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Johji Fukada

Publications and source records attributed to Johji Fukada.

26 records · Page 2Linked to original sources
PubMed2003

Isolated cerebral perfusion for intraoperative cerebral malperfusion in type A aortic dissection.

Cerebral malperfusion due to expansion of a false lumen can occur acutely during aortic repair when retrograde femoral perfusion is initiated. We detected this catastrophe by a rapid decrease in regional cerebral oxygenation and successfully treated it by immediate isolation of the cerebral circulation from the systemic circulation. The surgical management, including the above technique, for this rare event is described.

Aged↗
PubMed2003

Acute type A aortic dissection with intestinal ischemia predicted by serum lactate elevation.

Mesenteric ischemia can complicate acute aortic dissection. We report a case of acute type A aortic dissection with perioperative intestinal ischemia, which clinically manifested on the second postoperative day. Serial monitoring of serum lactate level by a conventional blood gas analyzer was useful for early diagnosis and for timely treatment of intestinal ischemia. In this report, monitoring of serum lactate level as a key for the successful management of intestinal ischemia is suggested.

Acute Disease↗
PubMed2002

Descending or thoracoabdominal aortic aneurysm repair without intercostal vessel reconstruction using contrast magnetic resonance angiography: report of two cases.

Two high-risk patients underwent a graft replacement for descending thoracic or thoracoabdominal aortic aneurysms without the reconstruction of any intercostal and lumbar arteries. The first patient was an 81-year-old woman with asthma and renal dysfunction who was diagnosed to have a descending thoracic aortic aneurysm extending from the Th8 to Th12 level. Contrast magnetic resonance angiography (MRA) demonstrated the Adamkiewicz artery to originate from the left second lumbar artery. The second patient was a 59-year-old man with left ventricular dysfunction due to aortic and mitral stenoses who was diagnosed to have a Crawford type IV thoracoabdominal aortic aneurysm. Contrast MRA showed the Adamkiewicz artery to originate from the left ninth intercostal artery. In general, the reestablishment of the spinal cord's blood supply, whenever possible, is generally considered to be necessary in such patients to prevent spinal cord injury. However, the reimplantation of intercostal vessels is the most complex aspect of this surgical modality, and therefore, it may cause a substantial increase in the cardiopulmonary bypass time. However, at least in some cases, such as the two cases presented herein, the use of contrast MRA was found to reduce the risk in surgery for descending thoracic or thoracoabdominal aortic aneurysms by eliminating the need for any intraoperative management of the intercostal and lumbar arteries.

Aged↗
PubMed2002

Aortic root remodeling operation: how do we tailor a tube graft?

BACKGROUND: In aortic root remodeling operation, it is difficult to perform graft sizing and tailor a graft appropriately. Thus the aim of this study was to create guidelines for sizing and tailoring that would help to standardize the operation. METHODS: We studied the anatomy of the aortic root and assessed the reliability of three equations reported to assist in graft sizing with aortic root casts obtained from 127 cadavers. RESULTS: Yacoub's equation and ours accurately predicted the diameter at the sinotubular junction. Three cusps of the aortic valve were not equal in size. Sinus height of the aortic root was unpredictable. CONCLUSIONS: Based on these results, we recommend that aortic root remodeling operation should be performed as follows: (1) graft sizing should be performed using Yacoub's way or our way; (2) the tube graft should be cut into three parts in proportion to the size of each cusp; and (3) the position of the commissures in the tube graft should be secured with sutures first, and the depth of the sinuses should be determined later.

Adult↗
PubMed2002

Less-invasive thoracic aortic aneurysm repair.

To minimize surgical trauma, we performed graft replacement of a descending aortic aneurysm through a minithoracotomy (12 cm) with the use of thoracoscopy and special vascular clamps. Contrast magnetic resonance angiography can be useful for preventing postoperative paraplegia by revealing the Adamkiewicz artery. The patient was satisfied with the postoperative comfort and good cosmetic result. Further refinement of the technique and instrumentation would make this technique a valuable adjunct to conventional thoracic aortic surgery.

