[show abstract][hide abstract] ABSTRACT: A 31-year-old man was diagnosed with acute ascending aortic dissection and massive aortic regurgitation following acute type B dissection during drug treatment. Although the aortic arch was not dissected, we performed aortic replacement from the aortic root to the proximal portion of the descending aorta. The aim of the operation was the prevention of aortic arch dissection, and closure of initial entry of type B dissection.
Annals of thoracic and cardiovascular surgery: official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 01/2002; 7(6):384-6. · 0.47 Impact Factor
[show abstract][hide abstract] ABSTRACT: We describe a 66-year-old woman who underwent open heart surgery because of congestive heart failure. During operation, we found a Stanford type A dissection and an aortic ring abscess, which had burst into the aortic lumen. No other entries were found. Pathological examination showed excessive neutrophil infiltration in the aortic root. We strongly suspect that the abscess produced the intimal tear to cause the aortic dissection.
The Annals of Thoracic Surgery 01/2002; 72(6):2136-7. · 3.45 Impact Factor
[show abstract][hide abstract] ABSTRACT: We assessed the efficacy of postoperatively administered oral Sotalol in preventing the occurrence of postoperative atrial fibrillation.
Subjects were 80 consecutive patients undergoing coronary artery bypass grafting (CABG) randomized alternately into a Sotalol group (40 patients) administered 80 mg of oral Sotalol daily starting on the postoperative day 1 and continued for 14 days, and a control group (40 patients) matched for age and gender.
The incidence of postoperative atrial fibrillation (21 patients) was significantly lower in the Sotalol group (6/40 patients; 15%) than in controls (15/40; 37.5%) (p < 0.05). Significant bradycardia or hypotension, necessitating drug withdrawal, occurred in 3 of 40 (7.5%) patients in the Sotalol group. None in the Sotalol group developed Torsardes de Pointes or sustained ventricular arrhythmias or other severe side effects. The sinus heart rate increased in both groups but less in the Sotalol group. QT, QRS, and QTc durations did not differ between groups. Postoperative hospital stay did not differ between groups.
Oral Sotalol administration of 80 mg daily was associated with a significant decrease in postoperative atrial fibrillation in patients undergoing CABG without appreciable side effects. Sotalol should thus be considered in preventing postoperative atrial fibrillation in patients undergoing CABG in the absence of heart failure and significant left ventricular dysfunction.
The Japanese Journal of Thoracic and Cardiovascular Surgery 10/2001; 49(10):614-7.
[show abstract][hide abstract] ABSTRACT: A technique of combined minimally invasive coronary artery surgery and abdominal aneurysm repair is described. A mini-sternotomy and off-pump coronary artery bypasses to the left descending branch and right coronary arteries are conducted before abdominal aneurysm repair in a simultaneous operation.
European Journal of Cardio-Thoracic Surgery 07/2001; 19(6):935-7. · 2.67 Impact Factor
[show abstract][hide abstract] ABSTRACT: To prevent neurological complications during cardiopulmonary bypass, cerebrovascular screenings by magnetic resonance angiography and computed tomographic scan of the brain were performed preoperatively in patients who had ischemic heart disease and all patients aged 60 years or older. From 1996 to 1999, 173 adult patients (mean age 65.1+/-7.7 y) were evaluated. Forty-one patients were considered to be at high risk from the screening tests and pulsatile cardiopulmonary bypass was applied. The remaining 132 patients were placed in the control group. Postoperative cerebral infarction caused by embolism was encountered in three patients (3/173, 1.7%), two in the high-risk group (2/41, 4.8%) and one in the control group (1/132, 0.8%), but the difference between these incidences was not statistically significant. Cerebral infarctions caused by brain hypoperfusion did not occur in this series. A neuropsychological test (Hasegawa's dementia scale, HDS) was done pre- and postoperatively. No one was diagnosed with dementia preoperatively, whereas 7 patients were diagnosed with dementia postoperatively. Among these 7 patients, 6 patients were in the high-risk group (17.1%, 6/35) and one patient was in the control group (0.9%, 1/113). Under these circumstances, using cerebrovascular screening and pulsatile cardiopulmonary bypass, cerebral infarction due to hypoperfusion did not occur, but cerebral infarction due to embolism was encountered, and neuropsychological dysfunction was not prevented.
