Masaru Yoshikai

Shin Kokura Hospital, Kitakyūshū, Fukuoka, Japan

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Publications (53)42.96 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: A 61-year-old male with homozygous familial hypercholesterolemia presented with dyspnea and syncope. He had been treated with low-density lipoprotein apheresis for 26 years. Echocardiography and computed tomography showed severe valvular and supravalvular aortic stenosis. Computed tomography and cardiac catheterization revealed a severely calcified narrowed aortic root and an occlusion in the proximal right coronary artery. During surgery, the ascending aorta was replaced under deep hypothermic circulatory arrest without aortic cross-clamping. After that, the aortic root from the annulus to the sino-tubular junction was enlarged with a two-ply bovine pericardial patch. An aortic valve replacement with a 17 mm mechanical valve and coronary artery bypass grafting to the right coronary artery were performed. The patient recovered from the surgery without any cerebrovascular complications.
    General Thoracic and Cardiovascular Surgery 02/2014;
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    ABSTRACT: We herein report a very rare case of a primary left atrial myxofibrosarcoma. A 61-year-old female presented with dyspnea and a wet cough. Chest X-ray film showed cardiomegaly and pulmonary congestion. Echocardiography and computed tomography revealed a left atrial tumor obstructing blood flow to the left ventricle. She was diagnosed with acute congestive heart failure due to functional mitralstenosis secondary to a left atrial tumor, and an emergency operation was performed. The tumor, which occupied left atrium, attached to the posterior wall of the left atrium and to the mitral valve, but had not invaded the left atrial wall. The tumor was removed from the left atrial wall, preserving the mitral valve and valve leaflets. The patient's post operative course was uneventful. The pathological diagnosis was myxofibrosarcoma, which rarely develops in the heart.
    Kyobu geka. The Japanese journal of thoracic surgery 12/2013; 66(13):1183-5.
  • European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 05/2009; 35(6):1078. · 2.40 Impact Factor
  • International journal of cardiology 08/2008; 127(2):e78-9. · 6.18 Impact Factor
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    ABSTRACT: A ventricular septal rupture (VSR) is a fatal complication after an acute myocardial infarction. Surgical repair with an infarction exclusion technique (IET) has improved the surgical outcome for VSR. However, a residual shunt from the left ventricle to the right ventricle has been still one of the problems associated with this technique. We modified the IET so as to avoid the occurrence of the residual shunt In our modification, interrupted mattress sutures were placed transmurally to obtain a secure fixation of the pericardial patch. As for the interventricular septum, the VSR was enlarged to about 1.5 cm in diameter with a cavitron ultrasonic surgical aspirator to facilitate the placement of transmural sutures from the right ventricle to the left ventricle. We performed VSR repair with this modified IET in 3 patients, and have obtained beneficial results.
    Kyobu geka. The Japanese journal of thoracic surgery 07/2008; 61(6):463-5.
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    ABSTRACT: We designed a mitral valve repair and successfully performed this repair for a case of broad, asymmetrical prolapse in the middle scallop of the posterior mitral leaflet. The repair procedure consists of making a fan-shaped leaflet by resecting the prolapsed portion in a trapezoid shape with detachment of the leaflet along the annulus and leaflet reapproximation by rotating this fan-shaped leaflet. This technique can utilize more leaflet tissue for filling the gap made by leaflet resection than the quadrangular resection and suture technique. As a result, it helps reduce tension on the suture lines, avoids the need for extensive annular plication, and also avoids leaflet distortion while making it easier to adjust the height of the leaflets that should be reapproximated. The essence of this mitral valve repair exists in the "resecting line of the leaflet," which has not yet been reported.
    General Thoracic and Cardiovascular Surgery 04/2008; 56(3):137-9.
  • The Journal of thoracic and cardiovascular surgery 02/2008; 135(1):218-9. · 3.41 Impact Factor
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    ABSTRACT: We herein describe a case with an acute aortic dissection, whose atherosclerotic coronary artery disease (CAD) could be accurately detected using a preoperative 64-row multidetector computed tomography (MDCT). Emergency surgery including a coronary artery bypass grafting and a total arch replacement were successfully performed without causing perioperative myocardial infarction. MDCT coronary angiography is a safe and noninvasive examination, therefore, we believe that MDCT coronary angiography should become a routine preoperative examination for patients with an acute aortic dissection in order to detect the presence of CAD.
