Biomedical subjects

Masaru Yoshikai

Publications and source records attributed to Masaru Yoshikai.

15 recordsLinked to original sources

PubMed2006

Stenosis of the bicuspid aortic valve with systemic lupus erythematosus.

We herein present a rare case of severe aortic valve stenosis with a bicuspid valve in a patient with systemic lupus erythematosus. The symptoms resulted from aortic valve stenosis, such as chest pain, dyspnea and syncope, which subsided after the insertion of an intra-aortic balloon pump. Thereafter, a calcified bicuspid aortic valve was successfully replaced with a mechanical valve. The pathological findings of the resected valve included irregular fibrotic thickening and marked calcification without any vegetation or thrombus formation. The efficacy of an intra-aortic balloon pump for the relief of symptoms associated with severe aortic valve stenosis indicates its usefulness for such critically ill patients prior to undergoing valvular surgery.

Aortic Valve↗

PubMed2006

Surgical revascularization for acute coronary syndrome: comparative surgical and long-term results.

OBJECTIVE: The purpose of this study was to evaluate the adequate timing of coronary artery bypass grafting (CABG) for acute coronary syndrome (ACS). METHODS: In our institution, emergency CABG has been avoided when possible for ACS patients favoring stabilization with medical therapies, including intra-aortic balloon pumping or percutaneous coronary intervention. After thorough preoperative examinations, an urgent CABG is performed. A total of 67 patients with ACS underwent CABG, comprised of 33 patients receiving an emergency CABG (emergent group: E-G) and 34 patients receiving an urgent CABG (urgent group: U-G). The early and long-term results were evaluated retrospectively. RESULTS: Preoperatively, the incidences of acute myocardial infarction and cardiogenic shock were significantly higher in E-G. No significant differences were found in the intraoperative factors except for the number of distal anastomoses (2.5 in E-G vs. 3.1 in U-G, p=0.01). The hospital mortality was 9.1% in E-G, and 2.9% in U-G, with no significant difference between the groups. Moreover, no patient in U-G necessitated emergency CABG while waiting for surgery. The patency rate of the grafts was 100% in E-G, and 96.2% in U-G. The 5-year survival rate excluding in-hospital death was 80.3% in E-G, and 78% in U-G (p>0.05). The 5-year cardiac event-free rate was 80.3% in E-G, and 80.9% in U-G (p>0.05). CONCLUSION: An emergency CABG can be reserved for ACS patients when symptoms and hemodynamic state are stabilized with medical therapies. Improvements in long-term results can be expected after high quality and complete surgical revascularization.

Aged↗

PubMed2006

Aortic dissection late after aortic valve replacement.

We experienced 3 cases of an aortic dissection occurring late after an aortic valve replacement, and successfully treated by an aortic root replacement. An aortic dissection involving the ascending aorta can develop late after an aortic valve replacement, and such an occurrence is associated with a high mortality and morbidity. The development of effective surgical strategies at the initial aortic valve surgery, strict control of blood pressure after aortic valve replacement, serial evaluations of aortic size, and the prophylactic replacement of the ascending aorta for patients with aortic dilatation after aortic valve replacement, all play clinically important roles in preventing an aortic dissection after aortic valve replacement. When an aortic dissection occurs in patients with a previous aortic valve replacement, an aortic root replacement should be performed in order to avoid leaving the fragile diseased aortic wall including the sinus of Valsalva.

Adult↗

PubMed2006

Complete rupture of the posterior papillary muscle caused by late reperfusion for acute myocardial infarction.

We describe a patient with acute mitral regurgitation due to complete rupture of the papillary muscle immediately after successful late reperfusion for inferior myocardial infarction. An 81-year-old woman was admitted complaining of mild chest discomfort. Although the electrocardiograms, biochemical test results, and her clinical history showed that several days had passed since the onset of acute myocardial infarction, a late coronary stenting was performed. Immediately after successful stenting, she suddenly developed acute pulmonary edema, leading to cardiogenic shock. In addition to high pulmonary capillary wedge pressure (mean 35 mmHg), color Doppler imaging revealed massive mitral regurgitation caused by complete rupture of the posterior papillary muscle. Emergent mitral valve replacement with a prosthetic valve was performed, saving the patient. Hence, late reperfusion should be considered carefully when treating a patient with a high risk, such as an elderly patient or a patient with single-vessel disease or initial transmural myocardial infarction.

