Yoshihiko Ohnishi

National Cerebral and Cardiovascular Center, Ōsaka, Ōsaka, Japan

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Publications (65)83 Total impact

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    ABSTRACT: Delirium after cardiac surgery is a serious complication, increasing morbidity and mortality. Despite its high expectations, off-pump coronary artery bypass grafting (OPCAB) has largely failed to reduce the incidence of postoperative neurological complications. To further investigate the reasons for this failure, we used perioperative brain magnetic resonance imaging (MRI) to determine the relation between MRI findings and postoperative delirium. Altogether, 98 patients undergoing elective OPCAB were enrolled in this prospective observational study. Patients underwent brain MRI and magnetic resonance angiography (MRA) before and after surgery to identify cerebral infarction, white matter lesions, and intracranial artery stenosis. Postoperative delirium in the intensive care unit was measured using the delirium rating scale. The relation between postoperative delirium and MRI findings was examined using logistic regression. Magnetic resonance imaging and MRA was completed in 88 (90%) of the patients. New ischemic lesions were present in seven (7.9%) patients. Delirium rating scale scores of 0, 1-7, and ≥ 8 were found in 25 (31%), 48 (60%), and seven (9%) patients, respectively. Multivariate logistic regression analysis revealed that new ischemic lesions (odds ratio [OR] 11.07, 95% confidence interval [CI]: 1.53 to 80.03; P = 0.017), carotid artery stenosis (OR 7.06, 95% CI: 1.59 to 31.13; P = 0.010), history of myocardial infarction (OR 3.78, 95% CI: 1.05 to 13.65; P = 0.043), and deep subcortical white matter hyperintensity (OR 3.04, 95% CI: 1.14 to 8.12; P = 0.027) were significantly associated with postoperative delirium. Magnetic resonance imaging findings of new cerebral ischemic lesions, carotid stenosis, and deep subcortical white matter hyperintensity correlated significantly with postoperative delirium in patients who had undergone OPCAB surgery.
    Canadian Journal of Anaesthesia 02/2015; 62(6). DOI:10.1007/s12630-015-0327-x · 2.50 Impact Factor
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    ABSTRACT: Postoperative respiratory complications are serious and frequently observed among patients who undergo thoracoabdominal aortic aneurysm (TAAA) repair. Paravertebral block (PVB) can provide effective analgesia for relief of postoperative thoracotomy pain and may reduce respiratory complications. However, the impact of PVB on postoperative pain and respiratory function in patients who undergo TAAA repair requiring intraoperative high-dose heparin administration is unknown. This study examined the efficacy of PVB on postoperative pain and respiratory function after TAAA repairs. Retrospective, observational cohort study. Single center in Japan. Fifty-eight consecutive patients who underwent TAAA repair from March 2013 to October 2014. Application of thoracic PVB. A total of 56 patients were analyzed. Two patients were excluded because 1 patient was dead within 24 hours after surgery and 1 patient was 9 years old. Patients with PVB were defined as group P (n = 17), and patients without PVB as group C (n = 39). There was no significant difference in baseline characteristics between the 2 groups. Both postoperative pain at rest and postoperative pain while coughing were assessed using a numeric rating scale (NRS); the incidence of reintubation and noninvasive positive-pressure ventilation (NPPV) also were compared between the 2 groups. The NRS score of postoperative pain at rest was significantly lower in group P (group P: Median 2, interquartile range 1 to 3; group C: Median 6, interquartile range 5 to 7; p = 0.000), and the NRS score of postoperative pain while coughing was significantly lower in group P (group P: Median 5, interquartile range 3.5 to 6.5; group C: Median 8, interquartile range 7 to 10; p = 0.000). Reintubation rate was significantly lower in group P (group P: 0%, group C: 23%, p = 0.045); the incidences of NPPV (group P: 12%, group C: 46%, p = 0.016) and postoperative pneumonia were significantly lower in group P (group P: 0%, group C: 28%, p = 0.024). PVB significantly reduced postoperative pain at rest and while coughing and significantly reduced the reintubation rate, the rate of NPPV use, and postoperative pneumonia without complications. PVB could be a safe and an effective analgesic method that reduces postoperative respiratory exacerbation in patients who undergo TAAA repair. Copyright © 2014 Elsevier Inc. All rights reserved.
