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Biomedical subjects

M Otaki

Publications and source records attributed to M Otaki.

At least 73 records · Page 4Linked to original sources
PubMed1991

[Surgical repair of Scimitar syndrome with azygos connection by extracardiac conduit between right pulmonary vein and left atrium].

We present a surgical case of 41-year-old woman with Scimitar syndrome. Preoperative catheterization showed azygos connection and L-R shunt ratio of 45% without intracardiac malformations. To our knowledge, this combination has not been previously reported. At operation the right single pulmonary vein was found and drained into the inferior vena cava below the diaphragm. Because of counter clockwise rotation of the heart the distance of the scimitar vein and the left atrium was too long for direct anastomosis, a polytetrafluoroethylene tube (10 mm in diameter) was utilized for an extracardiac conduit using cardiopulmonary bypass. Postoperative course was uneventful. We conclude that this technique is effective for this syndrome with a large amount of L-R shunt and a sufficient patency is expected.

Adult↗
PubMed1991

[Left ventricular-right atrial shunt due to infective endocarditis--report of a case].

Acquired left ventricular-right atrial shunt is a very rare cardiac disease. Infective endocarditis, cardiac operative procedures, and thoracic trauma were reported as origins. We report a case of a patient with left ventricular-right atrial shunt due to infective endocarditis. A 53-year-old male who had aortic regurgitation due to infective endocarditis developed suddenly severe congestive heart failure. Two-dimensional and pulsed doppler echocardiography demonstrated left ventricular-right atrial shunt. Emergency operation was done. The fistula was found through the atrioventricular membranous septum. The position from the left view was just below the commissure between the right coronary cusp and non coronary cusp and the opening position from the right view was just above the septal leaflet of tricuspid valve. Aortic valve replacement and direct closure of fistula were done and patient's recovery was uneventful. Case reports of left ventricular-right atrial shunt due to infective endocarditis have been rarely seen, most of which were followed by poor prognosis. Surgical intervention in acute phase is recommended.

Endocarditis, Bacterial↗
PubMed1991

[Clinical experience of autotransfusion of shed mediastinal blood using a new chest drainage unit].

The autotransfusion system (ATS) of shed mediastinal blood is expected as one of the techniques for non-blood open heart surgery. The ATS which has been used previously for this purpose required such items as cardiotomy reservoir, vacuum bottle, infusion pump and was complicated to manipulate. This time we have used a new chest drainage unit, Sentinel Seal Autotransfusion System (Sherwood Medical Co.), and report our clinical experience. This unit consists of two component parts. One is a blood collection bag which is later used for reinfusion of shed blood. The other part is a regular chest drainage unit with the water seal which protects pleural cavity from atmosphere. We used this system for 24 cases of open heart surgery and studied about the hematological and biochemical changes after reinfusing the shed blood postoperatively. There were no complications and side effects related to the reinfusion. The unit we have used is simple to handle and is useful when returning shed blood. We believe that this unit is quite safe for clinical use and that it will become a new strong support for non-blood open heart surgery.

Blood Chemical Analysis↗
PubMed1990

[A case report of the reinforcing technique with collared prosthesis for the prosthetic valve endocarditis in mitral position].

A 58-year-old female was admitted to our hospital because of the prosthetic valve endocarditis in mitral position. In the past, this patient was undertaken double valve replacement in mitral and aortic position. Nevertheless, postoperative course was not in stable condition, showing persistent sign of the infection. The appearance of mitral regurgitant murmur and regurgitant signal by colour Doppler cardiography could make sure of the diagnosis for prosthetic valve endocarditis (PVE) in mitral position. The operation for PVE in mitral prosthesis was undertaken as follows. As there was extensive annular infection around the mitral valve, the new mitral prosthesis (Duromedics valve) with the Gore-tex flange, so called collared prosthesis, was revised. The collared prosthesis was implanted in the mitral annulus by using the suture ring of the Duromedics valve as well as possible, furthermore, the Gore-tex flange were sutured in the left atrial wall 2 cm above the mitral ring. Postoperatively, the infection sign and congestive heart failure were completely subsided. This patient has been in very healthy condition these days and restored to the daily life.

Endocarditis, Bacterial↗
PubMed1990

[A case report of surgical treatment of prosthetic valve endocarditis in tricuspid position].

A case of right sided prosthetic valve endocarditis in tricuspid position was presented. This 38-year-old male underwent tricuspid valve replacement (TVR) with SJM (31 mm) prosthetic valve because of tricuspid valve endocarditis caused by staphylococcus epidermidis five years ago. At the beginning of this year, 1989, he was admitted with complain of high fever and bloody sputa. Doppler color imaging showed prosthetic valve was stenotic whose pressure gradient was 16 mmHg in peak pressure gradient, but vegetation was not identified. Following with gastrectomy perhaps due to AGML, re-TVR was done with Carpentier-Edwards vale (31 mm). He was discharged without any problems. It seems important to determine the timing of re-operation before leading any complications.

