Biomedical subjects

M Otaki

Publications and source records attributed to M Otaki.

114 records · Page 7Linked to original sources

PubMedDate not supplied

Disseminated cholesterol embolism after coronary artery bypass grafting.

Blue toe syndrome caused by cholesterol emboli is a relatively benign disease. However, disseminated cholesterol embolism is a life-threatening condition. We describe here the case of a 71-year-old female admitted because of anterior chest pain and intermittent claudication. Following cardiac catheterization, warfarin potassium was administered. However, the patient's toes soon darkened bilaterally, and BUN and creatinine levels increased from the normal value. Skin discoloration and renal failure were improved after stopping warfarin potassium administration. The patient underwent coronary artery bypass grafting and left femoropopliteal bypass. Cerebral infarction and renal failure occurred postoperatively due to disseminated cholesterol embolism. The patient died from renal failure on the 16th postoperative day without regaining consciousness following surgery. For high risk patients, interventional procedures to the ascending aorta must be avoided. When CABG cannot be avoided for coronary revascularization, off-pump bypass and use of arterial grafts are recommended.

Aged↗

PubMedDate not supplied

Cardiac pacing induced flow responses in internal thoracic artery and saphenous vein coronary artery bypass grafts.

The flow reactivity of an internal thoracic artery (ITA) graft and a vein graft for multiple coronary beds in response to different modes of cardiac pacing remains unclear. These experiments were conducted in 14 anesthetized dogs with the ITA or the vein grafted to the circumflex coronary artery, off pump, using a brief local occlusion. The left main coronary artery was occluded, rendering the entire left ventricle totally dependent upon the ITA graft or the vein graft. When the left main coronary artery was occluded and the heart rate was 120 beats per min, graft flow was 93.4 +/- 9.6 ml per min in the ITA, and 96.1 +/- 10.4 ml per min in the vein graft. Atrial pacing to increase heart rates 25% to 150 beats per min increased both the ITA graft flow (110.3 +/- 9.7 ml per min, p < 0.05 versus flow in sinus rhythm) and the vein graft flow (109.8 +/- 7.9 ml per min, p < 0.05 versus flow in sinus rhythm). The increases in flow in both cases were not attributable to changes in perfusion pressure. In contrast, ventricular pacing to the same heart rate decreased systemic pressure slightly, but insignificantly. Despite the slight decrease in perfusion pressure, ventricular pacing increased ITA flow (107.9 +/- 8.4 ml per min, p < 0.05 versus flow in sinus rhythm), but the increase in vein graft flow was not significant compared with flow in sinus rhythm (102.1 +/- 7.3 ml per min, p = ns versus flow in sinus rhythm).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMedDate not supplied

Prosthetic valve endocarditis. An analysis of the outcome in 32 cases.

To evaluated the clinical results and risk factors with prosthetic valve endocarditis (PVE), we reviewed data on 32 patients who were hospitalized over a period of 10 years because of prosthetic valve dysfunctions secondary to endocarditis. The linearized incidence of PVE was 0.89% per patient year. Overall mortality was 34% (11 of 32 patients). However, the mortality differed depending upon the factors associated with PVE: medical treatment alone (100%, p < 0.001), early onset within 12 months (53%, p < 0.05), and complication with systemic emboli (80%, p < 0.05). In contrast, anatomic valve position, mechanical valves, female gender, microorganisms, and conduction abnormality did not appear to be significant risk factors. In the 25 patients with medical-surgical therapy, there were 4 operative deaths (16%, 4 of 25 patients). Pre operative New York Heart Association Class IV (p < 0.05) and reoperations on an urgent basis (p < 0.04) had a significant correlation with the operative mortality. On the basis of these results, the outcome of PVE can be improved if conditions predisposing to myocardial damage or complications leading to deaths are prevented with initial treatment by antibiotics and subsequent surgical intervention.

Adult↗

PubMedDate not supplied

A comparative study in patients with Omnicarbon and Björk-Shiley heart valve replacement.

To compare the Omnicarbon heart valve and the Björk-Shiley spherical valve, operative results, hemodynamic parameters and late results were examined after mitral valve replacement. There were no early deaths, and 6 late deaths in the Omnicarbon valve (2.9% per patient-year). The actuarial survival rate at 6 years was 82.1 +/- 4.8% and freedom from valve-related complications was 86.4 +/- 2.2%. Pressure gradients and effective mitral valve areas at rest calculated by Gorlin's formula were satisfactory in both valve. Cardiac index (l/min/m2) was slightly changed according to the pacer-induced tachycardia, but there was a significant decrease in 160 bpm in the Omnicarbon valve (2.01 vs 2.39, p < 0.05). Peak pressure gradients and pressure half time by Doppler echocardiography, revealed the same trends as those of the Björk-Shiley valve during tachycardiac exercise, though regurgitant flow was detected in 7 patients in 160 bpm in the Omnicarbon valve, while in 2 in the Björk-Shiley valve (28% vs 10%, p = ns). Phonocardiographic study demonstrated that aortic closure to mitral opening click (AC-OpC) interval and Q wave of the electrocardiogram to mitral closing click (Q-CC) interval, which were related to the mitral valve gradients, fell within the normal range in both valves. However, the Björk-Shiley valve compared favorable to the Omnicarbon valve in the AC-OpC interval (70.9 msec vs 76.8 msec, p < 0.05). Hemolysis was of no clinical importance in the intact function of the Omnicarbon valve.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

Candida prosthetic valve endocarditis. An autopsy review.

Fungal endocarditis after cardiac surgery has been noticed increasingly in the past decade. We report a case of Candida parapsilosis endocarditis after mitral valve replacement in a patient with no predisposing factors. In this report we mainly examined the pathological findings in this patient with post-mortem examination.

Autopsy↗

PubMedDate not supplied

Spontaneous and time-related degeneration of Carpentier-Edwards bioprosthesis in mitral position.

To assess the spontaneous and time-related degeneration of the Carpentier-Edwards (C-E) bioprosthesis at 13 years after implantation, the cases of 48 patients who had undergone mitral valve replacement with C-E bioprosthesis are examined. The time-related clinical findings were started from a new rumbling murmur at an average of 5.9 years. The time-related change of transmitral flow was assessed by pressure half time and peak pressure gradient on pulsed Doppler cardiography, and pressure gradient and effective mitral valve area on cardiac catheterization. These values were expressed as an identical linearized curve: pressure half time Y = 13.3 X +41.9, peak pressure gradient Y = 1.47 X +1.25, pressure gradient Y = 1.90 X -3.79, mitral valve area Y = -0.87 X +1.39. From the combined evidence presented by these results, the initial structural deterioration of C-E bioprosthesis is stenotic change of the cusp, not tear or laceration, and correlates well in length of implantation, as evidenced by a linear curve. We are encouraged that the lack of catastrophic prosthetic valve failure, as has been associated with the pericardial valve, affords the opportunity for an elective safe reoperation.

Adult↗