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Biomedical subjects

A Shiikawa

Publications and source records attributed to A Shiikawa.

At least 19 recordsLinked to original sources
PubMed2003

[A giant left atrial myxoma with severe mitral valve regurgitation: report of a case].

A 76-year-old female underwent operation with a diagnosis of a left atrial myxoma with accompanied mitral regurgitation. Although no clinical findings of mitral regurgitation were noticed preoperatively, degenerative changes to the anterior leaflet as well as chordae tendinae possibly due to mechanical damage by the movement of the giant tumor through the mitral valve complex were observed in operation. Resection of the tumor and mitral valve replacement were successfully performed. Our case suggests that it is indispensable to investigate the mitral valve during operation even in case of the left atrial tumor with no preoperative findings of mitral regurgitation.

Aged↗
PubMed2002

[Severe tricuspid regurgitation late after aortic and mitral double valve replacement; report of a case].

A 59-year-old man had undergone aortic and mitral valve replacement (DVR) for rheumatic aortic and mitral valve stenosis 15 years ago. At that time, echocardiography did not detect tricuspid regurgitation (TR), and catheterization data showed right atrial pressure v wave of 8 mmHg and pulmonary artery pressure of 27/12 (17) mmHg. One year after DVR, hepatomegaly and jugular venous dilatation appeared, and after 5 years edema of both legs became apparent. After 7 years, chest X-ray showed an increase of cardio-thoracic ratio, and for the first time, echocardiography detected mild TR. Fifteen years after DVR, severe general fatigue, shortness of breath and hepatomegaly could not be controlled with medication. Catheterization data showed right atrial pressure v wave of 23 mmHg and pulmonary artery pressure of 28/13 (17) mmHg. Right ventriculography showed progression of severe TR. Tricuspid valve replacement (TVR) was performed using a St. Jude Medical 31 M mechanical valve under natural cooling and heart beating. The tricuspid valve was only slightly thickened and no subvalvular abnormalities were seen other than a severely dilated tricuspid annulus. Postoperative course was uneventful and he was discharged 44 days after the TVR. He is currently doing well 6 years after the TVR. All terms, he did not have pulmonary hypertension or left-side heart problems. We suspect that the cause of TR was not secondary, and was included in the category of isolated TR. If the left heart is completely treated, as in this case, it is important to follow-up for signs of right heart failure, before TR is detected.

Aortic Valve↗
PubMed2001

[A tube retractor for cardiac surgery].

A retractor exclusively used to retract the tubes in cardiac surgery which needs cardiopulmonary bypass was developed. The half-cylinder-shaped end, the lightly curved handle and the flat and triangular grip enable easy and effective grasp of the tubes. This new instrument facilitates operative procedures by effectively retracting the tubes which persistently obstruct the operative field, in such a case of placement of a retrograde cardioplegia tube via the right atrium.

Cardiopulmonary Bypass↗
PubMed2001

[A case report of primary cardiac leiomyosarcoma].

A 26-year-old woman presenting symptoms of rapid progressive heart failure consulted with our hospital. Two-dimensional echocardiography showed a large mass in the left atrium (LA) and severe pulmonary hypertension. Emergent operation was performed because of hemodynamic reason and the risk of embolism. The tumor (7 x 6 x 3 cm) which was lobulated and had a smooth surface was arising from posterior wall of LA extending into the ostium of right lower pulmonary vein. The portion of tumor located was excised. The defect was reconstructed by bovine pericardium. Postoperative histopathological diagnosis was leiomyosarcoma. Hemodynamics recovered after surgical treatment and there were no problems for 5 months. However, tumor recurrence in LA and pulmonary metastasis was found 5.5 months after surgery. The patient died two weeks later by progressive heart failure. Primary cardiac leiomyosarcoma is extremely rare. The current world literature is reviewed with respect to this rare tumor.

Adult↗
PubMed1998

[Postoperative complications after coronary bypass operations in patients with pulmonary impairment].

