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Biomedical subjects

H Moro

Publications and source records attributed to H Moro.

At least 37 records · Page 2Linked to original sources
PubMed1998

Surgery for giant popliteal artery aneurysm with a modified Sims' position.

A 73-year-old man with a giant popliteal artery aneurysm extending from the mid-thigh to the popliteal fossa underwent exclusion, bypass, and obliterative endoaneurysmorrhaphy while in a modified Sims' position. The use of this position allowed for exposure of the saphenous vein and the entire popliteal artery in the same operative field. No muscle division was required. Moreover, this position provided easy access to the superficial femoral and distal below-knee popliteal arteries.

Aged↗
PubMed1998

Complete intercostal artery reimplantation using a method of aneurysmoplasty.

We report the case of a 58-year-old woman who underwent repair of a chronic dissecting thoracoabdominal aortic aneurysm. Using a method of aneurysmoplasty under normothermic cardiopulmonary bypass, all intercostal arteries were quickly reperfused, and the spinal cord ischemic time was minimized. No neurological deficits developed in our patient using this method.

Aortic Dissection↗
PubMed1997

Coronary artery perforation with subepicardial hematoma.

Coronary artery perforation is a relatively rare complication in coronary angioplasty. We report the case of a 71-year-old male, who was salvaged by emergency surgery, for cardiogenic shock due to subepicardial hematoma associated with balloon angioplasty. Such a case has not yet previously been reported.

Aged↗
PubMed1997

Surgical treatment of aortic root abscess with damage of the mitral valve apparatus.

A 35-year-old man with an aortic root abscess successfully underwent aortic valve replacement and mitral valve repair using a prosthetic valve with a skirt which was secured to the sewing cuff. This is a useful technique for reinforcement of a fragile annulus and prevention of annular detachment. A further useful technique is to infuse normal saline from a Foley catheter inserted into the aortic root to estimate mitral valve coaptation.

Abscess↗
PubMed1997

Evaluation of the thoracodorsal artery as an alternative conduit for coronary bypass.

Complete coronary revascularization using arterial grafts has been performed recently because of their improved patency rates. However, as the need to repeat coronary bypass surgery has become more frequent, it can be difficult to find adequate conduits for further bypass surgery. Therefore, we investigated the use of the left thoracodorsal artery (LTDA) as an alternative bypass conduit. The length from its origin, internal diameter, and number and location of branches were angiographically measured in 16 patients, and in situ blood flow volume and external diameter were intraoperatively measured in 8. Moreover, each specimen of the LTDA, the internal thoracic artery (ITA), and the inferior epigastric artery (IEA) were evaluated histologically. We found that the thoracodorsal artery has the same diameter as the ITA angiographically, and the same histological findings as the IEA. In conclusion, the thoracodorsal artery may be useful as a coronary arterial graft.

Coronary Angiography↗
PubMed1997

[Long-term clinical results with a new surgical method for the fragile valvular annulus].

We performed prosthetic valve replacement with skirt in 11 patients for the fragile valvular annulus. Subjects included 6 patients with active infective endocarditis involving aortic root abscess, 2 patients with systemic disease requiring steroid treatment, and 3 patients with hemolysis or perivalvular leakage. Operative procedure in 11 patients was performed aortic valve replacement with Dacron or Xenomedica skirt attached to the prosthetic ring. One patient died of heart failure during perioperative period. 2 patients died of arrhythmia, heart failure in late postoperative period. The event free rate was 77.1% since 5 years after operation. We conclude that prosthetic valve replacement with skirt is useful to tha fragile valvular annulus.

Adult↗
PubMed1997

[DDD pacemaker implantation in the patient underwent Maze procedure].

We reported a 26-year-old man with mitral regurgitation and sick sinus syndrome. He underwent VVI pacemaker implantation, and admitted to our hospital due to congestive heart failure. Echocardiography and cineangiography revealed severe mitral regurgitation. Mitral valvuloplasty and modified Maze procedure were performed, and a DDD pacemaker was implanted after cardiopulmonary bypass. We recognized cross stimulation 7 months after operation. The reason of the cross stimulation was the position of the implanted atrial lead, which was the low right atrium. Thus, an atrial lead of DDD pacemaker should be carefully implanted in the patients underwent Maze procedure.

Adult↗
PubMed1996

Surgical implication of aortic dissection on long-term outcome in Marfan patients.

We herein review our 17-year surgical experience for the treatment of ascending aortic aneurysm in patients with Marfan syndrome to clarify the risks of increased mortality and reoperation. The subjects consisted of 15 patients who had all undergone surgery for the aortic root and ascending aorta at Niigata University Hospital between July 1978 and January 1995. Aortic valve replacement and ascending aortic wrapping were performed in 5 patients, Bentall or Cabrol operation in 6, and combined aortic arch reconstruction and Cabrol operation in 2, as the initial surgery. Patients who had an aortic dissection (Stanford type A) at initial surgery were assigned to group I (n = 7), while those with an aortic root aneurysm were assigned to group II (n = 8). In group I, 3 patients required a second operation for the remaining aortic arch aneurysm, and 1 died due to a late rupture of the distal aneurysm. In group II, no patient needed a reoperation; however, 1 died due to an intracranial hemorrhage and another due to composite valve graft failure and distal dissection. The results thus indicate that aortic dissection seems to affect long-term outcome, and therefore the combined repair of the aortic root and transverse arch is recommended in Marfan patients with aortic dissection involving the transverse aortic arch.

