Biomedical subjects

Hideyuki Fumoto

Publications and source records attributed to Hideyuki Fumoto.

8 recordsLinked to original sources

PubMed2006

Surgical revascularization for acute coronary syndrome: comparative surgical and long-term results.

OBJECTIVE: The purpose of this study was to evaluate the adequate timing of coronary artery bypass grafting (CABG) for acute coronary syndrome (ACS). METHODS: In our institution, emergency CABG has been avoided when possible for ACS patients favoring stabilization with medical therapies, including intra-aortic balloon pumping or percutaneous coronary intervention. After thorough preoperative examinations, an urgent CABG is performed. A total of 67 patients with ACS underwent CABG, comprised of 33 patients receiving an emergency CABG (emergent group: E-G) and 34 patients receiving an urgent CABG (urgent group: U-G). The early and long-term results were evaluated retrospectively. RESULTS: Preoperatively, the incidences of acute myocardial infarction and cardiogenic shock were significantly higher in E-G. No significant differences were found in the intraoperative factors except for the number of distal anastomoses (2.5 in E-G vs. 3.1 in U-G, p=0.01). The hospital mortality was 9.1% in E-G, and 2.9% in U-G, with no significant difference between the groups. Moreover, no patient in U-G necessitated emergency CABG while waiting for surgery. The patency rate of the grafts was 100% in E-G, and 96.2% in U-G. The 5-year survival rate excluding in-hospital death was 80.3% in E-G, and 78% in U-G (p>0.05). The 5-year cardiac event-free rate was 80.3% in E-G, and 80.9% in U-G (p>0.05). CONCLUSION: An emergency CABG can be reserved for ACS patients when symptoms and hemodynamic state are stabilized with medical therapies. Improvements in long-term results can be expected after high quality and complete surgical revascularization.

Aged↗

PubMed2006

Aortic dissection late after aortic valve replacement.

We experienced 3 cases of an aortic dissection occurring late after an aortic valve replacement, and successfully treated by an aortic root replacement. An aortic dissection involving the ascending aorta can develop late after an aortic valve replacement, and such an occurrence is associated with a high mortality and morbidity. The development of effective surgical strategies at the initial aortic valve surgery, strict control of blood pressure after aortic valve replacement, serial evaluations of aortic size, and the prophylactic replacement of the ascending aorta for patients with aortic dilatation after aortic valve replacement, all play clinically important roles in preventing an aortic dissection after aortic valve replacement. When an aortic dissection occurs in patients with a previous aortic valve replacement, an aortic root replacement should be performed in order to avoid leaving the fragile diseased aortic wall including the sinus of Valsalva.

Adult↗

PubMed2006

A safer technique of aortic root replacement after aortic valve replacement.

Aortic root replacement after aortic valve replacement (AVR) is often complicated by bleeding around the aortic root, which increases the risk of morbidity and mortality, making it a technically challenging procedure. We describe a new technique of aortic root replacement designed to minimize bleeding around the aortic root. This surgical technique focuses on safe dissection and exposure of the aortic root to avoid inadvertent entry into the right atrium or right ventricle; on modifying the proximal anastomosis of the graft to the aortic annulus; and on performing a coronary artery reimplantation that achieves complete hemostasis at the suture lines. We performed aortic root replacement after AVR in four patients over a 4-year period, without encountering any bleeding around the aortic root.

Adult↗

PubMed2004

Dual left anterior descending coronary artery: report of a case.

We report a case of Type I dual left anterior descending artery (LAD) successfully treated by coronary artery bypass grafting including the long LAD. This rare coronary artery anomaly is of clinical importance in the field of myocardial revascularization.

Angina Pectoris↗

PubMed2004

Papillary fibroelastoma of the tricuspid valve.

