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ABSTRACT: Bentall operation has been a gold-standard procedure for the aortic root reconstruction in the patients with aortic root aneurysms and aortic valve insufficiency (AI). Recently, native aortic valve preserving operation has been widely spread. In this study, we described the results of aortic root reconstruction in our institution and evaluated our operative methods. We selected Bentall operation for severely damaged or cardiac redo cases, and David operation for simple annuloaortic ectasia and AI. Recently, we have utilized Valsalva graft which provides the advantage of capability of larger prosthetic valve implantation and better hemodynamic performance.
Kyobu geka. The Japanese journal of thoracic surgery 10/2009; 62(11):952-7.
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ABSTRACT: Aortic regurgitation (AR) and, aortic root dilatation are serious problems occurring after arterial switch operation (ASO). We have experienced a case of 12-year-old boy with aortic root dilatation and AR after ASO. Consistent progression of AR and aortic root dilatation were observed during the follow-up period. The latest Z-score of Valsalva sinus was about 9. We performed the Bentall procedure instead of aortic valve-sparing operation because of the degenerative aortic valve and the excessive aortic root dilatation. The postoperative course was uneventful. Histopathological findings of the aortic wall showed degeneration of elastic fibers on both sides of the anastmosis.
Kyobu geka. The Japanese journal of thoracic surgery 12/2008; 61(12):1043-7.
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ABSTRACT: Aortic valve surgery for the small aortic annulus is still challenging for surgeons. Recently, the new types of high performance prosthesis have been developed and the chance of an aortic root enlargement (ARE) is decreasing. In this study, we propose the ideal strategy of the aortic surgery for the small aortic annulus. We analyzed the clinical records of 158 patients who underwent aortic valve replacement from August 1999 to October 2005 in our institution. The small aortic annulus was observed in 38 patients (24%). Fourteen patients of this group underwent ARE. Patient-prosthesis mismatch (PPM) was less frequently observed in patients with ARE compared to those without ARE. The additional time required for ARE was not considerable, and neither ischemic time nor cardiopulmonary bypass time was significantly prolonged by ARE. In conclusion, we have to select a prosthesis with sufficient orifice area to avoid PPM, otherwise we should choose an option of ARE. For this consideration, we definitely need the chart that demonstrates the relationship between the nominal size of various types of prostheses and the size of a patient's annulus that those prostheses actually fit.
Kyobu geka. The Japanese journal of thoracic surgery 05/2006; 59(4):269-75.
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ABSTRACT: We report a case of Carney triad which is very rare disease composed of gastrointestinal stromal tumor (GIST), pulmonary chondroma and paraganglioma. A 15-year-old girl was reffered for treatment with multiple tumors in the left lung. At the age of 13, she underwent total gastrestomy for GIST. At that time multiple pulmonary tumors have already developed and made a diagnosis of chondroma. Progressive enlargement of their size and persistent bloody sputum made her received operation. Finally she underwent left pneumonectomy. In general all 3 tumors have manifested for a long time. Gastric tumors and paragangliomas are often lethal. This shows the necessity of intensive and long-term follow-up.
Kyobu geka. The Japanese journal of thoracic surgery 08/2005; 58(7):597-601.
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ABSTRACT: An 11-year-old boy (weight 20 kg, height 124 cm), who was survived from ventricular fibrillation due to hypertrophic cardiomyopathy, admitted to our institution for implantable cardioveter defibrillator (ICD) implantation. We implanted a transvenous single coil lead and a device (Medtronic model 6943, GEM II VR 7229 Cx) in the subpectoral pocket. We selected this system because of less restriction on normal cardiac function, low operative morbidity, and expectation of long-term defibrillation threshold stability. Subpectoral implantation is cosmetically acceptable comparing with abdominal area. Lead insertion by cut-down technique is feasible and recommended to avoid lead-related complications. ICDs are infrequently used in pediatric patients and prospective study with long-term follow-up will be required to ascertain the prognosis for young survivors from sudden cardiac death.
Kyobu geka. The Japanese journal of thoracic surgery 06/2004; 57(5):364-6.
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ABSTRACT: A 52-year-old man was admitted with sudden onset of epigastralgia. Abdominal X-ray showed dilated intestine and computed tomography (CT) revealed extended type A aortic dissection. Marked abdominal distention and weak pulse of right femoral artery were recognized so malperfusion of visceral organs due to narrowing true lumen compressed by thrombosed false lumen was suggested. In the operation, right axillo-right femoral bypass was established preceding to median sternotomy. This graft was used as an arterial perfusion site of cardiopulmonary bypass, and replacement of the ascending aorta was performed under hypothermic circulatory arrest and retrograde cerebral perfusion. Sign of malperfusion of visceral organs was showed for several days after the operation but it disappeared without further intervention. Axillofemoral inflow of cardiopulmonary bypass may be effective procedure in these cases.