    Journal of Cardiac Surgery 01/2008; 23(3):277-9. · 1.35 Impact Factor
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    ABSTRACT: Herein is described a rare case of anomalous papillary muscle (APM) insertion which caused severe mitral regurgitation (MR). In this case, the anterolateral papillary muscle inserted directly into the left ventricular surface of the anterior mitral leaflet (AML), without an intervening chorda. The APM pulled the AML down towards the left ventricle, causing a marked tethering of the mitral valve. The dilatation and dysfunction of the left ventricle exacerbated the tethering of the mitral valve, which eventually caused severe MR. At surgery, after resection of the APM, the mitral valve was replaced with a prosthetic valve. A directly inserting APM, which is known as a rare cause of a left ventricular outflow tract obstruction, seems to transmit a stronger tethering force to the mitral leaflet than does a normal stay chorda. Thus, the present case shows that this type of APM might cause MR due to a mechanism of valve tethering.
    The Journal of heart valve disease 12/2007; 16(6):608-10. · 1.07 Impact Factor
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    ABSTRACT: The skeletonized internal thoracic artery (ITA) has several advantages over a pedicled one in coronary artery bypass grafting. A skeletonized ITA, which lacks surrounding tissue, thus seems more susceptible to the mechanical force exerted by a vessel clamp than the pedicled ITA. The purpose of this study was to assess the detrimental effect of vessel clamps on the intimal integrity of the ultrasonically skeletonized ITA. We skeletonized twelve ITAs with an ultrasonic scalpel in patients who underwent coronary artery bypass grafting, and thereafter two types of clamp, namely a metal clamp and a fibrous jaw clamp, were applied to the terminal portion of the ITA for 30 min. The intimal integrity of the ITAs was morphologically assessed using scanning electron microscopy. A metal clamp can cause serious intimal injury which disrupts the internal elastic lamina, and thus should be avoided for the temporary clamping of the skeletonized ITA. A fibrous jay clamp, however, hardly ever causes intimal injury, and its clinical use for the temporary clamping of the ultrasonically skeletonized ITA is therefore recommended. Vessel clamps can cause intimal injury of the ultrasonically skeletonized ITA, and the degree of the injury depends on the type of the clamp used.
    Interactive Cardiovascular and Thoracic Surgery 07/2007; 6(3):331-4. · 1.11 Impact Factor
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    ABSTRACT: We have routinely used postoperative continuous hemodiafiltration (CHDF) combined with intraoperative hemodialysis (IHD) for dialysis patients undergoing open-heart surgery. This perioperative management could avoid any limitation of potassium concentration in the cardioplegic solution, strict restriction of fluid administration, or blood transfusion. To evaluate the safety of this strategy, 22 dialysis patients who underwent open-heart surgery (Dialysis Group) were retrospectively compared with 30 patients with normal renal function selected from the same time period with rigorously matched clinical characteristics such as age, gender, and operative procedures (Matched Group). No significant difference was found in the operative variables such as the operative procedures, cardiopulmonary bypass time, and aortic cross-clamp time in both groups. There were two deaths (9.1%) in the Dialysis Group compared with Matched Group (0%). In the Dialysis Group, the levels of serum potassium and creatinine were well controlled in the perioperative period with a mean duration of IHD and CHDF of 243.7 +/- 60.6 min and 2.7 +/- 1.1 days, respectively. In particular, no significant difference between intraoperative and postoperative levels of serum potassium was observed in the Dialysis Group (P = 0.09), whereas there was a significant increase in the Matched Group (P = 0.004). Mean volume administered for the first 24 h after surgery was not different from the Matched Group. There were no vascular access-related complications in the Dialysis Group. Postoperative CHDF combined with IHD can provide a similar management protocol for dialysis patients compared to patients with normal renal function.
    General Thoracic and Cardiovascular Surgery 03/2007; 55(2):43-9.
