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Y Watanabe,
N Koyama,
N Shiono, M Kawasaki,
H Yokomuro,
T Ozawa,
T Fujii,
S Hamada,
H Masuhara,
S Wada,
K Yoshihara
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ABSTRACT: Off-pump coronary artery bypass grafting (off-pump CABG: OPCAB) has become a standard procedure, but the indication for the patients with severe acute coronary syndrome (ACS) has not been established. The purpose of this study is to evaluate the role of OPCAB for patients with acute myocardial infarction (AMI) and impending myocardial infarction (IMI). Clinical indication of OPCAB for acute coronary syndrome between November 1997 and December 2002, 14 patients diagnosed ACS out of 220 CABG cases underwent surgery. Twelve male and 2 female with a mean age of 66.3 +/- 7.5 were NYHA grade IV condition before surgery. Three of nine AMI cases and 4 of 5 IMI cases underwent OPCAB. Thirteen cases needed intra-aortic balloon pumping (IABP) support pre-operation, in 1 AMI and 2 IMI cases IABP had to be weaned during operation. The mean graft number was 2.6. Except one AMI case with severe cardiac damage, 13 cases were discharged in NYHA grade I-II condition. CONCLUSION: In early onset cases with still rising CK-MB, operative risk and result is difficult to evaluate pre-operatively. Equal results could be seen in IMI cases with no previous myocardial damage. We suggest, that in cases without severe myocardial damage, OPCAB could be one alternative treatment.
Kyobu geka. The Japanese journal of thoracic surgery 08/2003; 56(8 Suppl):678-81.
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S Wada,
Y Watanabe,
N Shiono,
H Masuhara,
S Hamada,
T Ozawa,
T Fujii,
H Yokomuro, M Kawasaki,
K Yoshihara,
N Koyama
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ABSTRACT: We describe a case of a 75-year-old man with abdominal aortic and right femoral tuberculous pseudoaneurysms 32 months after intravesical bacillus Calmette-Guerin therapy for bladder cancer. These aneurysms were probably brought on by systemic infection by Mycobacterium bovis. The infrarenal aorta and right common femoral artery were successfully replaced with an in situ expanded polytetrafluoroethylene graft. Tuberculous pseudoaneurysm after bacillus Calmette-Guerin therapy for malignancy is very rare, and we review the related literature.
Cardiovascular Surgery 07/2003; 11(3):231-5.
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Y Watanabe,
S Koyama,
N Shiono, M Kawasaki,
H Yokomuro,
T Ozawa,
T Fujii,
H Sakuragawa,
S Hamada,
T Masuhara,
K Yoshihara,
T Nagano,
S Ishiguro,
Y Yabe
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ABSTRACT: Recently OPCAB has become more and more common in CABG, although one problem of OPCAB like the quality of anastomosis has not been solved yet. We discussed the usefulness of intra-operative angiography during OPCAB.
During March 1997-July 2000, 55 patients underwent OPCAB (including 35 MIDCAB cases) in our institute. Graft flow and anastomosis were examined by intra-operative or immediate post-operative angiography.
Immediate postoperative angiography was performed in 22 MIDCAB cases. In 15 cases an excellent graft flow without stenosis could be confirmed, in 7 cases the native LAD was so small, which caused a poor flow of the LITA and three cases needed additional PTCA because of anastomosis stenosis. Intra-operative angiography was done in 9 MIDCAB and 17 OPCAB. As a result, re-anastomosis was performed in one case of MIDCAB because of severe anastomosis stenosis, one case of OPCAB had confirmed poor flow because of a small LAD, but in 24 cases an excellent graft flow could be seen on time. In 2 cases OPCAB was combined with PTCA to achieve complete revascularization.
Intra-operative angiography is a useful strategy to confirm the surgical results quickly in OPCAB (included MIDCAB). Using such a strategy, combination of OPCAB and PTCA as a new approach for complete revascularization can be performed safe and smooth.
Kyobu geka. The Japanese journal of thoracic surgery 05/2001; 54(4):332-6.
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K Yoshihara,
T Ozawa,
H Sakuragawa,
T Fujii, M Kawasaki,
N Shiono,
Y Watanabe,
N Koyama,
Y Mastuura,
T Saji,
Y Takanashi
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ABSTRACT: An eight-year-old boy, Noonan syndrome associated with ASD and PS, was referred to our department for surgical repair. During operation, the coronary sinus ostium was not found. Farther more exploration revealed completely unroofed coronary sinus without LSVC. The large ASD (confluent with coronary sinus ASD) was closed with a ePTFE patch. The pulmonary valve was thickened moderately and each commissure was adhesive, but not dysplastic. PS was released with commissurotomy and subpulmonary muscle resection. The postoperative course was uneventful and the patient discharged at 14 postoperative day. At present, he has been followed at outpatient without PS and any sign and symptom of myocardial hypertrophy.
Kyobu geka. The Japanese journal of thoracic surgery 03/1999; 52(2):134-7.
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ABSTRACT: A 4-year-old girl with pure pulmonary stenosis, hypoplastic right ventricle and atrial septal defect, underwent left modified Blalock-Taussig shunt at the age of 2 year. Her RVEDV was 62.7% of normal and TVD was 64.2% of normal at the age of 3 year. We observed development of right ventricle and performed simultaneously Glenn shunt and right ventricular outflow reconstruction (one and one half ventricle repair). Her general condition after operation became better. The size of tricuspid valve and right ventricle grew on Cardiac ultrasonography and catheterization examined after one year operation. In future, If the size of RV and TV might grow further, we should recommend her biventricular repair.
The Japanese Journal of Thoracic and Cardiovascular Surgery 10/1998; 46(9):933-8.
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ABSTRACT: A sixty-year-old male manifested high fever, bloody sputa and an abnormal shadow in the left hilus on chest X-ray film. He was treated with antibiotics as for a infections lung disease. But back pain which he had been suffered from didn't improve. He was referred to the second hospital with suspicion of lung neoplasm. He underwent radiation therapy. The shadow in the left hilus had been increasing in size with the radiation therapy. On CT scanning, the shadow was recognized as an impending aneurysm along the descending thoracic aorta. He was referred to our hospital and operated upon in emergency basis. On operative findings, the aortic aneurysm located from the distal portion of the left common carotid artery and was huge sacklar shape. In surgical procedure, the entrance in the descending aorta was closed with a vascular patch graft because the aortic wall around the entrance was normal and unaffected. Postoperative course was uneventful. We should learn some warning from this case.
Kyobu geka. The Japanese journal of thoracic surgery 06/1995; 48(5):409-11.
