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Biomedical subjects

H Ohteki

Publications and source records attributed to H Ohteki.

At least 55 records · Page 3Linked to original sources
PubMed1991

Evaluation of left ventricular early diastolic function after coronary artery bypass grafting relating to myocardial damage.

This clinical study was undertaken to evaluate resting left ventricular early diastolic function relating to perioperative myocardial damage after coronary artery bypass graft (CABG) with radionuclide ventriculography. Forty-eight cases undergoing CABG were divided into two groups--Group I: not complicated with perioperative myocardial infarction (PMI), and Group II: complicated with PMI. In group I (42 cases), early diastolic parameters such as peak filling rate (1/3 PFR) and mean filling rate (1/3 FR(m)) during first third diastole were not impaired in the postoperative and follow up periods. In contrast, in Group II (6 cases), early diastolic parameters were significantly decreased to 157 +/- 74% EDV/sec of 1/3 PFR(pre op: 234 +/- 74, p less than 0.05) and 153 +/- 80% EVD/sec of 1/3 FR(m) (pre op: 231 +/- 86, p less than 0.05) in the postoperative period, and these parameters were still decreased in follow up period. The time to peak filling rate, normalized to diastolic time (TPFR/DT) of Group II cases, was severely prolonged in both periods. From these results, the complication of perioperative myocardial infarction was suggested by the decrease of early diastolic function and the prolongation of the time to peak filling rate. Early diastolic function was a more sensitive parameter than systolic function in the detection of impaired cardiac function in those cases with perioperative myocardial damage after CABG.

Adult↗
PubMed1991

[Marfan's syndrome with annulo-aortic ectasia and ruptured mitral chorda--a case report of combined composite valve graft replacement of the aortic root and mitral valve replacement].

We report a case of Marfan's syndrome with acute heart failure caused by a ruptured mitral chorda that was successfully treated by one operation of combined composite valve graft replacement of aortic root and mitral valve replacement (MVR). A 23-year-old man was admitted to our hospital presenting severe dyspnea and chest pain. Echocardiography and cardiac catheterization studies demonstrated marked annulo-aortic ectasia, aortic regurgitation and significant mitral regurgitation due to a ruptured chorda. In operation, it was found that a chorda of the mitral posterior leaflet had been torn, with the leaflet completely prolapsed to the left atrium, and that the aortic root was dilated to 90 mm in diameter. The ascending aorta was extensively resected leaving those areas of aortic tissue involving the coronary ostia. Then the mobilized coronary arteries were reattached to the composite graft. MVR was performed with preservation of the whole anterior and posterior mitral valve apparatus except for that small part with the torn chorda. Histopathological findings of the aortic wall and mitral valve were compatible with those of Marfan's syndrome.

Adult↗
PubMed1991

Improved on-line thoracic duct drainage for lymphocytapheresis.

Lymphocytapheresis using thoracic duct drainage (TDD) is a recognized technique of extracorporeal immunomodulation for various autoimmune diseases such as rheumatoid arthritis (RA), and its clinical benefit has been reported and generally accepted. Lymphocytapheresis using TDD is very selective for removing lymphocytes (especially helper T-cells) but raises some problems such as hypoproteinemia due to the massive removal of lymph, and difficulties in repeated treatment. Along with the development of a new polyester fiber filter, we have developed a simple and effective method of lymphocytapheresis for wide adoption for these techniques. We performed lymphocytapheresis using TDD in patients with RA and previously reported its clinical efficacy indicated by the significantly lower number of peripheral lymphocytes and T4/T8 ratio. We present here our newly-developed on-line system designed to prevent hypoproteinemia. Furthermore we report on the advantages with a new subcutaneous vascular access device set up to manage the problems of repeated treatments. A small reservoir for keeping the thoracic duct open and returning lymph to the patient permitted sufficient lymph drainage and removal of lymphocytes and the clinical application of TDD is discussed.

Arthritis, Rheumatoid↗
PubMed1991

[Cardiopulmonary support in PTCA for severe coronary artery disease: its efficacy].