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    ABSTRACT: We herein report a case with an aneurysm of the right sinus of Valsalva, which developed 14 years after an aortic valve replacement (AVR) for aortic regurgitation caused by Takayasu arteritis. The aortic wall around the right coronary artery ostium showed calcification, as a result, the modified Bentall procedure and coronary artery bypass to the right coronary artery were successfully performed. A pathological study of the resected aortic sinus wall showed a disruption of the elastic fibers in the media, granuloma formation, and a marked proliferation of the collagen fibers in the adventitia, and these findings were compatible with Takayasu arteritis. The development of an aneurysm of the sinus of Valsalva late after AVR indicates the necessity of a close and lifelong follow-up for patients with Takayasu arteritis, especially focusing on the aortic root morphology.
    Journal of Cardiac Surgery 01/2007; 22(2):162-4. · 1.35 Impact Factor
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    ABSTRACT: We herein describe a surgical technique in a mitral valve replacement for a hemodialysis patient presenting with mitral valve stenosis and severe mitral annular calcification. Mitral annular calcification extending to the left ventricular myocardium was resected using a cavitron ultrasonic surgical aspirator (CUSA) to make a flat plane from the left atrium to the left ventricle. An autologous pericardium was secured to the posterior left ventricular wall and to the left atrial wall covering the mitral annulus for annular reconstruction. In the posterior mitral annulus, the prosthetic valve was fixed onto this pericardial patch. After the operation, the patient recovered well without any embolic complications. The prosthetic valve functions normally without any perivalvular leakage. Decalcification using the CUSA and the annular reconstruction with a pericardial patch is therefore indicated in valve replacement for patients with severe mitral annular calcification.
    Journal of Cardiac Surgery 01/2007; 22(6):502-4. · 1.35 Impact Factor
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    ABSTRACT: A surgical case of a massive mural thrombus in the left atrium associated with valvular heart disease is herein presented. The fresh autologous pericardium was used to cover the roughened left atrial endocardium after the removal of the mural thrombus. This procedure seems useful to prevent not only the perioperative thromboembolism caused by the dislodgement of the fragmented small thrombus but also any long-term future thrombus formation by creating a smooth surface layer with the autologous pericardium.
    Journal of Cardiac Surgery 01/2007; 22(5):443-4. · 1.35 Impact Factor
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    ABSTRACT: We experienced 3 cases of an aortic dissection occurring late after an aortic valve replacement, and successfully treated by an aortic root replacement. An aortic dissection involving the ascending aorta can develop late after an aortic valve replacement, and such an occurrence is associated with a high mortality and morbidity. The development of effective surgical strategies at the initial aortic valve surgery, strict control of blood pressure after aortic valve replacement, serial evaluations of aortic size, and the prophylactic replacement of the ascending aorta for patients with aortic dilatation after aortic valve replacement, all play clinically important roles in preventing an aortic dissection after aortic valve replacement. When an aortic dissection occurs in patients with a previous aortic valve replacement, an aortic root replacement should be performed in order to avoid leaving the fragile diseased aortic wall including the sinus of Valsalva.
    The Japanese Journal of Thoracic and Cardiovascular Surgery 04/2006; 54(3):120-3.
  • Keiji Kamohara, Masaru Yoshikai, Junichi Murayama
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    ABSTRACT: We describe a patient with acute mitral regurgitation due to complete rupture of the papillary muscle immediately after successful late reperfusion for inferior myocardial infarction. An 81-year-old woman was admitted complaining of mild chest discomfort. Although the electrocardiograms, biochemical test results, and her clinical history showed that several days had passed since the onset of acute myocardial infarction, a late coronary stenting was performed. Immediately after successful stenting, she suddenly developed acute pulmonary edema, leading to cardiogenic shock. In addition to high pulmonary capillary wedge pressure (mean 35 mmHg), color Doppler imaging revealed massive mitral regurgitation caused by complete rupture of the posterior papillary muscle. Emergent mitral valve replacement with a prosthetic valve was performed, saving the patient. Hence, late reperfusion should be considered carefully when treating a patient with a high risk, such as an elderly patient or a patient with single-vessel disease or initial transmural myocardial infarction.
