[Show abstract][Hide abstract] ABSTRACT: A 68-year-old man was referred to our hospital with infectious endocarditis (IE) of the mitral valve complicated by mycotic aneurysms located in the right middle cerebral artery (MCA) and the superior mesenteric artery (SMA). After coil embolization of the SMA aneurysm during angiography, surgical treatment of the MCA aneurysm was carried out. Antibiotic therapy for Enterococcus faecalis was continued throughout this period. After his IE was controlled, mitral valve repair was performed. The old vegetation on the edge of the anterior leaflet was resected and the defect was covered by transferring the posterior leaflet using the flip-over technique. Since there is no agreement about the optimum treatment of IE associated with multiple mycotic aneurysms, it is important to carefully plan the management of individual cases.
No preview · Article · Apr 2006 · Kyobu geka. The Japanese journal of thoracic surgery
[Show abstract][Hide abstract] ABSTRACT: Left ventricular myxoma is particulary rare. Our case is a 77-year-old female. Transesophageal echocardiography showed a giant tumor in the left atrium. An urgent operation was performed. A giant mass was excised en bloc via a transinteratrial septal approach. Histopathologically it was myxoma. As a transthoracic echocardiography at 1-year postoperation showed a tumor in the left ventricle. A mass was excised en bloc via a vertical approach. Histopathologically it was diagnosed again as myxoma. We looked at the earliest transesophageal echocardiogram again, and found the small tumor on the same area under the posterior mitral leaflet. At the diagnose of cardiac tumor, possibility of multiple formation should be always considered.
No preview · Article · Aug 2004 · Kyobu geka. The Japanese journal of thoracic surgery
[Show abstract][Hide abstract] ABSTRACT: Papillary fibroelastoma is one of the commonest benign tumor in the heart. In almost all of cases, symptoms never develop and the tumors are usually discovered coincidentally. Even though papillary fibroelastoma is a benign tumor, surgical extirpation is usually indicated for reason of productive serious complications. The tumors may cause left ventricular outflow obstruction, cerebral embolic infarction, myocardial infarction and even sudden death. The case we reported here is unusual case, because the patient developed symptoms and complaints such as palpitation, feverish and general fatigue. We measured tumor markers, interleukin 6, serotonin and histamine, but none of those was elevated in the blood samples. Surgical removal of the tumor attached to the base of posterior papillary muscle was carried out without causing mitral incompetence, and the pathological findings were compatible with papillary fibroelastoma. After the operation, the both symptoms and complaints disappeared unexpectedly.
No preview · Article · Sep 2003 · Kyobu geka. The Japanese journal of thoracic surgery
[Show abstract][Hide abstract] ABSTRACT: Sufficient O2 delivery to meet the demand is an important factor for protecting the brain during cardiopulmonary bypass (CPB). This study was designed to investigate the influences of temperature, pulsatility of blood flow (intra-aortic balloon pump-induced) and flow rate during CPB on the cerebral oxygenation.
Patients were divided into five groups. Normothermia (36 degrees C): pulsatile (n=8, 2.5 L/min/m2), nonpulsatile (n=12, 2.5 L), and nonpulsatile perfusion (n=12, 2.8 L); hypothermia (30 degrees C): pulsatile (n=9, 2.5 L) and nonpulsatile perfusion (n=11, 2.5 L). The oxygen saturation (SjVO2), lactate and CPK-BB levels in the jugular venous blood were measured.
In all of the normothermic groups, the SjVO2 value decreased during the CPB (p<0.1-0.01). No remarkable change was observed in the hypothermic groups, with the exception during the rewarming period in the nonpulsatile group. A higher SjVO2 and a lower frequency of SjVO2 values <50% were observed in the hypothermic pulsatile group, as compared with those in the normothermic groups (p<0.05). The levels of CPK-BB were nearly the same, however the levels of lactate were higher in the normothermic pulsatile and nonpulsatile (2.5 L) groups (p<0.05).
We concluded that the hypothermic CPB was advantageous over normothermic CPB in regard to the SjVO2 levels and lactate production. The beneficial effect of intra-aortic balloon pump assist was only obtained in the hypothermic CPB.
No preview · Article · Oct 2001 · The Journal of cardiovascular surgery
[Show abstract][Hide abstract] ABSTRACT: One Hundred and twenty-four patients undergoing elective coronary bypass surgery were retrospectively selected and divided into two groups according to their difference of cardioplegic methods, either antegrade (AC) only (n = 65) or combination of ante- and retrograde (AC + RC) cardioplegic delivery (n = 64). Myocardial blood flow in the right (RV) and left ventricles (LV) was measured during the cardioplegia by a laser Doppler. Peak CPK-MB levels were compared postoperatively between the two groups and more in detail according to extent of coronary obstructive disease. 1) The antegrade administration of cardioplegic solution provided preferential flow to the RV compared to the LV, whereas the retrograde administration resulted in the opposite result (AC; LV 6.9 +/- 4.7, RV: 8.6 +/- 5.3, p < 0.05, RC; LV: 9.0 +/- 4.9, RV: 5.9 +/- 4.6 ml/min/100 g, p < 0.05). This result suggested that the combination of both administrations was meaningful to obtain uniform distribution of cardioplegic solution. 2) The peak CPK-MB, compared in the entire two groups, was slightly low in the combination use (AC; 48 +/- 16, AC + RC; 43 +/- 15 IU/l, p = 0.08), but the clinical meaning did not exist. However, in the severe cases, which involved two of following criteria (left main disease, severe occlusion of left or right coronary), the max CPK-MB level was statistically decreased by the combined use of ante- and retrograde cardioplegia (AC; 50 +/- 16, AC + RC; 40 +/- 12 IU/l, p < 0.05). We concluded that the merit of combined use was limited to the cases with severely extended coronary obstructive disease.
