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ABSTRACT: Small patent ductus arteriosus, is generally closed in children using a transcatheter coil. This is done less often in older
patients or those with large patent ductus arteriosus. We report successful antegrade transcatheter coil closure of patent
ductus arteriosus in a 70-year-old woman. Into the patent ductus arteriosus, using flexible myocardial biopsy forceps, we
placed two large 0.052-inch Gianturco coils, which were easily used as multipurpose vascular occlusion coils. The forceps
and the coils were readily available and provided complete occlusion. Other delivery devices cannot deliver such large coils.
Transcatheter coil closure thus appears to be safe and effective for closing large patent ductus arteriosus in the elderly.
The Japanese Journal of Thoracic and Cardiovascular Surgery 04/2012; 49(6):381-383.
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ABSTRACT: An 11-year-old boy who had undergone extracardiac conduit repair for the corrected transposition of the great arteries at 1 year of age showed hemolytic anemia due to a significant stenosis of the conduit placed between the right ventricle and pulmonary artery. There was a pressure gradient of 157 mmHg across the stenosis, giving 1.6:1 of right to left ventricular pressure ratio. Hemoglobin was 93 g/L with increased serum lactate dehydrogenase of 1382 IU/L. Stent implantation into this obstructed conduit has decreased a pressure gradient to 45 mmHg, leaving 0.74 of right to left ventricular pressure ratio. At 3 months after the stent implantation, hemoglobin has normalized. This case illustrate that an extremely severe stenosis of the right ventricular extracardiac conduit can induce hemolytic anemia and stent implantation into the conduit can be one of the alternative treatments to alleviate conduit stenosis and stop hemolysis.
International Journal of Cardiology 04/2005; 99(1):135-6. · 7.08 Impact Factor
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ABSTRACT: Gastrointestinal complications (GICs) such as gastroduodenal ulcer, enterocolitis, and ischemic colitis after coronary artery bypass grafting (CABG) are rare, but are associated with high mortality and morbidity. The present study was performed to detect risk factors and to investigate outcomes following GICs after CABG.
Between January 1992 and December 2001, 17 of 549 patients (3.1%) developed GICs after CABG with cardiopulmonary bypass, presenting with gastrointestinal bleeding due to gastroduodenal ulcer, enterocolitis, or ischemic colitis. We conducted a retrospective analysis of these patients.
All patients required emergent treatment for hemorrhage by means of blood transfusion and endoscopic ablation and/or clipping. The following possible predictors of GICs were identified by logistic multivariate analysis: age over 70, diabetes mellitus (particularly insulin-dependent diabetes), history of cerebrovascular disease or history of renal failure and postoperative low output syndrome (LOS).
Our results suggested that GICs after CABG with cardiopulmonary bypass are rare but can be lethal. Early diagnosis and prompt intervention can be difficult but are potentially life saving for patients in whom GICs develop.
Annals of thoracic and cardiovascular surgery: official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 03/2005; 11(1):25-8. · 0.69 Impact Factor
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Cardiology 02/2005; 103(3):142. · 1.71 Impact Factor
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ABSTRACT: A 26-year-old patient, who has double inlet left ventricle, pulmonary atresia, and a patent vertical arterial duct, presented with progressive cyanosis with an arterial oxygen saturation of 71%. He had had three shunt operations and only the last aortopulmonary shunt was patent. Angiography revealed a stenotic aortopulmonary shunt, stenotic vertical arterial duct, and a branch stenosis of the left pulmonary artery. He underwent successful stent implantation into both the aortopulmonary shunt and vertical arterial duct and his arterial oxygen saturation increased to 88%. This case report illustrates that stent implantation into a vertical arterial duct is feasible and can be an alternative to shunt operation.
The Annals of thoracic surgery 02/2005; 79(1):e5-6. · 3.74 Impact Factor
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ABSTRACT: The effect on left ventricular performance of mitral valve replacement (MVR) with preservation of continuity between the mitral annulus and papillary muscle was studied in patients with mitral stenosis (MS).
Forty patients with MS who underwent MVR between 1986 and 1995 and had long-term echocardiographic follow up were studied retrospectively. Eighteen patients had conventional MVR (CMVR group), and 22 (PMVR group) had either preservation of autologous chordae tendineae (n = 6) or replacement of the chordae with expanded polytetrafluoroethylene sutures (n = 16).
Preoperatively, there were no significant differences between the two groups in age, body surface area, left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), fractional shortening (FS) or ejection fraction (EF). At 3.1-6.5 years after surgery, periodic echocardiography showed significant differences (p <0.05) in LVESD (35.8 versus 31.6 mm, respectively, in the CMVR and PMVR groups) and FS (31.8% versus 38.1%). At 6.6-9.7 years postoperatively, no significant differences were observed between the two groups in FS, but LVESD was significantly greater in the CMVR group than in the PMVR group (37.3 versus 31.5 mm).
