Biomedical subjects

H Horimi

Publications and source records attributed to H Horimi.

At least 19 recordsLinked to original sources

PubMed1996

[Successful surgical treatment of intraoperative aortic dissection complicating aortic valve replacement].

A 74-year-old man underwent standard aortic valve replacement. The aortotomy was closed by use of strips of Teflon felt because of somewhat friable thin aortic wall. After the termination of cardiopulmonary bypass, aortic cannulation site was carefully sutured enforcing with a piece of pericardium, since some bleeding persisted. The intraoperative diagnosis of acute aortic dissection (Stanford type A) was made with transesophageal echocardiography. Since extension of the dissection toward the aortic root was hardly possible due to the Teflon felt enforced aortotomy closure, further surgical intervention was not considered at this time. Thiry-two hours later after admission to CCU, sudden bleeding through the mediastinal tube prompted the patient back to OR for exploration Bleeding was noted from the posterior wall of the ascending aorta. Ascending aorta and transverse arch were significantly enlarged with notable discoloration. With the aid of extracorporeal circulation and selective cerebral perfusion, the total graft replacement of the ascending aorta and aortic arch was performed. The intimal tear located at the aortic cannulation site. The postoperative course was uneventful. Prompt recognition and appropriate surgical management are necessary to improve patient outcome.

Aged↗

PubMed1996

[Coronary reoperation--selection of conduit material and management of stenotic vein graft].

We have operated upon 30 cases of coronary reoperation during the past 12 years. The mean interval between the two operations was 46 months. The mean follow-up after reoperation was 61 months. The major reasons for reoperation were graft failure from technical problems in early and time-related degeneration in graft and native coronary progression in late cases. We aggressively have replaced the stenotic and obstructed vein graft with the arterial graft at reoperation since 1990. Hypoperfusion syndrome is clinical entity reported secondary to inadequate flow via the internal thoracic artery. For patients with atherosclerotic vein grafts to the LAD, the minimal manipulation of the old vein graft, adding the IMA graft to the LAD and leaving the stenotic vein graft intact appear to be safe and better procedure for long-term results. There were no operative and hospital death. Five and 10 years survival rate were 100% and 90% respectively. Five and 10 years event free rate were 92.1% and 82.9% respectively. The outcome of reoperation was satisfactory.

Adult↗

PubMed1996

[Emergent coronary bypass grafting after acute myocardial infarction].

In an attempt to examine various factors affecting the short- and long-term results of emergent coronary bypass graft surgery (ECABG) after an acute myocardial infarction (AMI), all patients undergoing ECABG without associated procedures at our institution from January 1987 to July 1995 were reviewed. Forty eight patients underwent ECABG after AMI. The hospital mortality rate was 20.8%. The charts of these patients were reviewed with regard to sex, age, preoperative shock, location of AMI, type of infarction, coronary anatomy, presence of postinfarction angina, technique of myocardial preservation, use of saphenous vein graft (SVG) alone, time from AMI to operation and short and long-term outcome. Univariate analyses showed that three factors were significantly associated with increased hospital death: preoperative shock (p = 0.001), type of infarction (p = 0.01), use of SVG alone (p = 0.003). Follow-up was 100% complete at a mean time of 36.4 +/- 4.8 months. Of all patients 77.0% were alive at 5 years after operation. Univariate comparison of survival curves and coronary event free curves showed that use of SVG alone was associated with decreased survival (p = 0.0009) and event free (p = 0.02) rates. Patients with non-Q-wave infarction and without cardiogenic shock may undergo ECABG relatively safely at any time. The use of internal thoracic artery at ECABG without cardiogenic shock does not increase hospital mortality and improves both long-term survival and freedom from coronary events.

Adult↗

PubMed1995

[Hiatal hernia incarceration during cardiopulmonary bypass in patient with acute aortic dissection--a case report].

A 67-year-old woman was admitted to our hospital under diagnosis of Stanford type A acute aortic dissection. Chest CT showed aortic dissection from the ascending to descending aorta, and large hiatal hernia. Operation was undergone under cardiopulmonary bypass and circulatory arrest with retrograde cerebral perfusion. A graft replacement was carried out from the ascending to transverse arch aorta. After the release of the cross-clamping of aorta, the heart was gradually oppressed anteriorly by extrapericardial mass, so that the patient could not be weaned from the cardiopulmonary bypass. The mass was revealed incarcerated hiatal hernia by ultrasonography. After laparotomy, diaphragm and hiatus were incised, the incarceration was relieved and the diaphgragm was repaired with a Goretex sheet. Then the patient could be weaned from cardiopulmonary bypass. Her postoperative course was uneventful except for acute renal failure, and she was discharged 60 days after the operation. The incarceration of hiatal hernia was thought to be caused by tissue edema and small bleeding during cardiopulmonary bypass. This is the first reported case with the incarceration of hiatal hernia which occurred during cardiopulmonary bypass.

