PubMed Health⌕ Search

Biomedical subjects

T Katogi

Publications and source records attributed to T Katogi.

At least 37 records · Page 2Linked to original sources
PubMed1999

Mitral valve replacement in patients younger than 6 years of age.

UNLABELLED: We present our experience in mitral valve replacement (including left-sided tricuspid valve in corrected transposition) in patients younger than 6 years of age. The long term results were examined with special focus on re-replacement of the valve. Between 1974 and 1995, we performed mitral valve replacement in 14 patients younger than 6 years of age, with no operative mortality. There were 3 late deaths, caused by endocarditis, valve thrombosis, and congestive heart failure, respectively. The five-year-survival rate after primary replacement was 85%, and the ten-year-survival rate was 75%, using Kaplan-Meier analysis. Ten patients (11 occasions) required repeated mitral valve replacements at 2 months to 17 years after the original replacement. The indication for the second or third mitral valve replacement was paravalvular leakage (2 patients), valve thrombosis (1 patient), degeneration in the porcine prosthesis (3 patients), and patient outgrowth of the original small prosthesis (5 patients). Again there was no operative mortality. One patient who suffered from multiple occasions of valve thrombosis died at two years after the second replacement. All patients who had outgrown the prosthetic valve received larger prosthesis at the second replacement than at the primary replacement. The actuarial percentage of freedom from valve-related events at 3 years, 5 years, and at 10 years, was 50%, 37%, and 8%, respectively. CONCLUSIONS: Mitral valve replacement in patients younger than 6 years of age can be performed relatively safely, but meticulous follow-up and appropriate decision making for re-replacement is mandatory for the long-term survival of these patients.

Child↗
PubMed1999

Prognosis of Marfan and non-Marfan patients with cystic medial necrosis of the aorta.

The characteristics and prognosis of patients with cystic medial necrosis of the aorta were reviewed. Subjects were 46 patients who underwent aortic and/or aortic valve surgery between August 1965 and October 1994. All had histologically documented cystic medial necrosis including 22 Marfan patients. The patients with Marfan syndrome were substantially younger (median age, 32 vs 50 years; p < 0.05), and experienced annulo-aortic ectasia more frequently {81% (17/22) vs 46% (11/24); p < 0.05} than those without the syndrome. Sixty-eight percent (15/22) of the Marfan patients and 63% (15/24) of the non-Marfan patients experienced complications with aortic dissection, although not to a significant degree. The hospital mortality rate was 14% (3/22) in the Marfan group and 21% (5/24) in the non-Marfan group, which was also not significant. Of the 38 survivors, developments in the health of 37 were completely followed-up until October 1997. The cardiovascular event-free rate for Marfan patients at 10 years (28%) was lower than that for non-Marfan patients (68%, p = 0.057), whereas the actuarial survival rates at 10 years were nearly equal (72% for the Marfan patients and 74% for the non-Marfan patients). Reoperation was the first cardiovascular event in 77% (10/13) of the Marfan patients and in 14% (1/7) of the non-Marfan patients (p < 0.05). Cardiovascular event was the main cause of late death both for Marfan patients (80%; 4/5) and for non-Marfan patients (86%; 6/7). In conclusion, independent of the presence of Marfan syndrome, careful follow-up is necessary for patients with cystic medial necrosis of the aorta to eliminate serious late complications.

Adolescent↗
PubMed1999

Effects of arteriovenous shunt on ventricular function in dog.