In the long term, MVR with preservation of continuity between the mitral annulus and papillary muscle improves systolic left ventricular performance in patients with MS.
The Journal of heart valve disease 11/2004; 13(6):931-6. · 0.81 Impact Factor
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ABSTRACT: To determine the change of serum concentration of vascular endothelial growth factor (VEGF) in patients with cyanotic congenital heart disease (C-CHD).
Patients comprised four groups: group A, 19 patients without cyanosis; group B, 24 patients with C-CHD; group C, 17 patients who had C-CHD and underwent biventricular repair; and group D, 15 patients who had single ventricle and underwent a Fontan type operation. Blood samples were obtained from upper arm veins and serum VEGF was determined. We determined correlation between serum VEGF and arterial oxygen saturation and compared levels of serum VEGF among groups. In addition, age and hemodynamic variables derived from cardiac catheterization were analyzed in terms of correlation with serum VEGF.
Serum VEGF significantly negatively correlated with arterial oxygen saturation (r = -0.62, p < 0.0001). Serum VEGF in B and D were significantly higher than those in A and C (median = 443 pg/mL in B and 302 pg/mL in D vs 180 pg/mL in A and 216 pg/mL in C, respectively). Serum VEGF was significantly negatively correlated with patient's age (p = 0.54, p < 0.04) in D, but significantly positively correlated with systemic venous pressure (p = 0.45, p < 0.01) in pooled data.
Patients with C-CHD have increased serum VEGF in parallel with the degree of cyanosis. With biventricular repair, cyanosis and serum VEGF are normalized. However, with a Fontan type operation, cyanosis disappears but serum VEGF may not be normalized because of elevated venous pressure in association with younger age.
The Annals of thoracic surgery 10/2004; 78(3):942-6; discussion 946-7. · 3.74 Impact Factor
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Cardiology in the Young 07/2004; 14(3):322-3. · 0.76 Impact Factor
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The Annals of Thoracic Surgery 07/2004; 77(6):2259-60; author reply 2260. · 3.74 Impact Factor
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ABSTRACT: Aortobronchial fistula (ABF) is a rare condition that is almost always fatal in the absence of prompt and proper treatment. However, treatment remains challenging, particularly in the aortic arch. We present six operations for 5 such patients, in which no in-hospital deaths occurred. One patient with mycotic aneurysm died suddenly 10 months postoperatively. Another patient required reoperation 5-months after operation due to additional ABF. No pseudoaneurysms or graft-related complications were observed in the remaining patients. In patients with ABF, performance of operations as soon as possible after onset and minimal dissection of adherent lung tissue appear to improve outcomes.
The Annals of Thoracic Surgery 06/2004; 77(5):1821-3. · 3.74 Impact Factor
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Journal of the American College of Surgeons 06/2004; 198(5):842-3. · 4.55 Impact Factor
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ABSTRACT: Aortoesophageal fistula occurring as a complication of a thoracic aortic aneurysm is difficult to repair because of the contaminated surgical field. We report the case of a 67-year-old man in whom an aortoesophageal fistula developed secondary to a dissecting thoracic aortic aneurysm. We performed in situ graft repair of the aneurysm, then covered the site with omentum and resected the esophagus to prevent graft infection. About 5 months later, the esophagus was reconstructed subcutaneously using an ascending colon pedicle. The patient recovered well and has resumed leading a normal life.
Surgery Today 02/2004; 34(4):357-9. · 1.22 Impact Factor
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ABSTRACT: Reoperative (redo) mitral valve surgery is still a continuing challenge to surgeons. The aim of this study was to detect the factors that affect late mortality or morbidity after redo mitral valve surgery in patients with rheumatic disease.
Between May 1983 and February 2003, 92 patients who underwent redo mitral valve surgery for rheumatic disease were enrolled. Risk factors influencing survival or cardiac events were investigated with univariate analysis and a Cox model.
Operative mortality rate was 4.2%. Kaplan-Meier actuarial analysis demonstrated an 84.7% 5-year, a 69.5% 10-year, and a 65.9% 15-year survival. Multivariate analysis demonstrated that age at surgery and preoperative New York Heart Association (NYHA) class were found to be independent predictors of late deaths, and that higher age, advanced NYHA class, and previous mitral valve replacement were independent predictors of cardiac events.
Redo mitral valve surgery can be achieved with low early mortality. However, long-term results of redo mitral surgery are not necessarily satisfactory in patients with preoperative advanced NYHA class or with a previous mechanical heart valve, and especially in 60 years or older age.