    The Japanese Journal of Thoracic and Cardiovascular Surgery 04/2006; 54(3):124-7.
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    ABSTRACT: The purpose of this study was to evaluate the adequate timing of coronary artery bypass grafting (CABG) for acute coronary syndrome (ACS). In our institution, emergency CABG has been avoided when possible for ACS patients favoring stabilization with medical therapies, including intra-aortic balloon pumping or percutaneous coronary intervention. After thorough preoperative examinations, an urgent CABG is performed. A total of 67 patients with ACS underwent CABG, comprised of 33 patients receiving an emergency CABG (emergent group: E-G) and 34 patients receiving an urgent CABG (urgent group: U-G). The early and long-term results were evaluated retrospectively. Preoperatively, the incidences of acute myocardial infarction and cardiogenic shock were significantly higher in E-G. No significant differences were found in the intraoperative factors except for the number of distal anastomoses (2.5 in E-G vs. 3.1 in U-G, p=0.01). The hospital mortality was 9.1% in E-G, and 2.9% in U-G, with no significant difference between the groups. Moreover, no patient in U-G necessitated emergency CABG while waiting for surgery. The patency rate of the grafts was 100% in E-G, and 96.2% in U-G. The 5-year survival rate excluding in-hospital death was 80.3% in E-G, and 78% in U-G (p>0.05). The 5-year cardiac event-free rate was 80.3% in E-G, and 80.9% in U-G (p>0.05). An emergency CABG can be reserved for ACS patients when symptoms and hemodynamic state are stabilized with medical therapies. Improvements in long-term results can be expected after high quality and complete surgical revascularization.
    The Japanese Journal of Thoracic and Cardiovascular Surgery 03/2006; 54(3):95-102.
  • Masaru Yoshikai, Junichi Muraya, Hiroya Fujita
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    ABSTRACT: We herein present a rare case of severe aortic valve stenosis with a bicuspid valve in a patient with systemic lupus erythematosus. The symptoms resulted from aortic valve stenosis, such as chest pain, dyspnea and syncope, which subsided after the insertion of an intra-aortic balloon pump. Thereafter, a calcified bicuspid aortic valve was successfully replaced with a mechanical valve. The pathological findings of the resected valve included irregular fibrotic thickening and marked calcification without any vegetation or thrombus formation. The efficacy of an intra-aortic balloon pump for the relief of symptoms associated with severe aortic valve stenosis indicates its usefulness for such critically ill patients prior to undergoing valvular surgery.
    The Japanese Journal of Thoracic and Cardiovascular Surgery 02/2006; 54(1):16-8.
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    ABSTRACT: Aortic root replacement after aortic valve replacement (AVR) is often complicated by bleeding around the aortic root, which increases the risk of morbidity and mortality, making it a technically challenging procedure. We describe a new technique of aortic root replacement designed to minimize bleeding around the aortic root. This surgical technique focuses on safe dissection and exposure of the aortic root to avoid inadvertent entry into the right atrium or right ventricle; on modifying the proximal anastomosis of the graft to the aortic annulus; and on performing a coronary artery reimplantation that achieves complete hemostasis at the suture lines. We performed aortic root replacement after AVR in four patients over a 4-year period, without encountering any bleeding around the aortic root.
    Surgery Today 02/2006; 36(2):201-3. · 0.96 Impact Factor
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    ABSTRACT: We herein present the case of a pseudo-false aneurysm which developed in a patient after a myocardial infarction in the posterior left ventricular wall. A 71-year-old man experienced an acute myocardial infarction due to occlusion in the left circumflex artery. Five weeks after the myocardial infarction, echocardiography and magnetic resonance imaging (MRI) disclosed a pseudo-false aneurysm at the posterior left ventricular wall. A patch closure of the aneurysm and coronary artery bypass grafting (CABG) to both the left anterior descending artery and the left circumflex arteries were successfully performed. At surgery, the Starfish Heart Positioner, a commercially available device that is designed to lift the heart during off-pump CABG, was found to be very useful for exposing the posterior left ventricular wall by lifting and fixing the apex of the left ventricle.
    Kyobu geka. The Japanese journal of thoracic surgery 10/2005; 58(10):879-82.