Annals of thoracic and cardiovascular surgery: official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 05/2001; 7(2):89-93. · 0.47 Impact Factor
[show abstract][hide abstract] ABSTRACT: For patients diagnosed with combined thoracic aortic aneurysms and cardiac lesions, we conduct a 1-stage operation for ascending and aortic arch grafting. We studied surgical outcome comparatively with patients undergoing aortic grafting alone. For descending and thoracoabdominal aortic grafting, we choose a 2-stage operation.
Subjects were 80 patients undergoing ascending and aortic arch aneurysm repair between June 1994 and March 1999. Group 1 consisted of 30 undergoing simultaneous cardiac repair. Concomitant cardiac procedures involved 21 valvular, 5 coronary arterial, and 4 valvular and coronary arterial surgeries. Group 2 consisted of 50 undergoing aortic grafting alone. We used crystalloid cardioplegia and additional antegrade continuous cold-blood coronary perfusion in Group 1, and crystalloid cardioplegia alone in Group 2.
Hospital mortality was 10% in Group 1 and 2% in Group 2. Surgery length, cardiopulmonary bypass time, and aortic cross-clamping time in Group 1 were significantly longer than Group 2. Myocardial ischemic time did not differ significantly. Postoperative ICU stay, mechanical ventilation time and catecholamine support time did not differ significantly. Actuarial survival was 66.9 +/- 13.1% at 52 months in Group 1 and 87.2 +/- 4.8% at 57 months in Group 2 (p = 0.2918).
Simultaneous cardiac repair and ascending and aortic arch aneurysm repair were conducted using continuous cold-blood coronary perfusion. Hospital mortality and mid-term survival did not differ significantly between groups.
The Japanese Journal of Thoracic and Cardiovascular Surgery 03/2001; 49(2):103-7.
[show abstract][hide abstract] ABSTRACT: Cerebral complication is an important factor affecting the outcome after coronary artery bypass surgery under cardiopulmonary bypass. One of the causes for cerebral complication is preoperative cerebrovascular stenotic lesion. Here, we have studied the effect of pulsatile perfusion on the rate of cerebral complication due to a cerebrovascular lesion in patients undergoing coronary arterial bypass graft under cardiopulmonary bypass.
261 consecutive elective patients underwent operation using cardiopulmonary bypass for management of the atherosclerotic ascending aorta. Group 1 consisted of 62 patients with a cerebrovascular stenotic lesion (> or = 75%) identified on a magnetic resonance angiogram or multiple cerebral infarction diagnosed using a computer tomogram. Group 2 consisted of 199 patients diagnosed with no significant cerebral lesion. In Group 1, the systolic blood pressure during cardiopulmonary bypass was maintained at a level of 80 mmHg by means of pulsatile flow. In Group 2, non-pulsatile perfusion was used as usual.
The overall hospital mortality was 1.5%, and no mortality was caused by a cerebral event. Only one patient in Group 1 suffered from temporary hemiparalysis. A cerebral complication occurred in only 1.6% in Group 1, and 0.4% overall. The actuarial freedom from cerebrovascular accident after 54 months was 84.4% in Group 1, and 96.2% in Group 2 (p = 0.0011).
Management of the atherosclerotic ascending aorta and the use of pulsatile perfusion were helpful in preventing cerebral injury during CABG.
The Japanese Journal of Thoracic and Cardiovascular Surgery 10/2000; 48(9):551-6.
[show abstract][hide abstract] ABSTRACT: Aorto-right atrium fistula associated with aortic dissection is a very rare complication. Here report a case of successful surgical repair of ascending aortic dissection complicated with aorto-right atrium fistula. A 65-year-old man was presented with sudden chest pain and dyspnea. Fifteen years ago, he had aortic valve replacement. An aortic dissection with fistula to the right atrium was diagnosed by echocardiography and cardiac catheterization. At operation, dense adhesion of the aortic root due to the previous cardiac operation was confirmed, and this was suggested as the cause for this rare complication.
