-
[show abstract]
[hide abstract]
ABSTRACT: Objective: The purpose of this study was to evaluate the adequate timing of coronary artery bypass grafting (CABG) for acute coronary
syndrome (ACS). Methods: 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. Results: 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). Conclusion: 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 04/2012; 54(3):95-102.
-
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. · 7.08 Impact Factor
-
[show abstract]
[hide abstract]
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
-
[show abstract]
[hide abstract]
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. · 0.81 Impact Factor
-
[show abstract]
[hide abstract]
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.
-
[show abstract]
[hide abstract]
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.
-
[show abstract]
[hide abstract]
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.
-
[show abstract]
[hide abstract]
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.
-
[show abstract]
[hide abstract]
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.
-
[show abstract]
[hide abstract]
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. · 1.22 Impact Factor
-
[show abstract]
[hide abstract]
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.
-
[show abstract]
[hide abstract]
ABSTRACT: A 72-year-old male patient was admitted with chest oppression. Echocardiography disclosed a mobile tumor which was located on the atrial side of the tricuspid valve. Neither tricuspid obstruction nor regurgitation was observed. The mobility and the size, 20 mm in diameter, of the tumor indicated the need to perform surgical treatment. Through a right atriotomy, the tumor with multiple papillary fronds was found on the basal zone of the anterior leaflet. A resection of the tumor and tricuspid valvuloplasty with a partial annular reconstruction were performed. A pathological examination confirmed papillary fibroelastoma. He had an uneventful recovery, and postoperative echocardiography detected neither any residual tumor nor tricuspid regurgitation. In conclusion, it is reasonable to state that echocardiography is useful for detecting cardiac tumors, and a surgical resection is indicated for a mobile or large papillary fibroelastoma even when it is located on the right side of the heart.
The Japanese Journal of Thoracic and Cardiovascular Surgery 12/2004; 52(11):538-41.
-
[show abstract]
[hide abstract]
ABSTRACT: Aortic valve lesions associated with alkaptonuria tend mostly to be due to aortic valve stenosis, while aortic valve regurgitation is only rarely observed. Herein, a case is reported of severe aortic valve regurgitation and a fibrous strand in a patient with alkaptonuria. A 65-year-old male, with a history of inferior myocardial infarction, presented with symptoms of congestive heart failure. Alkaptonuria was diagnosed based on urine coloration, skin pigmentation and ochronotic arthropathy in the vertebrae and hip. Grade IV aortic valve regurgitation with mild aortic valve stenosis and occlusive disease in the right coronary artery indicated a need for aortic valve replacement and coronary artery bypass grafting. Sclerotic change in the cusps, and shrinkage of the non-coronary cusp, impeded normal coaptation of the aortic valve, and the left-coronary cusp also had a fibrous strand suspending the free margin of the cusp from the aortic wall just above the commissure. The sclerotic change in the cusps, and shrinkage of the non-coronary cusp, appeared to be the causative lesion of aortic valve regurgitation, implying that cardiovascular ochronosis may cause aortic valve regurgitation.
The Journal of heart valve disease 10/2004; 13(5):863-5. · 0.81 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Coronary artery aneurysms rarely develop in patients with systemic lupus erythematosus. We herein describe a case of a right coronary artery aneurysm associated with systemic lupus erythematosus. A 49-year-old woman with known systemic lupus erythematosus presented with an acute myocardial infarction. A coronary artery aneurysm and thrombo-occlusion in the right coronary artery necessitated percutaneous coronary intervention. She experienced three myocardial infarctions during the following two months. A coronary artery dissection occurred during the percutaneous coronary intervention at the time of the last myocardial infarction, and emergency coronary artery bypass grafting was successfully performed. Difficulties in treatment with percutaneous coronary intervention and the fact that arteritis is a possible cause of a coronary artery aneurysm may indicate that surgical therapy, including coronary artery bypass grafting with or without the obliteration of an aneurysm, is the treatment of choice for a coronary artery aneurysm with systemic lupus erythematosus.
The Japanese Journal of Thoracic and Cardiovascular Surgery 09/2004; 52(8):379-82.
-
[show abstract]
[hide abstract]
ABSTRACT: The skeletonized internal thoracic artery (ITA) has several advantages over a pedicled one in coronary artery bypass grafting (CABG). An ultrasonic scalpel makes ITA skeletonization easy and speedy, however, the ultrasonic energy that is transmitted to the artery itself can occasionally injure the endothelium. Therefore, the endothelial integrity of the ultrasonically skeletonized ITA is a major concern related to this technique. The purpose of this study is to assess the endothelial integrity of the ultrasonically skeletonized ITA.
We skeletonized the left ITA with an ultrasonic scalpel in nine patients who underwent CABG, and thereafter the terminal portion of this artery was subjected to a morphological study. The endothelial integrity of this artery was morphologically assessed using scanning electron microscopy, and the results were compared to that of the left ITA skeletonized with fine scissors.
All ITA specimens showed a completely confluent endothelium, and no endothelial injury was observed by the scanning electron microscopic study.
The skeletonization of the ITA with an ultrasonic scalpel had no deleterious effect on the endothelium. This morphological study confirmed the safety and the reliability of this technique, and we therefore recommend its clinical use in the skeletonization of the ITA for CABG.
European Journal of Cardio-Thoracic Surgery 03/2004; 25(2):208-11. · 2.55 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We report a case of Type I dual left anterior descending artery (LAD) successfully treated by coronary artery bypass grafting including the long LAD. This rare coronary artery anomaly is of clinical importance in the field of myocardial revascularization.
Surgery Today 02/2004; 34(5):453-5. · 1.22 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: A rare case of left ventricular myxoma presenting embolization into the brachial artery is reported. The sessile tumor originated from the posteromedial papillary muscle and involved the chorda supporting the posterior mitral leaflet. Complete excision of the tumor with the posterior head of the posteromedial papillary muscle, with the chorda and with the posterior mitral leaflet necessitated valve replacement. The tumor was well visualized by the superior-septal and transaortic approaches. These enabled exploration of all four cardiac chambers so as not to overlook any multifocal myxoma. The left ventricular myxoma should be completely resected with the surrounding endocardium in order to avoid recurrence of the disease.
The Journal of heart valve disease 04/2003; 12(2):177-9. · 0.81 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We describe a simple reliable method to pass the right internal thoracic artery safely through the transverse sinus. At first, a 4-mm-wide vascular tape is passed through the transverse sinus. The cut end of the right internal thoracic artery is then attached to the right end of the tape with a hemoclip. Pulling the left end of the tape leftwards can ensure the passage of the right internal thoracic artery without any risk of twisting.
Surgery Today 02/2003; 33(11):882-4. · 1.22 Impact Factor