    Journal of cardiothoracic and vascular anesthesia 12/2014; DOI:10.1053/j.jvca.2014.12.009 · 1.48 Impact Factor
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    ABSTRACT: Objectives: The goal of this study was to compare cardiac output derived from the FloTrac/Vigileo (TM) system (COFT) with cardiac output measured by 3-dimensional transesophageal echocardiography (CO3D) in patients with severe heart failure undergoing cardiac resynchronization therapy. The impact of preoperative systemic vascular resistance index on the accuracy of the FloTrac/Vigileo (TM) system also was investigated. Design: Prospective clinical study. Setting: Cardiac surgery operating room of a single cardiovascular center. Participants: Forty-one patients undergoing elective cardiac resynchronization therapy lead implantation. Interventions: CO3D as the reference method and COFT were determined simultaneously after induction of anesthesia. Measurements and Main Results: Linear regression analysis showed a poor correlation between CO3D and COFT(R-2 = 0.16). Bland-Altman plots showed wide limits of agreement between CO3D and COFT. Bias was 0.60 +/- 0.63 L/min with a high percentage error of 58.2%. Subgroup analysis showed that the percentage error between CO3D and COFT was 74.1% in patients with a cardiac index <2.2 L/min/m(2) and 17.2% in patients with a cardiac index >= 2.2 L/min/m(2). Systemic vascular resistance index was significantly higher in patients with a cardiac index <2.2 L/min/m(2) (3,037 +/- 820 v 2,461 +/- 878; p = 0.039). Conclusions: The FloTrac/Vigileo (TM) system is not accurate in patients with low cardiac output, especially those with a cardiac index <2.2 L/min/m(2). A high systemic vascular resistance index in patients with low cardiac index may contribute to this inaccuracy.
    Journal of Cardiothoracic and Vascular Anesthesia 10/2014; 28(6). DOI:10.1053/j.jvca.2014.04.013 · 1.48 Impact Factor
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    ABSTRACT: Despite considerable advances in anesthesia technique, intraoperative aortic dissection remains a potentially lethal complication during on-pump cardiovascular surgery. Intraoperative dissection has been described worldwide, ranging between 0.06% and 0.24%. Here we present 8 patients who had intraoperative dissection during 10-year period with 6,266 on-pump cases (0.13%, 95% confidence interval 0.12% to 0.14%). In-hospital mortality rate of intraoperative dissection was 12.5% (1/8) at our institution, which was exceptionally lower than that reported previously (24% to 43%). Therefore, we also show our treatment strategy for intraoperative dissection with the related-literature review. The original surgical procedures were descending aortic replacement in 3 patients, valve replacement in 4 patients, and aortic-root replacement in 1 patient. Dissection occurred during aortic cannulation in 6 patients and during manipulation of aortic cross-clamping/de-clamping in 2 patients. Three patients had retrograde dissection extending and beyond the arch. Trans-esophageal echocardiography was useful to confirm dissection and ensure proper perfusion of the aortic-branches. Immediately after its diagnosis, all patients were managed with hypotensive strategy and subsequently underwent deep hypothermic circulatory arrest for prevention of dissection propagation. Among patients with intraoperative aortic dissection undergoing on-pump cardiovascular surgery, not only earlier diagnosis but proper anesthetic management may be crucial for the successful outcome.
    Masui. The Japanese journal of anesthesiology 02/2014; 63(2):143-8.
