[show abstract][hide abstract] ABSTRACT: Because of the decreased tolerance to ischemia and increased reperfusion injury in hypertrophied myocardium, myocardial hypertrophy is a well known risk factor for cardiac surgery. We have previously demonstrated in a left ventricular hypertrophy (LVH) model that a highly buffered cardioplegic solution (HBS) that provided glucose as a substrate and promoted anaerobic glycolysis during ischemia afforded superior myocardial protection when compared to standard formulations. And we reported the superiority of this cardioplegia in human cardiac surgery.
In this study, 16 patients with aortic stenosis (AS) and LVH receiving HBS were reviewed and compared to another patient group with AS and LVH who received either cold blood cardioplegia (CBC; n=5) or glucose insulin potassium (GIK; n=6).
Postoperative cardiac index was better in the HBS group than the other two groups with similar or lower catecholamine. CK-MB was lower in HBS group than GIK group, but this was not significant. Only one DC cardioversion was required in the HBS group, whereas 2 DC in the CBC group and total 7 DC in the GIK group.
We found that histidine buffered cardioplegic solution provided comparable or better pump performance after surgery with relatively lower inotropic requirement, less DC cardioversion and homologous blood requirements for left ventricular hypertrophied heart associated with aortic stenosis.
The Journal of cardiovascular surgery 03/2002; 43(1):37-41. · 1.51 Impact Factor
[show abstract][hide abstract] ABSTRACT: To clarify the pathophysiology of tonic spasms, 21 patients with West syndrome were analyzed using ictal and interictal single photon emission computed tomography (SPECT). We focused on whether ictal perfusion changes were observed in the focal cortical region. Eight of the patients studied showed definite focal cortical ictal hyperperfusion, indicating that there is a unique subset of West syndrome that can be classified as infantile localization-related epilepsy. Of those eight patients, only two showed asymmetric spasms, suggesting that seizure symptomatology in infants gives only limited information on the localization-related nature of epilepsy. Furthermore, the activation of subcortical structures by focal cortical regions might be attributable to the symmetric seizure phenomena. Thirteen patients showed a diffuse pattern in their ictal SPECTs; this probably included patients with diffuse hyperperfusion and those with no changes. The following have yet to be determined: (1) whether West syndrome is divided into subgroups based on the origin of spasms, in that some patients have the origin in the cortical hemisphere and some have the origin in structures other than the cortical hemisphere, such as the brain stem; (2) whether differences in ictal SPECT patterns reflect a unique nature of tonic spasms in West syndrome, where tonic spasms appear in clusters and the interval of each spasm is different among each patient.
Brain and Development 12/2001; 23(7):496-501. · 1.67 Impact Factor
[show abstract][hide abstract] ABSTRACT: Cerebrovascular disease and cervical artery diseases are potentially treatable conditions that are associated with an increased incidence of stroke after cardiac surgery. This prospective study was designed to determine the prevalence of cerebrovascular diseases in the high risk population of cerebrovascular event including some young patients in Japan and establish the strategy for cardiac surgery of patients with cerebrovascular disease.
100 (71 male, 29 female) of 126 consecutive patients undergoing cardiac surgery under cardiopulmonary bypass were screened for the presence of cerebrovascular disease by intra-arterial angiogram.
In seven patients angiographic evaluation disclosed some evidence of cerebrovascular disease for 50% or greater stenosis or cerebral aneurysm. Preoperative 99mTc-Hexamethyl propylene amino oxime (99mTc-HMPAO) single emission computed tomography (SPECT) with combination of balloon arterial occlusion test provided detailed information of cerebral ischemic tolerance and reliable decision making for surgical repair of cerebrovascular disease. No deaths were recorded and a small stroke in one patient.
We concluded that cerebrovascular screening in patients with cardiovascular disease may be requested in a high risk population of cerebrovascular events.
The Journal of cardiovascular surgery 01/2001; 41(6):911-4. · 1.51 Impact Factor
[show abstract][hide abstract] ABSTRACT: A 1-month-old girl showed frequent partial seizures of sudden onset. Continuous spikes were observed in left central area during the ictal period, although interictal EEG showed neither epileptiform discharges nor focal signs. Optimal seizures control was obtained with intravenous administration of diazepam and subsequent oral administration of phenobarbital. She showed neither abnormal physical and neurological signs after seizures nor sequelae. CT examination on two days after the onset of seizures showed no obvious abnormal high density area. However, MRI examination on 10 days after the onset showed subdural hematoma in the left front-temporal area and right occipital area. Except for MRI findings, this case may be diagnosed as benign infantile convulsion or benign complex partial epilepsies in infancy. This case suggested that serial neuroradiological examinations were recommended for prospective studies about benign infantile convulsion and benign complex partial epilepsies in infancy.