Adult↗
PubMed1990

[A case of constrictive pericarditis due to traumatic pericardial hematoma].

Although the cause varies widely, we recently experienced a case of constrictive pericarditis of which cause seemed to be traumatic as described below. The patient was a 62-year-old man having a history of epigastric trauma about 20 years ago. Since then, palpitation appeared and he was recently hospitalized in our department for the purpose of receiving an operation under the diagnosis of constrictive pericarditis. At operation, a hematoma was found in the pericardial region, which was considered to have been caused by trauma in the past. Less reports have so far been available concerning trauma-induced constrictive pericarditis and this case thus seemed to be of rarity as well.

Constriction, Pathologic↗
PubMed1990

[Experimental evaluation for tricuspid annular constriction with the model of tricuspid annular dilatation].

We have obtained the good result about tricuspid annular constriction (TAC) for secondary tricuspid insufficiency. The purpose of this study is to investigate the effectiveness of TAC for the experimental model of tricuspid annular dilatation. First of all, tricuspid annular dilatation was made surgically in 8 mongrel dogs by placing 8 incisions to tricuspid annulus except septal cusp under the condition of heart-lung preparation. On clinical evaluation, septal annulus was kept to be intact in many cases compared with the two other areas. This experimental model of tricuspid annular dilatation was considered to be substituted to the clinical model of tricuspid annular dilatation. TAC suture was surrounded circumferentially around the dilated tricuspid annulus. And then, TAC suture was pulled out from the right atrial wall, and the circumferential length of tricuspid annulus was completely accommodated by pulling the TAC suture. The hemodynamic status was observed by right atrial pressure (V wave and mean) and right ventricular end-diastolic pressure (RVEDP). After heart resuscitation and gradual increase of preload, right atrial pressure was significantly elevated especially right atrial pressure (V wave) compared with control values. When 2 cm of circumferential length of tricuspid annulus on an average was constricted by shortening of TAC suture, right atrial pressure was significantly decreased, and then RVEDP tended to decrease. It was shown that TAC was an effective operative technique for the secondary tricuspid annular dilatation and tricuspid insufficiency from the standpoint of experimental aspect as well as clinical results.

Animals↗
PubMed1990

[A study of tricuspid-tailoring annular constriction in autopsy cases--cases which appear to embody limitation of tricuspid-tailoring annular constriction].

We our department have performed tricuspid-tailoring annular constriction (T-TAC) as salvage operation for secondary tricuspid regurgitation (TR) with gratifying results. Of those cases undergoing MVR and T-TAC for mitral valve regurgitation (MR) and secondary TR with an associated severe cardiac cachexia, 2 autopsy cases in which an associated severe cardiac cachexia, 2 autopsy cases in which residual tricuspid regurgitation culminated in patient's death long after operation were investigated. In Case 1, the patient was discharged asymptomatic 2 months after operation, but later developed severe left heart failure and marked tricuspid regurgitation as precipitated by upper respiratory tract infection and died from exacerbation of LOS before undergoing a scheduled reoperation. T-TAC was found successful on autopsy. In Case 2, the patient died of long-persisting left heart failure and severe residual tricuspid regurgitation after following a similar postoperative course to that in Case 1. On autopsy stitches made through the tricuspid anterior leaflet, septum and posterior leaflet were found untied and loosened and the tricuspid annulus diameter increased. In severe valvular heart disease, even if T-TAC has proven successful, aggravation of cardiac failure may lead to the development of TR. Because of the fragility of myocardial tissue due to severe myocardial damage in such compromised patients, sophisticated operative techniques need to be devised. Cases illustrative of a limited long-term success of T-TAC used alone are presented.

Constriction↗
PubMed1989

[Operative indication for aortic valvuloplasty by rasping procedure from the point of histopathologic evaluation].

