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Biomedical subjects

H Ohteki

Publications and source records attributed to H Ohteki.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Two successful cases of surgical treatment for left ventricular rupture following myocardial infarction: the usefulness of percutaneous cardiopulmonary support system (PCPS)].

Two successful cases of surgical treatment for left ventricular (LV) rupture following acute myocardial infarction (AMI) are reported. The first case was a 62-year-old man with circulatory collapse caused by a blow out type LV rupture. The second case was a 68-year-old woman with a oozing type LV rupture. In both cases PCPS was applied for cardiopulmonary resuscitation. After stabilizing their hemodynamics and recovering consciousness with PCPS, surgical repair for LV rupture was performed successfully. The first case was getting well, but suddenly circulatory collapse occurred and he died for acute pulmonary arterial thromboembolism on 10 days after operation. The second case woman is doing well without complication 1 year after operation. In conclusion, PCPS may be useful for LV rupture following AMI for the recovery and maintenance of hemodynamics, and also play as a bridge for surgical repair.

Aged↗
PubMed1996

[Antiplatelet therapy after open heart surgery].

This study evaluated the effects of an antiplatelet drug for the patients after open heart surgery. Dipyridamole (D), aspirin (A), ticlopidine (T) and sarpogrelate hydrochloride (S) were chosen as an antiplatelet drug. The 6 groups were devided into as G 1 with warfarin (W) and D, as G 2 with W alone, as G 3 with A and D, as G 4 with A alone, as G 5 with A and T, and as G 6 with A and S. The indices of anticoagulation and antiplatelet were as follows: TT, APTT, PT, D. Dimer, fibrinogen, TXB2, 6 kPGF1 alpha, beta TG, vWF and platelet aggregation with Grading Curve methods. The results showed that D.Dimer was beyond the normal range in G 1 and G 2. Thromboxane B 2 was increased markedly in G 1 and G 2 and showed under the normal range in G 3 and G 6. In all groups, 6 kPGF1 alpha showed low levels than normal. Activation of platelet causes the increased beta TG which was not suppressed with the antiplatelet drugs administered. The platelet aggregation was not suppressed in G 1 and G 2. Mild to moderate suppression was seen in G 3 and G 4 with no difference between the two group. Moderate to marked suppression was demonstrated in G 5 and G 6. This study demonstrated that dipyridamole had no effects as antiplatelet function. Aspirin showed antiplatelet effects and the combination of aspirin with the another antiplatelet drugs demonstrated the additional effects.

Adult↗
PubMed1995

[Combined acute ascending aneurysm and chronic descending thoracic aneurysms].

A 66-year-old woman with a known chronic descending thoracic dissecting aneurysm was admitted following a chest X-ray which revealed a widening in the mediastinum and an increased cardiothoracic ratio. Echocardiography and chest CT showed a combined ascending thoracic dissecting aneurysm with a tripple lumen, pericardial effision, moderate aortic regurgitation, and the chronic descending thoracic dissection with incompletely thrombosed aneurysm. The chest CT also showed a normal aortic arch. The diagnosis was then made as combined acute ascending aortic dissection (DeBakey II) and chronic descending aortic dissection (DeBakey III). A 2-stage operation was planned, involving first a graft replacement of the ascending aorta, and then one month later a graft replacement of the descending aorta.

Acute Disease↗
PubMed1995

[A successful surgical treatment in a patient with penetrating left ventricular injury].

A 46-year-old man underwent emergency operation for penetrating cardiac injury resulting in cardiac tamponade. Echo cardiogram showed moderate pericardial effusion. At median sternotomy, incision of pericardium resulted in decompression of pericardial cavity with a subsequent fall in central venous pressure and increased blood pressure. Penetrating wound was found 3 mm from the left anterior descending coronary artery on the left ventricule. The wound was closed with direct mattress suture. He was successfully treated and doing well now.

Aged↗
PubMed1995

[A case of successful operation for chronic aortic dissection (DeBakey 1 type) complicated with cerebral infarction].