Percutaneous transluminal coronary angioplasty (PTCA) assisted by cardiopulmonary femorofemoral bypass was performed in 4 patients who were considered to be candidates for this technique because of their severe coronary artery diseases, including 2 with left main trunk disease, one with cardiogenic shock, and one with severe 3-vessel disease. Here we report the efficacy of cardiopulmonary support in PTCA. Case 1: An 85-year-old man with persistent unstable angina despite maximal doses of medications. Stenosis of the left anterior descending coronary artery (90%) was resolved by PTCA with cardiopulmonary bypass and intraaortic balloon pumping (IABP). Case 2: An 83-year-old man with unstable angina had high grade stenoses in the distal left main, left anterior descending and right coronary arteries. Although IABP was instituted for sustained chest discomfort and ST depression, the patient developed congestive heart failure. PTCA of the left main coronary artery with cardiopulmonary bypass was successfully performed. Case 3: A 64-year-old man with acute myocardial infarction. PTCA of the occluded left anterior descending coronary artery resulted in shock despite IABP, which was resolved by cardiopulmonary bypass with percutaneous insertion of cannulae, the technique we developed. Case 4: A 74-year-old man with unstable angina. He had a severe 3-vessel disease and a thrombus in the right coronary artery.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

Intraoperative ultrasonic imaging of the ascending aorta in ischemic heart disease.

In an attempt to locate any atherosclerotic lesion in the ascending aorta and to prevent embolization, intraoperative B-mode ultrasonography was performed in 100 patients with ischemic heart disease (31 women and 69 men). Ultrasonography was carried out with a 10-MHz probe placed directly on the ascending aorta. Ultrasonic imaging demonstrated an atherosclerotic lesion in the lower half of the aorta in 76 patients (76%), a lesion in the upper half of the aorta in 89 patients (89%), and a lesion at the orifice of the innominate artery in 99 patients (99%). Prospective palpation identified an atherosclerotic lesion in 12 (25%) of 48 patients. Thoracic computed tomography in 79 patients showed calcification in the lower half of the aorta in 6 patients (7.6%) and in the upper half of the aorta in 11 (13.9%). Palpation and thoracic computed tomography underestimated the frequency of atherosclerotic lesions. Intraoperative ultrasonography accurately identified atherosclerotic disease. This technique allows the surgeon to modify cannulation, aortic clamping, and operative technique to reduce the risk of perioperative stroke due to embolization of atherosclerotic debris from the ascending aorta.

Aorta↗
PubMed1990

[Mitral valve replacement with preservation of ventricular annular continuity].

We evaluated clinical effects of mitral valve replacement with preservation of ventricular annular continuity in 53 patients with isolated mitral stenosis and regurgitation. The patients were divided into 3 groups; Group 1: the patients had conventional mitral valve replacement, Group 2: with preservation of posterior leaflet ventricular annular continuity (VAC) (33 patients), and Group 3: preservation of both anterior and posterior leaflet (8 patients). Operative technique was described for pure mitral regurgitation and mitral stenosis. There was one patient died within 30 days operatively in each group. In Group 1 the patient died for poor LV function, in Group 2, the patient died for postoperative GVHD, and in Group 3, the death caused by postoperative LV rupture. We have observed no late death. Minor thromboembolization in early stage were seen in 2 cases of Group 2 and there were no apparent correlation with operative technique. Postoperative cardiac catheterization data (Pulmonary Artery wedge pressure, C.O, LVEF, LVEDV1) showed no significant difference among these 3 groups. Segmental wall contraction in left ventriculography demonstrated good contraction in Group 2 and Group 3 compared with that of Group 1. Left ventricular contraction index with heart rate corrected mean Vcf (Vcfc) and left ventricular end-systolic wall stress (sigma es) relation using two dimensional cardiac echogram demonstrated almost normal range in the groups 2 and 3. These findings suggests that mitral valve replacement with preservation of ventricular annular continuity has beneficial effects on postoperative left ventricular function and requires to be further investigated.