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    ABSTRACT: Moyamoya disease is a chronic cerebrovascular occlusive disease, occurring predominantly in young populations, that causes cerebral ischemia and hemorrhage. Patients with moyamoya disease are at high risk of neurological complications during cardiac surgery because of perioperative hemodynamic changes. However, there is no established evidence on temperature management during cardiopulmonary bypass. Previous reports described normothermia or mild to moderate hypothermia during cardiopulmonary bypass in patients with moyamoya disease; however, surgical conditions, such as not having enough space to clamp the aorta or a clean surgical field, sometimes force us to use deep hypothermic circuratory arrest. We report a successful case of a pediatric patient with moyamoya disease who underwent deep hypothermic circulatory arrest (18 °C) for hemiarch replacement without neurological complications. Deep hypothermia may be an alternative technique for achieving cerebral protection in the context of moyamoya disease.
    Journal of Anesthesia 01/2014; 28(4). DOI:10.1007/s00540-013-1782-6 · 1.12 Impact Factor
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    ABSTRACT: Stroke during pregnancy is rare, but after occurring, most patients develop serious neurological conditions. Hemorrhagic stroke, including intracerebral hemorrhage and subarachnoid hemorrhage, often requires emergency surgical intervention. In addition to significant maternal physiological changes, the potential for fetal harm should be considered during anesthetic management of these patients. Whether cesarean section or neurosurgical intervention should be prioritized or performed simultaneously in pregnant women with stroke is an important issue. Whether the patients receive general or spinal and epidural anesthesia is another clinically significant issue. Finally neurosurgeons, anesthesiologists, and obstetricians should cooperate to manage pregnant women with stroke.
    Neurologia medico-chirurgica 08/2013; 53(8):537-40. DOI:10.2176/nmc.53.537 · 0.65 Impact Factor
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    ABSTRACT: BACKGROUND:: Near-infrared spectroscopy has been used clinically to continuously and noninvasively monitor cerebral oxygen saturation (ScO2). However, there is no gold standard for measuring absolute values of ScO2. Although time-resolved spectroscopy (TRS) is one of the most reliable algorithms that reliably calculate absolute values of ScO2, there are very few clinical studies available. To evaluate the clinical relevance of ScO2 measurements using TRS, we compared ScO2 with jugular venous oxygen saturation (SjO2) during carotid endarterectomy. We also investigated factors associated with cerebral oxygen desaturation during clamping of the carotid artery. METHODS:: Sixty patients who underwent carotid endarterectomy were enrolled. ScO2 was measured by TRS-20 using TRS at 10 minutes before and after clamping of the carotid artery and 10 minutes after unclamping. SjO2 was measured simultaneously. The relationship between ScO2, SjO2, and estimated ScO2 (0.75×SjO2+0.25×SaO2) were examined by simple regression and the Bland-Altman analysis. Factors related to ScO2<60% were investigated by logistic regression analysis. RESULTS:: There was a significant correlation between ScO2 and SjO2 (r=0.49, P<0.002). Bland-Altman analysis revealed narrow limits of agreement between ScO2 and SjO2 (bias, 9.2%; precision, 12.6%), as well as ScO2 and estimated ScO2 (bias, -1.3%; precision, 9.7%). Impaired cerebral hemodynamics (Powers stage 2 or Kuroda type 3) was significantly associated with ScO2<60%. CONCLUSIONS:: ScO2 measured by TRS and SjO2 showed narrow limits of agreement. Reduced ScO2 was significantly associated with impaired cerebral hemodynamics.