Acute Disease↗

PubMed1994

[Concomitant graft replacement of the total aortic root and the transverse aortic arch for type A aortic dissection associated with Marfan syndrome: report of a case].

A 25-year-old man of Marfan syndrome with chronic stage aortic dissection of Stanford type A underwent concomitant graft replacement of the total aortic root and transverse aortic arch. The surgical procedure were performed with an aid of extracorporeal circulation, blood cardioplegia, using the techniques of "open distal anastomosis" under the deep hypothermic circulatory arrest and continuous retrograde cerebral perfusion for cerebral protection during circulatory arrest. The operative techniques consisted of total aortic root replacement using a composite graft with Piehler's and Carrel patch technique for left and right coronary artery, and total arch replacement using en bloc distal arch reconstruction and a composite graft replacement for innominate artery. There were no neurological complications. In the case of Marfan syndrome, type A aortic dissection involving aortic arch should be treated by concomitant graft replacement of the total aortic root and the transverse aortic arch in order to reduce the late risk of aortic dissection or annular dilatation.

Adult↗

PubMed1993

Isolated tricuspid valve stenosis caused by infective endocarditis in an adult: report of a case.

We report herein the case of a 42-year-old man in whom dyspnea on exertion was found to be caused by isolated tricuspid stenosis. Two-dimensional echocardiogram showed thickening of the tricuspid valve with a markedly enlarged right atrium. A color-flow Doppler examination-revealed severe tricuspid stenosis without regurgitation and a Doppler-derived tricuspid diastolic pressure gradient of 23 mmHg. At the time of surgery, the patient was noted to have a stenotic tricuspid valve with thickened leaflets, fused commissures, and almost normal chorda tendineae. The valve leaflets were teased apart to the scattered specimen, and tricuspid valve replacement was successfully performed. Microscopic examination of the specimen demonstrated infective endocarditis. Isolated acquired tricuspid stenosis is extremely rare and, to our knowledge, this is the first case of infective endocarditis being involved as the primary cause.

Adult↗

PubMed1993

[Serial assessment of ventricle function in diastolic volume loading caused by valvular disease].

Thirty patients underwent aortic valve replacement (AVR) for aortic regurgitation and fifty-two did mitral valve replacement (MVR) for mitral regurgitation. Preoperative echocardiographic studies classified each cases into two groups. Group A: LVDs (left ventricular end-systolic dimension) > 50 mm and FS (left ventricular fractional shortening < 25%, Group B: LVDs < or = 50 mm or FS > or = 25%. Serial assessments by echocardiography were done at one year, three years, and five years after operation. LVDs, FS, LVDd (left ventricular end-diastolic dimension), EF (ejection fraction, Pombo's method) were evaluated. In the Group A of the AVR cases, it took three years for the left ventricular function to recover, but in the MVR cases, the left ventricular function didn't reach to the normal range, moreover tended to worsen five years after operation. One of the reasons may be attributable to the preoperative hemodynamic states in which the left ventricular after-load is smaller in the MVR cases. For such long-standing unfavorable condition, the left ventricle could not get enough recovery. In the Group B of both cases, there is no difference of the postoperative recovery of the left ventricular function. Postoperative cardiac function must be discussed upon the serial evaluation after operation.

Aortic Valve Insufficiency↗

PubMed1993

[Two cases of re-expansion pulmonary edema].

A 62-year-old man and 26-year-old man with re-expansion pulmonary edema (RPE) after thoracic drainage as a treatment for pneumothorax are presented. Blood cell counting and biochemical serum analysis were performed throughout their treatment in both patients, and biochemical sputum analysis was in one patient. The results showed transient marked leukocytosis just after RPE. Total protein and albumin concentrations of sputum approximated to those of serum. The above results suggested that RPE is based on pulmonary microvascular injury, which may introduce leukocytosis.

Adult↗

PubMed1993

[A case of left atrial myxoma with cerebral infarction as initial symptom].

A 75-year-old man with an initial episode of cerebral infarction was found to have left atrial tumor by some noninvasive methods. Tumor was resected through transverse atriotomy. Excised specimen showed left atrial myxoma. Cardiac myxoma should be considered as one of ailments in elderly patients presenting with systemic embolization.

Aged↗

PubMed1993

[Blunt cardiac trauma resulting in ventricular septal perforation and mitral regurgitation due to papillary muscle rupture--a case report].

