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Biomedical subjects

J Iemura

Publications and source records attributed to J Iemura.

At least 19 recordsLinked to original sources
PubMed2002

Onset of complete atrioventricular block 15 years after ventricular septal defect surgery.

A 4-month-old girl with a ventricular septal defect underwent cardiac surgery. During the operation, complete atrioventricular block (CAVB) occurred, but on postoperative day 16 it converted to normal sinus rhythm with persistent complete right bundle branch block and left anterior hemiblock. Fourteen years after the operation, second-degree atrioventricular block was detected, but her general condition was good. Fifteen years after the operation, CAVB occurred. The intracardiac electrophysiologic recording revealed A-H and H-V block. A permanent pacemaker was implanted, and following the implantation she completely recovered.

Adolescent↗
PubMed2001

Treatment of deep infection following thoracic aorta graft replacement without graft removal.

Deep infection following thoracic aortic replacement constitutes an extremely serious and life-threatening complication, and its treatment remains a challenge to surgeons. We report our experience involving five patients in whom deep infection occurred around the graft. Four of the five patients were treated by emergency surgery and one was treated by elective surgery. Surgical procedures performed including hemiarch replacement in one case, total arch replacement in one case, suspension of aortic valve and ascending aorta replacement in one case, Bentall procedure in one case, and descending aorta re-replacement in one case. Methicillin-resistant Staphylococcus aureus was detected in four patients, methicillin-resistant Staphylococcus epidermidis in one, and Aspergillus in one patient from purulent discharge at the operative site. Reoperative debridement and irrigation drainage were carried out at an early phase of infection. Intermittent irrigation following the reoperation was performed in all cases. In addition, muscle flap filling or omental translocation was carried out in three patients. Although the reported principle of treatment for arterial graft infection is extraanatomical bypass or rereplacement after removal of the infected graft, such procedures may be technically difficult and have a high risk at the thoracic level. Local anti-septic irrigation, administration of antibiotics, and vascular-rich tissue filling are useful procedures, and it appears that it is not always necessary to remove prosthetic grafts.

Adult↗
PubMed2001

Surgical strategy for left ventricular free wall rupture after acute myocardial infarction.

BACKGROUND: Left ventricular free wall rupture is usually fatal without surgical intervention. However, the most appropriate surgical procedure remains controversial. METHODS: Seventeen patients (14 men, 3 women) who developed left ventricular free wall rupture after acute myocardial infarction were treated surgically. Their mean age was 65.4 years (range, 55 to 79 years). The following surgical procedures were performed: infarctectomy and patch reconstruction in 1 patient, direct closure with or without patch covering in 4 patients, simple patch covering anchored by running suture in 4 patients, and a sutureless technique in 7 patients. Endventricular patch closure was performed in 1 patient with ventricular septal perforation. RESULTS: One of 3 patients with a blow-out type rupture and 1 of 13 patients with an oozing type rupture died shortly after operation. The overall surgical mortality rate was 11.8%. CONCLUSIONS: Selection of the optimal procedure for each cardiac condition is important for obtaining good results. For patients with ongoing squirting bleeding, patch covering is the technique of choice. For oozing, the sutureless technique is preferable.

Aged↗
PubMed2000

Expanded polytetrafluoroethylene monocuspid valve for right ventricular outflow tract reconstruction.

BACKGROUND: Numerous materials have been used for reconstruction of the right ventricular outflow tract (RVOT) in patients with complex congenital heart defects. METHODS: Between January 1982 and March 1999, 19 patients (10 boys and 9 girls; mean age, 8.5 years) with severe RVOT obstruction underwent reconstruction using a transannular patch and expanded polytetrafluoroethylene (ePTFE) monocuspid valve. RESULTS: There were no perioperative deaths. Postoperatively, the mean +/- standard deviation RVOT gradient was 12 +/- 9 mm Hg. Echocardiography showed good motion of all cusps, and most had no or trivial pulmonary regurgitation. The difference between the preoperative and postoperative mean ratio of right-to-left ventricular peak systolic pressure was significant (p = 0.0001). In the 8 patients followed for 3 years or longer, pulmonary regurgitation was mild or better in 5 and moderate in 2, and the mean peak systolic RVOT gradient was 16.3 +/- 5.9 mm Hg. Five patients had good mobility of the monocusps. Two patients needed reoperation because of stenosis at the distal anastomosis of the transannular patch; 1 patient died. CONCLUSIONS: The ePTFE monocuspid valve may be useful in reconstruction of the RVOT.

Adolescent↗
PubMed2000

Coronary artery bypass grafting following substernal gastric interposition.

A 61-year-old man who had undergone substernal esophagogastric anastomosis for reconstruction after esophageal cancer, developed unstable angina 9 years later. Complete revascularization for triple-vessel disease was performed via a left thoracotomy approach under cardiopulmonary bypass. The successful results show that complete revascularization can be performed via this approach.