Adolescent↗
PubMed1996

Fringed valve prosthesis for aortic root abscess.

Two patients with aortic root abscess were successfully treated with a fringed valve prosthesis, in which a fringe material was secured to the sewing cuff of a bileaflet prosthetic valve using a 4-0 running suture. This fringed valve technique provides dual security for annular attachment of the prosthesis without coronary reimplantation. Good late outcome suggests it would be a useful alternative for aortic root abscess.

Abscess↗
PubMed1996

[Open heart surgery in patients with systemic diseases requiring steroid treatment].

Our surgical experiences in 9 patients who required steroid treatment for systemic diseases before, during and after the open heart surgery were reviewed. Subjects included 3 patients with systemic lupus erythematodes, 3 with aortitis syndrome, 1 with Behçet disease and 1 with rheumatoid arthritis. Cardiovascular lesion was aortic valve regurgitation in 2, Stanford A aortic dissection in 1 and ischemic heart disease in 3 patients. Duration of morbidity for systemic diseases before the surgery ranged between 0 nd 102 months, with a mean of 36 months. Steroid treatment was continued for 4 to 216 months (mean 70+/-76 months) before the surgery at a dose of 5-40 mg per day for conversion into prednisolone. In principal, methylprednisolone was given during the surgery, and the prednisolone was given at a dose of 20-140 mg per day on the day of operation or on the first postoperative day. Surgical procedures included a aortic valve prosthesis with Dacron cloth skirt implantation in 1 patient, surgical angioplasty of the left main coronary ostium in 1 and internal thoracic arteries grafting in 2 patients. Hospital mortality was 1 patient due to low cardiac output syndrome. Acute renal failure occurred in 2 patients with systemic lupus erythematodes, and wound complication was observed in 2 patients. In our experience, appropriate treatment for systemic diseases, timing of surgery and continuation of steroid treatment at an appropriate dose during and after the surgery seemed very important such as surgical procedure in order to prevent postoperative complications such as periprosthetic leakage and failure of anastomosis.

Aortic Arch Syndromes↗
PubMed1996

[The study on the mechanism of brain damage due to high flow and pressure during selective cerebral perfusion].

It has been reported that the high flow and pressure perfusion produced the brain damage during selective cerebral perfusion. This time we studied the mechanism of this brain damage with mock circulation. We made the mock circulation system of brain with the hard shell reservoir as cranium, and with the triple soft bags as brain tissue, involving into reservoir. We designed the control group that intracranial pressure (ICP) was 0 mmHg at pump off, and the increasing intracranial pressure (IICP) group that ICP was 10 mmHg at pump off. We measured the flow-pressure relationship in the control and IICP group, and then stenosis in outflow. In results, the flow and pressure in both the inflow and outflow side increased significantly (p < 0.001) in control groups, as pump flow increased. The changes of the flow and pressure in IICP group showed a same tendency to the control group. Moreover, both the inflow volume into bag and the outflow volume from bag decreased as pump flow increased stepwisely. The pressure in both inflow and outflow side increased significantly and the volume of the inflow side in IICP group showed a tendency to decrease, compared with the control. The stenosis in the outflow side produced the significant increase in the pressure of both inflow and outflow side, and intracranium, with the same pump flow as the control without stenosis. In conclusion, the high flow perfusion produced the increase of the several pressure in intracranial and extracranial vessels. Moreover, the high flow perfusion produced the decrease of the intracranial blood volume cerebral blood flow. The high flow perfusion does not necessarily contribute to the cerebral tissue perfusion. The stenosis at the side of venous return produced relative high perfusion. This result suggests that the venous return should be taken care of during the selective cerebral perfusion.

Blood Pressure↗
PubMed1996

[Clinical activity of native valve endocarditis].

We reviewed clinical course and surgical outcome of 31 patients with native valve endocarditis who underwent an operation between 1980 and 1994. In the present study, 15 patients who manifested a neurologic complication associated with endocarditis and/or those who had a periannular abscess were assigned as 'clinical active'. Comparing with non-active group (n = 16), clinical active group included more patients with increased C-reactive protein level and those with histological acute inflammatory reaction on excised valvular tissue. Optimal timing of the operation and surgical procedures for aortic root reconstruction were significant problems in the active group. Actuarial probability of survival at 5 postoperative year was 50.8 and 87.5% in the active and non-active group, respectively. The results suggest our 'clinical activity' is a useful predictor in patients with native valve endocarditis.

Abscess↗
PubMed1995

[Cabrol's operation and the aortic arch replacement for Stanford type A dissecting aortic aneurysm].