We report a successful operation for a patient of chronic aortic dissection complicated with cerebral infarction. A 60-year-old woman has been treated suffering from cerebral infarction for 7 years. She was referred to our hospital for abnormal chest X-ray and complaint of dry cough. The enhanced CT scan and aortogram demonstrated chronic aortic dissection (DeBakey I) extending from ascending aorta to the abdominal aortic bifurcation with occlusion of right common carotid artery and dilated ascending aorta and aortic arch. The onset of aortic dissection seemed to be, from a clinical point of view, coincident with the onset of cerebral infarction seven years ago. The replacement of the ascending aorta and aortic arch with woven Dacron velour graft were performed under hypothermic and selective cerebral perfusion. The postoperative course was uneventful although complicated with transient recurrence nerve palsy and she has been doing well.

Aortic Aneurysm, Thoracic↗
PubMed1995

[A case of successful redo-operation for active prosthetic valve endocarditis after modified Bentall operation].

A redo-operation for active prosthetic valve endocarditis after modified Bentall operation is reported. A 42-year-old man associated with Marfan syndrome was transferred to our hospital with complaints of high fever and general fatigue. A modified Bentall operation for acute aortic dissection was done five years ago. The aortic arch and descending thoracic aorta were replaced with prosthetic graft because of aneurysmal dilatation four years ago. Transesophagial echogram revealed a developing vegetation below the prosthetic valve and at the left ventricular outflow. A redo-operation of translocation method with Pieler method for coronary reconstruction was performed using a prosthetic valve of SJM 21 mm in size. After operation, hemolysis suddenly appeared and hepatic dysfunction gradually progressed. Reoperation was necessary for the redo-operation and and a SJM 21 mm valve was replaced with a new 25 mm SJM valve interposed between the graft. Hemolysis was immediately improved. A redo operation of translocation method with Pieler method for coronary reconstruction showed a good results.

Adult↗
PubMed1995

[Surgical treatment for Stanford type A acute aortic dissection].

From March 1983 to September 1994, 53 consecutive patients underwent an emergency operation for type A acute aortic dissection. Eighteen patients before 1988 (Group I) underwent simple ascending aortic replacement (n = 13) and composite graft replacement (n = 5) by conventional method. Thirty-five patients after 1989 (Group II) underwent extended ascending aortic replacement (n = 17), hemiarch replacement (n = 6), total arch replacement (n = 8) and composite graft replacement (n = 4) using a brief period of circulatory arrest. The overall hospital mortality rate was 36.8% in Group I and 25.7% in Group II. The survivals after initial operation was 47% at 10 years (Kaplan-Meier) and the event free rate was 78% at ten years, respectively. Computed tomographic scanning and aortogram demonstrated the patent false lumen in 20 patients (64.5%) at the descending thoracic aorta. In conclusion, extended ascending aortic replacement is the useful operative technique to perform accurate resection of intimal disruption and clamp-site aorta because the replacement of the entry site could reduce the risk of operative mortality and reoperation. Total arch replacement is not necessarily required, if the entry is properly resected by extended ascending aortic replacement or hemiarch replacement. Close follow-up must be considered at the patients with patent false lumen, especially in patient with Marfan's syndrome.

Acute Disease↗
PubMed1994

[Successful mitral valve replacement in multiple organ failure due to mechanical hemolytic anemia after mitral valve repair: a case report].

An 18-year-old man suffered multiple organ failure due to hemolytic anemia after mitral valve repair. He was admitted with mitral regurgitation (MR) and mitral valve repair was performed. However, after 3 days of the operation, he developed hemolytic anemia and heart murmur. A reoperation of mitral valve replacement was performed because of progressing heart failure with renal and liver dysfunction. The operative findings revealed a rupture in the choldae with dislocation of the C-E ring. The MR flow and dislocated ring are suspected to be the cause of the hemolysis. After the reoperation, the hemolysis and general condition were immediately improved. The indication of this reoperation should be carefully decided. In this case of multiple organ failure following mitral valve repair, reoperation of mitral valve replacement was successful.

Adolescent↗
PubMed1994

[A case of left ventricular hemangioma].

Left ventricle hemangioma in a 54-year-old man is reported. He was admitted to our hospital for chest discomfort. Coronary angiograms showed normal coronary arteries and a contrast blush in the left interventricle septum. Transesophageal echocardiogram also demonstrated the small floating tumor in the ventricular septum below the right coronary cusp. With the aid of cardiopulmonary bypass, the tumor was resected completely through transaortic approach. Histological examination revealed capillary hemangioma. The patient had uneventful recovery. To our knowledge, this is the seventh case of a left ventricular hemangioma treated surgically reported in the world literature.