Aged↗
PubMed2002

Thoracoabdominal or descending aortic aneurysm repair after preoperative demonstration of the Adamkiewicz artery by magnetic resonance angiography.

OBJECTIVE: The outcome of thoracoabdominal or descending aortic aneurysm repair after preoperative demonstration of the artery of Adamkiewicz (ARM) by magnetic resonance angiography (MRA) was investigated. METHODS: Between January 2000 and December 2001, 40 consecutive patients who had aneurysms of the thoracoabdominal or descending aorta underwent preoperative MRA to visualize the ARM. Thirty-two patients underwent replacement of the aneurysms, and 25 patients (TAAA, 11; TAA, 14) underwent replacement of the aneurysms with preoperative detection of the ARM. Only intercostal or lumbar arteries in aneurysms, which were detected as the origin of the ARM, were reattached to the graft. The results of thoracoabdominal aortic aneurysm operations in 11 patients in whom the ARM was preoperatively detected (group I) were compared with the results of TAAA operations in 26 patients in whom the ARM was not preoperatively detected (group II). RESULTS: MRA demonstrated the ARM in 29 (73%) of the 40 patients. The laterality of the arteries originated from the left side in 29 (100%) and between Th9 and Th12 in 25 (86%), between Th9 and L1 in 28 (97%) of the 29 patients. No spinal cord injury occurred in patients (TAAA and TAA) in whom the ARM had been preoperatively detected. Major complications following TAAA operations included paraplegia (0% in group I and 8% in group II), respiratory failure (9% in group I and 23% in group II), and renal failure requiring hemodialysis (18% in group I and 22% in group II). Operation times were 439+/-99 min in group I and 620+/-200 min in group II (P=0.008). CONCLUSIONS: Preoperative detection of the ARM is possible by MRA and is very useful for reducing the incidence of ischemic injury of the spinal cord and for reducing the time of an operation for repair of an aneurysm of the thoracoabdominal or descending aorta.

Aged↗
PubMedDate not supplied

Preserved atrial response to dobutamine stress after the modified maze procedure for chronic atrial fibrillation: echocardiographic assessment of atrial function.

BACKGROUND: The maze operation is effective in varying degrees for the restoration of atrial function at rest. However, the atrial mechanical function under stressed conditions has not been investigated. METHODS: Thirteen patients who regained normal sinus rhythm after the modified maze procedure for atrial fibrillation (Af) associated with valvular disease were enrolled in this study. A two-staged, low-dose protocol (at doses of 5 and 10 microg/kg/min) of dobutamine stress echocardiography (DSE) was performed to assess the probability of the appearance of atrial wave in 20 consecutive beats (Paw), the velocity of atrial filling wave (Av), and the early filling wave (Ev) with their ratio (A/E), as well as the left atrial area fraction (LAAF) which represents an ejection fraction of the left atrium. RESULTS: Under resting conditions, Paw was 72% and 50% at tricuspid (T) and mitral (M) position, respectively. During dobutamine stress (5 microg/kg/min), Paw tended to increase both at T and M position (86% and 60%, respectively). Av was significantly accelerated by dobutamine stress (10 microg/kg/min) in both T (from 0.36 to 0.54 m/s) and M (from 0.46 to 0.69 m/s) valvular flow, which was accompanied by a significant increase in A/E (from 0.69 and 0.31 to 0.87 and 0.40, respectively). Although heart rate was significantly increased during dobutamine stress, LAAF remained at the same level (0.18, 0.22 and 0.19 at rest, 5 and 10 microg/kg/min) and atrial output was expected to be enhanced by dobutamine stress. CONCLUSION: Restoration of atrial mechanical function after the maze operation is accompanied by preserved response to dobutamine stress.

Adrenergic beta-Agonists↗