The Japanese Journal of Thoracic and Cardiovascular Surgery 09/2000; 48(8):531-3.
[show abstract][hide abstract] ABSTRACT: Some reports have observed the response of cerebral blood flow to PaCO2 during hypothermic cardiopulmonary bypass. We studied the effect of PaCO2 on the cerebral circulation during hypothermic selective cerebral perfusion.
Between June 1992 and January 1998, 35 patients underwent aortic arch grafting using hypothermic selective cerebral perfusion (20 degrees C). In the earlier four patient (Group 1), carbon dioxide gas was not added. In the latter 31 patient (Group 2), carbon dioxide gas was added to the cerebral perfusion. The hemodynamics and rates of change in cerebral oxygen saturation were evaluated.
In Group 1, the index of cerebral arterial resistance was 9.2+/-2.2 at the start of selective cerebral perfusion and increased to 15.7+/-0.1 at the re-warming stage (p<0.05), and there was a significant decrease in cerebral oxygen saturation at the re-warming stage (p<0.001). In Group 2, the index of cerebral arterial resistance was 4.7+/-1.7 at the start of selective cerebral perfusion and 4.3+/-1.5 at the re-warming stage, a non-significant change. The change in cerebral oxygen saturation was also nonsignificant between the start of selective cerebral perfusion and the re-warming stage. Among the neurological outcomes, there was only one small cerebral infarction in Group 2; however, no delayed conscious recovery was observed.
The addition of CO2 to cerebral perfusion was a factor in inhibiting the increase in the cerebral vascular resistance at the re-warming stage.
The Journal of cardiovascular surgery 06/2000; 41(3):371-5. · 1.51 Impact Factor
[show abstract][hide abstract] ABSTRACT: We report the choice of aortic valve reconstruction, surgical results and postoperative results in 22 patients who underwent aortic root replacement between June 1996 and October 1999. We chose the replacement using bio-prosthesis in six patients over 65 years of age and valve preservation or replacement using mechanical prosthesis in sixteen patients under 65 years of age. Ten patients underwent valve replacement using mechanical prosthesis. There was one hospital death and one late death. Six patients underwent valve replacement using bio-prosthesis. There was no hospital death and no late death. Six patients underwent valve preservation. There was one hospital death. There was no event among five patients in the mid-term follow-up, although a longer follow-up must be necessary.
Kyobu geka. The Japanese journal of thoracic surgery 05/2000; 53(4):333-6.
[show abstract][hide abstract] ABSTRACT: The incidence of lower extremity ischemia secondary to acute aortic dissection is relatively low, however, the presenting symptoms are variable in term of severity. We report here in two cases of such circumstances who were successively differently treated. Case one was a 60 years old male presented with severe left leg pain. Even after the initiation of cardiopulmonary bypass, the leg ischemia did not improve, therefore selective leg perfusion was additionally performed through direct left femoral artery cannulation. The surgery toward dissection was completed by mean of simultaneous graft replacement of ascending aorta and aortic arch. The leg ischemia after the aortic procedure however had persisted, femorofemoral bypass was created to relieve the mal-perfusion. Case two was a 37 years old male admitted with severe left leg pain associated with sensory-motor nerve dysfunction with muscle rigidity. In this particular patient, femoro-femoral bypass was firstly reconstructed as the mean of leg salvage procedure. After we learned there was no serious reperfusion symptom manifested, we performed radical surgery toward the aorta. We believe that the decision making of surgical treatment for acute type A dissection complicated with the presence of lower extremity ischemia is based on the severeness of mal-perfusion.
The Japanese Journal of Thoracic and Cardiovascular Surgery 11/1998; 46(10):1004-8.