Kyobu geka. The Japanese journal of thoracic surgery 06/2004; 57(5):385-7.
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ABSTRACT: The authors report are a rare case of primary mucinous adenocarcinoma of the anterior mediastinum in a 34-year-old Japanese woman. Routine chest radiography revealed an abnormal mass lesion in the left upper mediastinum. Her serum CA 19-9 level was elevated at 299 (normal < 37) U/ml. The large tumor in the anterior mediastinum, 8 cm in diameter, were made of multicystic part with thick wall and thick spetrum and solid part in chest computed tomography (CT). Teratoma was suggested by percutaneous needle biopsy under CT scanning. When the chest was opened through a median sternotomy, adding a left collar incision, we found a hard tumor occupying the superior anterior mediastinum and then resected the tumor together with the left brachiocephalic vein, the left pleura, the pericardium and the left phrenic nerve because of invaded them. Grossly, the tumor was 13 x 10 x 8 cm and weighted 400 g. Pathologic diagnosis was mucinous adenocarcinoma of the anterior mediastinum. No primary cancer lesions were found in pancreas, ovarium, gastrointestinal tract and mammary gland. Microscopic examination showed minimal atypia site in mucinous adenocarcinoma and normal thymic tissues surrounding this tumor. These findings have led this case to conclude the primary tumor of thymus.
Kyobu geka. The Japanese journal of thoracic surgery 06/2004; 57(5):413-6.
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ABSTRACT: We had experienced 41 Fontan type operations between 1977 and 2002. Twelve patients had an atriopulmonary connection (APC), 3 patients had a lateral tunnel connection, and 2 had internal conduit repair and 24 patients received an external conduit repair. There were 3 operative deaths and 5 late deaths (5 months to 24 years). Kaplan-Meier analysis shows good 5-years survival in both group of atriopulmonary connection and that of total cavoplumonary connection (TCPC). However, survival and clinical status of APC patients deteriorated after 7 years. Atrial fibrillation and right pulmonary vein stenosis by giant right atrium become common in these patients. We recommend that patients with single ventricle have the TCPC type operation and patients with giant right atrium and poor clinical status after APC have the TCPC conversion.
Kyobu geka. The Japanese journal of thoracic surgery 05/2003; 56(4):280-5.
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ABSTRACT: It remains controversial whether biological or mechanical prostheses in the tricuspid position give better long-term results. It remains controversial whether biological or mechanical prostheses in the tricuspid position give better long-term results.
The clinical advantage of mechanical prostheses is evaluated in this article. Our subjects were 25 consecutive patients who The clinical advantage of mechanical prostheses is evaluated in this article. Our subjects were 25 consecutive patients who
underwent tricuspid valve replacement (TVR) from January 1985. Five patients underwent TVR with mechanical prostheses (MP), underwent tricuspid valve replacement (TVR) from January 1985. Five patients underwent TVR with mechanical prostheses (MP),
and 20 patients had bioprostheses (BP). The mean age of the patients was 50.8 ± 15.9 years for those with MP and 50.2 ± 11.5 and 20 patients had bioprostheses (BP). The mean age of the patients was 50.8 ± 15.9 years for those with MP and 50.2 ± 11.5
years old for those with BP. The preoperative New York Heart Association (NYHA) functional classification was 3.5 for those years old for those with BP. The preoperative New York Heart Association (NYHA) functional classification was 3.5 for those
with MP and 3.1 for BP. The mean follow-up period was 5.05 ± 2.05 years for MP, ranging from 3 to 7 years, and 7.2 ± 5.6 years with MP and 3.1 for BP. The mean follow-up period was 5.05 ± 2.05 years for MP, ranging from 3 to 7 years, and 7.2 ± 5.6 years
for BP, ranging from 1 to 12 years. No operative mortality occurred, but there was a single hospital death in a patient with for BP, ranging from 1 to 12 years. No operative mortality occurred, but there was a single hospital death in a patient with
BP due to sepsis after acute postoperative cholecystitis. One patient with BP suffered from neurological deficiencies. Long-term BP due to sepsis after acute postoperative cholecystitis. One patient with BP suffered from neurological deficiencies. Long-term
temporary cardiac pacing was required in one patient with MP and three with BP. A permanent cardiac pacemaker was implantedd in one patient with MP and three with BP. A permanent cardiac pacemaker was implanted
