Biomedical subjects

G Taniguchi

Publications and source records attributed to G Taniguchi.

At least 37 records · Page 2Linked to original sources

PubMed1992

[A successful surgical case of thoracoabdominal aortic aneurysm ruptured into the right pleural cavity].

A 55-year-old man was transferred to our cardiovascular center because of right hemothorax and hemorrhagic shock. Emergency CT scan revealed a thoracoabdominal aortic aneurysm (Crawford's type I-A) ruptured into the right thorax. The aneurysm was exposed by Stoney's spiral opening approach. A 24 mm Cooley Dacron graft was implanted in end-to-end fashion between the descending thoracic aorta and the abdominal aorta just above the celiac artery. The use of aortic artery cannula, femoral artery cannula and flexible polyvinyl tube provided safe and simple means as a temporary bypass during this graft replacement. Postoperative course was uneventful.

Aorta, Abdominal↗

PubMed1991

Improvement of left ventricular aneurysm after myocardial infarction: report of three cases.

We report on the disappearance of a left ventricular aneurysm after myocardial infarction in three cases. Coronary blood flow was restored by spontaneous recanalization in two cases and by angioplasty in one case. When the aneurysm was observed, the findings in these cases were (1) no or limited abnormal Q wave in surface electrocardiography, (2) total or subtotal stenosis of the proximal coronary artery without adequate distal filling through collaterals, (3) no ST shift in exercise electrocardiography, and (4) decreased but not absent thallium-201 uptake in myocardial scintigraphy. In Cases 1 and 2, respectively, 3 years and one year and 8 months after the myocardial infarction, an anginal episode occurred and the ventricular aneurysm disappeared. In Case 3, the aneurysm disappeared after coronary angioplasty. These cases suggest that even without a demonstration of reversible ischemic myocardium and/or severe stenosis without distal filling through collaterals, the myocardium presenting a ventricular aneurysm would be hibernating. These cases were also informative about the detection of hibernating myocardium.

Aged↗

PubMed1991

[Mechanical valve thrombosis in the tricuspid position--reoperative management of 2 cases].

Because valve thrombosis occurred after the tricuspid valve replacement with the mechanical valve, we performed replacement of the mechanical valve with the bovine pericardial valve in two cases. Case 1: The patient, at 13 years old, received open-heart surgery to correct infundibular stenosis. At 23 years of age, decortication and tricuspid valve replacement (TVR) with a phi 31 mm Björk-Shiley valve were performed due to constrictive pericarditis and tricuspid regurgitation developed after the initial operation. Thrombosis of the mechanical valve occurred after the TVR. Treatment with urokinase for the thrombolytic therapy failed to improve the valve opening. Finally 12 years after the TVR, replacement of the mechanical valve with a phi 27 mm Carpentier-Edwards bovine pericardial valve was performed. Case 2: The patient, at 21 years old, received open-heart surgery to close an atrial septal defect. At 40 years of age, mitral and tricuspid valve replacements were performed because regurgitation developed in both valves. The mitral and tricuspid valves were replaced with phi 27 mm and 31 mm St. Jude Medical valves, respectively. Thrombosis of the mechanical valve used for the TVR occurred 2 months after the replacement. The mechanical valve was replaced with a phi 27 mm Carpentier-Edwards bovine pericardial valve. In both cases, subjective symptoms improved and prosthetic valve complications did not occur after re-replacement with the bovine pericardial valve. These cases suggested that for TVR a bovine pericardial valve of sufficient size would be better to select than a mechanical valve.

Adult↗

PubMed1991

[A case of acute myocardial infarction due to simultaneous occlusion of the right coronary artery and left anterior descending coronary artery].

We reported a rare case of a 53-year-old man who experienced acute myocardial infarction due to simultaneous occlusion in the right coronary artery and the left anterior descending coronary artery. He also experienced thromboembolisms on several occasions. So anticoagulant therapy is necessary for patients with exceedingly poor LV function.

Angioplasty, Balloon, Coronary↗

PubMed1990

[Frozen blood from one closely related donor reduced complications of blood transfusion without adverse effects in the open-heart surgery].

We used frozen blood from one closely related donor in 24 patients (group I) who underwent open heart surgery for congenital heart disease, in order to reduce of complications from a large quantity of blood transfusion. Blood of 600-2200 ml was collected from the single donor and was kept frozen until the operation. Two conditions of the patients were instituted, (1) body weight less than or equal to 40 kg (2) the single donor is father or mother or a close relative. The group of these patients was compared with patients using frozen autologous blood (group II) and patients using banked blood (group III). In group I patients two times of decline of red blood cell counts (RBC), hematocrit (Ht), hemoglobin (Hb) and total protein (TP) were noticed. The first was the period during the cardio-pulmonary bypass. The second was the time about one week after the transfusion of frozen red cells. But degree of the decline was uneventful clinically. The increment of complications induced from the use of frozen red cells was not noticed, and there was no case of serum hepatitis in group I patients. We concluded that the open-heart surgery using frozen blood cells (single donor), if the application was appropriate, could be undergone safely and would be effective on reducing infection and reaction induced from blood transfusion.