No to hattatsu. Brain and development 08/2000; 32(4):328-33.
[show abstract][hide abstract] ABSTRACT: We used interictal single photon emission computed tomography (SPECT) on 40 patients with West syndrome to determine whether cortical perfusion abnormalities are closely related to the development of West syndrome and whether they are correlated with the long-term seizure prognosis or the developmental outcome. Localized cortical perfusion abnormalities were seen in 24 patients (60%), while 15 patients (38%) were classified as normal. The remaining patient showed hyperperfusion of the basal ganglia bilaterally. Of 24 patients with localized perfusion abnormalities, unifocal cortical hypoperfusion was present in 11, multifocal hypoperfusion in 10, multiple cortical hypo- and hyperperfusion in one, hyperperfusion of the bilateral frontal cortices and brain stem in one, and focal hyperperfusion in the residual frontal cortex in one. For statistical analysis, we focused on 26 patients (cryptogenic; 10, symptomatic; 16), who were followed for more than 2 years after the onset of tonic spasms (mean 5.0 years). The results showed that focal cortical perfusion abnormalities were not correlated with the long-term seizure prognosis, the developmental outcome, or the response to ACTH therapy. In agreement with previous reports, the results of interictal SPECT suggested that focal cortical lesions play an important role in the development of West syndrome. However, statistical analysis showed that the existence of cortical dysfunction as defined by SPECT did not predict the seizure prognosis or the developmental outcome.
Brain and Development 02/2000; 22(1):16-23. · 1.67 Impact Factor
[show abstract][hide abstract] ABSTRACT: A one-stage procedure for the treatment of mediastinitis after coronary bypass surgery utilizing the right gastroepiploic artery is described. This procedure consists of thorough debridement of mediastinal pus and necrotic tissue, excision of infected sternal bone, mediastinal irrigation, and immediate transfer of the "remnant" omental pedicle based on the "left" gastroepiploic artery without postoperative drainage or irrigation. Recently, this procedure was applied to our patients followed by excellent results.
The Annals of Thoracic Surgery 08/1999; 68(1):269-71. · 3.45 Impact Factor
[show abstract][hide abstract] ABSTRACT: Increasingly complex techniques of cardiac surgery often require prolonged myocardial ischemia. We previously reported a better myocardial preservation with histidine containing cardioplegia (HBS) in human open heart surgery. To see a safety margin of this cardioplegia for prolonged myocardial preservation, this study was retrospectively done. One hundred twenty-six patients received either intermittent multidose (20-30 minute) cold blood cardioplegia (CBC) plus topical cooling (aotric cross clamp time (ACC) < 120 minutes, n = 63) or HBS (n = 63). HBS group was divided into two groups with either short ACC (< or = 120 minutes, HBS-S, n = 46) or long ACC (> 120 minutes, HBS-L, n = 17). Cardiac index (C.I.) and dopamin/dobutamine requirement were measured 3, 6, and 12 hours post-bypass. Incidence of homologous blood transfusion was also studied. There was two deaths due to LOS in HBS-S group; four patients in HBS group required 5 DC cardioversion, whereas six patients required a total of 12 DC cardioversion in CBC group. Functional recovery were significantly better with significantly lower inotropic requirements in HBS-S group than CBC group and HBS-L group. Although preoperative ejection fraction and C.I. were significantly lower in HBS-L group, post-operative cardiac function and inotropic requirements in HBS-L was comparable to that seen in CBC group. We conclude that the highly buffered histidine crystalloid cardioplegia solution provides effective myocardial preservation with a wider safety margin for prolonged myocardial preservation in open heart surgery.
Kyobu geka. The Japanese journal of thoracic surgery 07/1999; 52(6):467-70.
[show abstract][hide abstract] ABSTRACT: Blood cardioplegia has been widely accepted in clinical cardiac surgery based on its excellent oxygen delivery and pH buffering capacity. To further conserve blood during clinical cardiac surgery, we formulated a new crystalloid cardioplegic solution containing histidine (100 mol/L) as the pH buffering agent.
Sixty patients being applied Histidine Buffered Solution (HBS) (n = 27) or Cold Blood Cardioplegic solution (CBC) (n = 33), both at 4 degrees C, were studied prospectively. Pre- and post-bypass left-ventricular (LV) volume was measured by echocardiography. With a ventricular pressure catheter, LV pressure-volume loops were constructed to determine the slope of the end-systolic pressure-volume relationship (Emax) without inotropes.
