Biomedical subjects

Hiromichi Fujii

Publications and source records attributed to Hiromichi Fujii.

14 recordsLinked to original sources

PubMed2006

Biventricular pacing 18 months after Batista operation.

We conducted biventricular pacing in a patient with dilated cardiomyopathy and complete left bundle branch block who had recurrent heart failure and mitral valve regurgitation 18 months after partial left ventriculectomy and mitral valve repair. An epicardial lead was fixed on the left ventricular free wall surgically through a thoracotomy, and the other two leads were implanted transvenously. Biventricular pacing restored contractile synchrony and led to more efficient left ventricular contraction and reductions in mitral regurgitation. Biventricular pacing may produce beneficial effects for patients with the recurrent intractable heart failure associated with cardiomyopathy and complete left bundle branch block after partial left ventriculectomy.

Bundle-Branch Block↗

PubMed2005

Relationship between granulocyte elastase and C3a under protamine dosing in on-pump cardiac surgery.

OBJECTIVE: The complement cascade and granulocytes are activated in on-pump cardiac surgery. If activation of complement directly regulates granulocytes, granulocyte elastase (GEL) should increase significantly after protamine administration. We examined the effect of protamine on granulocytes by protamine administration and observation of the effect on GEL and C3a. METHODS: Thirty patients who underwent coronary artery bypass grafting were randomly assigned to two groups. In 15 patients, protamine was administered 5 min after the termination of cardiopulmonary bypass, and was administered 35 min after cardiopulmonary bypass in the other 15 patients. All patients were perfused with heparin-coated circuits and received 300 IU/kg heparin and 3 mg/kg protamine. GEL and C3a concentrations were measured at 7 time points. RESULTS: GEL concentrations increased significantly just before aortic declamping and did not increase significantly after protamine administration. C3a concentrations, however, did not increase during cardiopulmonary bypass and did increase significantly after protamine administration. CONCLUSIONS: This study indicates that GEL does not increase after protamine administration and that complement concentration does not directly affect GEL release.

Aged↗

PubMed2005

Paradoxical cerebral embolism in a patient with Paget-Schroetter syndrome.

A 28-year-old man presented with transient speech disturbance and right hemiplegia. Computed tomography of the brain revealed a low-density area in the right cerebellum. A ventilation/perfusion lung scintiscan detected multiple perfusion defects in the both lungs and catheterization revealed pulmonary hypertension. Venography of the upper extremities revealed obstruction of the left subclavian vein. Furthermore, Doppler echocardiography revealed a right-to-left shunt via a patent foramen ovale. Those examinations demonstrated paradoxical cerebral embolism caused by Paget-Schroetter syndrome, which is a rare complication of the disorder. We hypothesize that the source of thrombi was the left subclavian vein and surgery was needed to prevent further thromboembolic events. At surgery, the upper half of the sternum was incised in the midline, and the left brachiocephalic vein was ligated. No thromboembolic episodes have occurred postoperatively.

Adult↗

PubMed2004

A new poly-2-methoxyethylacrylate-coated cardiopulmonary bypass circuit possesses superior platelet preservation and inflammatory suppression efficacy.

BACKGROUND: Poly-2-methoxyethylacrylate (PMEA) is a new coating material, and several studies have revealed that PMEA-coated cardiopulmonary bypass (CPB) circuits have good biocompatibility. This study sought to compare this biocompatibility with those of heparin-coated and noncoated circuits. METHODS: Forty-five patients undergoing coronary artery bypass grafting were randomly assigned to PMEA-coated (group P, n = 15), heparin-coated (group H, n = 15), or noncoated (group N, n = 15) circuit groups. Clinical data and the following markers were analyzed: (1) platelet preservation by number of platelets; (2) complement (C) activation by C3a and C4a levels; (3) inflammatory response by interleukin-6 (IL-6) and interleukin-8 (IL-8) levels. RESULTS: Platelet numbers were significantly preserved in group P compared with groups N and H. Postoperative blood loss did not differ among the groups. During CPB, C3a values were significantly lower in group H (536 +/- 145 ng/mL) than in group P (1,458 +/- 433 ng/mL, p < 0.01) and group N (1,815 +/- 845 ng/mL, p < 0.01). The C4a values did not differ 60 minutes after CPB initiation among the groups. The IL-6 and IL-8 levels were significantly lower in group P and group H than in group N. CONCLUSIONS: The PMEA coating was superior to heparin coating and noncoating in preserving platelets, and was equivalent to heparin coating in terms of the perioperative clinical course and inhibition of inflammatory cytokines, but slightly inferior in reducing complement activation.

