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1.
Kyobu Geka ; 65(2): 110-4, 2012 Feb.
Article in Japanese | MEDLINE | ID: mdl-22314164

ABSTRACT

We have evaluated the usefulness of off-pump coronary artery bypass grafting (CABG)[OPCAB]. The subjects were 153 patients who underwent isolated CABG between May 2005 and May 2009. They were divided into 2 groups( on-pump/arrest;ON group:76 subjects vs OPCAB;OFF group:77 subjects). The concomitant conditions, the number of bypasses, the postoperative outcome and the early graft patency rate were compared between the 2 groups. The mean age and the incidence of carotid artery lesions were significantly higher in the OFF group. The number of bypasses was significantly smaller in the OFF group. The postoperative intubation time and the length of postoperative hospitalization were significantly shorter in the OFF group. Concerning major postoperative complications, mediastinitis, cerebral infarction or bleeding was not observed in the OFF group. There was no hospital death in the OFF group. The early graft patency rate with saphenous vein graft (SVG) was significantly lower in the OFF group. Early stage extubation was achieved by the introduction of OPCAB. In some occasions, however, the target site could not be reached with OPCAB, and furthermore, the quality of anastomosis was poor. In order to achieve complete revascularization, therefore, on-pump/arrest surgery should be considered in some cases.


Subject(s)
Coronary Artery Bypass, Off-Pump , Aged , Coronary Artery Bypass , Female , Humans , Male , Treatment Outcome , Vascular Patency
2.
Case Rep Cardiol ; 2012: 429569, 2012.
Article in English | MEDLINE | ID: mdl-24826250

ABSTRACT

Finding an untreated or asymptomatic large ventricular septal defect (VSD) in an elderly patient is uncommon. The present case was an 81-year-old man who suffered from acute myocardial infarction due to three-vessel coronary disease, mitral and tricuspid valve insufficiency, and high-flow perimembranous VSD (Qp/Qs 2.3). Although the patient was elderly and the VSD had been asymptomatic for a long time, we considered that high-flow VSD and valve diseases should be repaired simultaneously with coronary disease. Then, he underwent elective surgery, namely, VSD patch repair concomitant with coronary artery bypass grafting, and mitral and tricuspid annuloplasty. His postoperative course was uneventful. We conclude that, even for an octogenarian, surgical repair of VSD is recommendable, if surgical indications are appropriate.

3.
Ann Thorac Cardiovasc Surg ; 17(3): 307-9, 2011.
Article in English | MEDLINE | ID: mdl-21697798

ABSTRACT

We report a case of a 66-year-old man who presented with an abnormal sensation, tenderness, and pain in the middle of his chest in May 2006, two years after a mitral valve replacement for severe mitral regurgitation and a MAZE operation for chronic atrial fibrillation elective cardiac. He was immediately admitted, and the x-ray examination revealed an abnormal elongation of the xiphoid process. At the time of discharge after the initial operation in 2004, x-rays indicated that the length of the xiphoid process was 3 cm; however, in 2006 it had elongated to 6 cm and was prominent in the anterior view. The patient underwent surgical extirpation of the xiphoid process while he was under local anesthesia. Histological examination of the resected xiphoid process revealed no signs of neoplastic or maligant change. The cause of the elongation of the xiphoid process was believed to be distraction tissue neogenesis. The xiphoid process, which fractured and separated from the sternum at the initial operation, was pulled down inferiorly by the rectus abdominis muscles, following which the xiphoid process became elongated and reconnected with the sternum. In cases of a fractured or amputated xiphoid process after median sternotomy, the xiphoid process should be resected to avoid its neogenesis.