No preview · Article · Dec 2000 · Kyobu geka. The Japanese journal of thoracic surgery
[Show abstract][Hide abstract] ABSTRACT: Three female patients with aortic stenosis associated with a severely small annulus underwent aortic valve replacement. In intraoperative measurements, a 19-mm obtulator could not pass through the aortic annulus in each case. We therefore concluded that it would be difficult to implant an appropriate-sized prosthesis in a routine fashion, so we performed an annular enlargement in a modified Nicks procedure. By using a wide teardrop-shaped patch for enlargement and slightly tilting insertion of a prosthesis, a 21 mm bileaflet mechanical prosthesis could be inserted into the enlarged annulus. Despite being a simpler method than other enlarging procedures, a two- or three-sizes larger prosthesis than the native annulus can be inserted with relative ease. Thus, the use of a 19 mm mechanical prosthesis may be avoidable in most adult cases.
No preview · Article · Jul 2000 · Annals of thoracic and cardiovascular surgery: official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia
[Show abstract][Hide abstract] ABSTRACT: A heparin/protamine titration system for measurement of heparin levels (Hepcon) is promising for efficient anticoagulation during cardiopulmonary bypass (CPB).
Fifty-seven patients subjected to CPB were divided into two groups, control (n = 24) and Hepcon groups (n = 33). The Hepcon group was further divided into three subgroups according to perfusion temperature. For the control group, conventional administration of an anticoagulant (300 IU/kg of heparin) and reversal protocol (heparin 1: protamine 1) was performed. For the Hepcon group, a heparin dose-response assay directed the initial dose of heparin. Hepcon also determined the dose of protamine by the titration. The initial dose of heparin in the control group (300 IU/kg) was statistically less than that of Hepcon group (360+/-80 IU/kg).
In the Hepcon group, the sensitivity to heparin was correlated with coagulation time (r = -0.78) and antithrombin III levels (r = 0.70), and individual difference of sensitivity resulted in a wide range of dosage (160 to 490 IU/kg). A strong correlation was observed between plasma and whole blood concentration of heparin (r = 0.86). However, they did not correlate with ACT values. Perfusion temperature didn't affect the heparin level, but did the ACT value. In the Hepcon group, the dose of protamine was significantly less and adverse events were rare.
In conclusion, whole blood heparin measurements correlated well with plasma heparin concentration. Protamine titration of heparin reduced the dose of protamine and decreased the chance of adverse reactions.
No preview · Article · Nov 1999 · The Journal of cardiovascular surgery
[Show abstract][Hide abstract] ABSTRACT: The minimal effective dose of aprotinin on hemostasis under normothermic perfusion, the influence of anticoagulant therapy on graft patency, and the thromboembolic and hemorrhagic events were investigated after aortocoronary bypass graft operation (CABG). One hundred CABG patients under normothermic perfusion were randomly divided into the following groups: (1) coumadin plus acetylsalicylic acid (ASA) (n=32); no aprotinin used during cardiopulmonary bypass (CPB); (2) minimal-dose, 10(6) KIU during CPB, aprotinin used, followed by ASA and coumadin (n=36); and (3) very low-dose, total of 2x10(6) KIU before CPB and during CPB; aprotinin used; anticoagulation therapy with heparin early after surgery and followed by replacement with ASA and coumadin (n=32). The patency of arterial grafts was 100% in all groups. The patency of vein grafts was 95-98% and there was no difference among the groups. The blood loss was significantly reduced in both aprotinin groups (groups 2 and 3) compared to the coumadin plus ASA group, although no difference existed between the 2 aprotinin groups. Postoperative thrombotic and hemorrhagic events were not observed in any group. From this study, it was concluded that 10(6) KIU aprotinin in pump-prime-only followed by oral ASA and coumadin was the recommendation from the benefit/cost consideration.
No preview · Article · Apr 1999 · Japanese Circulation Journal
[Show abstract][Hide abstract] ABSTRACT: Ideally, the mitral valve is a soft, thin and flexible tissue. In severe rheumatic mitral stenosis, however, its motion is restricted due to the adhesion of fibrous tissues and calcium. Open mitral commissurotomy was not effective in successfully restoring it to normal condition. By using a peeling technique with curettage during open mitral commissurotomy, the calcium and fibrous tissues are sufficiently removed. This method is effective in improving the flexibility of the anterior leaflet of the restricted mitral valve.
No preview · Article · Mar 1998 · Kyobu geka. The Japanese journal of thoracic surgery
[Show abstract][Hide abstract] ABSTRACT: Infective endocarditis associated with ruptured aneurysm of Valsalva disrupted the vicinity of aortic annulus (Valsalva, valve, left ventricular outflow tract). This condition did not accept insertion of prosthetic valve at normal position. Insertion of St. Jude valve was performed after the reconstruction of outflow tract with a xenopericardial patch. Proportionate sutures for the right cusp part was taken through the infundibular muscle at the right ventricular side, not in the pericardial patch. The bileaflet valve functioned properly in spite of the oblique insertion.
No preview · Article · Mar 1998 · Kyobu geka. The Japanese journal of thoracic surgery
[Show abstract][Hide abstract] ABSTRACT: The patient, who had an aortic stenosis, suddenly complicated with severe acute cardiac failure. The rupture of the mitral chordae tendineae was detected by the echocardiogram. Double replacements (aortic and mitral) were done immediately after the onset of chordae rupture. This condition, combination of aortic stenosis and sudden onset of chordae rupture, always results in severe heart failure which is explained by the combination of pressure and volume loading. Finally the emergent operation is believed to be an only solution for this situation.
No preview · Article · Sep 1997 · Kyobu geka. The Japanese journal of thoracic surgery