Hirokuni Naganuma

The Jikei University School of Medicine, Edo, Tōkyō, Japan

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Publications (15)11.02 Total impact

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    ABSTRACT: A patient with multiple leaks caused by active mitral prosthetic valve endocarditis with an annular abscess underwent repeat mitral valve replacement. To secure the new mitral prosthesis, sutures were placed through the healthy interatrial septal wall from right to left at the posteromedial region and then to the new prosthetic valve sewing cuff. In the anterolateral region, sutures were placed through the reconstructed annulus after debridement of the abscess and then reinforced with a pericardial xenograft patch. Postoperatively, the perivalvular leakage stopped and the patient recovered uneventfully.
    General Thoracic and Cardiovascular Surgery 06/2012; DOI:10.1007/s11748-012-0096-1
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    ABSTRACT: Chronic disseminated intravascular coagulation (DIC) complicates 5.7% of thoracic aortic aneurysm. DIC with thoracic aortic aneurysm is characterized by hyperfibrinolysis, but usually shows a stable condition in a state of compensated non-overt DIC with limited hemorrhagic symptoms. However, in some cases, hemorrhage caused by external factors may induce uncompensated overt DIC and lead to serious hemorrhagic tendencies. In the present study, we report a patient with a thoracic aortic aneurysm complicated by DIC who exhibited marked hemorrhagic tendencies. DIC remarkably improved following administration of recombinant human soluble thrombomodulin.
    01/2012; 41(3):148-151. DOI:10.4326/jjcvs.41.148
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    ABSTRACT: Cylothorax is one of a hazardous complication after thoracic aorta replacement. In this paper, we report effectiveness of octreotide acetate for postoperative persistent cylothorax. A 59-year-old female was referred to our hospital for chest pain. Previously she underwent arch reconstruction following aortic root replacement due to aortic dissection. Computed tomography (CT) revealed acute dissection on dissected descending aorta. Urgent descending aorta replacement was performed. After surgery, massive chylothoracic pleural fluid was drainaged. Although conventional medical treatment was not effective, drainage of chylothoracic pleural fluid significantly decreased after administration of octreotide acetate. Although mechanism has not been fully investigated, octreotide acetate was effective for persistent cylothorax after descending aorta replacement.
    Kyobu geka. The Japanese journal of thoracic surgery 12/2010; 63(13):1124-7.
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    ABSTRACT: The objective of this study was to reassess the validity of defining patient-prosthesis mismatch (PPM) in the aortic position on the basis of an indexed effective orifice area (iEOA) less than 0.85 cm(2)/m(2). From June 1996 to March 2008, 342 patients underwent aortic valve replacement with a Carpentier-Edwards Perimount valve. From the data collected, the transvalvular pressure gradient was determined by the modified Bernoulli equation, and EOA was calculated from the standard continuity equation. The actuarial survival rate at 10 years after surgery was 84.0% +/- 8.2%. The prevalence of PPM was 6.1% when a projected iEOA less than 0.85 cm(2)/m(2) was defined as indicating significant PPM. There was no difference between patients with moderate PPM (85.2% +/- 9.8%) and patients without PPM (81.0% +/- 8.7%; p = 0.44). The relation between mean transvalvular pressure gradient and iEOA demonstrated a gentler slope than that reported previously. Postoperative mean transvalvular pressure gradient was 17.4 +/- 5.6 mm Hg and 14.5 +/- 5.6 mm Hg in patients with an iEOA less than 0.85 and 0.85 or greater, respectively. Most patients had a postoperative mean transvalvular pressure gradient more than 10 mm Hg regardless of PPM. Our analysis suggested that an iEOA less than 2.0 cm(2)/m(2) might be the threshold for PPM, which should not be passed to achieve a low mean transvalvular pressure gradient (less than 10 mm Hg) with the Carpentier-Edwards Perimount valve. The implications of these findings include the necessity for reassessing the hemodynamic performance of each type of prosthesis when attempting to define PPM, to avoid residual significant transvalvular pressure gradient.