A 13-year-old girl was hit by a car and referred to our hospital because of progressive chest discomfort, cough, ECG abnormalities and sustained hypotension. 2-D/Doppler echocardiography recorded on admission demonstrated ventricular septal perforation with L-R shunt and mitral regurgitation due to rupture of the posterior papillary muscle and its adjacent myocardium. Patch closure of the ventricular septal perforation and fixation of the papillary muscle were performed. In five years after surgery, the patient is doing well with no echocardiographic evidence of mitral regurgitation.

Adolescent↗

PubMed1993

[A case of two-chambered right ventricle associated with severe pulmonary valve regurgitation].

A 40-year-old female was admitted to the hospital with the chief complaints of dyspnea on effort. Echocardiography and cardiac catheterization revealed an abnormal muscle bundle in the right ventricle which divided right ventricle into two chambers with the pressure gradient of 86 mmHg between them. And severe regurgitation associated with hypoplastic pulmonary valve and ventricular septal defect were noted. We removed the abnormal muscle bundle through the right atrial and ventricular approach, and pulmonary valve replacement and VSD closure were carried out. We report a case of two-chambered right ventricle with severe pulmonary valve regurgitation because of its rarity.

Adult↗

PubMed1992

Detection of aortopulmonary window with ventricular septal defect by Doppler color flow imaging.

Aortopulmonary window is a rare congenital cardiac anomaly. When it coexists with a ventricular septal defect, the accurate diagnosis of aortopulmonary window on the basis of clinical examination is difficult. We report the case of an infant who had an aortopulmonary window together with a ventricular septal defect. An accurate diagnosis could be attained by visualization of the defect using two-dimensional echocardiography and detection of the flow through it by Doppler color flow imaging.

Aortopulmonary Septal Defect↗

PubMed1992

[Delayed sternal closure after cardiac surgery].

Following cardiac surgery, approximation of sternum will produce systemic hypotension or elevation of left atrial and central venous pressures. A new criteria for delayed sternal closure is proposed. Sternal closure has to be delayed when mean left atrial or central venous pressures increased over 2 mmHg at the tentative closure. In seven cases (3.5%) of consecutive 201 patients was delayed the sternal closure under the above mentioned state, all survived and received the successful closure later. One of them died of congestive heart failure four months after the operation and one died of the rupture of the ascending aortic pseudoaneurysm eleven months after the initial operation. Microbiological examination of the mediastinal and pericardial contents obtained at the final sternal closure were negative in all cases. Comparing the total cardiopulmonary bypass time, ventricular fibrillation time, and myocardial ischemic time between in the secondary closure group and in the primary closure group, the total bypass time and the ventricular fibrillation time of the former were significantly longer than the latter, but the ischemic time revealed no difference. In conclusions, persistent elevation of left atrial or central venous pressures after cardiac surgery at the tentative sternal closure seems the reliable predictor for the delayed closure of the sternum. Careful post-operative management prevents serious mediastinal infection. Delayed sternal closure is preferable procedure for the patient with brittle hemodynamics after open heart surgery.

Adult↗

PubMed1992

[Transatrial approach to provide exposure of the left atrium].

Surgical exposure of the left atrial structures including the mitral valve apparatus is occasionally problematic, when the left atrium is small or noncompliant in the presence of previously implanted aortic prosthesis. We operated eleven cases with an incision that is a modification of a maneuver proposed by Dubost and colleagues, and all but one provide an excellent exposure of the left atrium and mitral valve apparatus. In one case of combined valvular disease complicated by chronic pericarditis, operative view was not satisfactory. The preserves equine pericardial patch was utilized to close the incision in 5 cases. No serious arrhythmias as atrioventricular conduction block was experienced. With this maneuver, the application is recommended to provide excellent exposure into the left atrium and mitral valve apparatus.

Adolescent↗

PubMed1992

[Effects of prostaglandin E1 in the treatment of congestive heart failure after mitral valve replacement].

Prostaglandin E1 (PGE1) was intravenously administrated to 3 patients for treatment of postoperative congestive heart failure. Preoperative diagnoses of these patients were mitral valve stenosis (2 cases) and mitral valve regurgitation (1 case), associated with tricuspid valve regurgitation in every case. Mitral and tricuspid valve replacements was performed in one case, and mitral valve replacement and tricuspid annuloplasty in two cases. After infusion of PGE1, the central venous pressure was decreased rapidly and the patients recovered from congestive heart failure. As minimal doses of PGE1 (0.01-0.03 micrograms/kg/min) was infused, neither remarkable systemic hypotension nor fall of PaO2 were observed. It appears that application of small amount of PGE1 can be a useful mean for the treatment of congestive heart failure after valvular surgery.

