| Japanese |
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| Title | 胸骨切開直後に突然の低血圧を来たしたBentall手術予定患者 |
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| Subtitle | 症例 |
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| Authors | 小高光晴*, 野村実*, 内田桂子*, 近藤泉*, 松本克平*, 白井希明*, 鈴木英弘*, 川添太郎** |
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| Authors(kana) | |
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| Organization | *東京女子医科大学麻酔学教室, **埼玉医科大学総合医療センター麻酔学教室 |
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| Journal | 循環制御 |
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| Volume | 14 |
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| Number | 4 |
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| Page | 555-558 |
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| Year/Month | 1993/ |
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| Article | 報告 |
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| Publisher | 日本循環制御医学会 |
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| Abstract | 今回我々は, 胸骨切開直後に突然の低血圧を来たし, 大腿動静脈を用い緊急で人工心肺を開始したBentall手術予定患者を経験したので若干の文献的考察を加えて報告する. 「症例」23才の女性. 現病歴として平成4年8月頃より心不全症状出現したため近医を受診し, ジギタリス, 利尿剤等の投薬を受け, 一時症状が改善した. しかし, 1週間後再び症状が増悪したため10月29日当院受診し心不全の診断にて12月11日緊急入院となった. 平成4年5月まではNYHA I度であったが8月以降はII度, 以降1ヶ月ずつでIIIからIV度へと症状が急激に悪化した. 既往歴として12才時側弯症手術をうける. 術後C型肝炎を併発した. 身体学的所見；身長156センチ, 体重44キロで以下に述べる徴候を呈していた. 漏斗胸(grade III), 側弯症, 細長い手指(手指間172センチ), 扁平足, 左眼緑内障性変化, 右眼水晶体亜脱臼, 側弯症, wrist sign(＋) thumb sign(＋), metacarpral index＝9.2. 以上よりマルファン症候群と診断された. |
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| Practice | 基礎医学・関連科学 |
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| Keywords | AAE, Bentall, Marfan's syndrome |
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| English |
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| Title | The anesthetic experience of a patient with funnel chest scheduled for Bentall operation following severe hypotension during sternotomy. |
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| Subtitle | |
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| Authors | Mitsuharu Kodaka*, Minoru Nomura*, Keiko Uchida*, Izumi Kondo*, Kappei Matsumoto*, Kimei Shirai*, Hidehiro Suzuki*, Taro Kawazoe** |
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| Authors(kana) | |
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| Organization | *Department of Anesthesiology,Tokyo Women's Medical College, **Department of Anesthesiology,Saitama Medical School |
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| Journal | Circulation Control |
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| Volume | 14 |
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| Number | 4 |
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| Page | 555-558 |
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| Year/Month | 1993/ |
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| Article | Report |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | We reported a case of 23-year-old woman with annulo-aortic ectasia (AAE) due to Marfan's syndrome and funnel chest who was scheduled for Bentall operation and she suddenly failed to extreme hypotension during sternotomy and emergency cardio-pulmonary bypass (CPB) was performed with femoral artery and vein cannulation. The cardiovasucular catheter data revealed Left Venticular Ejection Fraction 24%, Cental Venous Pressure (CVP) 18mmHg, Plumonary Artery Wedge Pressure 31mmHg and Cardiac Index 1.72l/min/m2 and diameters of aortic ring were 63x83mm. Weaning from CPB was easy with low dose catecholamine and postoperatively her vital signs were stable and she recovered well without no damage. In our institution patients with AAE and AR are in state of NYHA I or II. The case with NYHA IV were very rare. Consequently sternotomy caused further elevation of CVP and decrease of venous return which result in marked hypotension. Therefore before sternotomy we should try to decrease CVP, using valodelater and Fowler position, and start femoral artery and vein bypass to support cardiac function. |
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| Practice | Basic medicine |
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| Keywords | AAE, Bentall, Marfan's syndrome |
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