Acrylates↗

PubMed2004

Radionuclide study of mid-term left ventricular function after endoventricular circular patch plasty.

OBJECTIVE: Although the early result of endoventricular circular patch plasty (EVCPP) has been reported, few are seen about the long-term results. We studied left ventricular (LV) function in the early and mid-term periods after EVCPP with electrocardiographic-gated single photon emission computed tomography (Gated SPECT). METHODS: Consecutive 14 patients with LV asynergy after myocardial infarction, who had the EVCPP procedure, were studied by Gated SPECT. Mean age of patients was 67+/-10 years. Gated SPECT images were obtained and LV end-diastolic volume index (EDVI), LV end-systolic volume index (ESVI) and ejection fraction (EF) were studied with QGS(+) program. Gated SPECT study was performed before surgery, early (23 days) and mid-term periods (32 months) after surgery. RESULTS: EDVI changed significantly from preoperative value to early postoperative value (107+/-39 to 72+/-37 ml/m(2), P < 0.01). There was no significant difference between early and mid-term postoperative values. ESVI also changed significantly from preoperative value to early postoperative value, and from early value to mid-term postoperative value (78+/-37 to 51+/-34 to 47+/-35 ml/m(2), P < 0.05, respectively). EF increased significantly from preoperative value to early postoperative value, and from early value to mid-term postoperative value (30+/-10 to 35+/-13 to 45+/-18%, P < 0.05, respectively). CONCLUSIONS: Direct influence of EVCPP brought significant improvement of LV function in early period. Further decrease of ESVI and increase of EF were noticed from early period to mid-term period. This result suggest that the effect of EVCPP sustains long and yields reverse LV remodeling.

Aged↗

PubMed2004

Sonoclot analysis in cardiac surgery in dialysis-dependent patients.

BACKGROUND: Dialysis-dependent patients have multiple disorders of hemostasis; however, there are no reports of viscoelastic changes during cardiac surgery in such patients. METHODS: Hemostasis in dialysis-dependent patients during cardiac operations was evaluated. Thirty patients who underwent cardiopulmonary bypass (CPB) were studied: 6 with chronic renal failure undergoing dialysis (HD group), and 24 without hemodialysis. Blood samples were obtained at four points: before sternotomy, 30 and 90 minutes after the start of CPB, and after protamine administration. RESULTS: Activated clotting time (ACT) measured with Sonoclot analyzer was significantly correlated with ACT measured traditionally (r = 0.92; p < 0.001; y = 36.1 + 0.95x). Values for ACT measured with Sonoclot analyzer as well as traditional ACT increased significantly during CPB. Values for ACT measured with Sonoclot analyzer in the HD group were significantly longer than those in the control group. Before CPB, both ACT measured with Sonoclot analyzer and traditional ACT in the HD group were significantly longer than those in the control group; however, there were no significant differences in ACT measured with Sonoclot analyzer between the groups after CPB. Clot rates and peak signal values were significantly decreased during CPB in both groups, and returned to preoperative values after protamine administration. There were no significant differences in clot rate and peak signal values between the two groups. There were no differences between the two groups in changes of time to peak. Platelet counts in the HD group were significantly higher (p < 0.05) than those in the control group. There were no differences in platelet counts after CPB between the two groups. Antithrombin III levels decreased below 50% during and after CPB. Antithrombin III in the HD group was significantly lower (p < 0.01) than those in the control group. A significant time-group interaction was observed in antithrombin III levels. CONCLUSIONS: Sonoclot signatures in HD patients showed no significant differences in viscoelastic changes compared with non-HD patients.