Angina, Unstable↗
PubMed2000

Interposition of hydroxyapatite ceramic stents alternative to delayed sternal closure.

Ascending and hemiarch replacement surgery for an acute Stanford type A dissection in association with a previous type B dissecting aneurysm was performed on a 58-year-old female patient. However, sternal closure could not be performed after surgery due to hemodynamic deterioration. Even four weeks after the operation, sternal closure was impossible due to advanced adhesion around the mediastinum caused by mediastinitis. Therefore, hydroxyapatite ceramic spacers, which have osteogenesis and ossification characteristics, were interposed between the split sternum as stents to avoid further surgery.

Aortic Dissection↗
PubMed2000

Coronary artery bypass grafting in octogenarians.

The aging of the Japanese population and improvements in surgical techniques have resulted in an increasing number of elderly patients undergoing coronary artery bypass grafting (CABG). We reviewed the records of 11 patients 80 years of age or older (mean age 82+/-0.38 years, range, 80 to 85 years) who had undergone a CABG at our institution between August 1989 and February 1999. Eight patients were males and 3 were females. Preoperatively, 4 of 11 patients were categorized as New York Heart Association class II, 4 as class III, 3 as class II. The operations were elective in 8 cases, and emergent in 3. Three patients presented with neck and cerebrovascular disease. One patient experienced chronic renal failure. No patients died within 30 postoperative days and no in-hospital deaths occurred. A total of 11 were followed up for an average of 35+/-11 months (range, 1 to 105 months). One patient died due to unknown causes. There was a significant decrease in overall anginal symptoms after CABG among the survivors, with the average decrease being from NYHA class 3.1 to 1.5. In conclusion, CABG is a safe and effective surgical procedure in the treatment of octogenarians with heart disease.

Aged↗
PubMed2000

Successful treatment of MRSA mediastinitis after aortic arch replacement.

An aortic arch graft replacement was successfully performed for a true aneurysm on the distal aortic arch. However, Methicillin-resistant Staphylococcus aureus (MRSA) mediastinitis occurred after surgery. Following reoperation for debridement and irrigation of the mediastinal space, antibiotics were administered and continuous irrigation of mediastinal space with saline containing appropriate antibiotics and intermittently short duration irrigation with a large quantity of saline containing popidone-iodine were carried out with good results. This paper presents the successful treatment of mediastinitis after replacement of the aortic arch without removing the graft, followed by a brief review of the literature regarding infection of prostetic grafts for the thoracic aorta.

Aged↗
PubMed1999

An effective device to keep the sternum open.

Delayed sternal closure following cardiothoracic surgery facilitates the treatment of heart failure and arrhythmias caused by sternal closure, and also allows access to treat uncontrollable bleeding. The present study examines the use of stents made from disposable syringes for keeping the sternum open. The syringes demonstrated good strength, as well as resistance to tapping during pulmonary physical therapy and stability against body movement necessary to prevent the formation of decubitus ulcers. Thus, the proposed stent provides an inexpensive, easy, and effective method for keeping the sternum open.

Arrhythmias, Cardiac↗
PubMed1998

[A case of an expanding congenital left ventricular aneurysm].

Congenital ventricular aneurysm is rare. There have been only 17 case reports in Japan. Only 9 of them were treated surgically. In this paper, we report a case with a congenital left ventricular aneurysm successfully treated by surgery. A 42-year-old female was admitted to our hospital with chest pain and ECG abnormalities. Left ventriculography revealed aneurysmal formation of the left ventricle with normal coronary arteries. Surgical resection was performed because repeated echocardiography had showed its enlargement. Surgical treatment for congenital ventricular aneurysm seems to be indicated to those with worsening symptoms, volume enlargement or thrombus formation.

Adult↗
PubMed1997

Reconstruction of right ventricular outflow tract by pedicled pericardial valved conduit.

A modification of the Rastelli technique using a pedicled autologous pericardial valved conduit was performed on 3 patients aged 10 months to 3 years. Two patients in whom a prosthetic gusset was not used or was partially used showed good recovery during the follow-up period (3 months to 3 years). The pedicled autologous pericardial conduit may be expected to increase its diameter with physical growth.

Child, Preschool↗
PubMed1997

Timing of surgical treatment for active native value endocarditis.

