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1.
Kyobu Geka ; 71(11): 929-931, 2018 10.
Article in Japanese | MEDLINE | ID: mdl-30310004

ABSTRACT

Infective endocarditis (IE) after transcatheter aortic valve replacement (TAVR) is a rare complication, but has a high mortality. An 86-year-old female with symptomatic severe aortic stenosis underwent TAVR at our hospital and she was discharged without complication after 10 days. She was readmitted with high fever and acute heart failure 1 month later. Blood culture revealed Staphylococcus, and echocardiography showed vegetation on the septal cusp of the tricuspid valve and perforation at the membranous ventricular septum. We decided to perform emergency operation due to active infection and intracardiac complication despite appropriate antibiotic treatment. The infected valve was replaced with a bioprosthetic valve and the right ventricular (RV)-left ventricular (LV) communication was closed with a bovine pericardial patch. The patient received the antibiotics for 6 week and was transferred to the previous facility.


Subject(s)
Aortic Valve Stenosis/surgery , Endocarditis, Bacterial/surgery , Heart Valve Prosthesis , Postoperative Complications/surgery , Staphylococcal Infections/surgery , Transcatheter Aortic Valve Replacement/adverse effects , Acute Disease , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Aortic Valve , Endocarditis, Bacterial/drug therapy , Endocarditis, Bacterial/etiology , Female , Heart Failure/etiology , Humans , Postoperative Complications/drug therapy , Postoperative Complications/etiology , Staphylococcal Infections/diagnosis , Staphylococcal Infections/drug therapy , Treatment Outcome
2.
Ann Thorac Cardiovasc Surg ; 20 Suppl: 622-4, 2014.
Article in English | MEDLINE | ID: mdl-23995349

ABSTRACT

Surgical treatment for an atherosclerotic huge coronary aneurysm is very rare. We have reported 58 years old male who had a huge growing aneurysm in left circumflex coronary artery and underwent aneurysmectomy and coronary-coronary bypass grafting with saphenous vein.


Subject(s)
Coronary Aneurysm/surgery , Coronary Artery Bypass , Coronary Artery Disease/surgery , Saphenous Vein/transplantation , Coronary Aneurysm/diagnosis , Coronary Angiography/methods , Coronary Artery Disease/diagnosis , Humans , Male , Middle Aged , Tomography, X-Ray Computed , Treatment Outcome
3.
Gen Thorac Cardiovasc Surg ; 59(4): 284-7, 2011 Apr.
Article in English | MEDLINE | ID: mdl-21484557

ABSTRACT

A 36-year-old man suffering from exertional dyspnea was admitted to our hospital. An echocardiogram showed a left atrial tumor, which was excised via the left atrial approach. Histological examination of the surgical specimen revealed that it was a myxosarcoma. Twelve months after the surgery, the tumor recurred in the left atrium, and metastatic tumors were found in the right atrium and right ventricle. Surgery was performed once again, but examinations 5 months after the second surgery showed local recurrences and multiple metastases. Although the patient had received chemotherapy, he died 30 months after the first operation.


Subject(s)
Cardiac Surgical Procedures , Heart Neoplasms/surgery , Myxosarcoma/surgery , Adult , Biopsy , Chemotherapy, Adjuvant , Dyspnea/etiology , Echocardiography , Fatal Outcome , Heart Atria/surgery , Heart Neoplasms/complications , Heart Neoplasms/pathology , Humans , Male , Myxosarcoma/complications , Myxosarcoma/secondary , Neoplasm Recurrence, Local , Reoperation , Time Factors , Tomography, X-Ray Computed , Treatment Outcome
4.
Jpn J Thorac Cardiovasc Surg ; 54(10): 424-8, 2006 Oct.
Article in English | MEDLINE | ID: mdl-17087321

ABSTRACT

OBJECTIVE: The Heartstring is one of the devices that enable proximal anastomosis without clamping the aorta. We have applied the device not only to low-risk patients with normal aortas but also to high-risk patients with diseased aortas. The purpose of this study was to investigate the initial outcomes of using this device. METHODS: The Heartstring was used on 87 patients between January and December 2004. The patients comprised 62 men and 25 women 48-86 years old (mean 68.4 +/- 8.4 years). The ascending aorta was evaluated by computed tomography (CT) scanning before surgery. If a patient's aorta was severely calcified, epiaortic echocardiography was performed. The aortas were ranked into four grades, and the preoperative patient's status were evaluated by the EuroSCORE. Angiography was performed on the third postoperative day. RESULTS: CT scanning revealed that 74 patients had no calcification in the ascending aorta, 10 patients had scattered calcification, and 3 patients had plate-like calcification. The EuroSCORE was 6.86 +/- 1.03. We performed 93 proximal anastomoses and 149 distal anastomoses. The average distal anastomosis was 1.6 +/- 0.6 sites per graft. Of the distal anastomoses, 74.2% were to the circumflex artery territory. Postoperative coronary angiography revealed that all grafts were patent. CONCLUSION: The Heartstring facilitates safe proximal anastomosis, even in high-risk patients. Their short-term outcome was good. The device assists in bypassing circumflex artery territory. Long-term follow-up is necessary.


