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Biomedical subjects

F Isobe

Publications and source records attributed to F Isobe.

At least 55 records · Page 3Linked to original sources
PubMed1995

[Evaluation of surgical procedures based on the types of hypertrophied obstructive cardiomyopathy].

The surgical procedures were reviewed based on the types of hypertrophied obstructive cardiomyopathy in 20 patients. The patients were classified in three groups: (1) Asymmetric septal hypertrophy (ASH), (2) Atypical or diffuse concentric hypertrophy (DIF), (3) Mid ventricular obstructive hypertrophy (MID). Among 11 patients with ASH, the ventricular septal myotomy (My) or the myotomy-myectomy (Mye) were performed in 9 patients and MVR was performed in 2 patients. Among 6 patients with DIF, My or Mye were performed in 4 and MVR was performed in 2. All three patients with MID were treated with MVR. The intraventricular systolic pressure gradient greater than 40 mmHg was still existent postoperatively in one ASH patient on whom Mye was performed and in 3 DIF patients on whom My or Mye were performed. The four patients had III degree mitral regurgitation preoperatively and were successfully treated. The postoperative NYHA functional class became II or less in all patients. For ASH, the My was effective in 9 patients except one earlier patient. For DIF, further consideration of surgical procedure might be required. For MID, a MVR is recommended.

Adult↗
PubMed1994

[A case of aortitis operated twice Bentall's operation due to valve (graft) detachment].

A 40-year-old man had received emergency Bentall's operation due to acute aortic regurgitation (AR) of aortitis in October, 24, 1990. On out patient clinic, the CRP had been kept from 0.5 to 1.5 mg/dl in dose of 10 mg of prednisolone. In the midnight of November, 17, 1992, his condition deteriorated to circulatory shock and echocardiography revealed massive AR due to para-annular graft detachment with large pseudoaneurysm of 50 mm. He was transferred for emergency operation. The composite graft shifted 2-3 cm above the annulus and detached in three quarter of the annulus. Distal anastomosis was also detached in half of anastomosis and coronary anastomosis almost detached. He was operated on modified Bentall's operation employing Piehler's technique and he is now followed in dose of 10 mg of prednisolone. There are some cases of aortitis showing recurrent valve or graft detachment like this case, even if modified Bentall's operation have been done to decrease the mechanical stress to the annulus and the inflammation have been controlled under the dosage of steroid.

Adult↗
PubMed1994

Cox maze procedure for chronic atrial fibrillation associated with mitral valve disease.

Between April 1992 and October 1993, we combined a modified maze procedure with mitral valve repair (n = 26) or replacement (n = 36) in 62 patients with atrial fibrillation, including 16 patients undergoing reoperation. Associated procedures included aortic valve operation (n = 22), tricuspid annuloplasty (n = 28), atrial plication (n = 10), and others (n = 3). Duration of atrial fibrillation varied from 0.1 to 23 years (average 8.3 +/- 6.4 years), the f-wave voltage ranged from 0 to 0.45 mV (0.16 +/- 0.09 mV), and cardiothoracic ratio varied from 46% to 85% (64% +/- 9%). We modified the maze atriotomies to preserve the sinus node artery and used cryoablation to simplify procedures. Aortic crossclamp time was 142 +/- 25 minutes and cardiopulmonary bypass time 226 +/- 34 minutes. No early or late deaths occurred in a total of 783 patient-months of follow-up. In 52 patients (84%) who regained atrial rhythm, an atrial A-wave was detected in 84% for transtricuspid flow and in 71% for transmitral flow. One patient with sinus rhythm had an episode of transient neurologic ischemia 4 months after mechanical valve implantation. The 10 patients who remained in atrial fibrillation had preoperative fibrillation for a significantly longer time than the rest of the patients with atrial rhythm (14.8 versus 7.2 years p < 0.001) and a larger left atrial dimension (70 versus 58 mm, p < 0.01). Nonetheless, no variable alone could have predicted postoperative rhythm for individual patients. The results suggest that the maze procedure is safe and effective and therefore should be considered for patients with chronic atrial fibrillation undergoing mitral valve operations.

Adult↗
PubMed1994

Double switch operation in cardiac anomalies with atrioventricular and ventriculoarterial discordance.