Adolescent↗

PubMed1990

[A case of modified Fontan operation for complete atrioventricular canal of right dominance with double-outlet right ventricle, common atrioventricular valve regurgitation].

A 6-year-old boy was diagnosed to have complete atrioventricular canal (CAVC) with double-outlet right ventricle (DORV), common atrium and common atrioventricular valve regurgitation. The atrioventricular junction predominantly connected to the right ventricle (right dominance) and the left ventricle was hypoplastic (LVEDV = 64% of normal). The combination of DORV with right dominant CAVC makes more difficult to make intra-ventricular rerouting. A modified Fontan procedure, atrial partition and DeVega's annuloplasty were successfully performed. It is concluded that Fontan procedure might be preferable rather than intra-ventricular rerouting in this case.

Child↗

PubMed1990

[Post-operative evaluation of a 17 mm diameter Björk-Shiley Monostrut prosthesis for aortic valve replacement--pressure gradient and effective valve area].

A 17 mm diameter Björk-Shiley Monostrut prosthesis was implanted in a 64-year-old female for aortic valve replacement in a semi-emergency. This valve was one of the smallest valves which were available in Japan. The patient was admitted because of severe hemolytic anemia and heart failure. Echocardiography showed regurgitation and calcification of Ionescu-Shiley tissue valve which was implanted 5 years ago. The patient's body surface area was 1.2 m2. Because of narrow aortic annulus, we could barely implant a 17 mm diameter Björk-Shiley Monostrut prosthesis. The valve function was examined by Brockenbrough method. During catheterization, the heart rate was 85 b/min and cardiac index was 3.00 l/min/m2. In these hemodynamic conditions, simultaneous measurements of aortic and left ventricular pressures revealed only 9 mmHg mean systolic pressure gradient. Similarly, 20 mmHg of pressure gradient across the implanted valve was obtained by Gorlin's formula. We could calculate that the effective orifice area of a 17 mm diameter Björk-Shiley Monostrut prosthesis was 1.0 cm2. Postoperative echocardiography demonstrated 42 mmHg systolic pressure gradient across this prosthesis by Doppler techniques, and left ventricular wall thickness was not decreased. To best our knowledges, this was the first case in which post-operative evaluation such a small prosthesis was measured.

Aortic Valve↗

PubMed1989

The monoamine oxidase inhibitor-tyramine interaction.

Reports of hypertensive reactions from monoamine oxidase inhibitors (MAOI) began to proliferate in the early 1960s. Asatoor did extensive research and found that the combination of an MAOI and a food containing tyramine resulted in the hypertensive interaction ("the cheese reaction"). Because of the risk of intracerebral hemorrhage and death, clinicians were hesitant to use the MAOIs. Although progress on the metabolic effects of MAOIs has been slow, use of clinical information in addition to analysis of bioactive amine content of foods has allowed the formulation of dietary recommendations, which are thought to be useful clinically in the administration of MAOIs. This has resulted in the gradual return to use of these psychotropic compounds.

Diet↗

PubMed1989

Reperfusion through balloon catheter to minimize myocardial infarction during the interval between failed percutaneous transluminal coronary angioplasty and emergency coronary artery bypass grafting.

A 65-year-old man was admitted with chest pain. A diagnosis of spastic angina was made because of symptoms of recurrent anginal attacks associated with ST-segment elevations in the electrocardiogram. A selective coronary arteriogram revealed a 90% diameter narrowing of the proximal left anterior descending coronary artery (LAD). No angiographically visible collaterals from the right coronary artery to the LAD were observed. The ventriculogram showed normal contraction of the left ventricle with an ejection fraction of 65%. Percutaneous transluminal coronary angioplasty (PTCA) failed resulting in total occlusion of the stenosis. Repeat PTCA at a higher pressure and of longer duration failed to redilate the artery. Reperfusion with the blood from the femoral artery through the balloon catheter, which was used for the PTCA, was carried out until coronary artery bypass grafting (CABG). Blood flow rate of perfusion was approximately 25 ml/min. Reperfusion through the balloon catheter reduced chest pain and ST-segment elevations in the electrocardiogram. The patient tolerated the operative procedure well and his post-operative course was uncomplicated. The interval between the acute occlusion and revascularization by CABG was approximately 4 1/4 h. The ventriculogram taken 56 days after the CABG demonstrated normal contraction of the anterior wall of the left ventricle with an ejection fraction of 63%. Abnormal Q waves did not appear in precordial leads of the electrocardiogram after the surgery. The thallium scintigram showed no perfusion defects. In conclusion, this case suggested that autologous blood reperfusion through balloon catheter would be worth attempting in some cases for minimization of myocardial infarction during the interval between failed PTCA and emergency CABG.

Angioplasty, Balloon, Coronary↗

PubMed1989

Factors influencing acute high-grade restenosis in emergency percutaneous transluminal coronary angioplasty for acute myocardial infarction.