Subject(s)
Anastomosis, Surgical/instrumentation , Aorta/surgery , Coronary Artery Bypass/instrumentation , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Myocardial Ischemia/surgery , Treatment Outcome
5.
Surg Today ; 36(10): 927-9, 2006.
Article in English | MEDLINE | ID: mdl-16998689

ABSTRACT

We report a case of cardiac myxoma of the aortic valve. To our knowledge, this represents only the seventh such case ever documented. A 61-year-old woman underwent an echocardiography to screen for hypertensive-diabetic cardiac complications, which showed a mass on her aortic valve. Although she had not experienced a fever, the mass closely resembled a vegetation, resulting in an initial diagnosis of infective endocarditis. We extirpated the mass and repaired the aortic valve with the patient under cardiopulmonary bypass. The postoperative course was uneventful. Histological examination confirmed that the mass was a myxoma.


Subject(s)
Aortic Valve , Endocarditis/diagnosis , Heart Neoplasms/diagnosis , Myxoma/diagnosis , Cardiac Surgical Procedures , Diagnosis, Differential , Echocardiography , Female , Heart Neoplasms/surgery , Humans , Middle Aged , Myxoma/surgery
6.
Jpn J Thorac Cardiovasc Surg ; 53(4): 217-9, 2005 Apr.
Article in English | MEDLINE | ID: mdl-15875559

ABSTRACT

A 44-year-old man, unaffected by Marfan's syndrome, had previously undergone thoracoabdominal replacement for a chronic, type B dissecting aneurysm. Reconstruction of the visceral arteries was performed using an island technique. However, approximately 3 years after the operation, the reconstructed part of the aorta containing the visceral arteries became dilated and an aneurysm formed. We have succeeded both in repairing the aneurysms and "re-reconstructing" the visceral arteries using a branched graft. We conclude that the technique of separate revascularization is worth considering from the beginning, even if the patient does not present with Marfan's syndrome.


Subject(s)
Aortic Aneurysm, Thoracic/diagnosis , Aortic Aneurysm, Thoracic/surgery , Aortic Dissection/diagnosis , Aortic Dissection/surgery , Marfan Syndrome , Aortic Dissection/pathology , Aortic Aneurysm, Thoracic/pathology , Arteries/surgery , Blood Vessel Prosthesis , Diagnosis, Differential , Humans , Male , Middle Aged , Reoperation , Vascular Surgical Procedures , Viscera/blood supply
7.
J Cardiothorac Vasc Anesth ; 16(4): 463-7, 2002 Aug.
Article in English | MEDLINE | ID: mdl-12154427

ABSTRACT

OBJECTIVE: To determine hepatic and renal effects of hexafluoroisopropanol in patients undergoing coronary artery bypass graft surgery under sevoflurane anesthesia. DESIGN: Prospective, clinical comparison. SETTING: University hospital. PARTICIPANTS: Adult patients scheduled for coronary artery bypass graft surgery (n = 56) were divided into 3 groups according to renal function: group 1, patients with normal renal function (plasma creatinine <1.7 mg/dL), subdivided into 2 groups (group 1a and group 1b), and group 2, patients with impaired renal function (plasma creatinine > or = 1.7 mg/dL). INTERVENTIONS: Anesthesia was maintained with fentanyl, 20 microg/kg, and sevoflurane. In group 1a and group 2, sevoflurane dosage was 0.5 minimum alveolar concentration (MAC). In group 1b, it was 1.0 MAC of sevoflurane. During cardiopulmonary bypass, the same concentration of sevoflurane was given through a membrane oxygenator. MEASUREMENTS AND MAIN RESULTS: Serum hexafluoroisopropanol concentration was measured before induction of anesthesia, at the initiation of cardiopulmonary bypass, at the release of the aortic cross-clamp, at the end of cardiopulmonary bypass, at the end of surgery, and on the 1st postoperative day. Blood urea nitrogen, creatinine, 24-hour urinary output, aspartate aminotransferase, alanine aminotransferase, and total bilirubin were measured at preoperative evaluation, at the end of surgery, and on the 1st and 3rd postoperative days. The levels of hexafluoroisopropanol increased and peaked on the 1st postoperative day. Laboratory values showed no significant differences among all groups. CONCLUSION: The serum level of hexafluoroisopropanol after 0.5 MAC of sevoflurane anesthesia does not aggravate hepatic and renal functions.


Subject(s)
Anesthetics, Inhalation/metabolism , Anesthetics, Inhalation/therapeutic use , Coronary Artery Bypass , Methyl Ethers/metabolism , Methyl Ethers/therapeutic use , Adult , Aged , Alanine Transaminase/blood , Aspartate Aminotransferases/blood , Bilirubin/blood , Blood Urea Nitrogen , Cohort Studies , Creatinine/blood , Female , Humans , Japan , Kidney/blood supply , Kidney/drug effects , Liver/blood supply , Liver/drug effects , Male , Middle Aged , Propanols/metabolism , Prospective Studies , Sevoflurane , Treatment Outcome
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