Heart Neoplasms↗
PubMed1993

[Simultaneous operation of gastrectomy, cholecystectomy and coronary artery bypass grafting using right gastroepiploic artery].

We present a case who received the simultaneous surgical corrections of unstable angina, acute gastric ulcer, and cholelithiasis. A 72-year-old man was admitted to our hospital due to unstable angina. An emergency coronary angiography was performed and we found severe 2 vessels disease (RCA ostium and proximal LAD lesions). After the admission, the angina was poorly controlled and the surgical treatment had been considered. The patient developed sudden hematemesis due to the uncontrolled bleeding from gastric ulcer. Then the emergency operation was performed. Partial gastrectomy with preservation of RGEA and cholecystectomy were done followed by CABG to RCA with RGEA and to LAD with autologous saphenous vein. The postoperative course was uneventful and the patient is in good condition to date.

Acute Disease↗
PubMed1993

[A case of acute postinfarction mitral regurgitation and cardiogenic shock caused by a total rupture of the papillary muscle].

We report a case of mitral regurgitation caused by a total rupture of the posterior papillary muscle that had occurred after acute myocardial infarction. A 72-year-old woman was transferred to our hospital for cardiogenic shock. Echocardiogram revealed massive mitral regurgitation and prolapse of posterior mitral leaflet presumably due to a rupture of a papillary muscle. Cardiac catheterization demonstrated a total occlusion in the segment 2 of the right coronary artery. She had developed progressively increasing heart failure even though the patient had received a successful PTCA for a total occlusion of the right coronary artery. She underwent an emergency mitral valve replacement with preservation of the posterior leaflet using a SJM prosthetic valve. Intraoperative findings were confirmative of total rupture of the posterior papillary muscle. A postoperative course was uneventful. This case is the seventh case which has been reported as the successful operation of a total rupture of the papillary muscle in Japan.

Aged↗
PubMed1992

[Malignant fibrous histiocytoma of the heart].

A 59-year-old woman was referred to our hospital by a local cardiologist, with unknown cause of congestive heart failure and respiratory failure. No significant heart murmur was heard and a cardioechogram from the anterior chest was insufficient for diagnosis. On the night of admission, cardio-respiratory shock was found, and Swan-Gantz catheter data showed severe pulmonary hypertension. Transesophageal echo-cardiography (TEE) revealed a left atrial tumor, with wide neck anchored onto the posterior wall of the left atrium, and which was floating into the left ventricle during the diastolic phase. An emergency operation was performed and the tumor, (80 by 50 by 48 mm) was resected. The patient recovered well in the postoperation period. However the residual tumor continued to grow gradually in the pericardial cavity and the patient died 3 months after the operation. Primary MFH of the heart is rare and 29 cases have been reported. The prognosis of MFH is poor despite surgery. Whenever a left atrial tumor with a wide neck is attached to the posterior wall, it must be considered to be possibly malignant and surgical resection is recommended.

Emergencies↗
PubMed1992

[Syphilitic coronary ostial obstruction and aortic regurgitation associated with advanced gastric cancer: successful 2-stage surgery].

We report a case of syphilitic coronary ostial obstruction and aortic regurgitation associated with advanced gastric cancer for which subtotal curative gastrectomy and AVR with CABG was successfully performed in a two-stage operation. A 65-year-old male was admitted complaining of tarry stool and angina. A serological test for syphilis was strongly positive and angiography demonstrated a left coronary ostial obstruction accompanied by moderate aortic regurgitation. An endoscopic examination of the stomach revealed a Borrmann type II advanced gastric cancer with active bleeding. In the first stage, a subtotal gastrectomy with wide margin was performed, under hemodynamic monitoring because of the active tumoral bleeding. After the second-stage AVR, the postoperative course was uneventful.

Adenocarcinoma, Mucinous↗
PubMed1992

Aortic valve replacement for Takayasu's arteritis.

