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Biomedical subjects

O Shigemitsu

Publications and source records attributed to O Shigemitsu.

36 records · Page 2Linked to original sources
PubMed1995

[Surgical treatment of traumatic rupture of the aortic valve with dove-coo murmur--case report].

Aortic regurgitation due to traumatic rupture of the aortic valve with dove-coo murmur is rare. A 71-year-old man was admitted for cardiac failure due to aortic regurgitation with dove-coo murmur, 4 years after the traffic accident. The aortic valve replacement was performed and his postoperative course was good. The aortic valve was tricuspid valve with the tear in the left side of right coronary cusp, and the size of the tear was 7 mm. The aortic valve was not recognized the findings of inflammatory or rheumatic change in the pathological study.

Aged↗
PubMed1995

[Surgical treatment of right atrial papillary fibroelastoma, originated from the eustachian valve--a case report].

Papillary fibroelastoma is one of the most common benign primary cardiac tumor after myxoma. However, it is rare to originate from Eustachian valve. A 44-year-old woman was pointed out the right atrial tumor during admission for vasospastic angina. On two-dimensional echocardiogram, the tumor was found in the right atrium, and easily moved to the right ventricle. At operation, the tumor originated from Eustachian valve, and was resected together with the valve by means of extracorporeal circulation. The size of tumor was 57 mm in length, and the histological diagnosis was papillary fibroleastoma. The post-operative course was uneventful.

Adult↗
PubMed1994

Biocompatibility of a heparin-bonded membrane oxygenator (Carmeda MAXIMA) during the first 90 minutes of cardiopulmonary bypass: clinical comparison with the conventional system.

We clinically compared a heparin-bonded Carmeda MAXIMA membrane oxygenator to a nonheparin-bonded MAXIMA in 20 patients undergoing coronary artery bypass grafting or valve replacement. Reductions of fibrinogen, factor XII, and high molecular weight kininogen were greater in the MAXIMA group. Serum C3a and free hemoglobin were lower in the Carmeda group. The level of C4a, though remarkably lower than that of C3a, was higher in the Carmeda group then in the MAXIMA group. Both oxygenators performed well in terms of blood gas exchange. We conclude that the heparin-bonded Carmeda oxygenator offers superior biocompatibility during cardiopulmonary bypass.

Biocompatible Materials↗
PubMed1994

[A case of rupture of the ascending aorta owing to prosthetic graft dilation following replacement of the descending aorta].

A 55-year-old male was diagnosed as acute type A aortic dissection caused by retrograde propagation from a tear in the descending aorta. A replacement of the descending aorta was performed with a prosthetic graft (VASCUTEK). Sixteen days after the operation, the patient required an emergency operation due to a rupture in the ascending aorta. Transesophageal echo and contrast enhanced CT indicated the point of entry to be at the proximal anastomotic portion of the prosthetic graft and the prosthetic graft (30 mm in diameter) to be dilated to 45 mm. Intimal tear at anastomotic portion owing to graft dilation was suspected as the main factor causing rupture of the ascending aorta.

Aortic Dissection↗
PubMed1994

[Two cases of aortoesophageal fistula due to ruptured thoracic aortic aneurysm].

Aortoesophageal fistula due to ruptured thoracic aortic aneurysm is uncommon, and exhibits extremely high mortality. We experienced two cases of such lesion. The first case showed aneurysm in the aortic arch closed with Dacron patch but leaving the esophageal defect. The patient died of an infection of the patch graft after oral feeding. The second case was demonstrated infected aneurysm of the descending aorta. The patient was rescued by primary operation, replacement of the aorta by an artificial graft and resection of the esophagus, and the secondary operation, reconstruction of the esophagus. We recommend resection of aneurysm and the esophagus as well in the aspect of lower post-operative infection in the graft and of the better prognosis of the lesion.

Aged↗
PubMed1993

[Clinical experience of VA-bypass as a cardiac assist system using centrifugal pump with membranous oxygenator in patients with profound ventricular failure after cardiac surgery].

