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Biomedical subjects

O Kamisawa

Publications and source records attributed to O Kamisawa.

11 recordsLinked to original sources

[Rupture of dissecting aortic aneurysm associated with the right-sided aortic arch and anomalous course of the left brachiocephalic vein--a case report].

A case of ruptured dissecting aortic aneurysm (DeBakey IIIb) associated with the right sided aortic arch and anomalous course of the left branchiocephalic vein was reported. A sixty-nine-year-old female suddenly had the severe back pain and soon fell into shock. The diagnosis of a ruptured dissecting aortic aneurysm associated with the right sided aortic was obtained on CT scanning. CT films also showed the left brachiocephalic vein behind the ascending aorta. Emergency operation was performed through median sternotomy and left thoracotomy. The descending aorta, forming an aneurysm with the aberrant subclavian artery, prominently protruded far to the left, and was located behind the trachea and the esophagus. Extra-anatomical bypass grafting was performed between the ascending aorta and the distal descending aorta. The patient eventually died of multiple organ failure on the 11th day after operation. These findings were confirmed by autopsy. A rare vascular anomaly with aortic dissection was reported, and a surgical approach to that lesion was discussed.

Aged

[Concomitant graft replacement of the total aortic root and the transverse aortic arch for type A aortic dissection associated with Marfan syndrome: report of a case].

A 25-year-old man of Marfan syndrome with chronic stage aortic dissection of Stanford type A underwent concomitant graft replacement of the total aortic root and transverse aortic arch. The surgical procedure were performed with an aid of extracorporeal circulation, blood cardioplegia, using the techniques of "open distal anastomosis" under the deep hypothermic circulatory arrest and continuous retrograde cerebral perfusion for cerebral protection during circulatory arrest. The operative techniques consisted of total aortic root replacement using a composite graft with Piehler's and Carrel patch technique for left and right coronary artery, and total arch replacement using en bloc distal arch reconstruction and a composite graft replacement for innominate artery. There were no neurological complications. In the case of Marfan syndrome, type A aortic dissection involving aortic arch should be treated by concomitant graft replacement of the total aortic root and the transverse aortic arch in order to reduce the late risk of aortic dissection or annular dilatation.

Adult

[Congenital bicuspid aortic valve with regurgitation--a rare case showing a fibrous band between the conjoined cusp and the ascending aorta].

It is quite unusual that the congenital bicuspid aortic valve shows aortic valve regurgitation except postinflammatory event. In a case of aortic regurgitation with bicuspid valve, a fibrous band was recognized between the conjoined cusp and the ascending aorta at the operation. Since a degenerative change alone was discerned histologically in the resected specimen, this abnormal band was supposed to be an embryogenic remnant of the aortic valve. Six cases were reported previously and all of them were male, and five were Japanese.

Aorta

[Long-term follow-up results of stage III and IV thymomas and thymic carcinomas invading the great veins].

A series of 24 patients with stage III and IV thymomas and thymic carcinomas were reviewed with respect to the invasiveness of the superior vena cava (SVC) and brachiocephalic veins (BCV). Masaoka staging revealed stage III disease in 14 patients and stage IV in 10. Follow-up ranged from 3 months to 12 years and 10 months. In 9 patients with stage III disease involving the great veins, 6 patients underwent total resection, 2 subtotal resection, and one exploratory thoracotomy. Reconstruction of SVC was done in 2 patients and of left BCV in 7 and angioplasty of SVC in one. Although there were 4 tumor deaths and one myasthenic death, 4 patients were alive and tumor free. The longest survival after total resection with SVC replacement was 11 years and 7 months. In 3 patients with stage IV disease invading the great veins, 2 patients underwent partial resection and one received radiotherapy alone. Although 2 patients died of generalized metastases and respiratory failure respectively, one remained alive 2 years and 2 months with carcinoma. Although long-term survivors were obtained in the patients with adventitial involvement, prognosis was poor in the patients with intimal invasion.

Adolescent

[Serial assessment of ventricle function in diastolic volume loading caused by valvular disease].

Thirty patients underwent aortic valve replacement (AVR) for aortic regurgitation and fifty-two did mitral valve replacement (MVR) for mitral regurgitation. Preoperative echocardiographic studies classified each cases into two groups. Group A: LVDs (left ventricular end-systolic dimension) > 50 mm and FS (left ventricular fractional shortening < 25%, Group B: LVDs < or = 50 mm or FS > or = 25%. Serial assessments by echocardiography were done at one year, three years, and five years after operation. LVDs, FS, LVDd (left ventricular end-diastolic dimension), EF (ejection fraction, Pombo's method) were evaluated. In the Group A of the AVR cases, it took three years for the left ventricular function to recover, but in the MVR cases, the left ventricular function didn't reach to the normal range, moreover tended to worsen five years after operation. One of the reasons may be attributable to the preoperative hemodynamic states in which the left ventricular after-load is smaller in the MVR cases. For such long-standing unfavorable condition, the left ventricle could not get enough recovery. In the Group B of both cases, there is no difference of the postoperative recovery of the left ventricular function. Postoperative cardiac function must be discussed upon the serial evaluation after operation.

Aortic Valve Insufficiency

[A case of Stanford type A acute aortic dissection complicated with clotted false lumen and saccular aneurysm formation].

A 59-year-old farmer was admitted with severe anterior chest and back pain. As MRI showed a Stanford type A dissection, operation was performed. Surgical intervention revealed the clotted false lumen of the ascending aorta without intimal tear, and it was transected and primarily reconstructed with Teflon felt bolsters. Three months later MRI disclosed disappearance of the dissected lumen in the ascending and descending aorta. During the following two years and three months, a saccular aneurysm of the distal arch was found to be increased in size rapidly. The second operation was attempted to close the intimal defect with patch. As a whole this was a rare case of DeBakey type III acute aortic dissection complicated with proximal extension, clotted false lumen and saccular aneurysm formation at the site of the intimal tear.

Acute Disease

[Dissecting aortic aneurysm involving an aberrant right subclavian artery].

A 51-year-old man was admitted with severe interscapular and chest pain. Chest X-ray showed marked widening of the mediastinum. Aortography demonstrated DeBakey IIIb type dissecting aortic aneurysm and an aberrant right subclavian artery arising from the diverticulum of Kommerell. The intimal tear was repaired with direct suture closure with the aid of femoro-femoral bypass. Although the dissecting lumen was not obliterated completely, the patient has been well for seven years on antihypertensive treatment. This is a rare combination of congenital and acquired disease of the aorta. As far as we know, this is the first report in Japanese literature.

Aortic Dissection