Biomedical subjects

Mikihiko Kudo

Publications and source records attributed to Mikihiko Kudo.

10 recordsLinked to original sources

PubMed2006

[Minimally invasive cardiac surgery using port-access method].

From October 1997 to January 2006, we operated on 209 patients with port-access cardiac surgery. The patients were 116 with atrial septal defect (ASD), 85 with mitral valve disease, 2 with coronary artery bypass grafting (CABG), 10 with other (ventricular septal defect, partial endocardial fusion defect, myxoma). The average of postoperative hospital stay is 7 (shortest: 3) days. None of these patient have been readmitted, however, there was 1 mortality. The operative technique for ASD is established in this series. On the other hand, for mitral valve disease, a modification point such as prevention of a complication and shortening of cardiopulmonary bypass time were recognized. It seemed that careful determination of operative indication and establishment of security were important. Improvement and development of operative technology of port-access method will enable future safe total endoscopic or robotic cardiac surgery. In this paper, we report the latest surgical technique of port-access cardiac surgery.

Cardiac Surgical Procedures↗

PubMed2005

Intraoperative endoscopic resection of left ventricular tumors.

Two cases involving patients who underwent a successful endoscopic resection of a left ventricular tumor are presented herein. One was an 82-year-old woman with a left ventricular papillary fibroelastoma, who underwent previous coronary artery bypass grafting. In an attempt to make the procedure less invasive, we used an endoscope. With a full sternotomy, cardiopulmonary bypass, and cardioplegic protection, the endoscope was inserted into the left ventricular cavity through the mitral valve. The other patient was a 63-year-old man with left ventricular papillary fibroelastoma, in whom we performed an endoscopic transaortic resection. The endoscope provided an excellent view, and the tumors were easily extracted in both cases without any complications.

Aged↗

PubMed2005

Aortotomy and endarterectomy of the ascending aorta for aortic valve replacement in a patient with porcelain aorta.

Patients with a calcified "porcelain" aorta may also have aortic valve stenosis, necessitating aortic valve replacement to prevent cerebral complications. However, a porcelain aorta can be difficult to open, and ascending aorta repair sutures are almost impossible to insert in a calcified plate. We devised a method of aortotomy using a small oscillating saw, which allowed us to incise the aortic wall cleanly without destruction or the formation of debris. After partial endarterectomy of the calcified plate with aortotomy, closure of the aorta was buttressed with bovine pericardium. During the endarterectomy, we used an elevator designed for hand surgery to exfoliate the calcified intimal plate.

Aged↗

PubMed2005

Giant left ventricular pseudo-false aneurysm following myocardial infarction.

We report a successful surgical case of giant left ventricular pseudo-false aneurysm in a 63-year-old man. The abnormality of the inferior wall of the left ventricle was discovered incidentally by abdominal ultrasonography for health examination at another hospital. Transthoracic echocardiography and left ventriculography revealed a giant false aneurysm (74x75x40 mm) in the inferior wall of the left ventricle with a large orifice (70x58 mm). Repair of the aneurysm was performed under arrested heart, closing the large orifice with a Hemashield patch. Postoperative pathological examination proved that the wall of the aneurysm had myocardial tissue. The microscopic results strongly suggested that this aneurysm was a pseudo-false aneurysm.

Aneurysm, False↗

PubMed2005

Reoperation for a Starr-Edwards aortic prosthetic valve 33 years after initial implantation.

A 40-year-old woman admitted with heart failure had undergone aortic valve replacement with a Model 2310 Starr-Edwards valve due to aortic regurgitation 33 years previously. She had been followed up for several years, but discontinued follow-up and medication (including Warfarin) for the past 25 years. Echocardiography demonstrated marked dilatation and thickening of the left ventricle, and the peak pressure gradient of the prosthesis was measured as 87.9 mmHg. Under the diagnosis of chronic aortic valve prosthesis-patient mismatch with subsequent severe left ventricular dysfunction, the Starr-Edwards valve was explanted and replaced with a 23 mm St. Jude Medical prosthetic valve. The removed valve showed minimal cloth wear except for a small part of the strut. The postoperative echocardiography demonstrated recovering of left ventricular function. To our best knowledge, this case presents the longest duration for a surgically explanted Starr-Edwards aortic prosthetic valve in Japan.