in one patient with BP. There was one late death in the MP group and three late deaths in the BP group. The actuarial survival in one patient with BP. There was one late death in the MP group and three late deaths in the BP group. The actuarial survival
rates at 5 and 7 years after surgery were 80% and 80%, respectively, for MP and 88% and 88% for BP. There was one embolic rates at 5 and 7 years after surgery were 80% and 80%, respectively, for MP and 88% and 88% for BP. There was one embolic
episode, a minor stroke, in the BP group. Four patients with BP had valvular dysfunction at 3, 8, 9, and 10 years after surgery, episode, a minor stroke, in the BP group. Four patients with BP had valvular dysfunction at 3, 8, 9, and 10 years after surgery,
and two of these required re-TVR. Among BP patients, 93% were free from prostheses dysfunction at 5 years after surgery, and and two of these required re-TVR. Among BP patients, 93% were free from prostheses dysfunction at 5 years after surgery, and
78% were free from dysfunction after 10 years; all patients (100%) with MP were free from dysfunction at 7 years. This study 78% were free from dysfunction after 10 years; all patients (100%) with MP were free from dysfunction at 7 years. This study
suggests that TVR with MP shows no late complications and with careful anticoagulant therapy provides highly satisfactory suggests that TVR with MP shows no late complications and with careful anticoagulant therapy provides highly satisfactory
follow-up results. follow-up results.
Journal of Artificial Organs 08/2002; 5(3):0179-0183. · 1.59 Impact Factor
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ABSTRACT: A 45-year-old male was admitted to Nagoya University Hospital with dyspnea. He was examined by chest X-ray, CT, MRI, and bronchofiberscope. The chest X-ray showed a large abnormal shadow in the right lung field. A large tumor mass pressing the right lung occupied a half of thoracic cavity on a chest CT and MRI. Bronchofiberscopic findings showed a stenosis of the right intermediate bronchus. The clinical diagnosis was posterior mediastinal tumor. He underwent a posterolateral thoracotomy and the tumor was removed smoothly. The size of resected specimen was 15 x 13 x 11 cm. Histopathological examination of the specimen revealed a mediastinal neurilemmoma. He has been well for 4 months postoperatively.
Kyobu geka. The Japanese journal of thoracic surgery 12/2001; 54(12):1062-5.
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K Shigemitsu,
Y Sekido,
N Usami,
S Mori,
M Sato,
Y Horio,
Y Hasegawa,
S A Bader,
A F Gazdar,
J D Minna,
T Hida,
H Yoshioka,
M Imaizumi, Y Ueda,
M Takahashi,
K Shimokata
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ABSTRACT: The beta-catenin gene (CTNNB1) has been shown to be genetically mutated in various human malignancies. To determine whether the beta-catenin gene is responsible for oncogenesis in thoracic malignancies, we searched for the mutation in 166 lung cancers (90 primary tumors and 76 cell lines), one blastoma and 10 malignant mesotheliomas (two primary tumors and eight cell lines). Among the lung cancers, including 43 small cell lung cancers (SCLCs) and 123 non-small cell lung cancers (NSCLCs), we identified four alterations in exon 3, which is the target region of mutation for stabilizing beta-catenin. One primary adenocarcinoma had a somatic mutation from C to G, leading to an amino acid substitution from Ser to Cys at codon 37. Among the cell lines, SCLC NCI-H1092 had a mutation from A to G, leading to an Asp to Gly substitution at codon 6, NSCLC HCC15 had a mutation from C to T, leading to a Ser to Phe substitution at codon 45, and NSCLC NCI-H358 had a mutation from A to G, leading to a Thr to Ala substitution at codon 75. One blastoma also had a somatic mutation from C to G, leading to a Ser to Cys substitution at codon 37. Among the 10 malignant mesotheliomas, we identified a homozygous deletion in the NCI-H28 cell line. Cloning of the rearranged fragment from NCI-H28 indicated that all the exons except exon 1 of the beta-catenin gene are deleted and that the deletion junction is 13 kb downstream from exon 1. Furthermore, Northern blot analysis of 26 lung cancer and eight mesothelioma cell line RNAs detected ubiquitous expression of the beta-catenin messages except NCI-H28, although Western blot analysis showed that relatively less amounts of protein products were expressed in some of lung cancer cell lines. Our findings suggest that the beta-catenin gene is infrequently mutated in lung cancer and that the NCI-H28 homozygous deletion of the beta-catenin gene might indicate the possibility of a new tumor suppressor gene residing in this region at 3p21.3, where various types of human cancers show frequent allelic loss.