    The Annals of thoracic surgery 06/2010; 89(6):1951-5. DOI:10.1016/j.athoracsur.2010.03.011 · 3.65 Impact Factor
  • 01/2010; 39(6):335-338. DOI:10.4326/jjcvs.39.335
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    ABSTRACT: This study was performed to identify risk factors for hospital death in patients with acute and active infective endocarditis (AAIE) after surgical intervention. From 1980 to 2004, 94 patients underwent surgery for AAIE (age range, 3-77 years; 76% males). Congestive heart failure (CHF) was present in 44 patients, as well as vegetations in 64, septicemia in 16, abscesses in 17, and emboli in 22; 16 patients had prosthetic valve endocarditis. Streptococci were the most common bacteria (34 patients), followed by staphylococci (17 patients). Mechanical valves were selected for 73 patients and bioprosthetic valves for 16. Mitral valve plasty was performed in 4 patients. Aortic root or aorto-mitral discontinuity was repaired in 17 patients, including Manouguian's double valve replacement in 6 and aortic root replacement in 4. Overall hospital mortality was 15% (14 patients). Univariate analysis identified CHF (p=0.016), abscess (p=0.014), and prosthetic valve endocarditis (p=0.043) as risk factors. However, multivariate analysis only identified CHF (p=0.019) as an independent risk factor. In AAIE, early surgical intervention is advisable before the occurrence of complications such as root abscess and CHF, particularly before the onset of CHF.
    Circulation Journal 01/2009; 72(12):2062-8. · 3.69 Impact Factor
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    ABSTRACT: A 69-year-old woman was admitted to our hospital with heart failure. Echocardiography demonstrated severe mitral valve regurgitation due to chordae rupture of the posterior mitral leaflet. Although she was intubated and ventilation was initiated, her condition did not improve. On the 17th hospital day, she was scheduled to undergo mitral valve plasty. After induction of anesthesia, massive bleeding occurred from the tracheal granuloma (diameter, 3 cm), which had developed at the tip of the tracheal tube, and the airway was obstructed. Emergency percutaneous cardiopulmonary support (PCPS) was then introduced. Thereafter, endoscopic hemostasis was performed, followed by the excision of the granulation tissue using a gastric fiberscope. After excising the tissue, the patient could be ventilated; therefore, she was weaned from PCPS. The maximum PCPS flow was 4.0 l/min, and it was conducted for a 210-minutes duration. Her respiratory condition improved, and she was weaned from the ventilator 3 days after surgery. Mitral valve plasty was performed 55 days after the first operation, and she was discharged from the hospital in good health.
    Kyobu geka. The Japanese journal of thoracic surgery 01/2009; 61(13):1092-5.
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    ABSTRACT: We report re-do aortic valve and ascending aorta replacements by using the valve-on-valve technique for primary tissue failure of a Freestyle bioprosthesis. A 74-year-old male, who had had a 25 mm Freestyle bioprosthetic valve implanted by the sub-coronary method 5 years previously for aortic valve regurgitation due to congenital bicuspid valve, was referred to our hospital for dyspnea and palpitation. He presented with heart failure secondary to aortic regurgitation due to primary tissue failure, and computed tomography demonstrated an enlarged ascending aorta (5 cm in diameter). The operative findings revealed that the Freestyle bioprosthetic valve had a leaflet tear at the left coronary cusp. We replaced the degenerated Freestyle bioprosthesis with a 19 mm Mosaic aortic bioprosthesis by using the valve-on-valve technique, and ascending aorta replacement was performed simultaneously. This technique can be useful for re-do surgery for degenerated stentless valves to avoid potential risks of complete excision of the bioprosthesis.
    Kyobu geka. The Japanese journal of thoracic surgery 08/2008; 61(7):545-8.