    Journal of neurosurgical anesthesiology 12/2012; 25(3). DOI:10.1097/ANA.0b013e31827ee0cf · 2.35 Impact Factor
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    ABSTRACT: PURPOSE: Thoracic endovascular aortic repair (TEVAR) an emerging less invasive alternative to surgery, is now being increasingly employed, but spinal cord ischemia (SCI) is still a threat with this procedure. Delayed paraplegia has been frequently observed after TEVAR, suggesting there may be different courses of SCI between TEVAR and the conventional open surgical repair (OSR) of thoracic and thoracoabdominal aneurysms. Therefore, we conducted a study to investigate the risk factors for and the course of SCI after TEVAR and OSR. METHODS: We studied a series of 414 OSR and 94 TEVAR patients prospectively. Postoperative motor function, sensory disturbance, and bladder disturbance were assessed daily to evaluate the course of SCI. Previously reported risk factors for SCI were investigated. RESULTS: Spinal cord ischemia occurred in 6 patients (6.4 %) in the TEVAR group, and in 18 patients (4.3 %) in the OSR group, resulting in no significant difference (p = 0.401). A greater percentage of patients (n = 4, 66.7 %) with SCI in the TEVAR group had a delayed onset, compared with 16.7 % (n = 3) in the OSR group (p = 0.038). The rate of recovery of walking function after SCI and the incidence of sensory disturbance and bladder dysfunction was similar in the two groups. Multivariate analysis demonstrated that, in the TEVAR group, the stent length of aortic coverage was a significant risk factor for SCI. CONCLUSION: The incidence of SCI was similar in the OSR and TEVAR groups, but delayed SCI occurred more frequently in the TEVAR group. Except for the delayed onset of SCI, SCI showed a similar course of recovery in the two groups.
    Journal of Anesthesia 07/2012; 26(6). DOI:10.1007/s00540-012-1434-2 · 1.12 Impact Factor
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    ABSTRACT: We experienced a patient with severe COPD undergoing OPCAB who showed difficult perioperative respiratory and circulatory management. Since patients with severe COPDs are often complicated with not only respiratory but also circulatory problems such as right heart failure, it is necessary to assess preoperatively the method of intraoperative management including operative procedure.
    Masui. The Japanese journal of anesthesiology 04/2012; 61(4):411-3.
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    ABSTRACT: Paraplegia is a serious complication of descending and thoracoabdominal aortic aneurysms (dTAAs and TAAAs) surgery. Motor evoked potentials (MEPs) enable monitoring the functional integrity of motor pathways during dTAA and TAAA surgery. Although MEPs are sensitive to temperature changes, there are few human data on changes of MEPs during mild and deep hypothermia. Therefore, we investigated changes of MEPs in deep hypothermic circulatory arrest (DHCA) in dTAA and TAAA surgery. Fifteen consecutive patients undergoing dTAA and TAAA surgery using DHCA were enrolled. MEPs were elicited and recorded during each degree Celsius change in nasopharyngeal temperature during both the cooling and rewarming phases. Hand and leg skin temperature were also recorded simultaneously. In the cooling phase MEP amplitude decreased lineally in both the hand and leg. The MEP disappeared at ~16°C in both the hand and leg in 10 of 15 patients, but was still elicited in 5 patients. In the rewarming phase MEP in the hand recovered before the temperature reached 20°C for eight patients and 25°C for the other seven patients. In contrast, MEP in the leg recovered below 20°C for two patients and 30°C for three patients. For the other eight patients MEP waves did not recover during the rewarming phase. In the cooling phase of DHCA, MEP disappeared at ~16°C in some patients but was still elicited in others. MEP recovered below 25°C in the hand. Recovery of MEP in the leg was, however, extremely variable.