BACKGROUND: The bidirectional cavopulmonary shunt has been increasingly accepted as an interim step to the Fontan operation. However, the effect(s) of chronic volume overload on ventricular function are not yet well understood. METHODS: Twelve mongrel dogs, with (chronic volume overload group), or without (control group) a femoral arteriovenous shunt created 8 weeks before the assessment, were subjected to a right heart bypass from the right atrium to the proximal pulmonary trunk. Nonpulsatile perfusion via the bypass was achieved using a centrifugal pump and cross-clamping of the pulmonary trunk. Left ventricular function was evaluated using the end-systolic elastance and the Doppler flow pattern on echocardiograms (epicardiac and transesophageal, simultaneously) during acute volume loading. RESULTS: The left ventricular weight and the left ventricular weight/end-diastolic volume ratio showed no change from control values. The sum of the isovolumetric contraction time and the isovolumetric relaxation time divided by the ejection time remained constant during acute volume loading in the chronic volume overload group, while an increase was demonstrated in the control group. The chronic volume overload group showed a lower Ees (30.8 +/- 16.4 mmHg/cm2 vs. 107.6 +/- 70.3 mmHg/cm2, p = 0.03) than the control group. CONCLUSIONS: The global ventricular performance changed with chronic adaptation to the arteriovenous shunt, and became resistant to acute volume loading. Left ventricular contractility under nonpulsatile pulmonary perfusion was impaired by chronic volume overload, which is deleterious to the Fontan operation.

Animals↗
PubMed1999

Surgical angioplasty of left main coronary stenosis complicating supravalvular aortic stenosis.

We successfully treated obstruction of the main coronary artery, not aortic valve leaflet adhesion to the intimal shelf, complicating supravalvular aortic stenosis by modifying the Brom aortoplasty. An autologous pericardial patch was used to enlarge the left main coronary artery as well as the stenotic aorta. This modification allows simple and effective restoration of coronary blood flow, while maintaining the Brom procedure's merit of achieving anatomic geometry of the aortic root in such patients.

Adolescent↗
PubMed1998

[The role of bidirectional cavopulmonary shunt on selection of Fontan patients].

There are no objection against that pulmonary vascular resistance index (PVRI) is one of the most important factors for completion of successful application of Fontan-type operation. However, calculated PVRI in single ventricle physiology in often unreliable because of difficulty in accurate measurement of pulmonary blood flow, especially in patients with decreased pulmonary blood flow. Although the role of bidirectional cavopulmonary shunt (BCPS) in such patients has been increasingly recognized, the impact of BCPS on PVRI has not been fully understood. Between November 1993 and November 1996, 24 patients, aged between 0.54 and 22.2 years, with a wide variety of cardiac malformations underwent BCPS, and were followed up for the mean of 15.1 months. There were four hospital deaths (16.7%) and three deaths in follow-up (12.5%). Serial catheterization revealed that significant increase in mean arterial oxygen saturation from 75.8% to 83.9% (p = 0.005), and decrease in mean Nakata's index from 433 to 311 (p < 0.0001). PVRI calculated by using formulas derived from Ohm's law before BCPS (Pulmonary flow was derived from Fick formula) was highly (greater than 10 u.m2) or moderately (between 4 and 10 u.m2) elevated in 6 and 7 patients, respectively. However, PVRI in these patients was normal after BCPS. Fourteen out of 24 patients underwent total cavopulmonary connection (TCPC) with 8 to 15 months of interval from BCPS, and have been currently surviving, and in NYHA functional class I or II, except 2 patients who underwent take-down. In conclusion, early and midterm outcome after staged operation appears to be excellent. BCPS is a good interim procedure, in part because one can more properly select patients undergoing Fontan operations from the PVRI point of view.

Adolescent↗
PubMed1998

[Surgical repair of isolated congenital tricuspid regurgitation with artificial chordae--a case of two year-follow up].

