[Application of the vascular endoscope and CUSA system to myocardial squeezing].
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Biomedical subjects
Publications and source records attributed to M Atobe.
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The clinical features of 205 cases of rheumatic heart disease in Bangladesh, including unique two-dimensional echocardiographic findings, were reported, and these were compared with those of 387 Japanese cases. The percentage of mitral stenosis (MS), aortic valvular diseases including both aortic stenosis and aortic regurgitation (A), mitral stenosis with aortic valvular diseases (MS + A) were almost the same between the two countries, but that of mitral regurgitation (MR) was higher, mitral stenosis and regurgitation (MSR) was lower in Bangladesh. The mean age of the patients with mitral valvular diseases was very young and the incidence of atrial fibrillation was very low in Bangladesh. Males predominated over females in MS (male/female = 1.2/1) and the incidence of pulmonary hypertension in MS was higher in Bangladesh. A two-dimensional echocardiographic examination showed that the rough zone was heavily involved in the rheumatic process with having a narrow mitral valve orifice while the clear zone was relatively spared and pliable in many patients with MS in Bangladesh. In MR, posterior mitral leaflets were shortened and made immobile by its submitral complex which were also thickened, fused and shortened, and these resulted in a gap or non-coaptation of the two leaflets in many patients.
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Coupling valve grafting, a procedure to enlarge the annulus of the aortic valve and of the mitral valve simultaneously, is described. It consists of extending the J-shaped aortotomy through the middle of the noncoronary cusp into the superior aspect of the left atrium and down the anterior leaflet of the mitral valve. Then the mitral and aortic valves are replaced with a coupling valve graft, a vascular prosthesis attached to two prosthetic valves. This technique seems to be most suitable for patients in whom the valves of both annuli are narrow, as is often seen in aortic and mitral stenosis. Since both valve annuli can be enlarged greatly in this procedure, combinations of prosthetic valve sizes can be freely chosen for the two valves.
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