A 72-year-old male patient was admitted with chest oppression. Echocardiography disclosed a mobile tumor which was located on the atrial side of the tricuspid valve. Neither tricuspid obstruction nor regurgitation was observed. The mobility and the size, 20 mm in diameter, of the tumor indicated the need to perform surgical treatment. Through a right atriotomy, the tumor with multiple papillary fronds was found on the basal zone of the anterior leaflet. A resection of the tumor and tricuspid valvuloplasty with a partial annular reconstruction were performed. A pathological examination confirmed papillary fibroelastoma. He had an uneventful recovery, and postoperative echocardiography detected neither any residual tumor nor tricuspid regurgitation. In conclusion, it is reasonable to state that echocardiography is useful for detecting cardiac tumors, and a surgical resection is indicated for a mobile or large papillary fibroelastoma even when it is located on the right side of the heart.

Aged↗

PubMed2003

Left ventricular myxoma originating from the papillary muscle.

A rare case of left ventricular myxoma presenting embolization into the brachial artery is reported. The sessile tumor originated from the posteromedial papillary muscle and involved the chorda supporting the posterior mitral leaflet. Complete excision of the tumor with the posterior head of the posteromedial papillary muscle, with the chorda and with the posterior mitral leaflet necessitated valve replacement. The tumor was well visualized by the superior-septal and transaortic approaches. These enabled exploration of all four cardiac chambers so as not to overlook any multifocal myxoma. The left ventricular myxoma should be completely resected with the surrounding endocardium in order to avoid recurrence of the disease.

Cardiomyopathies↗

PubMed2002

An evaluation of coronary artery bypass grafting without aortic cross-clamping due to severely atherosclerotic ascending aorta.

OBJECTIVES: We evaluated coronary artery bypass grafting (CABG) in which aortic cross-clamping is not done due to severe atherosclerosis of the ascending aorta. METHODS: Subjects were 51 patients undergoing CABG without aortic cross-clamping during cardiopulmonary bypass under moderately hypothermic ventricular fibrillation in the 12 years from June 1988 to October 1999 (Group N). In some cases, empty beating or moderate hypothermic circulatory arrest was used. We compared these 51 with 1104 subjects undergoing conventional CABG with aortic cross-clamping and cardioplegic cardiac arrest in the 9 years from June 1988 to December 1997 (Group A). RESULTS: In all 6 cases with neurologic deficits, moderately hypothermic circulatory arrest was used during proximal anastomosis of saphenous vein grafts. Postoperative computed tomography scan showed them to have suffered infarction due to embolization. Multivariate analysis identified proximal saphenous vein grafting under moderately hypothermic circulatory arrest as a predictor of neurologic deficit. Complete revascularization was significantly lower in Group N. Actual survival and freedom from cardiac death were significantly lower in Group N. CONCLUSION: Manipulation of the atherosclerotic ascending aorta under moderately hypothermic circulatory arrest or ventricular fibrillation generates the highest risk of perioperative neurologic deficit and should thus be avoided. In-situ arterial grafting should be conducted with utmost care.

Adolescent↗

PubMed2002

Evaluation of coronary artery bypass grafting in acute myocardial infarction.

OBJECTIVES: We evaluated coronary artery bypass grafting (CABG) in acute myocardial infarction (AMI) within 14 days of onset. METHODS: Of 1,450 patients undergoing isolated CABG in the last 12 years we retrospectively analyzed operative risk factors and studied the use of CABG in treating AMI in 66 undergoing surgery during the AMI phase. We divided them into 2 groups: Group D (deceased: n = 8) and Group S (survivors: n = 58). RESULTS: Total operative mortality was 12.1% (8/66). Univariate analysis showed the following preoperative parameters to be significant in Group D: diabetes mellitus, cardiogenic shock, shortness of the interval between AMI onset and surgery, mean peak creatine phosphokinase-MB, AMI of the left main trunk, and failed recanalization of the infarcted artery. Multivariate analysis showed diabetes mellitus, cardiogenic shock, and AMI of the left main trunk as independent risk factors for hospital mortality. Intra-operative parameters between groups showed no statistical difference. Mortality in patients who did not suffer cardiogenic shock was zero. CONCLUSION: Maintenance of hemodynamics in the early phase is vital in treating AMI. The most important element in surgical intervention is revascularization of main branches. We concluded that CABG in AMI involves relatively low risk.

Adult↗