[show abstract][hide abstract] ABSTRACT: An aneurysm of the left sinus of Valsalva producing aortic valve regurgitation was treated by excising the aortic root including the aneurysm but leaving the aortic valve leaflets. The aortic valve was reimplanted inside a graft. Postoperative examinations revealed normal aortic valve function. In this case, the cause of aortic valve regurgitation was due to deformity of the aortic annulus. An aortic valve-sparing operation is an appropriate method for such a case.
The Annals of Thoracic Surgery 03/1998; 65(2):535-7. · 3.45 Impact Factor
[show abstract][hide abstract] ABSTRACT: A 28-year-old woman with heart failure was hospitalized at 21 weeks of gestation. Nine years previously mitral regurgitation was diagnosed, and she underwent mitral valve replacement with a Carpentier-Edwards pericardial valve. Echocardiography revealed primary tissue failure of the mitral prosthesis. Emergent mitral valve replacement was performed. Normothermic high-flow high-pressure pulsatile perfusion was performed during cardiopulmonary bypass. Fetal heart rate was monitored, and it remained above 150 bpm throughout the operation. No bradycardia was observed. The degenerated prosthetic valve was replaced with another Carpentier-Edwards pericardial valve to ensure a safe pregnancy and delivery. Pregnancy was carried to term, and a healthy baby was delivered vaginally.
[show abstract][hide abstract] ABSTRACT: A 55-year-old female afflicted with mitral valve stenosis and atrial fibrillation was admitted to our hospital complaining of chest pain, ST elevation of ECG (V2-5) and elevated CPK value were recognized. She was diagnosed as having acute myocardial infarction, and percutaneous transluminal coronary recanalization was performed immediately. The coronary angiogram showed occlusion by the thrombus at the proximal left anterior descending branch (#7), even, left ventriculogram showed ventricular aneurysm on the anterior wall. But these lesions could not be recanalized by 960,000 IU urokinase administration. She underwent aneurysmectomy and mitral valve replacement with 27 mm SJM prosthesis. When mitral valve stenosis accompanied with left ventricular aneurysm we considered in order to improve left ventricular function, it is necessary to undergo not only mitral valve operation but left ventricular aneurysmectomy aggressively.
Kyobu geka. The Japanese journal of thoracic surgery 06/1997; 50(5):400-3.
[show abstract][hide abstract] ABSTRACT: A five-year-old boy was admitted to our hospital because of a cardiac murmur and an abnormal electrocardiogram. He had a distinct pattern of facial features and mild mental and developmental retardation. An aortogram revealed that the aorta was hypoplastic from just above the Valsalva sinuses to the aortic arch. Moreover, the basal portions of the arch vessels were also hypoplastic. A diagnosis of diffuse supravalvular aortic stenosis was made. The pressure gradient between the left ventricle and the descending aorta was 74 mmHg on catheter examination. Surgical therapy was therefore indicated. The hypoplastic lesions of the aorta and arch vessels were enlarged with a Dacron patch under cardiopulmonary bypass and deep hypothermic circulatory arrest. The postoperative course was uneventful. The pressure gradient decreased to 7 mmHg on catheter examination. This type of supravalvular aortic stenosis is quite rare. Further follow-up is required to evaluate long-term outcome.
[show abstract][hide abstract] ABSTRACT: Aortic valve replacement was performed through a left anterolateral thoracotomy using cardiopulmonary bypass in a 59-year-old man who had previously received esophageal resection with substernal reconstruction by gastric tube. Through this approach, injury of the reconstructed tube was avoided and the valve replacement operation was safely performed. We conclude that the lateral thoracotomy approach remains a valuable alternative for certain exceptional cases.