Since June 1987, 10 of 19 consecutive patients with atrioventricular and ventriculoarterial discordance (average age 4 +/- 2 years) had undergone a double switch operation with the morphologically left ventricle used as a systemic ventricle. There were two combinations of procedures. Atrial switch combined with arterial switch was used in two patients who had a normal pulmonary valve. Atrial switch combined with ventriculoarterial switch by Rastelli's procedure was used in eight patients with pulmonary stenosis or atresia and a large ventricular septal defect. One early death and two late deaths have occurred in a postoperative follow-up period of up to 4 years. Subsequent problems were mainly related to the results of atrial switch procedures in patients who had a small atrium because of low pulmonary flow, especially in patients with apicocaval juxtaposition. Our experience suggested that the double switch operation would open a new era of definitive surgical treatment in half of the patients with atrioventricular and ventriculoarterial discordance.

Aorta↗
PubMed1993

Chronic depression of monopolar, endogenous type: with special reference to the premorbid personality, "Typus melancholicus".

We retrospectively examined 70 depressives, who first visited our outpatient clinic in 1989, agreed to our examination and met the criteria of major depression and melancholic type in DSM-III-R. Forty-nine recovered and 21 had a chronic course of a 2-year duration. Of the items examined in the multivariate analysis, a high total LE score, a long duration prior to entry and a high degree of "Typus melancholicus" greatly contributed to the chronicity in this order of magnitude. Age, severity at entry and sex contributed to it in relatively small degrees and familial loading of depression had almost no effect on the course. The relationship between the degree of "Typus melancholicus" and course of depression was discussed based on data.

Adult↗
PubMed1993

Characterization and surgical ablation of acute atrial flutter following the Mustard procedure. A canine model.

BACKGROUND: A high incidence of refractory atrial flutter has been reported as a late postoperative complication of the Mustard procedure. The objective of this study was to reproduce experimentally the long-cycle-length atrial flutter that occurs in these patients and attempt to ablate the arrhythmia surgically. METHODS AND RESULTS: Nine dogs underwent a simulated Mustard procedure, which included a longitudinal right atriotomy, a septectomy, and a continuous suture line placed in the usual baffle location. All animals were subsequently inducible into sustained atrial flutter after surgery. Activation-time electrophysiological maps of the various pathways of atrial reentry were determined using atrial endocardial molds containing 252 bipolar electrodes. Four distinct reentrant circuits were observed in the following locations: (1) around the tricuspid value annulus (n = 5; cycle length, 175 +/- 5 milliseconds), (2) around the atriotomy incision (n = 2; cycle length, 208 +/- 3 milliseconds), (3) in a pathway involving both atria (n = 1; cycle length, 180 milliseconds), and (4) around the mitral valve (n = 1; cycle length, 135 milliseconds). A common pathway for eight of the nine reentrant circuits included the free-wall segment of the right atrium (excluding the mitral valve circuit). In the first three animals, surgical ablation of the atrial flutter was not attempted, but an incision made perpendicular to the atriotomy down to the tricuspid valve annulus resulted in termination of the atrial flutter in the other six animals. One of these animals was subsequently inducible into an atrial flutter of different morphology (cycle length, 125 milliseconds) that involved an isolated left atrial reentrant circuit. CONCLUSIONS: The Mustard procedure creates several anatomic substrates that increase the probability of the heart to develop atrial flutter, and these may be amenable to subsequent surgical correction.

Animals↗
PubMed1993

[Surgical management of tetralogy of Fallot with absent pulmonary valve in infancy].

Between November, 1987 and May, 1990, definitive operation was performed in 7 infants for tetralogy of Fallot with absent pulmonary valve. Preoperative respiratory failure was serious in 5 patients and semi-emergency operation was done. Surgical procedure consisted of closure of ventricular septal defect, reconstruction of right ventricular outflow tract using heterograft valved pericardial roll and plication of aneurysmally dilated pulmonary artery with or without pulmonary artery suspension in 5 infants with severe respiratory distress and heart failure, operated on 26 days to 5 months of age. In the other two less symptomatic infants, operated on at 13 months of age, reconstruction of right ventricular outflow tract was performed by transannular bovine pericardial patch with monocusp. There were no operative death and six infants are doing well 6 months to 3 years postoperatively, but one patient died of prolonged respiratory infection and respiratory failure one year after operation. Postoperative pulmonary arteriogram revealed a 42 to 61 (mean 54) percent reduction in right and left pulmonary artery size in 3 patients who underwent extensive plication of pulmonary artery. We suggest that definitive plication with or without suspension of pulmonary artery, together with closure of ventricular septal defect and reconstruction of right ventricular outflow tract is supposed to eliminate air way obstruction.

