Biomedical subjects
Publications and source records attributed to H Satokawa.
We report a case of tuberculous pseudoaneurysm in the neck of the celiac artery involving the aorta. Recurrence of the aneurysm occurred after attempted direct repair. Therefore redo-surgery was performed, which involved resection of aneurysm and removal of the infected tissue with bilateral axillofemoral bypass.
The surgical outcomes in 11 patients with a Marfan syndrome (mean [+/- SD] age, 32 +/- 16: range 0.5 to 60) were evaluated. Echocardiography demonstrated annuloaortic ectasia (AAE) in nine patients, mitral regurgitation (5 months baby: valve replaced) and abdominal aortic aneurysm in one each. Among 9 AAE, root were replaced in 8 patients and aortic valve was preserved only one patient. Our early-time result is encouraging in our valve-sparing operation.
We report the case of a 72-year-old patient with a left main coronary artery originating from the pulmonary trunk with type A aortic dissection. He is the oldest patient among those reported in the literature, operated due to acute type A aortic dissection and has survived 4 year after the operation without surgery on the coronary artery.
Two hundred and fifty-six consecutive abdominal aortic aneurysms were repaired using three approaches for extraperitoneal exposure of the aorta and iliac vessels from February 1990 through September 1998. The perioperative mortality rate was 3.1% in 228 elective repairs and 14.3% in 28 ruptured cases. The initial 23 cases were repaired using Sicard's method. The duration of endotracheal intubation was 1.0+/-2.8 h, alimentation initiation was 2.7+/-1.6 days, and narcotic requirements were 1.2+/-1.1 times. Following these initial cases, we employed Williams' method for 192 abdominal aneurysms, however; repeated incisional pain and three cases of deforming bulge led us to avoid dividing muscles. In the last 13 cases, our approach was performed without muscle dividing. The narcotic requirements decreased to 0.3+/-0.7 times. As for postoperative complications, the larger skin incision approach had no shower embolism. However, the shorter skin incision had four cases of shower embolisms, one lymphorrhea and one vascular trauma by the aortic clamp. The extraperitoneal approach offers certain physiologic advantages with minimal disturbance of gastrointestinal and respiratory function. We believe that this method is useful for rapid approach to the proximal aorta in case of emergency. Postoperative wound complications could be prevented via an oblique incision without muscle dividing.
The purposes are to assess the problems associated with intravascular imaging methods such as angioscopy and intravascular ultrasound (IVUS) and to evaluate their efficacy through the results of our observations. A total of 54 limbs in 53 patients, 50 patients with chronic venous insufficiency and 3 patients with deep vein thrombosis, were diagnosed and operated on using angioscopy (Olympus OES, order made type) and IVUS (Endosonics, model 82700). The imaging catheters were inserted through a branch of the long saphenous vein and the valves and the intraluminal views were observed. By angioscopy, intraluminal views were clearly observed in 98% of all lesions. However, observation became more difficult in iliac veins compared to in femoral and in long saphenous veins (p < 0.01). Venous wall and thrombus were detected more by IVUS than by angioscopy (p < 0.01), but only 21 valves (24%) were visualized by IVUS among the 88 valves observed by angioscopy. The intravascular imaging method of angioscopy is more suitable for observing valves and intraluminal views compared with IVUS, whereas IVUS is more suitable for observing the cross-sectional venous wall.
Aprotinin administration during open heart surgery has been reported to reduce blood loss after extracorporeal circulation (ECC). We administered aprotinin to 12 patients undergoing CABG or prosthetic valve replacement. We examined the blood loss, the coagulation, and the fibrinolytic system in comparison with that in non-aprotinin group of 12 patients. In the aprotinin group, 1,000,000 units of aprotinin was infused intravenously before initiation of ECC and mixed with priming volume of ECC. After ECC, 250,000 units/hr was continuously infused until 1 hour after operation. The aprotinin group showed a significantly enhanced level of alpha 2 plasmin inhibitor and a significantly reduced level of plasmin-alpha 2 plasmin inhibitor complex and D-dimer. Post operative blood loss was not different between two groups. Operation time and closure time after heparinneutralization was shorter and postoperative blood use was lower in the aprotinin group. In conclusion, The administration of low dosed of aprotinin suppresses the fibrinolytic system resulting in the reduction of operation and closure time.
In order to minimize scar appearance and thereby improve postoperative cosmetic appearance for pediatric cardiac surgery patients, we performed partial median sternotomy incisions. A short midline incision, from 1 to 2 cm below the articular notch of the 2nd rib to the xiphoid process, was made. The sternum was divided from the xiphoid process to the articular notch of the 2nd rib. The thymus was mobilized and the pericardium incised longitudinally. The aorta and superior and inferior vena cava were mobilized to facilitate direct cannulations. Cardiopulmonary bypass was instituted in the usual fashion. From June to December 1997, 14 patients between the ages of 4 days and 12 years have undergone cardiac repair using this technique. Cases included 7 VSD (including 4 pulmonary hypertension and 1 DCRV), 5 ASD, 1 ECD and and 1 DORV with mitral atresia. All patients were extubated within 3 hours after surgery, and there were no wound infections or hospital mortalities (except one 4 day old baby who died by LOS on the 16th postoperative day). In our experience, this approach is safe and provides good exposure with excellent cosmetic results.