We studied the factors which may induce acute high grade restenosis in emergency percutaneous transluminal coronary angioplasty (PTCA). PTCA was attempted in 50 patients with acute myocardial infarction, and the balloon catheter passed successfully across the occlusion site in 47 (94%) of the patients. These 47 patients were analyzed. "Acute restenosis" was defined as a lesion which was revascularized to less than 50% luminal reduction narrowed again to more than 75% luminal reduction 5 min after the balloon inflation. Univariate and multivariate analyses were used for determining factors which significantly influenced acute restenosis. The incidence of at least one restenosis episode was 45%. Multiple regression analysis selected 5 factors associated significantly with an increased rate of acute restenosis: 1) angiographic evidence of dissection, 2) lesion in the right coronary artery (RCA), 3) lack of or insufficient administration of thrombolytic agent preceding PTCA, 4) curved lesion and 5) relatively small balloon/artery diameter ratio. Acute restenosis correlated significantly with late reocclusion. This study indicates that it is important to administer a thrombolytic agent prior to emergency PTCA, and to use an adequately sized balloon to the artery when the acute restenosis occurs by using relatively smaller sized balloon. The present data also demonstrated that patients with RCA and a curved lesion have a relatively high risk of acute restenosis. This study indicates how patients with relatively high risk of acute restenosis may be identified.

Acute Disease↗

PubMed1989

[Acceleration of the left main coronary artery stenosis following PTCA: a report of a case].

Acceleration of the left main coronary artery (LMCA) stenosis induced by guiding catheter which was used for percutaneous transluminal coronary angioplasty (PTCA) was demonstrated in a 68 years old man with post-infarction angina. He underwent PTCA to a subtotal lesion in the left anterior descending coronary artery (LAD). The LMCA with mild stenosis of 18% reduction of luminal diameter was unchanged during the course of PTCA. The guiding catheter was pushed repeatedly with considerable force for introducing balloon catheter due to the rigid lesion in LAD. Progression of the LMCA stenosis to a 64% was demonstrated at 6 months later angiographic restudy. It was considered that repetitive sliding of guiding catheter through the LMCA caused subangiographic intimal trauma and facilitate subsequent progression of stenosis. We examined the guiding catheter to the LMCA diameter ratio, the angle of the tip portion of the guiding catheter with LMCA, and severity of the target lesion in this case compared with other 27 controls in whom PTCA was performed to the lesion in left coronary artery. No difference of these 3 factors between this case and other 27 controls was obtained. Thus it might be difficult to predict progression of LMCA stenosis by these angiographic factors. Although the incidence of catheter-induced progression of LMCA stenosis was as low as 1 of 160 cases (0.6%) in our experience, it is important to attend to catheter-induced progression of LMCA stenosis and to make an early detection.

Aged↗

PubMed1989

[Surgical repair and late problem for Ebstein's anomaly--surgical cases with severe tricuspid stenosis or regurgitation].

In this report, we described our surgical experiences of Ebstein's anomaly with severe tricuspid stenosis (TS) or regurgitation (TR). Long-term clinical assessments and late problems of the treatment were also mentioned. From 1953 to 1988, a total of 2850 patients with congenital heart malformation underwent surgery in our hospital. During this period, 32 patients with Ebstein's anomaly were admitted, and surgical treatment was performed in 10 of these patients. Thus, the surgical treatment of Ebstein's anomaly took only 0.35% of total surgeries of congenital heart diseases. According to Takayasu's classification of Ebstein's anomaly, 6 of our these patients were classified into TS, and 4 into TR type. The operative methods were shunt operation in 3 patients, plication in 2 patients and tricuspid valve replacement (TVR) in 5 patients. One patient was died during the operative course of Glenn's procedure. Other 9 patients are alive and the longest follow-up period is 18 years at this moment. In the remaining two patients with shunt operation, Blalock-Taussig's procedure completely diminished their polycythemia. In the cases of TVR, the replaced valve was sutured to the right atrium in 2 patients with TS, true annulus in 2 patients with TR, valve remnant in one patient with TR type. Delayed cardiac tamponade occurred in 2 patients and calcification of Xenograft valve was observed at 8 years after the surgery in one patient with TVR. Although the hemodynamics did not improve immediately just after open heart surgery, cardio-thoracic ratio reduced and clinical symptoms were improved remarkably throughout the long-term follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1989

[Emergency operation in impending rupture of aortic arch dissecting aneurysm--a case report of dissecting aortic aneurysm with adhesion to the lung after lobectomy].

Successful surgical treatment of impending rupture of a aortic arch dissecting aneurysm in a 59-year-old man was reported. The aneurysm was tightly adhered to the lung, because he had a previous history of lobectomy. In this case, the permanent aortic bypass with permanent aortic clamp as a means of exclusion procedure of the aortic aneurysm was effective. The postoperative course was uneventful. In the emergency operation for aortic arch aneurysm, operative procedure should be selected by operative findings and risk.

Aortic Dissection↗

PubMed1988