Cardiopulmonary Bypass↗

PubMed2003

Rectus abdominis myocutaneous flap after unsuccessful delayed sternal closure.

Open chest management is one of the best options for severely impaired hearts after open-heart surgery. Reapproximation of sternal edges compresses the heart, so a less compressive method of chest wall reconstruction should be considered when sternal closure must be delayed. We applied a rectus abdominis myocutaneous flap approach in 3 patients after difficulties with delayed sternal closures. Two patients were weaned off intraaortic balloon pumping and survived without respiratory troubles or wound complications. This alternative method of chest reconstruction is useful in patients after an unsuccessful delayed sternal closure.

Aged↗

PubMed2003

Mallory - weiss tear complicating intraoperative transesophageal echocardiography.

A Mallory - Weiss tear occurred as a complication of intraoperative transesophageal echocardiography carried out in a 62-year-old man who underwent coronary artery bypass grafting. Left ventricular function was monitored in the transgastric short-axis view. Postoperative esophagogastroscopy revealed a Mallory - Weiss tear at the gastroesophageal junction and erosions in the cardia, presumably secondary to contact pressure by the echoprobe and ultrasonic thermal injury. When not actively imaging, the echoprobe should be left free in the esophagus with the acoustic power off.

Coronary Artery Bypass↗

PubMed2003

[Emergency operation for traumatic thoracic aortic rupture diagnosed by enhanced chest computed tomography; report of a case].

Thoracic aortic injury caused by blunt chest trauma is often fatal. Although aortography had been inevitable for thoracic surgery until recently, image of computed tomography (CT) is often superior to aortogram nowadays. We present a case of 64-yaer-old man with blunt chest trauma by traffic accident, who was successfully diagnosed and operated without invasive aortography. Thoracic aortic rupture was suspected by plain chest X-ray. His enhanced CT showed the localized leakage of contrast media near the arterial ligament of aortic arch. Because his condition was critically ill, operation was performed immediately without aortography. There found Y-shaped tear at the distal aortic arch, and was replaced with a prosthetic graft. Operation was performed under left heart bypass using heparin-coated circuit and centrifugal pump. We would stress that the enhanced chest CT is sufficiently diagnostic in thoracic aortic trauma like the present case.

Accidents, Traffic↗

PubMed2002

Open heart surgery for posttraumatic inferior vena caval thrombosis.

A 40-year-old woman was diagnosed as intrahepatic hematoma after blunt abdominal trauma. One month later computed tomography (CT) revealed the inferior vena caval thrombus extending into the right atrium. Emergency thrombectomy was performed under cardiopulmonary bypass. We believe that the thrombus, which was derived from laceration of the hepatic vein, extended through the inferior vena cava into the right atrium, and was the eve of pulmonary embolization. CT study should be repeated, once the intrahepatic hematoma was recognized. We emphasize that we should recognize the existence of such complication to prevent the catastrophic result.

Abdominal Injuries↗

PubMed2002

Value of intraoperative transesophageal echocardiography in preventing serious complications during valvular surgery. A report of four cases.