We report 12 cases of aortic valve replacement performed for Takayasu's arteritis and discuss the genesis of aortic regurgitation and the clinical outcome after aortic valve replacement. This group of twelve patients who underwent aortic valve replacement between April 1982 and March 1990 included four male and eight female patients, aged 24 to 67 years (mean age 48 years). Preoperative angiography showed systemic multiple stenoocclusive or aneurysmal dilated vascular lesions in addition to aortic regurgitation. The multiple lesions included a lesion in the aortic arch branch in nine (75%), in the pulmonary artery in seven (58%), an aneurysmal dilation in the ascending aorta of more than 6 cm in four (33%), a coronary lesion in four (33%), a thoracic aortic lesion in six (50%), and a lesion in the abdominal aorta and its visceral branch in six (50%). Simple aortic valve replacement alone was performed in two patients and in combination with another operation in ten patients, with aortic root reconstruction in two, ascending aortic plication in three, coronary artery bypass grafting in two, aortic arch branch bypass grafting in one, aortic arch branch bypass grafting and coronary ostium endarterectomy in one, and mitral valve replacement and ascending aortic plication in one. There was no operative death, and only one patient died later, 18 months after the operation, because of secondary amyloidosis. The postoperative recovery of the clinical status and cardiac function was good. Intraoperative observations suggested that aortic valve regurgitation may be caused by an extension of aortitis, although histopathologic examinations of the valve showed nonspecific findings. One of the characteristic problems in Takayasu's arteritis is the necessity for prednisolone administration in some patients preoperatively or postoperatively, or both. We conclude that aortic valve replacement for patients with Takayasu's arteritis is an effective and safe treatment. Our data related to the genesis of aortic regurgitation in Takayasu's arteritis remain insufficient to draw conclusions, and further analysis is planned.

Aortic Valve↗
PubMed1992

[A case report of primary rhabdomyosarcoma of the heart treated with mitral valve replacement].

We report a case of rhabdomyosarcoma involving the mitral valve of a 57-year-old female. She was referred to our hospital for progressive orthopnea and edema. Chest X-ray showed marked cardiomegaly and pulmonary congestion. Echocardiogram revealed solid mass in left atrium involving the mitral valve. Emergency operation was required because of acute heart failure. At the operation, the mitral orifice was obstructed by the tumor arising from the left atrium. After partial resection of the left atrium, mitral valve replacement with a Carpentier-Edward prosthesis was performed. Subsequently microscopic examination diagnosed as rhabdomyosarcoma. She died three months after the operation of heart failure probably due to progression of the remnant of the tumor. This, to our knowledge, is the first case of mitral valve replacement for a primary rhabdomyosarcoma of the heart in Japan.

Female↗
PubMed1992

[Postoperative evaluation of left ventricular peak filling rate and peak ejection rate by radionuclide ventriculography for aortic regurgitation].

Postoperative left ventricular (LV) time-activity curve and the first derivative in radionuclide method were evaluated in 28 patients with aortic regurgitation to clarify the postoperative cardiac function and to determine the adequate timing of operation. Twenty-eight patients were divided into two groups by preoperative echocardiogram. In Group I cases, echo-finding showed LV contractile dysfunction associated with both enlarged LV end-systolic dimension (LVDs) over 5 cm and depressed fractional shortening (%FS) below 25%. In Group II cases, the finding showed compensated cardiac function with relatively small LVDs below 5 cm or not so depressed %FS over 25%. Preoperative diastolic parameter of LV peak filling rate (PFR) in Groups II of 22 cases was depressed in comparison of normal control, although systolic parameters of peak ejection rate (PER) or ejection fraction were mildly depressed. Postoperatively, those parameters of PFR and PER were improved to normal control level (1. PFR: pre op = 206 +/- 73----post op = 311 +/- 79, p less than 0.001 2. PER: pre op = 309 +/- 65----post op = 389 +/- 103 %EDV/sec. p less than 0.001). In contrast, the preoperative parameters of PFR and PER in Group I of 6 cases were strikingly impaired, and post-operative those parameters were not improved to normal level (1. PFR: op = 154 +/- 39----post op = 190 +/- 88 2. PER: pre op = 223 +/- 74----post op = 244 +/- 78 %EDV/sec, NS). No postoperative complications occurred in Group II cases, in contrast, 2 cases in Group I were complicated with low output syndrome or ventricular fibrillation.(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Valve Insufficiency↗
PubMed1991

Successful combined operation for Takayasu's arteritis.

We report a case of Takayasu's arteritis complicated with aortic regurgitation and severe stenosis of the left coronary ostium and the innominate artery. Simultaneous surgical treatment of aortic valve replacement, coronary ostium endarterectomy, and aortosubclavian artery bypass using saphenous vein were performed. We discuss the choice of simultaneous operation and the option of surgical treatment for coronary ostium lesion due to Takayasu's arteritis.

Aortic Valve Insufficiency↗