Isolated congenital tricuspid regurgitation derived from primary dysplasia of the valvular apparatus is a rare cardiac abnormality. A 23-year-old woman was first diagnosed to have an isolated tricuspid regurgitation during infancy and was followed up at our hospital. She developed progressive cardiomegaly at the age of 22 years. The chest roentgenogram at the time of admission revealed marked cardiomegaly with a cardiothoracic ratio of 64%. Despite the severe regurgitation of the tricuspid valve, the catheter examination disclosed v and mean pressures of the right atrium of 9 mmHg and 5 mmHg, respectively. The operative findings revealed a markedly dilated tricuspid annulus of 45 mm in diameter (157% of normal) and fragile and redundant valve leaflets, anterior leaflet in particular. Anterior papillary muscle was absent without any vestige thereof. Chordae tendinae of the anterior and posterior leaflets were absent and those of the septal leaflet were attached to the ventricular septum. Each commissure was tethered to the ventricular wall by thick and short chordal tissue. The chordal abnormalities were repaired by four artificial chordae of 4-0 ePTFE suture and an annuloplasty with Carpentier-Edwards ring (36 mm) was added. She recovered uneventfully and was discharged on postoperative day 30. A follow-up echocardiography at 2 years after surgery showed excellent function and trivial regurgitation of the valve. No evidences of thrombus or calcification of the artificial chordae were detected. This experience draws us to conclude that the artificial chordal replacement is one of the useful surgical options for the repair of isolated congenital tricuspid regurgitation.

Adult↗
PubMed1998

Complications following reparative surgery for aortic coarctation or interrupted aortic arch.

Repair of aortic coarctation or interrupted aortic arch continues to be associated with major long-term morbidity. Thus, we conducted a review of 87 consecutive patients who underwent aortic arch repairs, focusing particular attention on the complications that developed. A two-stage strategy was employed if cardiac lesions were associated. The median age at surgery was 1.5 months with a range of 12 h to 56 years. The aortic arch was repaired using end-to-end anastomosis, subclavian flap aortoplasty, subclavian arterial turning-down aortoplasty, patch aortoplasty, tube graft interposition, or other methods. There were 10 patients who died soon after repair, and all of whom had complex cardiac anomalies. Of the remaining 77 patients, 8 developed recurrent stenosis. These 8 patients were all similar in age, being under 3 months old, and weighing 4 kg or less. A multivariable analysis of the infants identified interrupted aortic arch as an independent risk factor for the development of this complication with an odds ratio of 6.45. Complications following prosthesis-free techniques were similar in prevalence and timing. All reinterventions were mortality-free, but catheter dilation and patch aortoplasty were not always successful. Three extraanatomic bypasses were successfully performed, and one adult who had undergone a previous graft and pseudoaneurysm operation was successfully treated with an extraanatomic bypass. These findings led us to conclude that the initial repair should be performed without a prosthesis, and that reintervention for stenosis should combine catheter dilation and extraanatomic bypass.

Adolescent↗
PubMed1998

Surgical management of isolated congenital tricuspid regurgitation.

BACKGROUND: Isolated congenital tricuspid regurgitation without downward displacement of the leaflet is a rare clinical entity. Degenerative cusps and lack of chordae may preclude valvuloplasty and require valve replacement. METHODS: Three consecutive patients with isolated congenital tricuspid regurgitation underwent surgical repair between May 1995 and April 1997. Their ages were 23, 15, and 8 years old. Tricuspid valvuloplasty was feasible in all of them, with use of a gathering suture of the anterior leaflet, artificial chordae implantation, and ring annuloplasty. RESULTS: All 3 patients survived and recovered well after the operation. The cardiothoracic ratios on their chest roentgenograms decreased from 0.64 to 0.52 in patient 1, from 0.58 to 0.48 in patient 2, and from 0.60 to 0.44 in patient 3. Postoperative echocardiograms showed competent tricuspid valves and the disappearance of regurgitation in all cases. CONCLUSIONS: Although malformation of the valve is extensive in isolated congenital tricuspid regurgitation, application of artificial chordae with conventional valvuloplasty technique can avoid the use of prosthetic valves by establishing the competence of the tricuspid valve.

Adolescent↗
PubMed1998

Correction of total anomalous pulmonary venous connection of the cardiac type.