The value of routine transesophageal echocardiography (TEE) was confirmed by the detection of rare and potentially serious complications in four of 136 patients (2.9%) undergoing valvular surgery. In case 1, one leaflet of a St. Jude Medical (SJM) valve implanted in the mitral position was stuck in the closed position; normal valve function was restored by 90 degrees rotation of the prosthesis. In case 2, moderate regurgitation was observed after mitral valve replacement with a Carpentier-Edwards pericardial bioprosthesis. The mitral valve was replaced with a SJM valve; regurgitation was proved due to a suture loop jamming. In case 3, perivalvular leakage was detected after aortic valve replacement for infective endocarditis; an additional suture stopped the leakage. In case 4, a foreign body was observed in the left atrium after aortic valve replacement for calcified aortic stenosis. The left atrium was re-opened, and a free-floating portion of the calcified native aortic valve was identified and removed. Routine intraoperative TEE in valve surgery permits the identification and management of potentially serious complications before discontinuing cardiopulmonary bypass.

Aged↗

PubMed2002

Infective endocarditis with myocardial abscesses complicating percutaneous transluminal coronary angioplasty.

A 73-year-old man who had undergone percutaneous transluminal coronary angioplasty developed infectious endocarditis caused by Staphylococcus aureus. Echocardiography revealed vegetations of the aortic valve and severe aortic regurgitation. Endotracheal intubation was required for progressive heart failure. Serum creatinine kinase was elevated (411 IU/l: normal 30 to 140 IU/l). Electrocardiography showed no ischemic changes. Aortic replacement was performed to treat progressive heart failure, but the patient could not be weaned off cardiopulmonary bypass and subsequently died. A post-mortem examination revealed multiple myocardial microabscesses and myocardial infarction due to embolic vegetation. The possibility of multiple abscess formation when severe ventricle dysfunction occurs in infectious endocarditis is emphasized.

Abscess↗

PubMedDate not supplied

Comparison of volume study by left ventriculography and gated SPECT in endoventricular circular patchplasty.

Although quantitative gated SPECT (QGS) is widely used for left ventricular (LV) volume study, its accuracy is not established for those who have a large myocardial infarction scar or who had endoventricular circular patch plasty (EVCPP). Therefore, we compared LV volumes and LVEF calculated by QGS and those calculated by left ventriculography (LVG) before and after EVCPP. Sixteen patients (13 men and 3 women, mean age 67 +/- 9.5 years) were treated with EVCPP for postinfarction LV dyskinetic and/or akinetic scar. All patients were evaluated with both QGS and LVG before and after surgery. QGS was performed using eight frames per cardiac cycle, 1 hour after 740 MBq (99 m)Tc-tetrofosimin was administered. LVG images were acquired at a frame rate of 30 frames per second in the right anterior oblique 30-degree projection. We compared LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), and LV ejection fraction (LVEF) between QGS and LVG. There was an excellent linear correlation between QGS and LVG in LVEDV (preoperative; r = 0.87, postoperative; r = 0.94), LVESV (preoperative; r = 0.95, postoperative; r = 0.89), and LVEF (preoperative; r = 0.73, postoperative; r = 0.81) before and after EVCPP. However, both preoperative LV volumes and postoperative LVEF calculated from QGS gave a smaller value than those calculated from LVG. Postoperative volume data by QGS was much close to LVG. The present study indicated that volume study by QGS is very useful to evaluate the LV function after EVCPP. However, we should pay attention to those facts.

Aged↗

PubMedDate not supplied

Surgical treatment of multiple coronary artery fistulas with an associated small saccular aneurysm--a case report.

Coronary angiography (CAG) of a 57-year-old woman with anterior chest discomfort revealed no stenosis of the coronary arteries but multiple coronary artery fistulas (CAFs). The sites of origin for the CAFs were the right coronary artery, left main coronary artery, left anterior descending coronary artery, and ascending aorta. The only site for drainage was the main pulmonary artery. Furthermore, a small saccular aneurysmal formation was detected. Surgical treatment was considered better than conservative treatment or coil embolization, and ligation and division of the CAFs were performed during cardiopulmonary bypass. Using a Harmonic Scalpel to expose fistulous arteries was very effective. CAG performed immediately after surgery demonstrated that all CAFs were repaired. The postoperative course was uneventful.

Aorta↗