Aged, 80 and over↗

PubMed2006

A safer technique of aortic root replacement after aortic valve replacement.

Aortic root replacement after aortic valve replacement (AVR) is often complicated by bleeding around the aortic root, which increases the risk of morbidity and mortality, making it a technically challenging procedure. We describe a new technique of aortic root replacement designed to minimize bleeding around the aortic root. This surgical technique focuses on safe dissection and exposure of the aortic root to avoid inadvertent entry into the right atrium or right ventricle; on modifying the proximal anastomosis of the graft to the aortic annulus; and on performing a coronary artery reimplantation that achieves complete hemostasis at the suture lines. We performed aortic root replacement after AVR in four patients over a 4-year period, without encountering any bleeding around the aortic root.

Adult↗

PubMed2004

Dual left anterior descending coronary artery: report of a case.

We report a case of Type I dual left anterior descending artery (LAD) successfully treated by coronary artery bypass grafting including the long LAD. This rare coronary artery anomaly is of clinical importance in the field of myocardial revascularization.

Angina Pectoris↗

PubMed2004

Papillary fibroelastoma of the tricuspid valve.

A 72-year-old male patient was admitted with chest oppression. Echocardiography disclosed a mobile tumor which was located on the atrial side of the tricuspid valve. Neither tricuspid obstruction nor regurgitation was observed. The mobility and the size, 20 mm in diameter, of the tumor indicated the need to perform surgical treatment. Through a right atriotomy, the tumor with multiple papillary fronds was found on the basal zone of the anterior leaflet. A resection of the tumor and tricuspid valvuloplasty with a partial annular reconstruction were performed. A pathological examination confirmed papillary fibroelastoma. He had an uneventful recovery, and postoperative echocardiography detected neither any residual tumor nor tricuspid regurgitation. In conclusion, it is reasonable to state that echocardiography is useful for detecting cardiac tumors, and a surgical resection is indicated for a mobile or large papillary fibroelastoma even when it is located on the right side of the heart.

Aged↗

PubMed2004

Coronary artery aneurysm with systemic lupus erythematosus.

Coronary artery aneurysms rarely develop in patients with systemic lupus erythematosus. We herein describe a case of a right coronary artery aneurysm associated with systemic lupus erythematosus. A 49-year-old woman with known systemic lupus erythematosus presented with an acute myocardial infarction. A coronary artery aneurysm and thrombo-occlusion in the right coronary artery necessitated percutaneous coronary intervention. She experienced three myocardial infarctions during the following two months. A coronary artery dissection occurred during the percutaneous coronary intervention at the time of the last myocardial infarction, and emergency coronary artery bypass grafting was successfully performed. Difficulties in treatment with percutaneous coronary intervention and the fact that arteritis is a possible cause of a coronary artery aneurysm may indicate that surgical therapy, including coronary artery bypass grafting with or without the obliteration of an aneurysm, is the treatment of choice for a coronary artery aneurysm with systemic lupus erythematosus.

Aneurysm↗

PubMed2004

Endothelial integrity of ultrasonically skeletonized internal thoracic artery: morphological analysis with scanning electron microscopy.

OBJECTIVE: The skeletonized internal thoracic artery (ITA) has several advantages over a pedicled one in coronary artery bypass grafting (CABG). An ultrasonic scalpel makes ITA skeletonization easy and speedy, however, the ultrasonic energy that is transmitted to the artery itself can occasionally injure the endothelium. Therefore, the endothelial integrity of the ultrasonically skeletonized ITA is a major concern related to this technique. The purpose of this study is to assess the endothelial integrity of the ultrasonically skeletonized ITA. METHODS: We skeletonized the left ITA with an ultrasonic scalpel in nine patients who underwent CABG, and thereafter the terminal portion of this artery was subjected to a morphological study. The endothelial integrity of this artery was morphologically assessed using scanning electron microscopy, and the results were compared to that of the left ITA skeletonized with fine scissors. RESULTS: All ITA specimens showed a completely confluent endothelium, and no endothelial injury was observed by the scanning electron microscopic study. CONCLUSIONS: The skeletonization of the ITA with an ultrasonic scalpel had no deleterious effect on the endothelium. This morphological study confirmed the safety and the reliability of this technique, and we therefore recommend its clinical use in the skeletonization of the ITA for CABG.

