[Show abstract][Hide abstract]ABSTRACT: A 33-year-old man admitted to our hospital with an episode of chest discomfort and dyspnea. UCG, CT, MRI and DSA disclosed an annuloaortic ectasia with grade 3 aortic regurgitation and atypical coarctation of the aorta. Cabrol operation was performed with simultaneous graft bypass using a woven Dacron prosthesis between the ascending aorta and the abdominal aorta. The course of the bypass graft was arranged to pass behind the rectal muscle without laparotomy and major collateral vessels of the thorax could been kept without thoracotomy. There are only 10 reported cases of annuloaortic ectasia associated with atypical coarctation of the aorta in Japan. This is the second successful case report of one-stage surgery to the complicated cardiovascular disease.
No preview · Article · May 1993 · Kyobu geka. The Japanese journal of thoracic surgery
[Show abstract][Hide abstract]ABSTRACT: A new method was developed to prevent surgical injury of the atrioventricular conduction system in septation for single ventricle. The new method includes the use of small Teflon pledgets to cover the conduction system at the crossing sites of suture line, and so that stitches can be placed on the pledgets to skip the conduction system. This paper describes the results of an experimental study to delineate the effects of covering pledgets on the morphology and function of the underlying conduction tissues. Deep hypothermia was employed for this experiment in 15 mongrel dogs. The small Teflon pledgets were sutured to bridge the endocardial surface of the atrioventricular node through the right atriotomy. They were subjected to sacrifice at 1 week to 12 months postoperatively. Electrophysiological study including electrocardiography. His bundle electrography and responsiveness of the atrioventricular conduction to rapid stimulation was done before the sacrifice. The resected heart was embedded in Ceroidin-Paraffin and serially sectioned for pathological study. No noticeable injuries were noted in the underlying conduction system. The electrophysiological study showed normal sinus rhythm at the time of sacrifice. No significant changes were noted in PQ intervals comparing to preoperative state. There were no significant differences in AH intervals, HV intervals and responsiveness to rapid atrial stimulation between experimental and normal control groups. In conclusion, the Teflon felt pledgets were demonstrated to have no detrimental effects on the atrioventricular conduction system in the chronic stage.
[Show abstract][Hide abstract]ABSTRACT: In some cases of old myocardial infarction (OMI), left ventricular wall motion was improved after revascularization, though viability of the infarcted myocardium was not detected by left ventriculography (LVG) and exercise thallium-201 myocardial scintigraphy (EX-Tl). So to obtain more correct information of the viability, EX-Tl was performed again after ergometer rehabilitation for an OMI patient whose myocardial viability of the infarcted zone could not detected by LVG and EX-Tl. Incomplete fill in was showed in the EX-Tl after rehabilitation. So percutaneous transluminal coronary angioplasty (PTCA) was performed. Left ventricular wall motion was improved after three months. EX-Tl after rehabilitation is useful to evaluate the viability that could not detected by LVG and EX-Tl.
No preview · Article · Jul 1989 · Kaku igaku. The Japanese journal of nuclear medicine
[Show abstract][Hide abstract]ABSTRACT: We reported a case of syphilitic aortic arch aneurysm, which was examined by IADSA, X-ray CT and MR Imaging. A large aneurysm with the thick mural thrombus and central narrow lumen was clearly shown by MR Imaging. MR Imaging is an useful modality for the diagnosis of the aortic arch aneurysm with a very narrow lumen, which cannot be easily pointed out by IADSA.
[Show abstract][Hide abstract]ABSTRACT: Our experience with the surgical management of hypoplastic right ventricle with intact ventricular septum has included 20 patients with pulmonary atresia and 3 patients with critical pulmonary stenosis. Group 1 consisted of 7 infants who were treated by transarterial pulmonary valvotomy. Four of them were lost shortly after surgery. Group 2 included 11 neonates and one infant who were treated by systemic-pulmonary shunt with 2 operative death. Group 3 included 4 infants who underwent primary prosthetic enlargement of the right ventricular outflow tract. Two of the 4 were lost in the early postoperative period. Eight of 13 patients in groups 1 and 2 who survived the initial palliative procedures underwent additional operations to enlarge the right ventricular outflow tract, and 5 patients survived. However, adequate right ventricular and tricuspid valve growth was obtained in only patients in whom the prosthetic enlargement of the right ventricle was performed in early infancy. These findings strongly suggest the necessity to decompress the right ventricle completely, as early as possible. In conclusion, 1) transarterial pulmonary valvotomy seldom provided satisfactory decompression of the right ventricle, and operative risk was high. 2) systemic-pulmonary shunt to re-establish pulmonary blood flow improved neonatal survival, although this procedure may not provide a satisfactory long term palliation. 3) primary or secondary operative enlargement of the right ventricle in early infancy provided decompression of the right ventricle and accelerated substantial right ventricular growth. For patients without an infundibulum or for those in whom attempts to induce tricuspid valve growth had failed, a Fontan type procedure seemed to be the procedure of choice.
No preview · Article · Nov 1986 · The Tohoku Journal of Experimental Medicine
[Show abstract][Hide abstract]ABSTRACT: From May 1980 through April 1982, 9 patients underwent the Mustard operation for simple transposition of the great arteries (simple TGA) at the Tohoku University Hospital, Sendai. There was no early postoperative death, although one patient was lost with pulmonary venous obstruction in the late postoperative period. No pulmonary venous obstruction occurred since the introduction of expanded polytetrafluoroethylene (EPTFE) intraatrial baffle. Normal sinus rhythm has been preserved in all patients since direct, high superior vena cava cannulation was adopted. Postoperative hemodynamic study at an average 12 months after surgery revealed normal right ventricular function at rest. Work-function curve which is related to the right ventricular end-diastolic pressure and minute work index revealed good response of the right ventricle in two of three patients after methoxamine infusion test. All late survivors are acyanotic and clinically well. The Mustard procedure has dramatically improved the survival rate and quality of life for those with simple TGA. Presently, we continue to utilize the Mustard procedure for simple TGA until the superiority of other operations are demonstrated.
No preview · Article · Feb 1985 · The Tohoku Journal of Experimental Medicine
[Show abstract][Hide abstract]ABSTRACT: This paper presents our recent results of the Mustard procedure (intra-artrial baffle operation) for the complete transposition of the great arteries performed in 24 infants and children during the past 6 years at the Tohoku University Hospital. All intracardiac repairs were performed using "bypass hypothermia" (surface-induced deep hypothermia, circulatory arrest, and limited cardiopulmonary bypass). The hospital mortality rate was 8% in patients with simple transposition without pulmonary hypertension (Group I, one death in 12 patients), 50% in patients with ventricular septal defect (VSD) and pulmonary hypertension (Group II, 3 deaths in 6 patients), and 20% in patients with VSD and pulmonary stenosis (Group III, one death in 5 patients). Various types of longstanding dysrhythmia were found in 6 out of 18 long-term survivors, and subsequent pace-maker implantation was necessary in one infant. Postoperative pulmonary venous obstruction occurred in 3 infants, and surgical relief of the obstruction was successfully undertaken in 2 of them. Prevention of postoperative dysrhythmia, pulmonary venous obstruction, and possible brain damage are also discussed.
No preview · Article · Mar 1979 · The Tohoku Journal of Experimental Medicine