Twelve patients including 6 ischemic heart diseases, 5 valvular diseases, and one adult atrial septal defect combined with mitral and tricuspid valve insufficiency were treated with circulatory assist system for postoperative severe low-cardiac output syndrome. Intra-aortic balloon pumping (IABP) was used in all cases. In early 7 cases, left heart bypass system was employed including one roller pump, one left ventricular assist device (LVAD), and 5 centrifugal pump. Only one LVAD case could be weaned but died of sustained ventricular arrhythmias 5 days postoperatively. In recent 5 cases, veno-arterial bypass (VA-bypass) was employed using centrifugal pump with membranous oxygenator. Venous blood was drained from the right atrium and oxygenated blood was returned to the right axillary artery. Real time reinfusion of drained blood from intrapericardial and mediastinal tube to the central vein served efficiently to maintain hemodynamics and to save homologous blood transfusion. Three of 5 cases who were treated with Va-bypass survived and are doing well. We conclude that VA-bypass consisting with centrifugal pump and oxygenator returning oxygenated blood to the right axillary artery combined with IABP were useful strategies as biventricular support for profound cardiac failure following surgery.

Aged↗
PubMed1993

[Surgical treatment of endocardial cushion defect in 3 elderly patients].

We performed surgical treatment for partial endocardial cushion defect in 3 patients over fifty year old. Case 1 was a 55-year-old-male with TR of grade II. Case 2 was a 59-year-old-female with TR and MR, and was repaired mitral cleft by a mattress suture. She needed infusion of dopamine (over 5 micrograms/kg/min) for 6 days and therapy of mediastinitis postoperatively. Case 3 was 56-year-old-male without atrioventricular valve regurgitation. Preoperative left ventricular volume was small in all patients, therefore perioperative circulatory control, mainly water balance, and respiratory control were importance. All patients survived, and both decreasing of CTR and improvement of NYHA classification were recognized in all three patients. In conclusion the operation for ECD in even elder patients was effective, but intensive care needed perioperatively.

Endocardial Cushion Defects↗
PubMed1993

[A case of double mitral valve with severe mitral regurgitation detected by transesophageal echocardiography].

A 66-year-old woman with double mitral valve (bridge type) and severe mitral regurgitation by spontaneous ruptured chordas is reported. The case with this combination has not been reported in the literature. She had not any other congenital heart diseases. The mitral valve was clearly shown by two-dimensional Doppler transesophageal echocardiography. Mitral valve replacement with Medtronic-Hall valve was carried out successfully.

Aged↗
PubMed1993

[A case of aortic dissection (DeBakey-I) occurring 20 months after aortic valve replacement].

Simple aortic valve replacement was performed in a 59-year-old man whose ascending aorta was moderately dilated (45 mm) because he had no characteristics of Marfan's syndrome or other connective tissue diseases. However, about 20 months later, reoperation needed to be performed for aortic dissection of DeBakey type I. The pathological findings of the aortic wall obtained at the initial operation revealed cystic medial necrosis. The occurrence of aortic dissection after aortic valve replacement is uncommon but not rare, especially in patients with cystic medial necrosis and/or dilated aortic root. Therefore, in these patients, wrapping or replacement of the ascending aorta may be required at the same time of aortic valve replacement.

Aortic Dissection↗
PubMed1991

Aortic valve replacement and splenectomy in a patient with chronic idiopathic thrombocytopenic purpura--preoperative management with high-dose gamma-globulin.

We report the management of a patient with chronic idiopathic thrombocytopenic purpura and severe aortic valvular disease. Preoperative intravenous high-dose gamma-globulin administration was employed, and aortic valve replacement combined with splenectomy were performed during the same operation. The platelet count at admission was 34,000/mm3 and increased to 146,000/mm3 after the gamma-globulin therapy. Platelet transfusion at the end of the cardiopulmonary bypass was considered no longer necessary in the postoperative period, because the platelet count increased quickly after the procedure. The postoperative course was uneventful. We believe that open heart surgery and splenectomy can successfully be performed simultaneously in a patient with chronic idiopathic thrombocytopenic purpura treated with high-dose gamma-globulin therapy.

Aortic Valve Insufficiency↗
PubMed1991

Analysis of perioperative ventricular arrhythmias in valvular heart diseases by Holter ECG recording.