Subject(s)
Atrial Fibrillation/surgery , Cardiac Surgical Procedures/adverse effects , Exostoses/etiology , Sternotomy/adverse effects , Xiphoid Bone , Aged , Exostoses/diagnostic imaging , Exostoses/surgery , Heart Valve Prosthesis Implantation/adverse effects , Humans , Male , Mitral Valve Insufficiency/complications , Mitral Valve Insufficiency/surgery , Osteotomy , Tomography, X-Ray Computed , Treatment Outcome , Xiphoid Bone/diagnostic imaging , Xiphoid Bone/surgery
4.
Ann Thorac Cardiovasc Surg ; 17(2): 166-9, 2011.
Article in English | MEDLINE | ID: mdl-21597414

ABSTRACT

We report a case of a 48-year-old man with a history of violent coughing fits and general fatigue underwent urgent surgery for cardiac tamponade, and who was later diagnosed with metastatic intracardiac squamous cell carcinoma of the esophagus. After admittance to Munakata Suikokai General Hospital, Fukuoka, Japan, echocardiography showed extensive pleural and pericardial effusion and a mass, 4 by 2 cm, with a solid echo pattern in the right ventricular cavity. The working diagnosis was primary malignant cardiac tumor of unknown origin with multiple metastases. To prevent sudden death due to obliteration of the outflow tract of the right ventricle, we performed urgent surgery for cardiac tamponade. Histological examination of the resected tumor revealed squamous cell carcinoma. Fiberoptic esophagoscopy showed hypertrophy of the esophageal wall and a submucosal tumor extending throughout the esophagus. Microscopic examination of the esophagus biopsy specimen showed moderately differentiated squamous cell carcinoma, the histology of which was similar to that of the resected tumor and cytology of pericardial effusion. The patient recovered and was able to return home for a few days; however, he was readmitted, and despite maximal supportive therapy, he died one month after the operation.


Subject(s)
Carcinoma, Squamous Cell/secondary , Esophageal Neoplasms/pathology , Heart Neoplasms/secondary , Biopsy , Carcinoma, Squamous Cell/complications , Carcinoma, Squamous Cell/surgery , Cardiac Surgical Procedures , Cardiac Tamponade/etiology , Echocardiography , Esophageal Neoplasms/complications , Esophagoscopy , Fatal Outcome , Heart Neoplasms/complications , Heart Neoplasms/surgery , Heart Ventricles/pathology , Humans , Male , Middle Aged , Pericardial Effusion/etiology , Pleural Effusion, Malignant/etiology , Treatment Outcome
5.
J Cardiol ; 53(1): 150-3, 2009 Feb.
Article in English | MEDLINE | ID: mdl-19167652

ABSTRACT

This report describes an asymptomatic case of atrial lead perforation which developed 5 years after pacemaker implantation. Although retrospective findings of computed tomography showed a screw-in atiral lead had already perforated 9 months after the implantation, the lead protrusion on chest X-rays and pacing failure had not been noticed until another 3 years later. At first, this complication was managed conservatively, however, a lead perforation progressively developed and, as a result, open surgery was performed to remove the lead. We therefore should be aware of the potential occurrence of a progressive protrusion of a perforated lead.


Subject(s)
Heart Atria/injuries , Pacemaker, Artificial/adverse effects , Device Removal , Electrodes, Implanted/adverse effects , Female , Humans , Middle Aged , Sick Sinus Syndrome/therapy , Time Factors
6.
Ann Thorac Surg ; 75(5): 1631-3, 2003 May.
Article in English | MEDLINE | ID: mdl-12735594

ABSTRACT

Prosthetic valve dysfunction (PVD) due to pannus formation is an infrequent but serious complication. A 72-year-old man who underwent aortic valve replacement was diagnosed with PVD and aneurysm of the Sinus of Valsalva. Multidetector-row computed tomography (MDCT) was used to examine the cause of PVD before reoperation. MDCT demonstrated that tissue regarded as pannus extended from the left ventricular septum into the pivot guard. These findings were confirmed by observations during reoperation. MDCT can be a useful diagnostic technique for the anatomical and functional evaluation of PVD.