Rasping procedure is proposed by the author as one of the methods of aortic valvuloplasty and defined as shaving the surface of rheumato-degenerative aortic valve by using the electric rasp. Materials were the removed rheumato-degenerative aortic valves as specimen, and classified into 3 groups. The first group (type I) was valve lesion limited to valve free edge, second (type II) was mild thickening entirely, third (type III) was severe thickening with calcified degeneration. Rasping procedure was performed for the thickened portion of the valve specimen by the electric rasp. Morphologic examinations after rasping procedure were evaluated by histopathologic study. Histopathologically, there was hyaline degenerative connective tissue in superficial layer above the collagen fiber's layer in rheumato-degenerative thickened valve in type I. This hyaline degenerative connective tissue was considered to be fragile and pathologic in the tissue structure. Rasping procedure could remove this connective tissue layer. Type II, there was the similar finding to the type I from the free edge to the mid portion of the cusp. So, Rasping procedure was effective for type I and type II valve degeneration. On the contrary, the calcified lesion (type III), rasping procedure was not effective in valve coaptation and the pathological findings showed the fragmentation in the calcified layer. In the pathological comparison with the slicing procedure for type II by the surgical knife, there was a crack and cleft in the collagen fiber's layer in the case of slicing procedure. It can be concluded the results of histopathological study of the rasping procedure proved to be superior to the conventional aortic valvuloplasty (slicing method).

Aortic Valve↗
PubMed1989

[Coronary artery stenosis following aortic valve replacement--a case report].

A case with severe left main trunk (LMT) stenosis nine months after aortic valve replacement was presented. The patient, 57-year-old female, underwent aortic valve replacement with a tilting disk valve (Omnicarbon 21 A). Her postoperative course was uneventful, but angina pectoris developed after nine months. Coronary angiography was performed and revealed 99% LMT stenosis. Operation was performed with OTCA to LMT and with a saphenous vein graft to left anterior descending artery. Coronary artery stenosis following aortic valve replacement may be dangerous and it must be treated as soon as the diagnosis is established.

Aortic Valve↗
PubMed1989

[Clinical evaluations of surgical treatment of infective endocarditis].

This paper shows the clinical evaluations of surgical and medical treatment of infective endocarditis (IE). IE occurred in 33 cases (10.1%) among 372 cases of valve replacement. Of all the 33 patients, IE was consisted of native valve endocarditis (NVE) and prosthetic valve endocarditis (PVE). IE was evaluated as for the microorganism, complication, operative indication and operative mortality. At first, all of NVE underwent surgical treatment, active phase endocarditis 4 and healed endocarditis 14. Microorganism was streptococcus aureus in an overwhelming majority. Operative indications was congestive heart failure in almost all cases, next to vegetation and infection resistant to medical treatment. Operative mortality was 5.6% (1 out of 18 cases), which case was in the septic shock and cerebral bleeding prior to the surgical treatment. The others was satisfactory condition postoperatively. Next of PVE, PVE happened in 15 cases, in which there were 5 cases of bioprosthetic PVE and 10 cases of mechanical valve PVE. Microorganism for PVE was staphylococcus epidermidis in the major part (60%). Mortality in PVE was 53.3% (8 out of 15), but mechanical valve PVE was worse in prognosis than bioprosthetic PVE. Cerebral complications occurred in 3 cases of mechanical valve PVE, on the other hand there was no cerebral complication in bioprosthetic PVE. As for the hemodynamic change in PVE, mechanical valve PVE had the tendency to take the prompt or sudden deterioration of hemodynamics caused by endocarditis surrounding the suture ring, especially in mitral position, on the contrary hemodynamic deterioration was gradually proceeded in bioprosthetic PVE. UCG made much of the diagnosis of PVE, especially in mechanical valve PVE, in which cases endocarditis was recognized only surrounding the suture ring. PVE takes the miserable outcome in many cases, so carefully observation is necessary in order not to lose the timing of the surgical treatment.

Adult↗
PubMed1989

[Time-related degeneration of Carpentier-Edwards bioprosthesis in mitral position].

Carpentier-Edwards bioprostheses have been shown to provide a low incidence of valve-related complications, especially thromboembolism, but the durability has caused the serious concern. This report suggests that Carpentier-Edwards prostheses have been gradually degenerative, and stenotic degeneration and the year after operation are well correlative. In Osaka National Hospital, Carpentier-Edwards prostheses were implanted in 89 patients in mitral position from 1973 to 1981. Of all the patients, 50 patients were undertaken to single valve replacement in mitral position and could be followed up in our department. For a total of 50 patients, materials are 30 patients who could be detected by clinical findings, pulsed Doppler echocardiography, cardiac catheterization and soft X-ray evaluation in explanted prostheses at reoperation. Follow-up duration was ranged 4.2 to 12.1 years with a mean duration of 7.94 years. The age ranged from 32 to 71 years of age. The initial diagnosis of the time-related degeneration was the appearance of newly acoustic rumbiling murmur. Furthermore, regurgitant murmur, arrythmia (atrial fibrillation) and cardiac enlargement were followed in addition to rumbling murmur. The assess of the transmitral flow such as pressure half time and peak pressure gradient by pulsed Doppler echocardiography was the easy way to evaluated the time-related degeneration. Time-related stenotic change by pulsed Doppler was expressed as a linearized curve. At 6 years and below valve function seemed not to be impaired but stenotic dominant degeneration with the cusp tear was prominent beyond 7 years. Cardiac catheterization data could make sure of the pulsed Doppler findings by assessing mitral valve gradient and mitral valve area.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[The determinant factors for open heart surgery with non-blood transfusion--analysis by quantitative theory class II].

