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61.
62.
Yoshie Ochiai Kazuhiro Kurisu Takashi Kajiwara Hiroshi Kumeda Ryuji Tominaga 《The Japanese Journal of Thoracic and Cardiovascular Surgery》2004,52(2):81-83
We describe a case of type B aortic dissection with large ascending aortic aneurysm occurring 12.8 years after aortic root
replacement (Cabrol procedure) in a non-Marfan patient with cystic medial necrosis of the aorta. We have successfully performed
an extended total aortic arch replacement using a four-branched graft through the “L-indsion” approach (a combination of a
left anterior thoracotomy and upper half median sternotomy). Of note, a histological specimen from the aneurysmal ascending
aortic wall revealed “healed aortic dissection” with fibrous tissue replacing the media and intima in addition to multiple
foci of cystic medial necrosis. 相似文献
63.
观察7例慢性哮喘病人胸导管引流治疗前后外周血淋巴细胞内 cAMp/cGMP 值的变化。结果发现,慢性哮喘病人外周血淋巴细胞内 cAMP/cGMP 的值较正常人低(P<0.001);胸导管引流治疗后,哮喘病人外周血淋巴细胞内 cAMP/cGMP 值较治疗前升高(P<0.01)。提示,慢性哮喘病人外周血淋巴细胞功能异常、活性增强,这可能是哮喘发病的重要原因之一。胸导管引流引起的免疫抑制作用,一个重要的机理就是影响淋巴细胞内环核苷酸的代谢,而使淋巴细胞的活性降低,这可能也是胸导管引流治疗慢性哮喘的机理之一。 相似文献
64.
Summary. In recent years the continuity equation has been established as a valuable non-invasive method for calculating aortic valve area. The continuity equation cannot be used if there is calcification or sub-valvular stenosis in the left ventricle-outflow tract, because the area of the outflow trace is not circular in those cases. The authors have tested the value of a non-invasive variant of the Gorlin formula, as an alternative method of identifying severe aortic stenosis. They examined 32 consecutive patients with aortic stenosis with both methods. Seventeen patients had severe stenosis (valve area^0–7 cm2), calculated by the continuity equation. The other 15 patients had moderate stenosis (valve area 0–7–1–0 cm2). Using the non-invasive variant of the Gorlin formula, the authors were able to identify 16 of the 17 cases with severe stenosis, thus showing that the method is useful for identifying severe aortic stenosis. (P<0–001 by x2-test). 相似文献
65.
We studied 100 patients who underwent an isolated aortic valve replacement (AVR) between 1974 and 1991. The patients were divided into the following two groups and compared: group A, which consisted of 40 patients operated on before 1978 who underwent continuous left coronary perfusion with blood; and group B, which consisted of 60 patients operated on after 1979 in whom St. Thomas solution was used in combination with topical cardiac cooling. Moreover, we divided the group B patients into two subgroups: group Bl, who underwent AVR before 1986 during which we administered St. Thomas solution with ice slush every 30 min; and group B2, who had AVR after 1986 in which we used St. Thomas solution with a cold saline (4°C) solution and treated with a small amount of slushed ice every 15 min. The incidence of supraventricular tachycardias was 15% in group A, 50% in group BI, and 15% in group B2. The severity of preoperative New York Heart Association (NYHA) functional class, the type of valve lesions, cardiothoracic ratio, left ventricular function, aortic clamp time, bypass time, and use of drugs did not correlate with the incidence of supraventricular tachycardias in either group A or B. In group B2 patients, we paid a lot of attention to cooling the right atrium as well as the left ventricle by immersing the whole heart using a 4°C saline solution, which led to a remarkable reduction of the incidence of supraventricular tachycardia. This fact indicates that right atrial preservation is one of the most important factors for reducing the incidence of supraventricular tachycardia. 相似文献
66.
目的 总结腔内隔绝术治疗Stanford B型胸主动脉夹层动脉瘤某些特殊情况下近端内漏的治疗方法,比较延伸移植物(cuff)延伸释放法和后撤释放法的价值。方法 2001年以来,stanford B型胸主动脉夹层动脉瘤腔内隔绝术中发生近端内漏6例,分别采用向近端延伸法和后撤法植入cuff封闭内漏。结果 3例采用延伸法,其中1倒采用1枚cuff,1例采用5枚cuff,均完全封闭内漏;1例采用1枚cuff封闭不完全,带漏返回。3例采用后撤法,各用l枚cuff一次性将近端内漏消除。结论 主动脉弓远端或降主动脉近端成角明显时,如腔内隔绝术治疗Stanford B型主动脉夹层动脉瘤术中发生近端内漏,采用后撤法植入cuff是一种效果满意的方法。 相似文献
67.