Adolescent↗
PubMed1989

[A case report of thrombosed St. Jude Medical valve in aortic position].

We report a successful elective re-aortic valve replacement following thrombolysis therapy with Urokinase. Patient was a 56-year-old male with acute heart failure caused by thrombosed St. Jude Medical valve in aortic position. The thrombosed valve occurred 6 years after the implantation due to poor control of anticoagulation therapy. Surgical findings demonstrated the origin of thrombus at the hinge area. Prompt diagnosis and adequate therapy is essential for the thrombosed valve especially in case of mechanical valve. Thrombolysis therapy should be considered if possible, although emergency operation is always indicated.

Aortic Valve↗
PubMed1989

[Atypical coarctation of the thoracic aorta with fibromuscular dysplasia--report of a successful surgical repair and review of the literature].

We report a case of 14-year-old woman of fibromuscular dysplasia (FMD) with involvement of the thoracic aorta. Our case is characterized by a segmental stenosis of the thoracic aorta with multiple systemic arterial branch lesions. Atypical coarctation of the thoracic aorta was replaced with Dacron woven graft and the specimen of the lesion demonstrated medial fibroplasia. There have been reported only 9 cases of FMD of the aorta so far and all were female except one case. This report is the first case report of FMD of the thoracic aorta.

Adolescent↗
PubMed1989

[Pulmonary arteriovenous fistula (PAVF) diagnosed by two-dimensional Doppler echography].

We report a case of pulmonary arteriovenous fistula (PAVF) with efficiency of the two-dimensional doppler echography for clinical evaluation. A 23-year-old female admitted to our hospital for lips cyanosis, exertional dyspnea and abnormal round shadow by chest X-ray. The two-dimensional echography demonstrated an efferent artery and a drainage vein of the PAVF. Pulmonary arteriography confirmed the diagnosis of a solitary PAVF located in the S10 of the left lung. The fistula was enucleated successfully with the recovery of cyanosis and dyspnea.

Adult↗
PubMed1989

[Coronary artery dissection secondary to coronary arteriography: presentation of two cases and review of the literature].

Two reports of coronary artery dissection secondary to coronary arteriography and followed by emergency aorto-coronary bypass are presented. One case includes pathological specimen demonstrating medial and intimal change in the dissected coronary artery, which may have predisposed this artery to dissect. Also the literature on catheter-induced coronary artery dissection is reviewed.

Angiography↗
PubMed1989

[A successful emergency operation of acute aortic dissection (DeBakey I) with aortic root rupture and right coronary avulsion].

We report a successful emergency operation for a patient of acute aortic dissection with cardiogenic shock. A 73-year-old man was admitted to our hospital with a complaint of severe chest pain. The emergency aortography and echocardiography demonstrated aortic dissection (DeBakey I) with aortic valve regurgitation and massive pericardial effusion. The emergency operation started 2 hours after the onset. We performed reconstruction of ascending aorta and aortic valve using composite graft, since the patient had aortic root rupture and right coronary avulsion. Subsequently, the right coronary bypass grafting of saphenous vein was performed in addition to the reimplantation of left coronary artery by carrel patch method. The postoperative course was uneventful and the patient remains asymptomatic.

Acute Disease↗
PubMed1989

[A case report of concomitant surgery of mitral regurgitation and lung cancer].

We report a case of 70-year-old woman who was simultaneously operated on mitral valve replacement for severe mitral regurgitation and the right middle lobectomy for adenocarcinoma through a median sternotomy. Concomitant cardiac and pulmonary operation can be safely performed through a median sternotomy excluding left lower lobectomy.

Adenocarcinoma↗
PubMed1989

[A successful surgical treatment of left coronary artery-pulmonary artery fistula with giant saccular aneurysm].