Oncogene 08/2001; 20(31):4249-57. · 6.37 Impact Factor
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ABSTRACT: We evaluate the clinical efficacy of sarpogrelate, an antiplatelet drug that improves red blood cell deformability, to reduce the intravascular hemolysis problems suffered frequently by patients implanted with heart valve prostheses.
Subjects were 34 patients undergoing mechanical heart valve replacement and having serum lactate dehydrogenase concentrations 20% above the maximum normal range.
Sarpogrelate was given daily, 100 mg orally for the first 6 months and 200 mg thereafter.
Average serum lactate dehydrogenase decreased significantly from 423 +/- 108 IU/l, to 391 +/- 83 IU/l with the 100 mg dose, and to 361 +/- 86 IU/l with the 200 mg dose. The percentage of reticulocytes decreased from 15.5 +/- 5.3/1000 to 15.3 +/- 5.7/1000 at the 100 mg dose and 13.1 +/- 4.0/1000 at the 200 mg dose. Serum iron concentrations increased significantly from 63.2 +/- 24.8 micrograms/dl to 76.2 +/- 16.2 micrograms/dl at the 100 mg dose, and to 70.9 +/- 26.2 micrograms/dl with the 200 mg dose.
Sarpogrelate is a useful drug for patients with implanted heart valve prostheses and subsequent high serum lactate dehydrogenase because it works as an antiplatelet drug and reduces mechanical hemolysis.
The Japanese Journal of Thoracic and Cardiovascular Surgery 01/2001; 48(12):769-74.
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ABSTRACT: We have been implanting endovascular stent grafts (EVG) via midsternotomy for distal aortic arch surgery since February 1997. The early clinical results are evaluated.
There were 11 true aneurysms (8 fusiform, 3 saccular) and one chronic type B dissection. The average age was 68 yr (63-81). EVGs were PTFE-covered two-8 bend Z stents in the first eight cases and made with the same stents and ultrathin woven Dacron grafts in the last four cases.
Total arch replacement and aortocoronary bypass grafting were combined in one and two patients, respectively. The average retrograde cerebral perfusion time was 42+/-8 min. The cardiopulmonary bypass time averaged 211+/-26 min. All patients awoke early after operation (4.5+/-1.2 h). All but one case was extubated within 24h. There was no operative mortality, but paraplegia and cerebral infarction were complicated in one case each. Their maximum diameter (73.9+/-21.2mm) decreased significantly after operation (68.7+/-20.1mm) and one year thereafter (63.1+/-16.0 mm). True aneurysms were thrombosed completely. A chronic type B dissection revealed impending rupture due to false lumen infection one year after operation. The whole descending aorta replacement was performed but the patient died 6 months thereafter due to cerebro-vascular complication.
Implantation of EVGs reduces operative invasion for distal arch surgery. This procedure should improve mortality, while long-term results have not been clarified.
Cardiovascular Surgery 01/2001; 8(7):545-9.
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ABSTRACT: We studied the calcification of four kinds of xenopericardium used in cardiac surgery. Group 1: bovine Pericardium (Tissueguard. Biovascular, inc), Group 2: bovine pericardium (No-React. Shelhigh, inc), Group 3: porcine pericardium (Rigg. Polystan, inc), Group 4: equine pericardium (Xenomedica. Baxter-Edwards, inc). Each pericardium was implanted in abdominal subcutaneous pouches of rats. The mean calcium content of each Group after eight weeks of subcutaneous implantation were 0.67 +/- 0.15 mg/g, 0.51 +/- 0.15 mg/g, 161 +/- 18 mg/g and 173 +/- 18 mg/g in Group 1, Group 2, Group 3 and Group 4, respectively. There was no significant difference between Group 1 and 2, or between Group 3 and 4. On the other hand, there were significant differences between Group 1, 2 and Group 3, 4 (p < 0.001). The deposition of calcium and inflammatory changes were markedly observed microscopically in Group 3 and 4, but in Group 1 and 2, they were only slightly observed. CONCLUSION: Two kinds of bovine pericardium are superior to both porcine and equine pericardium in the point of less calcium deposition and inflammatory cellular response after implantation.
Kyobu geka. The Japanese journal of thoracic surgery 07/2000; 53(6):468-71.
