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Biomedical subjects

Hiroshi Sugiki

Publications and source records attributed to Hiroshi Sugiki.

9 recordsLinked to original sources
PubMed2006

Heparin reduction with the use of cardiotomy suction is associated with hyperfibrinolysis during distal aortic perfusion with a heparin-coated semi-closed cardiopulmonary bypass system.

We sought to elucidate the effects of different anticoagulation levels and the use of cardiotomy suction on the postoperative coagulatory and fibrinolytic systems in patients undergoing distal aortic perfusion using a fully heparin-coated (semi-)closed cardiopulmonary bypass (CPB) system incorporating a soft reservoir bag. Thirty-two patients were divided into two groups: those who underwent cardiotomy suction (S group, 18 patients) and those who did not (N group, 14 patients). We administered 1-2 mg/kg heparin in the S group, which achieved an activated clotting time (ACT) of 345 +/- 71 s. In the N group, we administered 0.7-1 mg/kg heparin, which achieved an ACT of 297 +/- 52 s. Data on platelet counts and serum levels of fibrinogen, antithrombin III, D-dimer, and fibrin degradation products (FDP) were collected, and factors influencing these variables were analyzed by multiple regression analysis. Both the patient group and the initial ACT level were independent factors influencing postoperative levels of FDP and D-dimer, whereas peak ACT level and the use of selective visceral/renal shunt/perfusion, but not the patient group, were independent factors influencing the postoperative platelet counts. In the S group, a significant inverse correlation was found between the ACT and levels of FDP or D-dimer, whereas no correlation was found in the N group. The use of cardiotomy suction was associated with elevated FDP and D-dimer levels even when a fully heparin-coated semi-closed CPB system was used. Lower ACT levels with the use of cardiotomy suction were associated with higher FDP and D-dimer levels, whereas such a relationship did not exist when cardiotomy suction was not used.

Aged↗
PubMed2006

Proximal aortic replacement with ascending-descending bypass for a diffuse aneurysm: report of a case.

We performed successful ascending-arch aortic replacement and concomitant ascending-to-descending aorta bypass with exclusion of a descending thoracic aneurysm, via median sternotomy, for a ruptured aortic aneurysm involving the entire thoracic aorta. The patient was an 80-year-old man with cardiopulmonary dysfunction and a history of lung tuberculosis. This operation, which has been used for complex descending thoracic aortic lesions such as recoarctation, is a feasible option for a diffuse thoracic aortic aneurysm when single-stage repair is mandatory.

Aged, 80 and over↗
PubMed2006

Bileaflet mechanical valve sound analysis using a continuous wavelet transform.

Bileaflet mechanical valve closing sounds have splits, the duration of which is not constant in normally functioning valves. However, no reports have discussed the influences of valve malfunction on the split interval, neither have any studies discussed the fact that mechanical valve closing sound signals must be analyzed using a time-frequency analysis because they are nonstationary signals. The continuous wavelet transform (CWT), a time-frequency analyzing method using mother wavelets modified by scale numbers, was selected in this study for analyzing bileaflet valve closing sounds because it is easy to understand and has no limitations such as the cross-terms in the Wigner-Ville distribution or the tradeoff between time and frequency resolutions of the short-time Fourier transform. This study compares the properties of the mother wavelets of various CWTs and selects one that is suitable for detection of the clear split in bileaflet mechanical valve closing sound signals. This article also establishes a standard frequency analyzing system for bileaflet mechanical valve sounds. A preliminary study with chirp Doppler signals for comparing the frequency properties of the mother wavelets of various CWTs suggested that Ishikawa's modified Morlet CWT has better time and frequency resolution at the highest frequency scale. Morlet/power CWT analysis of normal in vivo bileaflet valve closing sounds of the ST. Jude Medical (SJM), ATS, and Carbomedics (CM) valves demonstrated clear splits of very short interval at the highest level of frequency. Detection of the disappearance of the split by using this analytical method may be the key to identifying bileaflet mechanical valve malfunction in outpatient departments.

Aortic Valve↗
PubMed2006

Novel technique for volume reduction of giant left atrium: simple and effective "spiral resection" method.

Despite some controversial studies, an enlarged left atrium has an impact on postoperative complications, and surgical correction should be considered, particularly in patients with a markedly enlarged left atrium. We present herein 2 patients with a giant left atrium (left atrial dimensions of 107 and 93 mm on echocardiograms), and describe an effective and simple procedure, the "spiral resection" method, to reduce any part of the dilated wall of the left atrium with a single incision.

Aged↗
PubMed2005

[Risk factors for the surgical repair of ventricular septal perforation; an 8-year multiinstitutional analysis].

OBJECTIVE: The purpose of this study was to determine the surgical outcomes and risk factors for surgical repair of the ventricular septal perforation (VSP). METHOD: From 1995 to 2003, 41 patients with VSP underwent surgical repair. There were 18 males and 23 females, with the mean age of 71.7 +/- 9.2. Sixteen patients (39.0%) had the preoperative shock, while 30 patients received intraaortic balloon pumping (IABP) assistance and 1 of those required percutaneous cardiopulmonary support (PCPS). Mean durations from onset of myocardial infarction and VSP to operation were 5.8 +/- 9.4 and 2.4 +/- 8.1 days, respectively. Twenty-six patients underwent infarct exclusion technique, 11 underwent patch closure, and 4 Daggett operation. Mean cardiopulmonary and aortic cross-clamp time were 211 +/- 85 and 105 +/- 43 minutes, respectively. RESULTS: Thirty days mortality was 11 (26.8%). Nine patients (22%) required PCPS after repair, however, 2 weaned off the support and only 1 discharged the hospital. Residual shunt was found in 12 patients (29.3%), and 4 underwent the reclosure of the residual shunt 13 +/- 8.6 days after the initial operation, whereas none of patients with PCPS had residual shunt. Univariate analysis revealed the preoperative shock (p = 0.03), longer cardiopulmonary bypass time (p < 0.01), and the need for PCPS after repair (p < 0.01) were the risk factors for the early mortality. Multivariate analysis indicated the cardiopulmonary time over 210 minutes and the need for PCPS to be the significant risk factors. CONCLUSION: The long cardiopulmonary bypass support after repair and the subsequent need for PCPS imply the poor left ventricular function. Since the residual shunt was not the cause of PCPS, the surgical outcome for VSP may be limited in patients with poor left ventricular function. In these patients, other therapeutic strategies may be required, such as ventricular assisting devices, transplantation, or regenerative therapy.