We report a rare case of 76-year-old man who developed ruptured thoracoabdominal aortic aneurysm complicated with abdominal high aortic occlusion. His left limb was amputated due to Buerger's disease. CT showed that the aneurysm extended from the descending thoracic aorta to the upper part of the abdominal aorta and its had a maximum width of 68 x 83 mm. Angiogram revealed the aortic occlusion at the level of the left renal pelvis. We performed emergency operation, which was aneurysmectomy and replacement with artificial vascular graft, under femoro-femoral and subrenal aortic extracorporeal bypass. Because of the severe calcification at the subrenal aorta and the weak pulsation of the left renal artery, the bypass was placed from the aortic graft to the right lower limb and the left renal artery was reconstructed. Abdominal aortic occlusion might increase his hypertension and might cause aneurysmal change on the proximal aortic wall.
A 51-year-old female was referred to our institute because of chest oppressive feeling. Echocardiography and magnetic resonance imaging revealed a left atrial tumor with ventricular septal defect. At operation patent foramen ovale was recognized. After excision of the tumor including intraatrial septum, which defect was repaired using a Teflon patch, and the ventricular septal defect was closed directly.
We reported a rare case of left ventricular lipoma, which arose nearby the papillary muscle in the left ventricular wall. It was disclosed by echocardiography and nearly diagnosed by computed tomography and magnetic resonance images. We successfully removed the tumor. It measured 3.8 x 1.5 x 1.3 cm and 3.6 g. Microscopically, it was not encapsulated and consisted of mature adipose tissue. But, it did not invaded the cardiac muscles. In conclusion, the tumor detected lipoma. Postoperative course is uneventful, and the patient has been followed by serial echocardiography.
Mitral stenosis associated with left atrial ball thrombus is rare. Removal of left atrial ball thrombus and mitral valve replacement was performed in two patients successfully. The rate of thromboembolism was high in patient who has left atrial ball thrombus. Also, sudden death was reported in these cases due to incarceration of ball thrombus in the mitral orifice (hole-in-one thrombus). We concluded that we should operate the MS associated with left atrial ball thrombus as soon as possible.
Two cases of congenital cardiac anomaly associated with esophageal atresia and tracheo-esophageal fistula were presented. One case was HLHS, and the other was TAPVR. Esophageal procedures were performed earlier than cardiac procedures in both cases. Primary anastomosis for esophageal atresia just after birth in the latter case. Corrective procedures for cardiac anomalies were performed at 36 days and 35 days after birth, respectively. The HLHS case died perioperatively and the TAPVR case survived the operation and is alive one year postoperatively.
Two women (16-year-old, 54-year-old) of atrial septal defect with absence of right superior vena cava and persistent left superior vena cava were successfully operated on. Electrocardiographic findings show coronary sinus rhythm and atrial fibrillation. When we closed atrial septal defect cannulated to persistent left superior vena cava via the coronary sinus directly, sick sinus syndrome was not appeared postoperatively.
A 24-year-old man with ruptured aneurysm of sinus of Valsalva into the right atrium originating from the noncoronary sinus is presented. On aortography through the ascending aorta the right atrium in systolic phase and the right ventricle in diastolic phase were opacified. We considered ruptured aneurysm like a streamer (wind sock) entered into the right ventricle in diastolic phase and into the right atrium in systolic phase. Post-aneurysmectomy course was uneventful, and radiographic examination revealed complete repair of the aneurysm.
The patient was a 71-year-old male who complained of palpitation and tachycardia. The echocardiogram showed a bulging of the anterior mitral valve leaflet toward the left atrium that persisted throughout cardiac cycle. The cine angiogram showed deformity of the anterior mitral valve leaflet with severe mitral regurgitation and mild aortic regurgitation. At operation, a perforated aneurysm was recognized at the anterior mitral valve leaflet without thrombus and vegetation. The size of aneurysm was 40 x 25 x 25 mm. The patient underwent MVR + AVR, and the postoperative course was uneventful. Pathological examination of the anterior mitral valve leaflet revealed scar-like fibrosis and old inflammatory change. It was judged a true aneurysm of mitral valve, because the structure of endocardium was kept.
To investigate disseminated intravascular coagulation (DIC) after valve replacement, we studied DIC score in 80 patients with combined cardiac valvular disease. Thirty-three patients with (TR group) and 47 patients without (control group) tricuspid regurgitation were compared. 1) TR group, that included patients with severe cases, showed a significantly longer operative time and greater bleeding volume (p less than 0.01). 2) The DIC score was significantly higher in TR group. Administration of gabexate mesilate to patients with DIC improved their platelet counts. These results indicate that patients with combined cardiac valvular disease with tricuspid regurgitation have a hemorrhagic tendency and are subject to DIC. Administration of gabexate mesilate is useful for DIC.
A rare case of right atrial thrombosis was observed in a 49-year-old woman. She had cyanotic ostium secundum atrial septal defect without pulmonary hypertension. By postoperative cardiac catheterization, she was diagnosed as having isolated right ventricular hypoplasia.
Anomalous coronary artery originating from the aorta without complicated congenital cardiac anomaly is rare. We describe a case with the left coronary artery originating from the right sinus of Valsalva. Cardiac catheterization revealed a left coronary artery transverse between the aorta and the pulmonary artery. Severe atherosclerotic stenosis was present at segment 3 of the right coronary artery. Electrocardiogram and myocardial scintigraphy revealed that the angina occurred due to stenosis of the right coronary artery. We tried PTCA, but could not pass the catheter through the stenosis. After PTCA, he complained of anterior chest pain frequently, so we performed an aortocoronary bypass operation to the right coronary artery with saphenous vein graft. Postoperative course was not eventful and angina disappeared.