The postoperative courses of 112 patients with pulmonary disease (59 with obstructive disease = Group 0, 38 with restrictive disease = Group R and 15 with mixed disease = Group M) who underwent elective coronary artery bypass grafting were retrospectively reviewed. Preoperative pulmonary function test (percentage of vital capacity = %VC and percentage of forced expiratory volume at 1 second = FEV1.0%) of these group showed typical abnormal values, and velocity ratio of 50% and 25% of maximum expiratory flow volume (V50/V25) of each groups were measured abnormal values (3.99 +/- 1.44 of Group O, 4.26 +/- 1.42 of Group R and 3.74 +/- 1.82 of Group M). The our strategy for these groups were a). Using skeletonization method for harvesting internal mammary artery (IMA) b) Take care not to injure the phrenic nerve and open the pleural cavity as surgical techniques (Harvesting IMA) and c) Administration of theophylline derivatives and corticosteroids to prevent bronchospasm d) Administration of concentrated serum albumin and diuretics to prevent pulmonary edema as therapeutic measures. The length of stay in the intensive care unit and ventilation time of each groups were not significantly longer. Patients of group M had more respiratory complications (atelectasis, pleural effusion, pneumothrax, bronchospasm, and pneumonia) than did patients of group R (p < 0.05), but did not more nonpulmonary complications and hospital deaths. The four in hospital deaths (2 with group O, 1 with group R and 1 with group M) were not directly related to pulmonary complications. Thus, result of CABG in patients with pulmonary impairment definitely proved to be satisfactory by our strategy, but mixed pulmonary diseased significantly had more pulmonary complications.

Cardiac Surgical Procedures↗
PubMed1996

Effects of smaller physical size on complex arterial grafting in coronary artery operations.

BACKGROUND: The trend in coronary artery bypass grafting is for a gradual transition to the more extensive use of arterial grafts. This study was designed to investigate the effects of patient body size on complex arterial grafting in coronary artery bypass procedures. METHODS: Four hundred forty-five patients who underwent coronary artery bypass grafting with two or more distal anastomoses using arterial grafts were divided into two groups according to body surface area: group A (n = 114), 1.60 m2 or less; and group B (n = 331), greater than 1.60 m2. Preoperative patient characteristics and early and long-term results were compared between the groups. RESULTS: The prevalence of female sex (27% in group A versus 0.9% in group B; p < 0.0001) and age (62.7 +/- 8.1 years in group A versus 58.9 +/- 7.0 years in group B; p < 0.001) were significantly different. However, the prevalence of previous myocardial infarction and of left ventricular dysfunction and the extent of coronary artery disease were not significantly different. Three patients (2.6%) in group A and 3 patients (0.9%) in group B died within 30 days of operation (p = 0.18). The 1-month patency rate of arterial grafts was not significantly different (98.7% versus 96.7%; p = 0.16), but that of venous grafts was significantly lower in group A than in group B (88.9% versus 97.7%; p = 0.045). No significant difference was noted in the 3-year actuarial survival rate (93.8% versus 91.6%). CONCLUSIONS: The extensive use of arterial grafts in patients with small body size was associated with excellent long-term results, with no significant increase in operative mortality or morbidity.

Body Constitution↗
PubMed1996

Coronary artery bypass grafting with both internal thoracic arteries and the right gastroepiploic artery.

From July 1989 to March 1995, 83 patients (79 men, 4 women, mean age 58.3 years, range 35 to 76 years) underwent coronary artery bypass grafting with the both internal thoracic arteries (ITAs) and the right gastroepiploic artery (RGEA). Postoperative follow-up ranged from one to 69 months with a mean of 31 months. Seventy-eight patients (94%) had either triple vessel disease or left main disease. A total of 264 distal anastomoses with arterial grafts were constructed; 90 with the left ITA, 73 with the right ITA, 90 with the RGEA and 1 with the inferior epigastric artery (IEA). An additional saphenous vein graft was constructed in 13 patients including 4 sequential bypass grafting. The mean number of distal anastomoses was 3.4. Postoperative angiography was performed in 80 patients (96%) 3 to 4 weeks after the operation. There were no operative deaths or hospital deaths. No patients developed perioperative myocardial infarction. Graft patency in arterial grafts was 96% (242/253), 95% (80/84) in the left ITA, 100% (82/82) in the right ITA and IEA (1/1), and 93% (80/86) in the RGEA. Graft patency in vein grafts was 99% (84/85) and overall patency rate was 96% (326/338). Four patients (5%) died during follow-up period but all were non-cardiac deaths. Six postoperative percutaneous transluminal coronary angioplasties (PTCA) (7%) and two reoperations (re-CABG) (2%) were required, but no patients developed myocardial infarction (MI). The 5-year actuarial survival rate and cardiac event (cardiac death, MI, PTCA, and re-CABG) free rate was 90.1% and 86.6% respectively. In conclusion, the clinical outcome of the coronary artery bypass grafting with the both ITAs and RGEA was satisfactory in terms of low operative risk, high patency rate, and excellent long-term results.