Surgical treatment of the cardiac type of total anomalous pulmonary venous connection requires special techniques. The treatment and outcome in 17 consecutive patients who had undergone primary repairs of the cardiac type between 1965 and 1996 were reviewed. The median age was 3 months and median weight 4.2 kg. The connection was the coronary sinus in ten patients, and the right atrium in six. Interatrial communication was routinely augmented. The right atrial cavity was partitioned using a patch to direct the anomalous pulmonary veins into the left atrium through the atrial septal defect in the first 13 patients. In the last four patients, the free wall flap of the right atrium was developed as a neoseptum. There were three early postoperative deaths during the early period of conventional repair. Two patients developed residual or recurrent diffuse obstruction in the individual lobar veins; reoperation to relieve the obstruction was attempted but unsuccessful. One sudden death occurred in a patient with occasional heart block. Ten survivors have been asymptomatic during follow-up, but two incomplete heart blocks and one atrial flutter were noted among patients who underwent conventional repair. The right atrial wall flap technique was not associated with any mortality or morbidity, such as arrhythmia and recurrent pulmonary vein stenosis during 12 to 63 months of postoperative obstruction. In conclusions, a flap technique using the right atrial wall appears to be a promising method to decrease the incidence of supraventricular arrhythmias and pulmonary vein drainage obstruction following repair of the cardiac type.

Cardiac Surgical Procedures↗
PubMed1997

Long-term follow-up of surgical patients with single-ventricle physiology: prognostic anatomical determinants.

Although univentricular or biventricular repair is not always possible for hearts with single-ventricle physiology, it has been proven to produce a satisfactory outcome. It is hypothesized that patient prognosis can be predicted by anatomical diagnosis at presentation. Between 1961 and 1995, 158 patients with single-ventricle physiology, including tricuspid atresia and hypoplastic left heart syndrome, were referred to the authors' institute, and underwent 260 surgical interventions. Follow-up was 99% complete. Patient survival and anatomical risk factors were examined by the Kaplan-Meier method, and multivariate analysis including the Cox proportional hazard model. Mean (s.e.m.) actuarial survival rates at 1, 5, 10 and 20 years following birth were 70.3(3.6)%, 56.3(4.0)%, 48.8(4.2)%, and 40.9(4.7)%, respectively. Definitive palliation was attempted in 38 patients (univentricular in 35 and biventricular in three). Multivariate analysis identified systemic ventricular outflow tract obstruction, mitral atresia, situs ambiguus, and pulmonary vein drainage tract obstruction as independent prognostic factors for overall survival. Visceral heterotaxy was the only independent risk factor for lack of application or failure (death or take-down within 30 days of operation) of univentricular or biventricular repair. In conclusions, these anatomical factors in hearts with single-ventricle physiology affect long-term mortality, despite multiple and heterogeneous surgical efforts.

Female↗
PubMed1997

[Extra-anatomic bypass from the ascending aorta to the supraceliac abdominal aorta--surgical option applied to reoperation for aortic coarctation or interruption].

The optimal approach for reoperation following repair of aortic coarctation (CoA) or interruption (IAA) remains controversial. Four patients underwent extra-anatomic bypass for restenosis after repair of CoA or IAA. The age ranged from 4 to 12 years. The initial repairs for two CoA, one type A-IAA, and one type B-IAA consisted of two grafting, one subclavian arterial turning-down aortoplasty, and one subclavian flap aortoplasty. All of them underwent during infancy. Preoperative right arm systolic pressure ranged from 140 to 190 mmHg ar rest. Through a midline sternotomy and an upper laparotmy incision, an extra-anatomic bypass from the ascending aorta to the supraceliac abdominal aorta was employed using a 12 to 18 mm tube graft. All patients survived surgeries, and their hypertension markedly improved. Our experience confirms safety and effectiveness of this option in selected young patients with re-stenosis of following repair of CoA or IAA.

Aorta↗
PubMed1995

[A case of acquired von Willebrand disease due to pulmonary stenosis after Jatene's operation].