The aim of the study was to assess the optimum timing of surgical treatment for the active phase of native valve endocarditis. A retrospective study was conducted of the records of patients who had undergone aortic and/or mitral valve replacement for active native valve endocarditis during 1979-94 at Kinki University Hospital. Thirty-three patients with active infective endocarditis of the native valves were treated surgically. Their mean age was 45.4 years (range 11-71). The infective organism was streptococcus in 9 cases, Staphylococcus aureus in 8, and enterococcus in 4 cases. Blood cultures were negative in 9 cases. Of the patients infected with Staphylococcus aureus, 3 died soon after the operation and 1 died later during hospitalization. These 4 patients had been treated medically more than 2 weeks before operation. Another patient who was also treated medically more than 2 weeks before surgery survived. In contrast, all 3 patients infected with Staphylococcus aureus who were operated on within 2 weeks after the onset survived. No early or in-hospital deaths were documented among patients infected with organisms other than Staphylococcus aureus. Among patients who had suffered preoperative embolic episodes, the time from the initial pyrexia to the embolic event was clearly shorter in those infected with Staphylococcus aureus than in those infected with other organisms. Among the former group, 5 out of 6 patients suffered an embolism within 2 weeks of the onset of pyrexia and the remaining 1 within 3 weeks. Thus, in patients presenting with active native valve endocarditis caused by Staphylococcus aureus, surgical treatment should be performed as soon as possible after the onset of pyrexia, preferably within 2 weeks or as soon as the infective organism is identified as Staphylococcus aureus.

Adolescent↗
PubMed1995

[Two successful cases of total extracardiac right heart bypass].

We reported two successful cases of extracardiac total right heart bypass using 20 mm EPTFE conduit (modified total cavopulmonary connection). They were seven-year-old boy and nine-year-old girl. Both patients had complex heart disease including cyanosis, atrioventricular discordance. We selected this technique instead of modified Fontan or conventional total cavopulmonary connection because of safeness and easiness of surgery and the hemodynamic benefits. They don't have any restriction for their life postoperatively. We propose this technique as an alternative surgical option in candidates for a Fontan procedure or conventional total cavopulmonary connection.

Blood Vessel Prosthesis↗
PubMed1994

Bivalvation with bridging for common atrioventricular valve regurgitation in right isomerism.

A child with regurgitation in the common atrioventricular valve associated with complex heart disease underwent bivalvation with bridging for common atrioventricular valve regurgitation and arterial-pulmonary shunt for low pulmonary blood flow. Postoperative cardiac catheterization and color Doppler echocardiography revealed elimination of atrioventricular valve regurgitation and ventricular enlargement, reflecting an increase in pulmonary artery blood flow. We describe the concept and technique of bivalvation with bridging for common atrioventricular valve regurgitation.

Child↗
PubMed1994

[A successful case of repeated prosthetic valve re-replacement for somatic growth in childhood].

The patient who had had systemic atrio-ventricular valve replacement with Björk-Shiley 19 M at the age of 4 years was treated successfully with repeated re-replacement with St. Jude Medical 23M and St. Jude Medical 27M at the age of 8 years and 16 years respectively, because of his somatic growth. Two size larger valve was easily replaced at each operation. The original disease of this patient was corrected transposition of the great arteries with ventricular septal defect and regurgitation of the left atrio-ventricular valve caused by Ebstain anomaly and severe pulmonary hypertension. This case revealed that the annulus of the atrio-ventricular valve would grow even when fixed to the prosthetic valve sawing ring, thereby permitting the use of a larger-sized valve at the time of second and third prosthetic valve re-replacement.

Adolescent↗
PubMed1993

[Successful surgical management of postinfarction left ventricular free wall rupture in a case of systemic lupus erythematosus].

A 58-year-old woman of postinfarction left ventricular free wall rupture (LVFWR) was surgically treated with good results. She had been treated with Prednisolon for 15 years with the diagnosis of systemic lupus erythematosus. The rupture was noted six hours after the onset of myocardial infarction and she was taken to the emergent surgical intervention. During the operation, active bleeding was found in the higher anterior wall of the left ventricle and a Dacron graft was sutured to cover the infarcted area. The postoperative course was uneventful. This report seemed to be the first one of the successful surgical management of LVFWR in the course of the treatment for SLE in the literature.

Emergencies↗
PubMed1992

[Successful surgical treatment of subdural hematoma following mitral valve replacement].

A 56-year-old woman, followed after mitral commissurotomy, was admitted to the hospital because of congestive heart failure of NYHA IV. Cardiac catheterization demonstrated severe MSR and TR. MVR using a SJM prosthetic valve and TAP with DeVega's method were performed under cardiopulmonary bypass with moderate hypothermia (25 degrees C). Postoperative hemodynamic condition was good with a uneventful convalescence. But disturbance of consciousness was seen with gradual deterioration and anisocoria developed on the 4th postoperative day. CT scan revealed a subdural hematoma in the right frontal and parietal region. Irrigation of the hematoma was performed immediately by neurosurgeons. She resumed full consciousness and was discharged from the hospital without any sequelae on the 49th postoperative day. The importance of the early diagnosis and the immediate treatment for the subdural hematoma following open heart surgery was emphasized.

Extracorporeal Circulation↗