A surgical case of left coronary artery-pulmonary artery fistula with giant saccular aneurysm was reported. The aneurysm was successfully resected under total extra-corporeal circulation. The patient was 67-year-old female who was admitted for evaluation of chest pain and heart murmur. On coronary angiography, the diagnosis was made as a coronary artery fistula originating from the left anterior descending artery and draining into the pulmonary artery. The operation was indicated by the fact that the combination with giant saccular aneurysm and positive findings of ischemic changes on exercise electrocardiogram. Intraoperative flowmetry on the fistula revealed that estimated average flow was 200 ml/min and the coronary steal phenomenon was strongly suggested. We concluded that surgical treatment for coronary fistula with giant aneurysm can be done with minimal risk.

Aged↗
PubMed1989

[Mycotic abdominal aneurysm requiring emergency operation due to sudden thrombotic obstruction: a case report].

A 59-year-old man was admitted with history of low grade fever, general malaise and low back pain. Physical examination showed a pulsatile mass in the mid-abdomen. There were slight leucocytosis, elevated BSR and CRP. Abdominal ultrasonography, CT and MRI revealed an abdominal aneurysm within which there was an intimal flap and thrombus. Though blood culture was not positive, antibiotic therapy was initiated on the presumption of a mycotic abdominal aneurysm. Six days after admission, he complained of numbness in the lower extremities and both femoral pulsations were not palpable. Emergency surgery was undertaken. The aneurysm was adhered to the IVC and the ileum and there was a large thrombotic mass in it. Aneurysmectomy and Y-graft interposition were done uneventfully. Pathology revealed marked thickness of the aorta and infiltration of lots of inflammatory cells. The culture of aneurysmal wall was negative. This is the very rare case because of sudden thrombotic occlusion of the mycotic abdominal aneurysm. Several important features of this disease have been also discussed.

Aneurysm, Infected↗
PubMed1988

Surgical treatment of coronary aneurysm developed after PTCA.

Two patients who developed coronary aneurysm at the site of Percutaneous Transluminal Coronary Angioplasty (PTCA) in proximal LAD accompanied by severe re-stenosis just proximal to the aneurysm are described. Both patients underwent Coronary Arterial Bypass Grafting (CABG) to distal LAD to stop anginal attacks refractory to any anti-anginal drugs and to prevent a rupture of a coronary aneurysm. After the operation the anginal attacks disappeared and no trace of coronary aneurysm was visible in the coronary angiogram.

Angioplasty, Balloon↗
PubMed1988

[Operative results of acquired valvular disease with blood cardioplegia followed by terminal cardioplegia].

Cold blood cardioplegia followed by terminal cardioplegia was employed as a method of myocardial protection for acquired valvular disease. Postoperative clinical results of both cardiac iso-enzyme and cardiac function were discussed from the effect of the myocardial protection. In operative procedures of 62 cases, 30 cases underwent mitral valve replacement and other mitral repair, 17 cases aortic valve replacement, 10 cases double valve replacement and 5 cases modified Bentall operation. Iso-enzymes of Creatine-Kinase (CK) and Lactate-Dehydrogenase (LDH) were measured by the constant time-interval. Cardiac function was estimated in acute postoperative phase and late phase. Hospital mortality was 1.5%. The cause of death was thought to be postoperative Graft Versus Host Disease with skin rash and pancytopenia. Cardiac function during acute phase well recovered in 62 cases of which two cases were controlled with intra-aortic balloon pumping. The values of CK-MB were measured during aortic cross-clamp, 30 min, 3 hours, 6 hours and 24 hours after cross-clamp release. Peak CK-MB value was detected 3 hours or 6 hours in almost cases. In contrast, peak LDH-1 value was detected 24 hours after cross-clamp release. Perioperative myocardial infarction was occurred in one case with modified Bentall operation whose CK-MB value was elevated over 150 IU/L at 3rd hour and 24th hour. However, the cardiac radio-isotope data of this case revealed good cardiac function with left ventricular ejection fraction (LVEF) 76% by cardiac pool imaging in spite of small postero-lateral perfusion defect by Thallium 201 scintigram.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