Bioprosthesis↗
PubMed1992

[Total repair for truncus arteriosus].

Total repair for truncus arteriosus using an external conduit was performed in 12 patients from 1978 through 1989. Six cases were infants (mean age: 3.4 months) and 6 were children (mean age; 1 years 9 months). Two cases had Collet-Edwards type II truncus and the other 10 cases had type I truncus. One of the infants was associated with an interruption of the aorta and another had a severe regurgitation of the truncal valve (TrV). For external conduits, we used a non-valved conduit in one infant, a composite valved conduit of Dacron containing a heterograft valve in 4 children and a valved pericardial roll made of an autologous or porcine pericardium in 5 infants and 2 children. One infant with a severe regurgitation of the TrV needed valve replacement along with enlargement of the annulus of the TrV. One infant who had replacement of the TrV died early postoperatively. Another infant died 10 months after total repair due to an infection of an external conduit. Cardiac catheterization was performed in all 10 survivors. The mean value for the systolic pulmonary/systemic pressure ratio decreased from 0.98 +/- 0.09 preoperatively to 0.36 +/- 0.09 postoperatively. Replacement of an external conduit was performed due to a conduit stenosis in 2 children and 1 infant, 10 years and 2 months, 7 years and 9 months, and 1 year and 8 months after the total repair, respectively. In one of these 2 children, replacement of the aortic valve was performed due to a severe aortic regurgitation. We conclude that our results of total repair for truncus arteriosus were satisfactory. However, it remains to be solved how to manage an infant with truncus arteriosus associated with a severe regurgitation of the TrV.

Bioprosthesis↗
PubMed1992

[Biventricular repair for right isomerism associated with transposition of great arteries and common atrioventricular canal].

A 5-years old boy, whose thoracic situs was right isomerism, was diagnosed as transposition of great arteries, common atrioventricular canal (intermediate type), severe tricuspid valve regurgitation, pulmonary valve stenosis, bilateral superior vena cava and left sided inferior vena cava. The preoperative RVEDV was 95% and LVEDV 160%, and LV/RV pressure ratio was 0.54. Atrial rerouting using pericardial patch, replacement of tricuspid valve and pulmonary valvotomy were performed. Postoperative course was uneventful. This was a rare case of right isomerism who received biventricular repair.

Child, Preschool↗
PubMed1991

[Modified Fontan operation for a single ventricle with a nonconfluent pulmonary artery].

A 8-year-old boy with a double inlet right ventricle with a non-confluent pulmonary artery was operated on with a modified Fontan operation. He had right isomerism, right aortic arch, bilateral superior caval veins, and left-sided inferior caval vein. Hepatic veins were separately drained to the right-side atrium. Left Blalock-Taussig shunt and right central shunt operations had been previously performed. Firstly, we had reconstructed the central pulmonary artery with a 16 mm porcine pericardial roll to unify the nonconfluent pulmonary arteries. Secondly, about 2 months after the first operation, we performed a modified Fontan operation. Systemic venous return from the inferior caval vein and the hepatic veins were drained to a reconstructed pericardial roll with an intraatrial Gore-Tex graft, and bilateral superior caval veins were also anastomosed to the roll. The structure of the pulmonary arterial system is one of the most important factors to determine the outcome of a modified Fontan operation. Even if the central pulmonary artery is absent, however, a modified Fontan operation is applicable for the patient whose peripheral pulmonary arteries have enough growth.

Blood Vessel Prosthesis↗
PubMed1991

[Ventricular septation combined with arterial switch for a patient with double inlet left ventricle with right sided rudimentary right ventricle and ventriculoarterial discordance].

A 5-year-old boy with double inlet left ventricle and ventriculoarterial discordance (SDD type) underwent ventricular septation with arterial switch procedure. Previously he had received pulmonary arterial banding at 3 months-old. Preoperative cardiac catheterization revealed Qp/Qs 1.26, Pp/Ps 0.19 and LVEDV was 315% of normal (as left ventricle). Arterial switch with Lecompte modification was performed in order to separate ventricle with straight patch could be done. Post operative course was uneventful and patient was extubated 4 post operative day. These procedures had employed in this patient as follows; 1) systemic ventricle could be constructed with morphological left ventricle with mitral valve. 2) left ventricular outflow tract stenosis due to ventricular outlet foramen occasionally observed in conventional procedure such as intraventricular rerouting could be prevented, and 3) ventricular septation could be easy and simple with straight patch.