胸主动脉夹层动脉瘤腔内隔绝术手术入路的探讨 总被引:3,自引:0,他引:3
目的 探讨为胸主动脉夹层动脉瘤(TAD)行腔内隔绝术(EVE)选择合适的导入动脉。方法 以彩超,CTA或MRA为检查手段,评估导入动脉(股动脉、髂总动脉、腹主动脉下段等)的直径大小(≥8mm)、有否硬化斑块、狭窄、是否被夹层累及、有否扭曲及其程度,从而选择具体的手术入路。结果 本组37例TAD行EVE术所选择经股动脉手术入路23例、经髂总动脉手术入路14例。未选择经腹主动脉下段手术入路。即时操作成功率为100%。结论 合理的选择导入动脉作为手术入路,是EVE手术治疗TAD顺利完成的要点。 相似文献
68.
再次液氮冷冻保存对猪主动脉瓣膜细胞活性及组织结构的影响 总被引:1,自引:0,他引:1
目的了解再次冷冻保存对主动脉瓣膜细胞活性及组织结构的影响,探讨液氮冷冻保存的主动脉瓣解冻后再次冷冻保存使用的可行性.方法将猪主动脉瓣叶在抗菌处理后按随机数字表法分成三组,每组6个瓣叶,组Ⅰ作对照,组Ⅱ、组Ⅲ控制降温速率降至-80℃后在液氮中保存,1个月后融化解冻.组Ⅲ解冻并在室温下放置15分钟后更换保存液,再次降温至-80℃后放入液氮中保存,2个月后再融化解冻.采用XTT比色法测定各组瓣膜细胞活性,用免疫荧光组织化学染色、光学显微镜、透射电子显微镜行组织学检测.结果组Ⅱ冷冻保存后瓣膜细胞活性下降到组Ⅰ的63.97%,组织结构一定程度受损;组Ⅲ瓣膜细胞活性下降至组Ⅰ的38.60%,组织结构损害也进一步加重.结论液氮冷冻保存的猪主动脉瓣一经解冻融化,不宜再次冷冻保存使用. 相似文献
69.
Makoto Kamada Kenji Ohsaka Susumu Nagamine Hidemitsu Kakihata 《The Japanese Journal of Thoracic and Cardiovascular Surgery》2003,51(10):552-556
Acute aortic dissection complicated with acute myocardial infarction (AMI) is the most fatal situation. We experienced the
successful treatment for acute type A aortic dissection complicated with inferior AMI following aortic valve replacement (AVR).
A 60-year-old man had had AVR for aortic regurgitation. Sixteen months after the AVR, he had a sudden onset of severe chest
pain with complete atrioventricular block. Immediately, temporary pacing and cardiac catheterization were conducted, showing
the occlusion of the right coronary artery due to acute type A aortic dissection. On his way to our hospital, direct current
shock was conducted 3 times for ventricular fibrillation. We replaced the ascending aorta combined with coronary artery bypass
grafting and the postoperative course was uneventful. The key to treat acute aortic dissection complicated with AMI is early
accurate diagnosis, prompt temporary pacing for bradycardia, defibrillation for lethal arrhythmia and insertion of a perfusion
catheter if possible. These preoperative hemodynamic stabilization gives us the chance to save these patients. 相似文献
70.
Masahito Minakawa Kenji Takahashi Norihiro Kondo Masaharu Hatakeyama Toshihiko Kuga Ikuo Fukuda 《The Japanese Journal of Thoracic and Cardiovascular Surgery》2003,51(11):582-587
Objective: Reoperative coronary bypass grafting is at high risk. Particularly in redo cases where the patent graft is running near
the midline of the sternum, the graft may be exposed to injury by a median sternotomy and subsequent dissection. Whereas,
off-pump bypass grafting from the left axillary artery or descending thoracic artery by a left thoracotomy approach is safe
for preventing graft damage.Methods: From March 1998 to February 2002, we performed off-pump coronary artery bypass grafting by a left thoracotomy approach in
9 patients. The left axillary artery was used as the inflow vessel in 4 cases, and the descending thoracic, aorta in 5.Results: The radial artery was anastomosed proximally to the axillary artery in 4 cases and the descending thoracic aorta in one
case. The saphenous vein graft was anastomosed, proximally to the descending thoracic aorta in 4 cases. Transdiaphragmatic
minimally invasive bypass grafting for the right coronary artery was simultaneously performed in 3 cases. Postoperative cardiac
events were ventricular arrhythmia in 6 cases and supraventricular arrhythmia in 3 cases. There was no damage to the patent
grafts. Postoperative coronary angiography performed, in 8 cases revealed all the grafts to be patent without stenosis. Cardiac
symptoms were not found after the operation in any of the cases.Conclusions: These procedures can prevent the injury to patent grafts caused by a median sternotomy, and will be one of the useful strategies
for reoperative off-pump coronary artery bypass grafting. 相似文献