Alprostadil↗

PubMed1992

[Management of infective endocarditis].

Clinical manifestations and the results of management of infective endocarditis were reported. Of 46 patients, 17 cases received medical treatment alone (group A), and 29 cases underwent surgical interventions (group B). Affected valves were aortic in 29, and mitral in 24. In group B, however, infection occurred on the aortic valve in 22, and on the mitral valve in 11. Aortic valve was more often affected in group B than in group A (p less than 0.05). Embolic complications were observed in 5 of group A, 4 of whom had involvement of cerebral vessels, and in 4 of group B, all of whom had cerebral emboli. Of 8 cerebral embolic episodes, 6 emboli originated from mitral valvular lesions. In group A, 6 (35.3%) died of cerebral accidents or acute heart failure within 30 days after the onset of illness. In group B, 20 cases were operated on at chronic stage, and 9 cases underwent operation at active stage. Various procedures, alleged to be the most favorable, were selected to the individual patient. No mortality was found in the former group, but one patient (11.1%) in the latter group died of multiple organ failure 31 days after surgery. All patients, who were operated on at active stage, received intravenous administration of antibiotics for 6 to 8 weeks after the operation. Comparing the actuarial survival rate of group A and group B, group B was superior to group A for initial 4 years, but no significant difference was discernible thereafter.

Actuarial Analysis↗

PubMed1991

[Surgical treatment and their long-term results of the ascending aortic lesions involving coronary arteries].

Seventeen patients underwent surgical treatment of the ascending aorta, aortic valve, and coronary artery as well. Diagnosis of 13 patients were annulo-aortic ectasia, 3 had dissecting aneurysm (type I: 2, type II: 1), and one had supra-valvular aortic stenosis. In annulo-aortic ectasia, Bentall's method was carried out in 11 cases, and Cabrol's operation was performed in 3, one of the latter group had received Bentall's procedure 4 years prior to the second operation. One patient died of acute myocardial infarction 3 days following operation, who had severe stenosis of the left anterior descending artery not detected by preoperative angiography. During long-term follow up, 2 patients died of cardiac failure. Three patients had dissection of the ascending aorta and coronary artery (right coronary artery: 2, left coronary artery: 1). The aorta was reconstructed, aortic valve was replaced, and coronary artery was revascularized with saphenous vein graft. They have been alive and well up to post operative 6 years. Right coronary ostioplasty as well as aortic valve replacement and extended aortoplasty were attempted in one patient with Williams' syndrome. This patient had been well until sudden death which occured 11 months after the operation.

Adult↗

PubMed1991

[Left atrial thrombus in the early postoperative period after mitral valve replacement].

Left atrial thrombus after mitral valve surgery is believed to be relatively rare. However, we previously reported on cases of left atrial thrombus (LAT) with spontaneous regression in the early postoperative period. Forty two patients who underwent mitral valve replacement were studied using computerized tomography (CT). Early postoperative LAT was found in 11 patients out of 42 (26.2%); all of whom had an uneventful postoperative course. The mean preoperative atrial diameter in the LAT group (81.4 mm) was greater than that in the non-LAT group (57.0 mm). This was the most decisive factor significant enough for discriminating between the two groups. Other factors, including age, sex, length of symptoms, preoperative NYHA classification, cardiac rhythms, preoperative cardiac index, duration of cardiopulmonary bypass, type of artificial valve used, duration of intubation and period prior to anticoagulant therapy were not significant. From March 1988, 10,000 U/day of heparin was administered to 20 of the 42 patients. LAT developed in 2 cases (10%). Of the 22 patients who did not accept heparin therapy, 9 (41%) developed LAT. Of the 11 patients having postoperative LAT, 6 were treated by fibrinolytic therapy (urokinase plus heparin). A decrease in thrombus size was observed in 3 cases, and no change in the other 3. Postoperative anticoagulant therapy with warfarin and dipyridamole was administered to all 11 LAT patients, in 8 cases, LAT disappeared for 3 to 42 months period. We therefore conclude as follows: 1) The incidence of early postoperative LAT was 26.2% (11/42). 2) Postoperative thrombus was more likely to occur in the left atrium with a large diameter. 3) Heparin dose of 10,000 U/day seemed to be an effective prophylactic therapy for LAT. 4) Fibrinolytic therapy with urokinase and heparin was not always favorable in LAT cases. 5) In 8 cases out of 11, LAT was resolved under standard anticoagulant therapy with warfarin and dipyridamole in long-term period.

Adult↗