Seventy-one consecutive patients undergoing cardiac surgery for acquired valvular diseases were analyzed to determine the incidence of and the predisposing factors to postoperative ventricular arrhythmias. We recorded the Holter ECGs before (pre-op), and within 24h (op-day) and 4 to 10 weeks after operation (post-op) and determined the frequency of ventricular arrhythmias and the degree according to the Lown grade. The relationship between the op-day ventricular arrhythmias and clinical, hemodynamic, operative or postoperative variables was examined. The operation included mitral valve replacement or open mitral commissurotomy (49 patients, group M), aortic valve replacement (12 patients, group A) and a combined mitral and aortic operation (10 patients, group A + M). In all groups, the frequency and the degree of ventricular arrhythmias increased at the op-day and decreased at the post-op period approximately to the pre-op level. The frequency and Lown grade of the 3 groups were similar in each of the pre-op, the op-day and the post-op periods. The frequency and Lown grade of the op-day ventricular arrhythmias increased with increases in the arrhythmia frequency and Lown grade at the pre-op period, and in patients with left ventricular (LV) dysfunction at the post-op period, as evidence by an increased LV volume and decreased ejection fraction on echocardiograms. Furthermore, the frequency of ventricular premature contractions in the op-day was significantly less when a cardioplegia solution containing magnesium was used than in the case of a cardioplegia solution without magnesium. The op-day ventricular arrhythmias showed no significant relation to extracorporeal circulation time, aortic cross-clamping time, the antiarrhythmic drugs used and the op-day serum levels of K and CK-MB.

Adult↗
PubMed1991

[A case of left atrial ball thrombus without mitral disease].

A 65-year-old man who had a left atrial ball thrombus without mitral disease is reported. Ultrasonic cardiogram gave this diagnosis. His ECG showed atrial fibrillation and severe bradycardia. Thrombus attached to the left appendage with short stalk was removed under extracorporeal circulation and a pacemaker (VVI mode) was implanted. Postoperative course was not eventful.

Aged↗
PubMed1990

[The 19mm St. Jude Medical prosthetic aortic valve evaluated by long-term hemodynamic sequelae].

To assess the usefulness of the 19 mm St. Jude Medical (SJM) aortic valve prosthesis for cases of small aortic annulus, post-operative evaluations of pressure gradient of the prosthesis (AVR) and left ventricular (LV) function were performed using bicycle ergometric exercise tests. Seven patients who underwent AVR with 19 mm SJM (19 mm group) and eight control subjects whose SJM was greater than 21 mm in diameter were observed. LV function was assessed by the M-mode echocardiography and the pressure gradients of the prosthesis by the continuous wave Doppler echocardiography. The results were as follows: 1. Mean body surface area (BSA) was 1.35 m2 in the 19 mm group and 1.52 m2 in the control group (p less than 0.01). 2. NYHA functional classes improved equally in both groups after surgery. 3. The post-operative cardiac index at rest measured by cardiac catheterization significantly improved in both groups after surgery. 4. Results of the exercise tests: 1) Left ventricular end-systolic volume index (LVESVI) was decreased on exercise in both groups: from 21.3 to 18.0 ml/m2 in the 19 mm group (p less than 0.01) and from 21.5 to 17.0 ml/m2 in the control group (p less than 0.01). 2) Ejection fraction and fractional shortening significantly increased in both groups on exercise. 3) The pressure gradients significantly increased on exercise in both groups: from 30.4 to 38.3 mmHg in 19 mm group (p less than 0.01) and from 28.8 to 36.6 mmHg in the control group (p less than 0.01). Although the pressure gradients were greater in the 19 mm group, there were no significant differences between the two groups at rest and on exercise. It was concluded that the 19 mm SJM aortic valve prosthesis was acceptable in size for small aortic annulus in elderly women whose body surface area was less than 1.47 m2.

Adult↗
PubMed1985

[A case of abdominal wall fistula due to cholangioma].

A 59-year-old woman was admitted to our hospital complaining of intractable abdominal wall fistula. Several examinations led to the suspicion of a fistula due to liver cell tumor. Histologically, the tumor was diagnosed as cholangioma. Chemotherapy was very effective after fistulectomy, and to date, she has been doing well for 34 months.

Abdominal Muscles↗
PubMed1983

[Coexisting malignant lymphoma and early cancer of the stomach].

A 62-year-old man with malignant lymphoma and early gastric cancer as two independent growths in the stomach was reported. In the resected stomach, malignant lymphoma was observed as a protruding lesion measuring 5.5 X 3.0 X 1.2 cm with four giant folds at the anterior wall of the upper gastric body. There also was a poorly differentiated adenocarcinoma as an early gastric cancer of type IIc + III; it measured 0.9 X 0.7 cm and invaded the submucosal layer at the antral portion. There were no pathological findings, excepting intestinal metaplasia, in the mucosal layer between the two lesions. There was no metastasis from either the malignant lymphoma or the adenocarcinoma to perigastric lymph nodes.

Adenocarcinoma↗