The serious complications in the field of cardiovascular surgery are the blood transfusion related problems such as post transfusion hepatitis, AIDS, GVHD and immunosuppressed conditions. These problems have not been settled so far. In our department, open heart surgery with non-blood transfusion is the final goal and extracorporeal circulation with non-blood priming has been indicated under normal conditions. However depending on the cases, blood transfusion is definitely required. Under such circumstances, we analyzed the determinant factors as to whether open heart surgery with non-blood transfusion may be indicated or not, according to the formula based on the quantitative theory (class II). Extracorporeal circulation with non-blood priming were indicated on 124 patients in our department, and they were divided into two groups; blood transfusion group (group I): 64 patients, and non-blood transfusion group (group II): 60 patients. These two groups were compared for study in terms of age, preoperative weight, the body surface area, preoperative Ht value, calculated Ht value at the start of extracorporeal circulation, the aortic cross-clamping time, the total extracorporeal circulation time and total bleeding amount. The following are described in the order of importance. 1) Calculated Ht value: more than 30%. 2) The amount of blood loss after ECC is removed: less than 500 ml. 3) Preoperative body weight: more than 50 kg. 4) Preoperative Ht value: more than 40%. 5) The total ECC time: less than 90 min. In addition, prospective factors which should be considered preoperatively are determined in the following orders. 1) Calculated Ht value. 2) Preoperative Ht value. 3) Preoperative body weight.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Transfusion↗
PubMed1989

[A comment on optimal shaped prosthesis for tricuspid valve using an experimental model].

The prosthesis for mitral valve has been in use instead of the prosthesis for tricuspid valve, since the latter prosthesis has not at present been available. In view of the shape of tricuspid valve, which is essentially flat in form, it is not good for replacing with the prosthesis for mitral valve which has an almost circular shape because of the difficulties in suturing, and many criticisms on this substitution have been raised. In order to obtain more suitable prosthesis as exactly benefits TVR, we have developed at first an instrument indicating the change of cardiac function occurring in the course of fixing the annulus of tricuspid valve that would undergo the difference in shape from circular to flat, using experimental models throughout, which has eventually led to the exploration of the possible exact shape of a prosthesis of the annulus for tricuspid valve. Our series of experiments proved as conclusion that the annulus of tricuspid valve is more advantageous when fixed with an ellipse of a flattened rate 1.6 compared with any circular ones tested. In view of the left ventricular stroke work, it is apparent that a prosthesis for mitral valve which is circular in shape should not be applied. We emphasize that a prosthesis for tricuspid valve which is ellipse in shape with desired flattened rate of 1.6 should be developed for our future applications.

Animals↗
PubMed1989

[Application of a large occlusion balloon catheter to re-do open heart surgery].

A very rare case having re-do open heart surgery four times during two years was reported. The case was 30 year-old-male complicated with aortitis syndrome and underwent mitral valve replacement because of infective endocarditis. But the prosthetic valve repeated detachment over and over again after first MVR in spite of complete treatment of steroid for aortitis syndrome. When fourth re-operation, it was easily expected that median sternotomy, cannulation and clamping would be difficult because of tough adhesion. So large occlusion balloon catheter was used to clamp the ascending aorta and operative field was exposed by left thoracotomy under femoro-femoral bypass. We could accomplish the operative procedure safely under "instrument free" operative field. Large occlusion balloon catheter is very useful for aortic clamping in case of not only reoperation but calcified aorta and so on.

Adult↗
PubMed1988

Extensive spinal necrosis with spinal leptomeningeal dissemination of cerebral astrocytoma. Case report.

A 58-year-old male with malignant astrocytoma in the right parietal lobe developed ascending spinal dysfunction 15 months after subtotal resection of the primary lesion. He was treated by postoperative radiation and combined chemotherapy. Autopsy revealed extensive spinal necrosis affecting the level below the lower cervical region. Microscopic examination demonstrated diffuse leptomeningeal metastasis of glioma cells to the whole spine. There was no previous report in the literature of massive myelomalacia attributable to leptomeningeal dissemination an astrocytic supratentorial tumour. Clinical and neuropathological findings suggested that disturbance of venous drainage of the spinal cord might be responsible for myelomalacia in this case.

Astrocytoma↗