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Biomedical subjects

R Shirakura

Publications and source records attributed to R Shirakura.

At least 199 records · Page 11Linked to original sources
PubMed1985

Ninety consecutive corrective operations for tetralogy of Fallot with or without minimal right ventriculotomy.

Eighty-eight patients with tetralogy of Fallot and two patients with ventricular septal defect and pulmonary atresia underwent repair without right ventriculotomy (n = 43) or with a minimal right ventriculotomy (n = 47) of 10 to 15 mm. The ventricular septal defect was closed through the tricuspid valve in 75 patients. The pulmonary valve was either preserved or reconstructed to maintain its competence. The age at operation was 1 or 2 years in 51 patients. There was one operative death and there were no late deaths. The results of postoperative cardiac catheterization in the present series of patients (n = 34) were compared with those of control patients (n = 21) who had repairs with a conventional right ventriculotomy in the preceding period. There was no significant difference in right ventricular/left ventricular systolic pressure ratio or in cardiac index either at rest or during isoproterenol infusion between the two groups. The incidence of significant pulmonary regurgitation (Grade greater than or equal to 2/4) was less (p less than 0.05) in the present patients (47%, n = 34) than in the control patients (81%, n = 21). The right ventricular end-diastolic volume index (ml/m2) was smaller in the present patients than in the control patients both at rest (91 +/- 37 versus 142 +/- 28, p less than 0.01) and during isoproterenol infusion (81 +/- 21 versus 109 +/- 30, p less than 0.01). The right ventricular ejection fraction was higher in the present patients than in the control patients during isoproterenol infusion (57% +/- 4% versus 49% +/- 6%, p less than 0.01). The incidence of ventricular arrhythmias (Lown's grade greater than or equal to 2) was less in the present patients (6/35) than in the control patients (36/65) (p less than 0.005). This method of repair for tetralogy of Fallot carries no more risk than the conventional method, and the results are better with respect to postoperative right ventricular function and ventricular arrhythmia.

Adolescent↗
PubMed1984

Ambulatory electrocardiographic study of the frequency and cause of ventricular arrhythmia after correction of tetralogy of Fallot.

Ambulatory 24-hour electrocardiographic monitoring with a Holter recording system was performed in 100 patients after repair of tetralogy of Fallot. The incidence and severity of ventricular arrhythmia (VA) were studied relative to operative age, follow-up period after corrective surgery, hemodynamic data, ventricular function and operative method. Significant VA (Lown grade 2 to 4) was detected in 41 patients. Patients with significant VA (group I) were older (11.7 +/- 10.0 years old) at operation than those without VA (group II) (5.5 +/- 5.8 years, p less than 0.001). The follow-up period after operation in group I (9.5 +/- 4.8 years) was significantly (p less than 0.001) longer than that in group II (5.5 +/- 4.3 years). The incidence of elevated right ventricular (RV) systolic pressure was significantly (p less than 0.005) higher in group I (43%) than in group II (7%). RV ejection fraction in group I (48 +/- 6%) was significantly (p less than 0.001) lower than that in group II (56 +/- 5%). The new operative method for tetralogy of Fallot without or with minimal right ventriculotomy was more frequently performed in group II (49%) than in group I (15%, p less than 0.005). Pulmonary regurgitation, RV and left ventricular size, and left ventricular ejection fraction were not related to severity of VA. Thus, serious VA was related to higher age at operation, longer interval after surgery, elevated RV systolic pressure, depressed RV ejection fraction and RV scar.

Adolescent↗
PubMed1984

Transaortic closure of ventricular septal defect in atrioventricular discordance with pulmonary stenosis or atresia. Results in five patients.

In five patients (aged 5 to 11 years) with atrioventricular discordance, pulmonary stenosis or atresia, and origin of the aorta from the right ventricle, transaortic closure of the ventricular septal defect was performed. Double-outlet right ventricle was confirmed in four patients. All patients underwent placement of an extracardiac valved conduit from the anatomic left ventricle to the pulmonary artery. Neither operative death nor postoperative complete heart block resulted. Postoperative follow-up periods were from 3 months to 4 years (average 35 months), and one patient who had no evidence of complete heart block died suddenly 2 years postoperatively. Aortic regurgitation developed in two patients from possible trauma during the operation: Regurgitation was mild (causing symptoms) in one patient who had had poor surgical exposure with a subpulmonic ventricular septal defect and a well-developed subaortic conus; it was trivial (asymptomatic) in the other patient. Transaortic ventricular septal defect closure, suturing a patch on the anatomic left ventricular side in patients with atrioventricular discordance and double-outlet right ventricle or similar anomalies, might help to avoid postoperative complete heart block if the aorta is large and the subaortic conus is not well developed.

Aorta↗
PubMed1984

[Reconstructive valve surgery in congenital heart disease].

As part of various defects in congenital heart disease, valvular lesions are frequently encountered and remain as one of the difficult subjects. Recent advances in the management of valvular lesions and late results of repair and replacement were reported. In congenital aortic stenosis, most of patients have obtained satisfactory results with valvotomy, but some required reoperation with valve replacement even during childhood. In supracristed VSD associated with aortic regurgitation, late recurrence of regurgitation was found in some, but 70% of the patients showed free of diastolic murmur after 10 years. In tetralogy of Fallot, definitive repair of pulmonary valve was performed in last 5 years with composite patch with patient's own pericardium to reduce postoperative pulmonary regurgitation. Recently, pericardium is treated with glutaraldehyde on the operating table to prevent late shrinkage. As external conduit, homograft aorta, which had been utilized previously, showed good late results comparable to xenograft in terms of free from reoperation. Xenograft has been frequently utilized without significant late obstruction so far. In atrioventricular canal, endocardial cushion prosthesis technique has been utilized satisfactory with recent modification of the wings made by glutaraldehyde treated patient's own pericardium as well as in tetralogy.

Follow-Up Studies↗