    Journal of Anesthesia 12/2011; 26(2):160-7. DOI:10.1007/s00540-011-1313-2 · 1.12 Impact Factor
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    ABSTRACT: To compare cardiac output (CO) measurements acquired using the Flotrac/Vigileo system (Edwards Lifesciences, Irvine, CA) and CO measured by transesophageal echocardiography using the product of the aortic valve area, the time integral of flow at the same site, and the heart rate during abdominal aortic aneurysm (AAA) surgery. A prospective clinical study. Cardiac surgery operating room of 1 heart center hospital. Twenty patients undergoing elective AAA surgery. CO was determined simultaneously using the Flotrac/Vigileo system (CO(AP)) and transesophageal echocardiography (CO(TEE)) as the reference method at 8 time points during AAA surgery. One hundred sixty simultaneous datasets were obtained. The authors observed a significant correlation between CO(AP) and CO(TEE) values (R = 0.56, p < 0.001). Bland-Altman analysis of CO(AP) and CO(TEE) showed a bias of 0.12 L/min and limits of agreement from -1.66 to 1.90 L/min, with a percentage error of 41%. Just after aortic clamping, CO(AP) significantly increased, but CO(TEE) decreased in comparison with previous measurements. There was a significant association among changes in CO(AP) and pulse pressure, heart rate, and central venous pressure (CVP). However, changes in CO(TEE) were only associated with variations in heart rate. CO(AP) values were not clinically acceptable for use in AAA surgery because of wide variations during aortic clamping and declamping. Changes in pulse pressure, heart rate, and CVP were associated with significant changes in CO(AP), whereas only changes in heart rate showed associated changes in CO(TEE).
    Journal of cardiothoracic and vascular anesthesia 09/2011; 26(2):223-6. DOI:10.1053/j.jvca.2011.07.011 · 1.48 Impact Factor
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    ABSTRACT: Pregnant patients with prosthetic valve need anticoagulation therapy during pregnancy to prevent stuck valve. Regarding the thrombosed valve, there is a dilemma between anticoagulation to prevent further thrombus formation and postoperative bleeding after caesarian section until valve replacement surgery. A 35-year-old woman in her 34th weeks of pregnancy with a thrombus on prosthetic mitral valve was scheduled for emergency caesarian section under general anesthesia. Anticoagulation therapy with heparin was started after admission to the intensive care unit targeting the range between 70-100 second of activated partial thromboplastin time to prevent further thrombus formation. Heparin was administered intravenously (25,000 units per day), but APTT was kept over 110 seconds. Abdominal wall hematoma was detected by percutaneous echo next day and surgery for removal of hematoma was performed. Mitral valve replacement surgery was performed on the postoperative third days successfully. Postoperative anticoagulation therapy with heparin should be started carefully in consideration of physiological change of clotting ability after the termination of pregnancy.
    Masui. The Japanese journal of anesthesiology 06/2011; 60(6):724-7.
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    ABSTRACT: Off-pump coronary artery bypass surgery (CABG) has not abolished the risk of postoperative stroke and delirium seen for on-pump CABG. Advanced arteriosclerotic changes are common in both on-pump and off-pump CABG. We sought to analyze if advanced arteriosclerotic changes are risk factors of stroke or transient ischemic attack (TIA), and delirium after off-pump CABG. Patients undergoing off-pump CABG between 2001 and 2005 were reviewed using medical records (n=685). Potential risk factors of postoperative stroke and delirium were identified from previous studies. Further, variables retrieved from carotid artery duplex scanning as indices of advanced arteriosclerosis, were examined. The incidences of postoperative stroke/TIA and delirium after off-pump CABG were 2.6% (n=18) and 16.4% (n=112), respectively. Carotid artery stenosis >50% was a significant risk factor of stroke or TIA (P=0.02) as well as delirium (P=0.04) after off-pump CABG. A history of atrial fibrillation (AF) (P=0.037) or diabetes mellitus (P=0.041) was a risk factors of postoperative stroke or TIA. In contrast, age over 75 years (P=0.006), creatinine >1.3 mg/dl (99 μmol/l) (P=0.011), a history of hypertension (P=0.001), past history of AF (P=0.024), and smoking (P=0.048) were significant risk factors of postoperative delirium.