Endothelium, Vascular↗

PubMed2004

Aortic valve regurgitation in alkaptonuria.

Aortic valve lesions associated with alkaptonuria tend mostly to be due to aortic valve stenosis, while aortic valve regurgitation is only rarely observed. Herein, a case is reported of severe aortic valve regurgitation and a fibrous strand in a patient with alkaptonuria. A 65-year-old male, with a history of inferior myocardial infarction, presented with symptoms of congestive heart failure. Alkaptonuria was diagnosed based on urine coloration, skin pigmentation and ochronotic arthropathy in the vertebrae and hip. Grade IV aortic valve regurgitation with mild aortic valve stenosis and occlusive disease in the right coronary artery indicated a need for aortic valve replacement and coronary artery bypass grafting. Sclerotic change in the cusps, and shrinkage of the non-coronary cusp, impeded normal coaptation of the aortic valve, and the left-coronary cusp also had a fibrous strand suspending the free margin of the cusp from the aortic wall just above the commissure. The sclerotic change in the cusps, and shrinkage of the non-coronary cusp, appeared to be the causative lesion of aortic valve regurgitation, implying that cardiovascular ochronosis may cause aortic valve regurgitation.

Aged↗

PubMed2003

Passing the right internal thoracic artery through the transverse sinus.

We describe a simple reliable method to pass the right internal thoracic artery safely through the transverse sinus. At first, a 4-mm-wide vascular tape is passed through the transverse sinus. The cut end of the right internal thoracic artery is then attached to the right end of the tape with a hemoclip. Pulling the left end of the tape leftwards can ensure the passage of the right internal thoracic artery without any risk of twisting.

Humans↗

PubMed2003

Left ventricular myxoma originating from the papillary muscle.

A rare case of left ventricular myxoma presenting embolization into the brachial artery is reported. The sessile tumor originated from the posteromedial papillary muscle and involved the chorda supporting the posterior mitral leaflet. Complete excision of the tumor with the posterior head of the posteromedial papillary muscle, with the chorda and with the posterior mitral leaflet necessitated valve replacement. The tumor was well visualized by the superior-septal and transaortic approaches. These enabled exploration of all four cardiac chambers so as not to overlook any multifocal myxoma. The left ventricular myxoma should be completely resected with the surrounding endocardium in order to avoid recurrence of the disease.

Cardiomyopathies↗

PubMed2002

Coronary artery bypass grafting to a calcified right coronary artery.

A severely calcified coronary artery demands a special technique in coronary artery bypass surgery. We have successfully developed a "punch-out" technique for a calcified right coronary artery in a dialysis patient. After an incision into the target coronary artery, the calcified arterial wall was resected using a punch to make an oval hole for anastomosis. Limited endarterectomy, which consisted of dissection and removal of the calcified endothelium and media around this hole, preserving the adventitia, enabled the anastomosis. This technique can be used for a severely calcified coronary artery that is unamendable to conventional coronary artery bypass grafting.

Calcinosis↗

PubMed2002

Splenic abscess associated with active infective endocarditis.

Splenic abscess is a rare complication in infective endocarditis. Here, we present two cases of splenic abscess associated with active infective endocarditis. Body computed tomography before emergency valvular surgery revealed abscess in the spleen. In case 1, the abscess was localized within the spleen; splenectomy and valve replacement were performed through the same median skin incision. In case 2, the splenic abscess was diagnosed as ruptured; valve replacement was performed, followed by splenectomy through a separate skin incision. No recurrence of infection occurred after surgery in either case. In surgical treatment for active infective endocarditis, body computed tomography is essential to diagnose splenic abscess preoperatively. If there is an abscess, then splenectomy and valvular surgery should be performed simultaneously to prevent reinfection after valvular surgery. The approach to the spleen should be individualized according to the extension of the abscess.

Abscess↗

PubMed2002

Mitral annular reconstruction.

Mitral annular reconstruction using a pericardial patch was performed in 3 cases of atrioventricular disruption. This technique may be useful for atrioventricular disruption in cases of active endocarditis, redo valve replacement, left ventricular rupture after mitral valve replacement, and annular calcification.

Aged↗