Subject(s)
Aortic Valve/diagnostic imaging , Aortic Valve/surgery , Heart Valve Prosthesis Implantation/adverse effects , Heart Valve Prosthesis/adverse effects , Prosthesis Failure , Tomography, X-Ray Computed , Aged , Aortic Aneurysm/diagnostic imaging , Humans , Male , Sinus of Valsalva
7.
Artif Organs ; 26(5): 460-6, 2002 May.
Article in English | MEDLINE | ID: mdl-12000444

ABSTRACT

This study was conducted to determine the effect of thrombolytic therapy with tissue plasminogen activator (t-PA) for nonstructural malfunction of bileaflet cardiac valve prostheses. Twenty-seven patients with bileaflet prosthetic valve malfunction diagnosed by a combination of cineradiography and transthoracic echocardiography were treated with the administration of intravenous t-PA. The treatment resulted in complete success in 55.6% (15 of 27), partial success in 22.2% (6 of 27), and no change in 22.2% (6 of 27). In the complete success and partial success groups, the condition of the patients in 85.7% (18 of 21) of the cases improved within 24 h after the administration of t-PA. Six cases in whom thrombolytic therapy was instituted more than 1 month (ranged from 1 to 38 months, mean 14.7 months) after the diagnosis of prosthetic valve malfunction showed significantly less effectiveness of thrombolytic therapy with t-PA. Only one patient (3.7%) had a major complication (thromboembolism) after t-PA treatment. The results suggest that thrombolytic therapy with t-PA in patients with nonstructural malfunction of bileaflet cardiac valve prostheses is effective with low incidence of complication when the treatment is instituted early after the diagnosis.


Subject(s)
Heart Valve Prosthesis/adverse effects , Plasminogen Activators/therapeutic use , Thrombolytic Therapy , Thrombosis/etiology , Thrombosis/prevention & control , Tissue Plasminogen Activator/therapeutic use , Adult , Aged , Cineradiography , Female , Heart Valve Diseases/surgery , Humans , Male , Middle Aged , Retrospective Studies
8.
Circ J ; 66(4): 372-6, 2002 Apr.
Article in English | MEDLINE | ID: mdl-11954952

ABSTRACT

The effect of colforsin daropate hydrochloride (colforsin), a water-soluble forskolin derivative, on blood flow in internal mammary artery (IMA) grafts was evaluated in a prospective randomized study of 26 patients undergoing coronary artery bypass grafting. Patients were randomized to receive either colforsin treatment (colforsin; n=14) or no colforsin treatment (control; n=14). Administration of colforsin (0.5mg x kg(-1) min(-1)) was started after induction of anesthesia and was continued for 6 h. IMA blood flow and hemodynamic measurements were assessed perioperatively. During cardiopoulmonary bypass (CPB), perfusion flow was adjusted to 2.5 L/m2 and IMA free blood flow was measured. IMA blood flow was also measured 1 h after CPB by an ultrasonic flow meter. Systemic vascular resistance was significantly lower in the colforsin group during and after CPB. IMA blood flow was significantly greater in the colforsin group than in the control group during (44 +/- 2 vs 33 +/- 3 ml min-1 x m(-2), p=0.02) and after CPB (38 +/- 6 vs 20 +/- 3ml x min(-1) m(-2), p=0.01). IMA blood flow 1 h after CPB correlated inversely with concurrent systemic vascular resistance (r=-0.61, p=0.001). Intraoperative administration of colforsin daropate hydrochloride caused potent vasodilation, resulting in an increase in IMA blood flow. The results indicate that the regimen can be used perioperatively in patients undergoing coronary artery bypass grafting.


Subject(s)
Colforsin/analogs & derivatives , Colforsin/therapeutic use , Hemodynamics/drug effects , Internal Mammary-Coronary Artery Anastomosis , Blood Pressure/drug effects , Female , Heart Rate/drug effects , Humans , Internal Mammary-Coronary Artery Anastomosis/methods , Lactates/blood , Male , Middle Aged , Treatment Outcome
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