, combined antegrade and retrograde intermittent cold cardioplegia provides excellent myocardial protection for patients with prolonged aortic cross-clamping.

Lecithinized superoxide dismutase (L-SOD) has a higher affinity for cell membranes than recombinant human superoxide dismutase has. The purpose of this study, is to evaluate the protective effects of L-SOD against ischemia/reperfusion injury in blood-perfused isolated rat heart subjected to 30-min global normothermic ischemia. Fifteen isolated hearts were divided into three groups: group I (n=5), the untreated control group, group II (n=5) received 3, 000 units of L-SOD administered into the perfusion circuit at the beginning of reperfusion, and group III (n=5) received 3, 000 units of L-SOD administered into the perfusion circuit 10min after reperfusion. Left ventricular developed pressure, maximum positive and negative dp/dt, coronary vascular resistance and myocardial water content were assessed in each group. The percent recovery of left ventricular developed pressure in group II was significantly higher than that in group I and group III (77.4±11.1% in group II, 38.2±4.4% in group I, 40.2±4.1% in group III, p<0.01). The percent recovery of maximum positive dp/dt in group II was significantly higher than that in group I and group III (70.0±11.2% in group II, 41.8±7.8% in group I, 38.0±5.7% in group III, p<0.01). The percent recovery of maximum negative dp/dt in group II was also significantly higher than that in group I and group III (74.9±11.0% in group II, 41.3±8.0% in group I, 46.3±5.9% in group III, p<0.01).There was no significant difference of coronary vascular resistance or myocardial water content among the three groups. These results suggest that L-SOD administered at the time of reperfusion has protective effects against ischemia/reperfusion injury in the isolated rat heart.

An extremely rare case of true brachial arterial aneurysm due to blunt trauma is reported. A 55-year-old male suffered from blunt trauma in his right upper arm when he was 8 years old. He had noticed a mass in his right upper arm for more than 30 years, however, it grew rapidly to 7×6×5cm within several months. Digital subtraction angiography revealed a large saccular aneurysm of the right brachial artery. The aneurysm was removed and replaced by a saphenous vein graft.