There were no postoperative deaths in either group. Thirty minutes after reperfusion Emax was significantly better in the HBS group than in the CBC group (6.0 +/- 1.0 mmHg/cm3 vs 3.7 +/- 0.8 mmHg/cm3). Cardiac Index was also significantly higher in HBS group than in CBC group with lower inotropic requirement. Homologous blood transfusion was avoided in 64% of the patients receiving HBS versus 48% of the patients with CBC.
We conclude that the new histidine-buffered cardioplegic solution provides effective protection with excellent recovery of pump performance in clinical open heart surgery.
The Thoracic and Cardiovascular Surgeon 07/1999; 47(3):148-52. · 0.93 Impact Factor
[show abstract][hide abstract] ABSTRACT: We report on a 3-year-old girl with West syndrome and with focal hypsarrhythmia. The left hemisphere of the patient was virtually completely defective and continuous hypsarrhythmia was only seen in the residual right frontal cortex, where an interictal single photon emission computed tomography (SPECT) showed hyperperfusion. Despite a focal epileptic pattern, the tonic spasms were quite symmetrical. In our patient, spasms might not require the sensorimotor cortex, but the brainstem containing the descending pathways that control spinal reflexes and other infratentorial structures seem to be essential for the occurrence of spasms. This is in accordance with the result of an ictal SPECT that showed hyperperfusion of the brainstem and cerebellum. These findings suggest that hypsarrhythmia originates from cortical lesions, while subcortical structures may be primarily responsible for the tonic spasms in this patient.
Brain and Development 04/1999; 21(2):129-31. · 1.67 Impact Factor
[show abstract][hide abstract] ABSTRACT: Clear evidence of cerebral blood circulation has not been shown after axillo-axillary bypass surgery in patients with subclavian steal syndrome.
We investigated the cerebral circulation and blood flow in 3 patients receiving axillo-axillary bypass by RI angiography using 99mTc-dl hexamethyl propylene amine oxime (99mTc-HMPAO). Two patients had vertebral basilar cerebral symptoms which were related to decreased cerebral blood flow evidenced by 99mTc-HMPAO.
After the correction, cerebral symptoms disappeared and improved cerebral blood circulation detected by 99mTc-HMPAO-SPECT.
We concluded that axillo-axillary bypass was a fairly effective procedure to improve cerebral blood circulation evidenced by 99mTc-HMPAO-SPECT.
The Journal of cardiovascular surgery 07/1998; 39(3):291-3. · 1.51 Impact Factor
[show abstract][hide abstract] ABSTRACT: We evaluated the ictal and interictal single photon emission computed tomography (SPECT) of 9 patients with West syndrome (WS). In this group, we noted two clear patterns of cortical hyperperfusion and subcortical hyperperfusion in the ictal SPECT. Both patterns were different from the previously documented ictal patterns for complex partial seizures (CPS) or secondarily generalized seizures. Our results suggest that the tonic spasms of WS do not always have a single neurophysiological basis; e.g., patients with hemihypsarrhythmia and focal hypsarrhythmia did not show ictal hyperperfusion of the lesion with hypsarrhythmia. These findings indicate that the origin of hypsarrhythmia as an EEG feature and the origin of tonic spasms may be different in such patients. In particular, hypsarrhythmia appears to originate from cortical lesions, whereas the subcortical structures may be primarily responsible for the tonic spasms. Our report is the first published study of ictal SPECT in patients with WS.
[show abstract][hide abstract] ABSTRACT: Blood cardioplegia has been widely accepted due to better oxygen delivery, pH buffering and free radical scavenge. We have found that a crystalloid cardioplegia solution formulated to accelerate anaerobic glycolysis with high buffering capacity. To conserve blood cardioplegia, we formulated a crystalloid cardiopletia containing 100 mM histidine for buffering. This cardioplegia (HBS) was compared to cold blood cardioplegia in patients requiring open heart surgery. Eighty patients including HBS (n = 28), and CBC (n = 40) were involved in this study. Left ventricular end-systolic elastance (Emax; mmHg/cm3) was evaluated pre- and postoperatively. Cardiac index and inotropic requirement were also monitored at 1, 3, and 12 hours after cardiopulmonary bypass. There was no death in either group. All hearts returned to previous rhythm in HBS group, whereas total 12 DC cardioversions were requested in 6 patients. Emax was significantly higher in HBS group (5.2 +/- 0.6 mmHg/cm3) than in CBC group (3.4 +/- 0.4 mmHg/cm3). Cardiac index was also significantly higher in HBS group postoperatively than in CBC group with lower inotropic requirements. We conclude that histidine containing crystalloid cardioplegia provides excellent recovery of cardiac performance with lower inotropic requirements in open heart surgery. The ease of use, and lack of blood are other important advantages of this crystalloid cardioplegia.
