Objective: Cerebrovascular atherosclerosis is known to play a crucial role in perioperative stroke in coronary arterial bypass grafting (CABG). This study is to identify the degree of severity of cerebrovascular lesio...Objective: Cerebrovascular atherosclerosis is known to play a crucial role in perioperative stroke in coronary arterial bypass grafting (CABG). This study is to identify the degree of severity of cerebrovascular lesions for which patients can still undergo CABG with an acceptably low risk in current techniques. Methods: Cerebrovascular atherosclerosis was evaluated and graded for 200 consecutive patients prior to CABG. Grading was initially based on the level of stenosis in carotid, vertebral, and cerebral arteries: grade-0: normal or mild stenosis in cerebral arteries or stenosis <50% in other arteries;grade-1: moderate in cerebral arteries or 50% - 69% in others;grade-2: severe in cerebral arteries or 70% - 89% in others;grade-3: occlusion in cerebral arteries or 90% - 100% in others. The grading was finally adjusted to a risk of regional ischemia by considering symptoms, number of lesions, and brain perfusion in scintigram. Therefore, some patients were up-graded. Off-pump CABG was scheduled for all patients. The lowest systolic arterial pressure during surgery was differently controlled in each grade: grade-0: ≥70 mmHg;grade-1: ≥80 mmHg;grade-2: ≥80 mmHg with intra-aortic balloon pump (IABP);grade-3: ≥90 mmHg with IABP;grade-4: ≥90 mmHg with IABP and administration of thyamiral. Results: Grade-1 and -2 included 38 and 29 patients respectively. Grade-3 initially included 36 patients and 14 of them were up-graded to grade-4 (extremely high risk patients). Stroke was seen in one patient (0.5%), for whom mild speaking disturbance occurred on the fifth day from CABG. Conclusion: Patients with severe cerebrovascular atherosclerosis can undergo CABG with a low risk of stroke. Intraoperative management of blood pressure may be critical for stroke prevention in CABG.展开更多
Membranous septal aneurysm (MSA) is a rare anomaly and known to cause ventricular tachycardia and atrioventricular block. However, underlying mechanisms have not been addressed in its long history. We report first 3-D...Membranous septal aneurysm (MSA) is a rare anomaly and known to cause ventricular tachycardia and atrioventricular block. However, underlying mechanisms have not been addressed in its long history. We report first 3-D electro-anatomical mapping of MSA during and three years following the surgery. An elderly patient underwent a surgery for MSA. In the mapping, we located the His bundle near MSA and observed delayed potentials around MSA. Our report showed that electrophysiological character of myocardium was changed around MSA and this change might be a reason for ventricular tachycardia and atrioventricular block. An ordinary surgery for MSA might not resolve this problem since we still observed delayed potentials three years after the surgery.展开更多
文摘Objective: Cerebrovascular atherosclerosis is known to play a crucial role in perioperative stroke in coronary arterial bypass grafting (CABG). This study is to identify the degree of severity of cerebrovascular lesions for which patients can still undergo CABG with an acceptably low risk in current techniques. Methods: Cerebrovascular atherosclerosis was evaluated and graded for 200 consecutive patients prior to CABG. Grading was initially based on the level of stenosis in carotid, vertebral, and cerebral arteries: grade-0: normal or mild stenosis in cerebral arteries or stenosis <50% in other arteries;grade-1: moderate in cerebral arteries or 50% - 69% in others;grade-2: severe in cerebral arteries or 70% - 89% in others;grade-3: occlusion in cerebral arteries or 90% - 100% in others. The grading was finally adjusted to a risk of regional ischemia by considering symptoms, number of lesions, and brain perfusion in scintigram. Therefore, some patients were up-graded. Off-pump CABG was scheduled for all patients. The lowest systolic arterial pressure during surgery was differently controlled in each grade: grade-0: ≥70 mmHg;grade-1: ≥80 mmHg;grade-2: ≥80 mmHg with intra-aortic balloon pump (IABP);grade-3: ≥90 mmHg with IABP;grade-4: ≥90 mmHg with IABP and administration of thyamiral. Results: Grade-1 and -2 included 38 and 29 patients respectively. Grade-3 initially included 36 patients and 14 of them were up-graded to grade-4 (extremely high risk patients). Stroke was seen in one patient (0.5%), for whom mild speaking disturbance occurred on the fifth day from CABG. Conclusion: Patients with severe cerebrovascular atherosclerosis can undergo CABG with a low risk of stroke. Intraoperative management of blood pressure may be critical for stroke prevention in CABG.
文摘Membranous septal aneurysm (MSA) is a rare anomaly and known to cause ventricular tachycardia and atrioventricular block. However, underlying mechanisms have not been addressed in its long history. We report first 3-D electro-anatomical mapping of MSA during and three years following the surgery. An elderly patient underwent a surgery for MSA. In the mapping, we located the His bundle near MSA and observed delayed potentials around MSA. Our report showed that electrophysiological character of myocardium was changed around MSA and this change might be a reason for ventricular tachycardia and atrioventricular block. An ordinary surgery for MSA might not resolve this problem since we still observed delayed potentials three years after the surgery.