The Annals of Thoracic Surgery 01/2004; 76(6):1939-43; discussion 1943. · 3.74 Impact Factor
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ABSTRACT: A successfully-treated case of acute type B aortic dissection associated with a mycotic aneurysm is reported. A 69-year-old man had a history of febrile illness and a high CRP level with increased enzyme activity of the hepatobiliary system before the onset. The culture of the abscess in the distal arch aneurysm revealed Bacteroides fragilis. A Dacron graft replacement between the distal arch and the proximal descending aorta was successfully performed with Teflon felt reinforcement, and the graft was covered with omental flap. The patient was discharged without recurrence of infection 2 months after the graft replacement.
The Japanese Journal of Thoracic and Cardiovascular Surgery 11/2003; 51(10):545-7.
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ABSTRACT: For patients with a history of heparin-induced thrombocytopenia (HIT) who undergo cardiac or vascular surgery, the optimal anticoagulation substitute for heparin has yet to be established. Recombinant hirudin has been recommended; however, this agent is unsuitable for patients with renal dysfunction. Argatroban was used in the present patient who had a history of HIT and renal dysfunction and required peripheral vascular surgery. Argatroban was easy to monitor and control, regardless of renal function, and has advantages over other anticoagulants for such patients.
Circulation Journal 11/2003; 67(10):889-90. · 3.77 Impact Factor
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The Annals of Thoracic Surgery 08/2003; 76(1):340-1; author reply 341-2. · 3.74 Impact Factor
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ABSTRACT: Whether preoperative tricuspid regurgitation (TR) will regress or progress late after surgery is unknown. The aim of this study was to evaluate predictors of significant TR late after mitral valve surgery.
A retrospective analysis was performed on a total of 174 patients who underwent mitral valve surgery without tricuspid valve surgery. Preoperatively, 46 patients (26%) had 2+ TR, and 128 patients (74%) had 1+ or less TR. Postoperative 3+ TR was considered significant TR. Variables were used to evaluate predictors of TR development by univariate or multivariate analysis.
The mean follow-up was 8.2 years (range 1.0 to 14.5 years) after surgery. There was progressive TR (3+ or more) in 28 patients (16%) during the follow-up period. In univariate analysis, atrial fibrillation, rheumatic etiology, huge left atrium, left ventricular dysfunction, and preoperative 2+ TR were significant risk factors for TR development. Multivariate analysis identified preoperative 2+ TR, atrial fibrillation, and huge left atrium as statistically significant predictors for late TR after surgery.
Aggressive repair of accompanying TR should be undertaken at the time of initial surgery in patients with huge left atrium or atrial fibrillation, even if preoperative TR is 2+.
The Annals of Thoracic Surgery 07/2003; 75(6):1826-8. · 3.74 Impact Factor
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Journal of Thoracic and Cardiovascular Surgery 06/2003; 125(5):1158-9. · 3.41 Impact Factor
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ABSTRACT: There is little information available concerning plasma concentrations of B-type natriuretic peptide (BNP) in children with a ventricular septal defect. The aim of the present study was to determine hemodynamic factors that control plasma concentrations of BNP and the clinical implications of BNP compared with atrial natriuretic peptide (ANP) in children with ventricular septal defect.
Fifty-nine patients with ventricular septal defect (28 boys and 31 girls) without pulmonary vascular disease were enrolled. The patients' ages ranged from 3 months to 13 years (mean 3.1 years). Plasma BNP and ANP were determined by immunoradiometric assay. Hemodynamic variables derived from cardiac catheterization were analyzed in terms of correlation with BNP and ANP.
It was found that plasma BNP significantly positively correlated with ANP (ANP = 2.1 x BNP + 25 pg/mL; r = 0.81, P < 0.0001) and BNP never exceeded ANP in the present patient series. Plasma BNP as well as ANP significantly positively correlated with pulmonary to systemic flow ratio (r = 0.65 and r = 0.59, respectively) and mean pulmonary artery pressure (r = 0.72 and r = 0.68, respectively). In addition, plasma BNP of > or =20 pg/mL and ANP of > or =50 pg/mL identified children with mean pulmonary artery pressure of > or =20 mmHg with a sensitivity of 82% and 97%, respectively, and a specificity of 89% and 84%, respectively.
Plasma BNP and ANP reflect pressure and volume loads to the pulmonary artery and right ventricle and may help to identify children with ventricular septal defect complicated by pulmonary hypertension that demands early intervention.
Pediatrics International 06/2003; 45(3):249-54. · 0.63 Impact Factor
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The Journal of heart valve disease 04/2003; 12(2):270-1; author reply 271. · 0.81 Impact Factor