    Interactive Cardiovascular and Thoracic Surgery 12/2010; 12(3):379-83. DOI:10.1510/icvts.2010.248872 · 1.11 Impact Factor
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    ABSTRACT: Surgical clipping may cause stenosis of parent arteries or occlusion of perforating arteries in cerebral aneurysm surgery. To prevent postoperative motor deficits, motor-evoked potentials (MEPs) have been used. This enables to detect cerebral ischemia. However, the rate of false negatives (motor deficits with preserved MEP) has been relatively higher than in aortic surgery. We hypothesized that postoperative motor deficits with preserved intraoperative MEP do not always represent false negatives. We reviewed medical records of patients for cerebral aneurysms surgery with transcranial MEP monitoring from September 2003 to March 2009. We reviewed aneurysm location and size, abnormal computed tomography findings, and clinical outcome. Motor status was evaluated immediately after extubation and anytime when the symptom of motor deficits was found. One hundred and eleven patients underwent cerebral aneurysm clipping with transcranial MEP. Ninety-eight patients manifested no intraoperative MEP changes and no postoperative motor deficits. Six patients showed intraoperative MEP changes, resulting in no motor deficits in 4 patients with MEP recovery and hemiparesis in 2 without MEP recovery. Four patients of 6 had aneurysm in anterior choroidal artery (AchA). Other 6 patients showed postoperative motor deficits despite preserved intraoperative MEP. Two of 6 patients showed no motor deficits just after extubation, but developed deficits 5 hours after coming out of anesthesia. Only 1 of the 6 patients had aneurysm in AchA. In AchA aneurysm surgery, intraoperative MEP monitoring seems to be useful. False negative in MEP monitoring may include new-onset hemiparesis despite preserved intraoperative MEP.
    Journal of neurosurgical anesthesiology 07/2010; 22(3):247-51. DOI:10.1097/ANA.0b013e3181de4eae · 2.35 Impact Factor
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    ABSTRACT: We report on a child with moyamoya disease combined with von Gierke's disease. A 7-year-old girl with von Gierke's disease had a stroke associated with moyamoya disease. She had had many episodes of hypoglycemia and severe metabolic acidosis before surgery. General anesthesia was induced with midazolam 3 mg and fentanyl 100 microg followed by rocuronium 12 mg. After tracheal intubation, anesthesia was maintained with sevoflurane 2.5% in 33% oxygen and 66% nitrous oxide. We used mainly mixture of saline and glucose as intraoperative fluid instead of acetated Ringer solution, and controlled administration of glucose according to blood glucose levels. The patient's plasma lactate levels and base excess during operation showed changes compared with those before operation, because sodium bicarbonate was used during the surgery. The duration of anesthesia was 374 minutes. The patient woke up and spontaneous respiration returned, and the trachea was extubated in the operating room. We were able to manage this case safely without any complications.
    Masui. The Japanese journal of anesthesiology 02/2010; 59(2):260-3.
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    ABSTRACT: Off-pump coronary artery bypass grafting surgery (OPCAB) frequently results in significant jugular bulb desaturation. Although jugular bulb desaturation during OPCAB may be associated with postoperative cerebral injury, routine jugular bulb oximetry appears to be invasive and expensive. We hypothesized that intraoperative hemodynamic compromise during OPCAB due to cardiac displacement is associated with jugular bulb desaturation which correlates with specific hemodynamic and physiological changes. Hemodynamic and physiological data were measured at the following points: (1) before anastomosis of the coronary artery (baseline); (2) during anastomosis of the left anterior descending artery; (3) during anastomosis of the circumflex branch or posterior descending artery; and (4) after chest closure. Arterial, mixed venous, and jugular venous bulb blood gas analyses were performed serially. Jugular bulb desaturation (<or=50%) frequently occurred during surgical displacement of the heart. Mixed venous oxygen saturation (S(VO2)), partial pressure of carbon dioxide (Pa(CO2)), and central venous pressure (CVP) showed a significant relationship with jugular bulb oxygen saturation (r = 0.45) by multivariate linear regression analysis. Multivariate logistic regression analysis also demonstrated that S(VO2) <or= 70%, Pa(CO2) <or= 40 mmHg, and CVP >or= 8 mmHg were likely predictors of the occurrence of jugular bulb desaturation. Changes in S(VO2) and Pa(CO2) were associated with jugular bulb oxygen saturation, and S(VO2) <or= 70%, Pa(CO2) <or= 40 mmHg, and CVP >or= 8 mmHg had a significant odds ratio for jugular bulb desaturation. We suggest that achieving normal values of S(VO2), Pa(CO2) and CVP may be important to prevent cerebral desaturation during OPCAB.