The Annals of Thoracic Surgery 02/1997; 63(1):225-7. · 3.45 Impact Factor
[show abstract][hide abstract] ABSTRACT: A 59-year-old man came to our hospital because of hoarseness and chest pain. On initial examination, a chest roentgenogram showed no abnormality. Three weeks later, while the patient was waiting to undergo a computed tomographic (CT) scan, shock suddenly developed. A chest roentgenogram revealed an extremely wide mediastinal shadow. A CT scan revealed rupture of the aortic arch near the base of the left subclavian artery, although there was no aneurysm. An emergency operation was performed. The ruptured aortic arch was replaced with an artificial graft during cardiopulmonary bypass with selective cerebral perfusion. A diagnosis of infectious aortitis was not made until a pathologist discovered colonies of gram-positive cocci in the resected specimen of the aortic arch. Postoperatively, antibiotics were administered for only four days. The patient is well about two years after the operation. Infectious aortitis had a very low prevalence and rarely involves the thoracic aorta. However, we should be aware of that it may cause aortic rupture even in the absence of aneurysmal dilatation.
[show abstract][hide abstract] ABSTRACT: We used retrograde cerebral perfusion (RCP) to protect the brain in patients undergoing aortic arch replacement from May 1991 to July 1992. Subsequently, we have been using selective cerebral perfusion (SCP). In this study, a group of six patients undergoing RPC were compared with 5 patients undergoing SCP with regard to the intraoperative electroencepharogram (EEG) and post operative clinical course. There were no deaths in either group, but transient palsy of the right arm developed in one patient in the RCP group. The amplitude of intraoperative EEG was examined at four points: before cardiopulmonary bypass, during RCP or SCP, at 30 degrees C and at 35 degrees C during rewarming. The EEG amplitude at these four points was expressed as a ratio to the value before cardiopulmonary bypass. The ratios at these four points were 1, 0, 0.08, and 0.19 in the RCP group and 1, 0, 0.70, and 0.90 in the SCP group, respectively. In the SCP group, EEG recovered rapidly, whereas in the RCP group EEG did not recover until the completion of cardiopulmonary bypass in all but one patient. These results indicated that RCP does not provide reliable protection of the brain.
[show abstract][hide abstract] ABSTRACT: Long-term follow up results of valve replacement with Carpentier-Edwards pericardial bioprosthesis were analysed. From April 1985 to March 1994, a total of 99 bioprostheses were implanted in 92 patients. Aortic valve replacement was performed in 27, mitral valve replacement in 43, combined aortic-mitral valve replacement in 7 and tricuspid valve replacement in 15 patients. The actuarial survival rates at 9 years were 84% (aortic), 59% (mitral), 69% (aortic-mitral) and 76% (tricuspid) respectively. One patient sustained a thromboembolic event after mitral valve replacement, however, none of that complication occurred after aortic or tricuspid valve replacement. Two patients with mitral valve replacement required reoperation because of structural deterioration after 8 years. Five cases of bioprosthetic infection encountered, and three died. Actuarial freedom from overall valve-related complications at 9 years was 97% for aortic, 72% for mitral and 100% for tricuspid valve replacement respectively. There was no structural deterioration of the aortic and tricuspid valve. Actuarial freedom from structural deterioration of the mitral valve was 84% at 9 years. We conclude that the Carpentier-Edwards pericardial bioprosthesis has low incidence of valve related complication within the 9 years time frame of this study.
[show abstract][hide abstract] ABSTRACT: A 60-year-old man who undergone uneventful mitral valve replacement 9 years and 5 months previously was referred to us because his chest roentgenogram showed rapidly growing abnormal shadow. Two-dimensional echo cardiography revealed a left ventricular pseudoaneurysm. Emergent surgery was performed under the cardiopulmonary bypass. The aneurysm, which arose posteriorly from the base of the left ventricle, had a thin wall that could be separated from the pericardium. It was therefore diagnosed to be a subepicardial aneurysm. Examination of his previously implanted mitral prosthesis (a Duromedicus valve) revealed that the mitral orifice was partially occluded by a thrombus. The Duromecicus valve was therefore removed, and the ruptured left ventricular wall was closed from both outside and inside. A St. Jude Medical valve was then placed in the mitral position. Pseudoaneurysm or subepicardial aneurysm formation is a possible late complication after mitral valve replacement. Physicians and surgeons should be aware of this late complication in patients who had undergone mitral valve replacement because it urgently requires surgical correction.