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    ABSTRACT: Background This study was performed to identify risk factors for hospital death in patients with acute and active infective endocarditis (AAIE) after surgical intervention. Methods and Results From 1980 to 2004, 94 patients underwent surgery for AAIE (age range, 3-77 years; 76% males). Congestive heart failure (CHF) was present in 44 patients, as well as vegetations in 64, septicemia in 16, abscesses in 17, and emboli in 22; 16 patients had prosthetic valve endocarditis. Streptococci were the most common bacteria (34 patients), followed by staphylococci (17 patients). Mechanical valves were selected for 73 patients and bioprosthetic valves for 16. Mitral valve plasty was performed in 4 patients. Aortic root or aorto-mitral discontinuity was repaired in 17 patients, including Manouguian's double valve replacement in 6 and aortic root replacement in 4. Overall hospital mortality was 15% (14 patients). Univariate analysis identified CHF (p=0.016), abscess (p=0.014), and prosthetic valve endocarditis (p=0.043) as risk factors. However, multivariate analysis only identified CHF (p=0.019) as an independent risk factor. Conclusion In AAIE, early surgical intervention is advisable before the occurrence of complications such as root abscess and CHF, particularly before the onset of CHF. (Circ J 2008; 72: 2062 - 2068)
    Circulation Journal 01/2008; 72(12):2062-2068. DOI:10.1253/circj.CJ-08-0224 · 3.69 Impact Factor
  • H Naganuma, K Mashiko, M Hanai, T Abe
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    ABSTRACT: A 60-year-old woman has been followed under the diagnosis of De Bakey type Illb acute aortic dissection. She developed sudden backache, and the diagnosis based on the emergent computed tomography (CT) was De Bakey type I dissection. At the operation, previous De Bakey type Illb dissection was far from the new dissection observed in the ascending aorta and arch aorta. We replaced the ascending aorta and aortic arch with woven Dacron graft (arch first technique) under retrograde cerebral perfusion. Since the residual dissection (De Bakey type III) in the multiple aortic dissection has tendency to dilate fast, intensive follow-up of the patient would be necessary.
    Kyobu geka. The Japanese journal of thoracic surgery 04/2006; 59(3):241-3.
  • 01/2003; 32(6):362-365. DOI:10.4326/jjcvs.32.362
  • 01/2002; 31(6):425-427. DOI:10.4326/jjcvs.31.425
  • 01/2002; 31(6):385-387. DOI:10.4326/jjcvs.31.385
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    ABSTRACT: Almost 33 years have elapsed since the introduction of the Kay-Shiley disc valve in Japan. Following the development of pyrolite carbon, the Kay-Shiley valve is no longer in clinical use. We report the case of a female patient who had had an isolated mitral valve replacement with the Kay-Shiley disc valve with single muscle guard 22 years previously. After numerous thromboembolic episodes with the Kay-Shiley disc valve, a successful reoperation was done with the CarboMedics valve. The explanted valve revealed that the grooved occluder disc had a loosely adherent clot. The thromboembolism is a notorious complication associated with this valve. We recommend re-replacement of the Kay-Shiley valve whenever possible.
    The Japanese Journal of Thoracic and Cardiovascular Surgery 11/1999; 47(11):574-6. DOI:10.1007/BF03218066
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    ABSTRACT: Only three cases of the combination of bicuspid aortic valve and ruptured aneurysm of the sinus of Valsalva, associated with previously repaired coarctation of aorta, have been reported. A twenty-year-old man with a sudden onset of CHF due to ruptured aneurysm of the sinus of Valsalva underwent intracardiac repair by direct closure of the sinus Valsalva in combination with patch closure of a subarterial VSD. Although, no AR was detected preoperatively, massive regurgitation occurred after the repair due to subsequent failure of aortic valve coaptation in the present of the bicuspid aortic valve, which was not diagnosed preoperatively. Aortic valve replacement with SJM 25 mm was successfully performed.
    The Japanese Journal of Thoracic and Cardiovascular Surgery 06/1998; 46(5):509-12. DOI:10.1007/BF03217782