    Journal of Anesthesia 11/2009; 23(4):477-82. DOI:10.1007/s00540-009-0794-8 · 1.12 Impact Factor
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    ABSTRACT: The population of children undergoing successful surgery for congenital heart disease (CHD) continues to increase. Increasing number of patients with a Fontan circulation is reaching adulthood and requiring anesthesia for noncardiac surgeries. We anesthetized a patient with a Fontan circulation (9 years old) for giant internal carotid-ophthalmic artery aneurysm trapping. There was a difficulty in cannulating internal jugular vein for measuring central venous pressure because of abnormal collateral arteries around the internal jugular vein. Central venous pressure of around 15 mmHg seemed appropriate to keep good hemodynamic condition during this surgery. In this condition, cerebral cortex was not edematous. Careful management of circulatory volume stabilized hemodynamic state. However, when heart rate decreased below 75, ectopic atrial rhythm occured. Anesthetic time was 13 hr and 40 min. The patient was extubated in the operating room. We have to take into consideration that there are anatomical abnormalities and arrhythmia in the patients with a Fontan circulation.
    Masui. The Japanese journal of anesthesiology 07/2009; 58(6):753-6.
  • Kenji Yoshitani, Yoshihiko Ohnishi
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    ABSTRACT: The advancement of surgical and anesthetic techniques reduced cardiac morbidity and mortality. As a result, the attention has been focused on the perioperative cerebral complication, which contribute to more than 20% of perioperative deaths. Cognitive dysfunction is associated with increased medical costs, decreaged quality of life, and mortality. However, the incidence of cognitive dysfunction has a wide variety due to methodological variations in evaluating cognitive dysfunction, showing the complexity of cognitive dysfunction. The score of cognitive test can include learning effect and natural decline of cognitive dysfunction in elderly population. The research including the control group seems to overcome these issues, but still remains to have problems. Further, patients with cardiac disease have comorbid factors to induce postoperative sequelae compared to healthy population. We describe these issues which require continued researches.
    Masui. The Japanese journal of anesthesiology 04/2009; 58(3):308-14.
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    ABSTRACT: We report an emergent case of cardiac tamponade due to rupture of the left ventricle. Preload and intracardiac volume were decreased by percutaneous cardiopulmonary support (PCPS), which led to the collapse of the cardiac chamber. The collapsed cardiac chamber made it difficult to diagnose cardiac abnormalities by preoperative transthoracic echocardiography (TTE). On loading fluid infusion and transfusion as volume load to improve the hemodynamic status, transesophageal echocardiography (TEE) revealed several leakages in the left ventricular myocardium. Continuous careful observation on TEE led us to a confident diagnosis of left ventricular rupture. The diagnosis by TEE also led to the employment of the appropriate procedure. TEE is useful for detecting an abnormality due to the location of the cardiac chamber and echocardiographic probe. We also note that continuous careful observation led to the employment of the appropriate procedure.
    Journal of Anesthesia 02/2009; 23(1):108-10. DOI:10.1007/s00540-008-0702-7 · 1.12 Impact Factor
  • Kenji Yoshitani, Yoshihiko Ohnishi
    Journal of Anesthesia 02/2008; 22(4):502-4. DOI:10.1007/s00540-008-0671-x · 1.12 Impact Factor