Aged↗
PubMed2004

Bilateral coronary ostial patch angioplasty with autologous pericardium in Takayasu arteritis: a case requiring replacement of the aortic valve and ascending aorta.

Since the lesions and stages of Takayasu arteritis vary with each patient, surgical treatment of this disease requires meticulous planning for the timing of operation, technique, material used, and postoperative medication. We report a rare complex lesion of Takayasu arteritis, which required simultaneous repairs for aortic regurgitation, a dilated ascending aorta and bilateral coronary ostial stenosis. Such multiple lesions have not been reported previously. A 47-year-old woman was referred to us because of heart failure and chest pain. The coronary ostial stenosis were enlarged with generously sized autologous pericardial patches, and separate aortic valve and ascending aortic replacements were performed since the diameter of the Valsalva sinus was 37 mm. The postoperative course was uneventful, but steroid therapy was commenced postoperatively because inflammatory reaction remained high.

Angioplasty↗
PubMed2004

Surgical results for active endocarditis with prosthetic valve replacement: impact of culture-negative endocarditis on early and late outcomes.

OBJECTIVE: Surgical treatment of active infective endocarditis requires not only hemodynamic repair, but also special emphasis on the eradication of the infectious focus to prevent recurrence. This goal can be achieved by the combination of aggressive debridement of infective tissue and appropriate and adequate antibiotic treatment. We reviewed our experience with active endocarditis and identified factors determining early and late outcomes, particularly focusing on the factor of culture-negative endocarditis. METHODS: Sixty seven patients with clinical evidence of active endocarditis who underwent operation between 1991 and 2001 were evaluated. The aortic valve was infected in 28 (42%), the mitral valve in 23 (34%), and multiple valves in 16 (24%). Native valve endocarditis was present in 58 (87%) and prosthetic valve endocarditis in 9 (13%). Mean follow-up was 5.7 years (range, 0.2-11.5 years). RESULTS: Microorganisms were detected in 46 (69%): Staphylococcus aureus in 9 (13%), other staphylococci in 9 (13%), streptococcus species in 19 (28%), and others in 9 (28%), whereas 21 (31%) patients had culture-negative endocarditis. Operative mortality was 17.8% (12 patients). Reoperation was required in 8 (12%), while 3 late deaths (5.5% of hospital survivors) occurred. All events, including death, reoperation, periprosthetic leak, and recurrence of infection, occurred within 2 years after operation. Actuarial freedom from reoperation, late survival, and events at 5 years were 81.6, 76.4, and 68.6%, respectively. On multivariate analysis, no independent adverse predictor was detected for hospital death, whereas the following independent adverse predictors were identified: preoperative heart failure (P=0.0375), prosthetic valve endocarditis (P=0.0391) and culture-negative endocarditis (P=0.0354) for poor late survival; culture-negative endocarditis (P=0.0354) and annular abscess (P=0066) for poor event-free survival. Freedom from events was similar between patients with Staphylococcus aureus infection (3-year freedom 55.6%) and culture-negative endocarditis (3-year freedom 47.6%), whereas events were significantly low in patients with streptococcus infection (3-year freedom 100%). CONCLUSIONS: In our analysis, no independent adverse predictor was detected for hospital death; however, culture-negative endocarditis was identified as an independent predictor for both late survival and events after surgery. Event-free survivals were similar between staphylococcus infection and culture-negative endocarditis, and all events occurred within 2 years after operation, suggesting the necessity of close follow-up during that period.

Adolescent↗
PubMed2004

[Aortic root redissection associated with the use of gelatin-resorcin-formalin glue following surgical treatment for acute type A aortic dissection; report of a case].

A late redissection case of the aortic root after total arch replacement for acute Stanford type A aortic dissection was reported. A 55-year-old male was treated with total arch replacement for acute Stanford type A aortic dissection. The aortic valve was bicuspid valve, and the right coronary leaflet was prolapsed because of the dissection of right and non coronary cusp. Resuspension of the commissure and the fixation of the dissected aortic wall with gelatin-resorcin-formalin (GRF) glue was performed during the operation. The initial postoperative course was uneventful and the patient discharged 52 days after the operation. Redissection of aortic root was pointed out on the computed tomography (CT) 3.5 years after the operation. As the second operation, the aortic root replacement was performed. Coronary artery bypass for right coronary artery was simultaneously performed with right internal thoracic artery because the right coronary ostium was stenotic and showed ischemic change on electrocardiogram monitor during the operation. The redissection was seen on the right coronary sinus, which was fixed by the GRF glue during the first operation. The pathological study showed the migration of macrophages and the tear of the fibrous tissue. These findings was thought to be associated with the use of the GRF glue. Careful use of the GRF glue for the fixation of the dissected aorta during the surgical treatment for the Stanford type A aortic dissection was thought to be important.

Aortic Dissection↗