The case of a 9-year-old girl with pulmonary stenosis complicated by acquired bleeding tendency after Jatene's operation is reported. Coagulation study revealed that platelet count and von Willebrand factor were reduced. Catheterization study revealed severe pulmonary stenosis, the pressure gradient between the right ventricle (RV) and pulmonary artery (PA) being 190 mmHg. A link between pulmonary stenosis and bleeding tendency was suggested and the patient was diagnosed as having acquired von Willebrand disease due to activated platelet/von Willebrand factor interactions enhanced by "shear stress" at the site of pulmonary stenosis. Right ventricular outflow reconstruction was done when she was 9 years-old. Due to a protocol based on the results of the challenge test that we instituted to determine the efficacy and effective duration of blood derivatives and hemostatic agents, perioperative massive bleeding was avoided. Bleeding tendency disappeared and coagulation study findings normalized with correction of the abnormal hemodynamic state.

Child↗
PubMed1994

[Preliminary clinical results of surgery for type A acute aortic dissections using gelatin-resorcin-formaldehyde glue].

We used gelatin-resorcin-form-aldehyde (GRF) glue to fuse the false lumen of type A acute aortic dissection in four patients. All were operated on within 3-24 hours after onset, and gluing of the two cylinders of the dissecting aorta could be done safely in a short time. Initial intimal tears were located in the transverse aorta in three patients and in the proximal descending aorta in one. Simple transection and end-to-end anastomosis of the ascending aorta was done for the first two cases. But in the last two patients, we resected the intimal tear in the transverse aorta and applied GRF glue to the stump of the aortic arch and to that of the aortic root, followed by graft replacement of the ascending aorta. There were no hospital deaths. But we had to reoperate on one patient five months after the first operation due to potentially residual dissection in the aortic root. GRF glue is a very useful adhesive for acute aortic dissection operations, but further refinement of the operative technique using it is necessary.

Acute Disease↗
PubMed1994

[The surgical treatment of coarctation of the aorta and interruption of the aortic arch in the first three months of life--effectiveness of temporary bypass between the pulmonary artery and the descending aorta].

From February 1987 to January 1994, we operated on 24 patients with coarctation of the aorta (CoA) and 9 patients with interruption of the aortic arch (IAA). A policy of staged repair was followed, consisting of reconstruction of the aortic arch with pulmonary artery banding and ligation of the ductus arteriosus in the first stage and intracardiac repair with pulmonary artery band removal in the second stage. In recent cases an extended aortic arch anastomosis was performed using a heparin-coated "shunt tube" between the pulmonary artery and the descending aorta to maintain blood flow to the lower half of the body during aortic cross-clamping. The use of the shunt increased intraoperative urine output (p < 0.05). This technique may allow patients whose condition is poor to undergo aortoplasty more safely. One patient died. This patient had CoA and total anomalous pulmonary venous return, who underwent a one-stage repair, in violation of our policy (early mortality 3.0%). There were two interim deaths before the second stage repair. At present, 18 patients have undergone staged intracardiac repair, including VSD closure (14 cases), Jatene's procedure (1), Ratelli's procedure (1), Damus-Kaye-Stansel (DKS) procedure (1), total cavo-pulmonary connection (TCPC) + DKS procedure+annuloplasty of a common atrioventricular valve (1). There were two early deaths and one late death following intracardiac repair, all in patients with IAA plus VSD.

Anastomosis, Surgical↗
PubMed1994

[A case of successful surgical treatment for coarctation of the aorta associated with ruptured cerebral aneurysm].

We present a case of a sixteen year old boy with coarctation of the aorta who suffered ruptured cerebral aneurysm. Both cerebral and aortic lesions were successfully corrected. He complained of sudden headache and nausea. Subarachnoid hemorrhage was diagnosed by computed tomography of the head. Cerebroangiography demonstrated coarctation of the aorta. Clipping of cerebral aneurysm was done at first, then three months later, complete resection of the aortic coarctation and artificial graft replacement was done by using femoral veno-arterial cardiopulmonary bypass.

Adolescent↗