We report our techniques on conducting a closed-circuit femoral-femoral bypass during descending aortic surgery by which collected blood can be easily returned into the right atrium.The main circuit was composed of a centrifugal pump, an artificial membrane lung, and a filter.A reservoir with a roller pump was connected to the main circuit via a filter.Extracorporeal circulation was established by right atrial drainage via the femoral vein and femoral arterial return.On aortic crossclamping, systemic blood pressure was controlled by activating the roller pump in reverse rotation and shifting the body blood into the reservoir temporarily.For a small amount of bleeding after aortotomy, the reservoir blood was returned via the femoral artery by activating the roller pump in normal rotation.When a large amount of bleeding was present making the systemic blood pressure fall, the main circuit was clamped just distal to the centrifugal pump and reservoir blood was directly returned to the right atrium to maintain systemic pressure.Confirming that bleeding was reduced, the clamp distal to the centrifugal pump was gradually released and blood was delivered to both the right atrium and the femoral artery.We believe that our system is a highly beneficial modality.
Abstract Paravalvular leak after mitral valve replacement causes serious symptoms such as heart failure and hemolysis. However, whether re-replacement or direct leak site repair is the appropriate surgical treatment for this condition remains controversial. Herein, we describe a case of paravalvular leak repaired using left atrial appendage tissue with excellent results. The proposed technique enables the repair of a leak at 9 o’clock with healthy full-thickness autologous tissue. For this method, the leak must be located near the left pericardium, and the left atrial appendage must not adhere to the pericardial sac. Although this technique can only be used under specific conditions, it is a useful option for cardiac surgeons.
A 73-year-old male presented with myocardial infarction and cardiogenic shock.Computed tomography revealed massive mural thrombi in the thoracic aorta, infrarenal abdominal aorta, and pulmonary trunk (Fig. 1).The patient had undergone surgery for colon cancer 6 years ago and the etiology might be attributed to paraneoplastic syndrome.www.elsevier.com/locate/ejcts
We had performed indirect revascularization surgery, mainly EMS, for cases with moyamoya disease, because EMS can revascularize a large area including the territory of anterior cerebral artery. However, in our initial cases, we found that three sides in two cases had post-operative ischemic complications. These cases suggested that intracranial hypertension due to pressure exerted by swelling caused by edema in the myoflap after EMS was one of the reasons for these infarctions. For the prevention of intracranial hypertension due to the edema in the myoflap, when we did EDAMS with dural pedicle insertion, we put into practice the new ideas about shaving the boneflaps to half of their original thickness, and prescribed 20% Mannitol after surgery. We tried these new ideas concerning treatment on four sides in three cases with moyamoya disease, and we were able to get good outcomes without any new neurological deficits.
A bipolar radiofrequency clamp is an attractive alternative to the cut-and-sew technique for surgical ablation of atrial fibrillation. We have been using this device for isolating the posterior left atrium. However, there is a risk of disconnection of the ablation lines as well as perforation of the left atrium by the tip of the radiofrequency clamp. Here, we report our simple contrivance to make the procedure more secure and safe.