Adult↗

PubMed2005

A surgical case of ventricular septal perforation after repairing left ventricular free wall rupture.

A 78-year-old woman with diagnosis of acute myocardial infarction (AMI) in the anteroseptal area fell into cardiogenic shock suddenly just before starting percutaneous coronary intervention (PCI). Echocardiography showed left ventricular free wall rupture, then an emergent operation was performed by sutureless patch repair using collagen fleece with fibrinogen-based impregnation. Eight days later from the initial operation, the onset of ventricular septal perforation (VSP) was recognized. Fifteen days after, the infarct exclusion technique with endocardial patch was performed. She has been doing well 4 months after the operation without residual shunt. To our best knowledge, this is the first surgical case report that free wall rupture of left ventricle and VSP which are serious complications after myocardial infarction happened in succession.

Aged↗

PubMed2004

Intraoperative trans-mitral endoscopic resection of left ventricular tumor.

A successful resection of left ventricular tumor in an 82-year-old woman who had undergone coronary artery bypass grafting ten years ago is presented. In an attempt to make a procedure less invasive, we chose a trans-mitral endoscopic resection with minimum dissection because of reoperation on patient of advanced age. With the use of cardiopulmonary bypass and cardioplegic protection, the right side of left atrium was incised longitudinally. The endoscope was inserted in the ventricle via the mitral valve. A stalk of the tumor was cut by snare strangulation and the whole tumor was extracted endoscopically. The postoperative course was uneventful. To our best knowledge, this is the first report on endoscopic resection of the left ventricular tumor via a mitral valve. This method appear to be the choice in resecting the left ventricular tumor.

Aged↗

PubMed2004

Intermittent circulatory arrest for repairing postoperative mycotic pseudoaneurysm in the ascending aorta.

Postoperative mycotic pseudoaneurysm in the ascending aorta associated with mediastinitis is one of the most serious complications after cardiovascular surgery. Circulatory arrest is usually needed for repairing this lesion; it is likely that the procedure needs unpredictably prolonged arrest time due to uncontrollable bleeding or serious adhesion. With this reason we employed intermittent circulatory arrest instead. The purpose of this paper is to describe 2 cases which demonstrated the method of intermittent circulatory arrest for repairing postoperative mycotic pseudoaneurysm in the ascending aorta.

Aged↗

PubMed2003

Floating ball thrombus in the left atrium with mitral stenosis.

We report a case of a floating ball thrombus in the left atrium with mitral stenosis in a 76-year-old woman. The patient had been followed-up at our hospital due to mitral valve stenosis for several years, and was recognized to have atrial fibrillation and a left atrial mural thrombus by echocardiography. She was admitted to our hospital for right cerebral infarction. Echocardiography showed a floating ball thrombus in the left atrium. After the treatment of cerebral infarction, she was referred to cardiac surgery, and a semi-urgent operation was performed. Removal of the ball thrombus and mitral valve replacement were performed simultaneously. The thrombus was single, round, soft, relatively smooth surfaced, and about 30 x 30 x 30 mm in diameter. The postoperative course was uneventful. Left atrial ball thrombus appears to be uncommon. This is a rare case, in which it was documented that a pre-existing left atrial mural thrombus was thought to drop off spontaneously, to be a cerebral embolic source, and to develop into a ball thrombus in the left atrium.

Aged↗

PubMed2002

Acute aortic dissection involving an aberrant right subclavian artery.

Although the aberrant right subclavian artery is the most common abnormality in aortic arch development, it is unusual to encounter this abnormality when repairing acute aortic dissection. We report a case of Stanford type A acute aortic dissection involving an aberrant right subclavian artery in a 45-year-old man. We used the elephant trunk procedure to surgically manage the intimal tear and aberrant right subclavian artery. This is, to our knowledge, the first report in Japan of surgical reconstruction of an aberrant right subclavian artery in conjunction with acute aortic dissection.

Acute Disease↗