[show abstract][hide abstract] ABSTRACT: We describe a simple device for facilitating arterial graft anastomosis during coronary artery bypass grafting. This device can be constructed in seconds from an intravenous catheter. It helps the operator to make the first several stitches on the arterial graft heel, and also helps the assistant to hold the arterial graft easily.
The Annals of Thoracic Surgery 03/1995; 59(2):533-4. · 3.45 Impact Factor
[show abstract][hide abstract] ABSTRACT: A new omental transposition technique was applied to a patient who underwent resection and in situ reconstruction of purulently infected abdominal aortic aneurysm to prevent recurrent retroperitoneal and graft infection. After wide separation from the transverse colon, the omental pedicle was transposed to the infrarenal retroperitoneal space through an opening of the transverse mesocolon to wrap the prosthetic graft and fill the infected space. The postoperative course was uneventful without any sign of recurrent infection in follow-up lasting 8 months. The authors' experience suggest that this 'transmesocolic' technique is an effective modality for critically ill patients with infected abdominal aorta.
[show abstract][hide abstract] ABSTRACT: A 28-year-old female who had had irradiation on the chest wall at the age of 5 as a remedy for keroid granulation after burn, recently developed congestive heart failure. Severe tricuspid regurgitation was demonstrated by echocardiography with a certain calcification in the cardiac shadow on chest radiogram. Calcified right ventricule and ventricular septum were noticed operatively, which disturbed ventricular motion and also caused tricuspid valve deformity. These calcified myocardium apparently corresponded with the irradiation field. After tricuspid valve replacement, she regained physical activity satisfactorily without congestive heart failure. Because she had no other known causes of cardiac calcification such as hypercalcemia, myocarditits, myocardial infarction or renal diseases, irradiation on the chest wall could be responsible for the severe myocardial calcification.
[show abstract][hide abstract] ABSTRACT: A 43-year-old male diagnosed as constrictive pericarditis with dyspnea, fatigability and substantial pericardial calcification on chest roentgenogram underwent pericardiectomy through median sternotomy. The heavily calcified pericardium which was adherent to the anterior and diaphragmatic surface of the heart was successfully resected by the combined use of ultrasonic surgical aspirator (CUSA) and argon beam coagulator (ABC). Intraoperative bleeding was minimal because the adhesion between the pericardium and myocardium, coronary arteries or inferior vena cava were easily dissected with CUSA. Intraoperative hemostasis was also satisfactory with ABC. Perioperative measurements of right ventricular ejection fraction were also effective in evaluating the right ventricular function.
[show abstract][hide abstract] ABSTRACT: A 59-year-old female having the disrupted brachiocephalic artery (BCA) and multiple bone fractures caused by a traffic accident was transferred to our hospital in a hypovolemic shock status with a wide mediastinum on the chest radiograph. Intraarterial digital subtraction angiography was effective in confirming the bleeding site of the artery. The patient underwent an urgent operation 4 hours and 22 minutes after admission. Through median sternotomy the BCA was simply clamped, followed by a direct suture repair of the 2/3-circumferential transection on the proximal portion of BCA. The patient had an uneventful postoperative course without any neurological complications.
[show abstract][hide abstract] ABSTRACT: We reported a case of ankylosing spondylitis which successfully underwent aortic valve replacement for combined aortic and mitral regurgitation. A 42-year-old man was admitted with symptoms of shortness of breath and anginal pain. He was previously diagnosed ankylosing spondylitis by an orthopedician A grade III/VI to and fro murmur was audible at the left sternal border. Retrograde aortography revealed severe aortic regurgitation and mild mitral regurgitation. Cardiac catheterization showed moderately pulmonary hypertension and high pulmonary artery wedge pressure. He underwent aortic valve replacement with SJM prosthetic valve. His postoperative course was uneventful. In Japan, ankylosing spondylitis is rare disease, and cardiac lesions associated with these conditions is seldom met to us. The surgical problems and management of these lesions are discussed.
Kyobu geka. The Japanese journal of thoracic surgery 04/1993; 46(3):275-8.
[show abstract][hide abstract] ABSTRACT: Chondrosarcoma of rib origin is rare in Japan. A 51-year-old man came to our hospital with chest pain and coin lesion in the left superior part of the chest X-ray film. It was suspected to be the posterior mediastinal tumor based on CT and MRI. Operation was done to remove the tumor and the histological diagnosis was chondrosarcoma. The tumor measured 2.5 x 2.6 x 2.2 cm arising from the posterior portion of the left third rib. Combined resection of descending aortic adventitia was done. The patient is doing well without symptoms of recurrence 15 months after operation.