Aorta↗
PubMed1990

A patient with ventricular tachycardia showing remarkable fatty infiltration and lymphocytic myocarditis in the right ventricular wall.

A 14-year-old boy without overt heart disease underwent encircling ventriculotomy and cryoablation because of ventricular tachycardia resistant to antiarrhythmic therapy. Resection of the right ventricular wall with the origin of the ventricular tachycardia was performed on the basis of information obtained by epicardial mapping at operation, and histological examination showed unique findings of remarkable fatty infiltration and lymphocytic myocarditis.

Adipose Tissue↗
PubMed1990

[Surgical treatment of ventricular tachycardia in patients with arrhythmogenic right ventricular dysplasia and their long follow-up results].

We have treated surgically the drug-refractory ventricular tachycardia (VT) in patients with arrhythmogenic right ventricular dysplasia. The early and late results of the cryoablation were studied. We operated 8 patients. They showed 10 clinical VTs. A total of 21 VTs were detected (17 VTs during preoperative EPS, 4 VTs during intraoperative EPS). 19 VTs were operated: the origins of 15 VTs were determined by the intraoperative mapping, while those of 4 VTs were suspected by the preoperative EPS. During the follow-up time (mean 3.25 +/- 1.46 years), no patient died, VTs recurred in 2 patients and a new VT was seen in one patient. No recurrence was recognized in 12 VTs operated with the cryoablation applied from the endocardial side, but 4 out of 7 VTs recurred which were operated from the epicardial side. Cardiac arrest induced by aortic clamping didn't affected the efficacy of the cryoablation in the case of epicardial approach. CTR increased slightly postoperatively, from 49.9 +/- 4.4% to 53.3 +/- 5.3% at the 29.2 +/- 15.9 pom. No patients showed the signs of congestive heart failure postoperatively and required the medication except the patients with VT recurrence and a patient with the atrial flutter-fibrillation. In conclusion, even though this disease has the difficulty in the eradication of arrhythmia, VTs actually threatening the patient life at present could be cured by the cryoablation from the endocardial side.

Cryosurgery↗
PubMed1990

[Nonischemic ventricular tachycardia with coronary arterio-venous fistula].

A 22 year-old man who suffered ventricular tachycardia (VT) during 8 years was admitted to our hospital for treatment of VT. He also had diseased, coronary arterio-venous fistula with a mild L-R shunt and coronary fistula was closed operatively 4 years ago because it was presumed to be a cause of VT, but the VT remained after the closing on the fistula. After admission in our hospital, catheter endomyocardial mapping and coronary cineangiography were undergone and revealed that the coronary artery was intact and a pre-excitation area located in the LV apico-lateral wall. Dual catheter ablations were attempted but resulted in failure. Then, surgical cryoablation was employed under the use of extracorporeal circulation, following epicardial and endocardial mapping. Cryoablation (-150 degrees C) to the postero-septal wall of LV could terminate VT completely.

Adult↗
PubMed1990

[Surgical therapy of congenital aortic valvular stenosis in neonates and infants].

The preoperative evaluation, surgical course, and early follow-up results of 5 infants less than 4 months of age who underwent aortic valvotomy for severe valvular stenosis between 1983 and 1985 were reviewed to determine the early prognosis of these neonates. Two of the 5 patients had been used respiratory support due to severe congestive heart failure and dyspnea. Emergency aortic valvotomy was performed in all during cardio-pulmonary bypass which achieve maximal relief of the stenosis without significant causing aortic insufficiency. There was a single operative death and there was one late death at 2 months after surgery who was regarded to have a extensive endocardial fibroelastosis. The other three patients have had a favorable early prognosis during mean follow-up period of 1.78 (0.4-3.8) years. They had been followed by means of two-dimensional and doppler echocardiography, which inferred that the aortic pressure gradient had been kept under 41 mmHg and which indicated that there were no LV enlargement to prove significant aortic valve insufficiency. These results indicate that early infants with severe valvular stenosis can undergo sufficient valvotomy safely and have a favorable early prognosis.

Aortic Valve↗