Abdominal Muscles↗
PubMed1993

[A right internal thoracic artery graft to the left anterior descending artery].

From 1987 to 1991, 48 patients received a right internal thoracic artery (RITA) to the left anterior descending artery (LAD). No operative death occurred, but two patients (4.2%) died during hospitalization due to graft versus host disease, and congestive heart failure. Graft patency of the RITA was 100%. After a 17.2 month mean follow-up, the 4 year actuarial survival rate (including all causes of death) was 85.3%, and the 4 year cumulative cardiac event free rate (including all cardiac deaths, myocardial infarction, reoperation, and PTCA) was 87.6%. The length of the RITA graft to the LAD, 15.6 +/- 1.1 cm, was significantly longer than that of the left internal thoracic artery (LITA) to the LAD, 12.9 +/- 1.1 cm. However, the flow of the RITA-LAD graft, 42.3 +/- 21.1 ml/min, was same as the flow of the LITA to the LAD, 42.1 +/- 19.6 ml/min. These findings justify wider use of the RITA to the LAD as a second arterial graft.

Adult↗
PubMed1992

[Sequential coronary artery bypass using gastroepiploic artery].

We carried out sequential coronary bypass grafting using the gastroepiploic artery (GEA) as an in situ graft in seven patients. Four patients had sequential graft from the right coronary to the circumflex. Three patients were anastomosed to two or three peripheral branches of the right coronary artery. There were no early deaths. Postoperative angiograms revealed that the patency rate was 92.3% (12/13 anastomoses). Sequential GEA grafting is available to anastomose the peripheral branches of the right coronary and the circumflex where the in situ internal thoracic artery is difficult to access. Therefore, this procedure will be indicated for multiple coronary artery bypass grafting.

Aged↗
PubMed1992

[Surgical versus nonsurgical therapy of fatal tachyarrhythmias].

Interventional treatment is necessary for fatal drug-refractory tachyarrhythmias. Thirty-three, 33 and 16 patients (pts) with intractable ventricular tachycardia (VT) and/or fibrillation (VF) were managed with cryosurgery (CS), electrical catheter ablation (EA) and implantable pacer-cardioverter-defibrillator (PCD), respectively. Seventy-six and 43 pts with sudden death risk in the Wolff-Parkinson-White syndrome (WPW) also underwent CS and EA, respectively. CS success rates were 85% in VT/VF and 95% in WPW. Those of EA were 48% and 81%, respectively. EA success rates were 100% (6/6) in idiopathic verapamil-sensitive VT originated from LV, 0% (0/2) in VT following TOF repair and 0% (0/2) in idiopathic VT originated from right ventricular outflow tract. A new VT developed in 5 of 11 pts with arrhythmogenic right ventricular dysplasia (ARVD) following EA. PCD was effective for prevention from sudden death in idiopathic VF and pleomorphic VT. All of pharmacologic, EA and CS therapies were relatively effective in ischemic heart disease without low EF. In conclusion, the decision of VT-VF therapy may be affected by the underlying heart disease and EA may be established as an initial intervention for high risk WPW.

Adult↗
PubMed1992

[A case report of thrombosed St. Jude Medical valve in a patient with macroglobulinemia].

A 66-year-old man who had undergone MVR using a ST. Jude Medical valve entered the hospital with acute heart failure and cardiogenic shock 3 months after surgery. He had had a symptom of petechiae due to macrogloburinemia after initial MVR and had been in the poor control of anticoagulation therapy because of presence of petechiae. He was diagnosed as prosthetic valve thrombosis using echocardiography and underwent emergency re-MVR using a Central Open Bioprosthesis (COB) which was developed by our department. He was doing well 8 month after re-MVR. Selection of prosthetic valve should be performed carefully in the patient with hemorrhagic disease, and careful observation and proper anticoagulant therapy should be carried out after valve replacement.