Replacement of the aortic arch was performed simultaneously with Cabrol's operation utilizing modified selective cerebral perfusion (SCP) in a patient with a Stanford type A dissecting aortic aneurysm. Preoperative arteriography revealed that the dissection involved both common carotid arteries. For this reason, antegrade SCP was performed via the branches attached to the composite graft which were anastomosed to both of the common carotid arteries following clamping under deep hypothermia. The operation was successfully performed, and the patient's postoperative recovery was uneventful. This method of SCP is useful in the treatment of patients with prior difficulty or risk of cannulation.

Adult↗
PubMed1994

[The changes on cerebral hemodynamics during selective cerebral perfusion cooling].

We studied the influence on cerebral hemodynamics with 10 pigs, weighing 25 to 30 kg, when the temperature of perfusion blood changed in both rapid cooling and rewarming, and in slow them. As for the protocol of temperature, we decided that rapid change was the large temperature gradient of more than 0.5 degree C/min, and slow change was the small gradient of less than 0.3 degree C/min. Cardiopulmonary bypass (CPB) was established with a flow rate of 60 ml/kg/min, and core cooling was performed until the temperature of the returned blood from internal jugular vein reached 25 degrees C/min. For selective cerebral perfusion (SCP), blood was infused into aortic arch with the clamp of descending aorta at the temperature of less than 20 degrees C. We measured regional tissue cerebral blood flow (TCBF), intracranial pressure (ICP), carotid arterial flow (CAF), and carotid arterial pressure (CAP), and PCO2 in both CPB and SCP. Rapid cooling during CPB caused an elevation in CAP, and marked decrease in CAF, ICP, and PCO2. In contrast, rapid rewarming caused the significant increase in CAF, ICP. Slow change did not cause marked difference in CAP, CAF, and ICP, and PCO2. Moreover, TCBF was not significant in both rapid and slow changes. On the other hand, rapid change in SCP caused a significant decrease in CAP, significant difference in CAF, ICP. Slow change did not cause significant difference in them as same as in CPB. In conclusion, we presume that the influence on cerebral hemodynamics is less in slow cooling and rewarming than in rapid changes.

Animals↗
PubMed1994

Long term clinical results with 19 mm or 21 mm standard aortic St. Jude Medical prosthesis.

Comparison of long term clinical results after aortic valve replacement with 19 mm or 21 mm vs. 23 mm or larger bileaflet prostheses has not yet been reported. Between December 1979 and September 1993, 80 consecutive patients who underwent isolated aortic valve replacement at Niigata University using a standard St. Jude Medical valve were assigned to small size group (19 mm and 21 mm, n = 34) or to large size group (23 mm or larger, n = 46). In the small size group, patient's age was older, body surface area smaller, female patients and calcified aortic stenosis were dominant (all p < 0.01). The left ventricular systolic dimension was shorter (p < 0.001), while the cardiothoracic ratio was similar to that of the large size group. All patients received warfarin treatment, and target thrombotest level was 15 to 25% (equivalent to INR 1.6 to 2.1). Actuarial survival rates including hospital death in the small size group (94% at fifth postoperative year) were comparable to those in the large size group. Cerebrovascular event occurred in two patients with the small size prosthesis (1.3%/pty) and three with larger prosthesis (0.9%/pty). Major hemorrhagic complication was not observed in either group. No significant difference was noticed in the proportion free from valve-related morbidity. In the patients with aortic stenosis (n = 41), the left ventricular posterior wall thickness decreased from 15 mm preoperatively to 11 mm late post surgery in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

[The protective effect and problem of retrograde cerebral perfusion].

In order to study the protective effect and problem of retrograde perfusion (RCP), cerebral hemodynamics and cerebral metabolism were evaluated in fourteen pigs weighing 25-30 kg. Intracranial pressure, carotid arterial flow and pressure, and internal jugular venous pressure as cerebral hemodynamics; pyruvate, lactate, and oxygen consumption as cerebral metabolism; and brain temperature were measured. The animal was cooled to electrical cerebral silence on electroencephalogram under cardiopulmonary bypass. Then, animals were divided into three groups: group I (n = 4); circulatory arrest; group II (n = 3); RCP through superior vena cava (SVC); group III (n = 7); RCP through bilateral internal jugular vein (IJV). Retrograde perfusion flow was regulated to maintain the SVC pressure or IJV pressure of 30 mmHg, for 90 minutes. The variations in brain temperature were least in group III. As perfusion flow increased, intracranial pressure, and inferior vena cava (IVC) pressure increased. But, cerebral perfusion pressure, which was calculated from the difference of intracranial arteriovenous pressure, did not increase and, SVC pressure and returned blood flow through the aorta did not increase in group III. In group II, there was no significant relation between pump flow, SVC pressure, and intracranial pressure, but SVC pressure had a positive correlation with the pressure gradient of SVC-IJV. The uptake of cerebral lactate, cerebral pyruvate, and lactate-pyruvate ratio, and cerebral oxygen consumption were superior in group III than other groups. In conclusion, RCP through IJV was advantageous to maintain hypothermia and aerobic metabolism of the brain during systemic hypothermic circulatory arrest.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