Aged↗
PubMed1991

[Coronary artery bypass graft stenosis suspected to be due to hemostatic agents: a case report].

A 66-year-old man had a CABG with a saphenous vein graft. During the surgery, oxidized cellulose and fibrin glue were used and left in place for hemostasis. Six months after the surgery, the first postoperative CAG was performed and a stenosis of the coronary bypass graft near the proximal anastomosis was found. The first PTCA was done and the stenosis was released. Re-stenosis was observed at the same site one year after the first PTCA and a second one was performed. Five years and nine months after the surgery, the patient started complaining of severe chest pain even though he was receiving medication. Graft stenosis at the same site was observed by CAG. A cyst 3 cm in diameter, with irregular wall thickness was found near the proximal portion of the bypass graft. Resection of the cyst and re-CABG was performed uneventfully. Microscopically, the cyst consisted of fibroblasts, small vessels, collagen fiber and giant cells and was diagnosed as granuloma. In the giant cells, oxidized cellulose fiber was observed. No comparable cases have been reported in the literature. Topical hemostatic agents were discussed.

Aged↗
PubMed1991

[Successful surgical correction of endocardial cushion defect in a 63-year-old female patient].

We have experienced a surgical correction of a 63-year-old female patient with ECD, who had suffered from severe congestive heart failure. Massive left to right shunt and severe mitral and tricuspid regurgitation were noted. The correction consisted of mitral valve replacement, patch closure of the ostium primum defect and annuloplasty of tricuspid valve. Postoperative course was uneventful. Surgical correction should be recommended even in old patient.

Endocardial Cushion Defects↗
PubMed1991

[The automatic implantable cardioverter defibrillator--clinical experience in patients with life-threatening ventricular tachyarrhythmias].

Five patients (pts) with life-threatening ventricular tachyarrhythmias (idiopathic VF; 2 pts, Torsade de pointest; 1 pt, VT/VF after valve replacement; 2 pts) underwent surgical treatment of the automatic implantable cardioverter defibrillator (AICD). Implantation of an AICD was indicated for patients who survived circulatory arrest due to documented VT and/or VF. The patient should be medically refractory or medical treatment precluded by hemodynamic instability; other surgical treatment should not be possible. We selected myocardial electrode for sensing and small and large patch electrodes for defibrillating. VF/VT was induced 1 to 6 times for the measurement of defibrillation threshold (DFT). In all of our pts, the AICD appropriately discharged at postoperative EPS. In three of pts, the AICD discharged within the postoperative hospital phase, in two because of sinus tachycardia during treadmill test and restored sinus rhythm after non-sustained VT. As for complications, in one pt. with severe LV dysfunction, incessant form of VT/VF occurred after DFT testing and LV assist circulation and IABP were needed. In two pts, inappropriate discharge and in two, pericarditis were recognized postoperatively. It was considered that this system was effective for the treatment of life-threatening ventricular tachyarrhythmias but strict indication was necessary because of unsolved problems.

Adult↗
PubMed1990

[Surgical salvage of cardiac rupture: a case report].

A 39-year-old man suffered from acute myocardial infarction. Echo cardiography showed the presence of intra-pericardial fluid. We had emergent operation. We successfully salvaged cardiac rupture with fibrin glue and oxy-cellulose without cardiopulmonary bypass. His post-operative course was uneventful. The patient was discharged on the seventh week after the operation. The problems of acute cardiac rupture were discussed.

Adult↗
PubMed1990

[Successful surgical treatment of automatic atrial tachycardia].

A 3-year-old boy had chronic repetitive atrial tachycardia. The tachycardia could not be induced neither terminated with rapid atrial pacing nor atrial extrastimuli. Overdrive suppression and warm-up phenomenon were demonstrated. These electrophysiological features suggested atrial ectopic automaticity. Endocardial and epicardial mapping determined the origin of tachycardia at the left atrial appendage. The LA appendage was excised and the tachycardia was completely terminated. The patient is asymptomatic without medication and echocardiographic indices of left ventricular function returned to normal over 1 year follow-up period.

Child, Preschool↗