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Biomedical subjects

T Kazui

Publications and source records attributed to T Kazui.

At least 127 records · Page 7Linked to original sources
PubMed1994

[Results of reoperation for prosthetic dysfunction in the mitral position].

We analyzed surgical results of 91 patients who underwent re-mitral valve replacement (reMVR) for valve morbidity between January 1981 and March 1994 in an attempt to draw some therapeutic guidelines. The study population consisted of 38 men and 53 women, ages 32-73 (mean 52 +/- 10) years. The causes of valve morbidity were structural deterioration in 71 patients, nonstructural dysfunction manifested by paravalvular leakage in 5 valve thrombosis in 7 and prosthetic valve endocarditis in 8. Twelve of ninety-one patients (13.2%) died postoperatively in the hospital. All the patients were divided into the survivors (n = 12) and the nonsurvivors (n = 79). Mean right atrial pressure, extracorporeal circulation time, concomitant coronary artery bypass grafting, and application of intra-aortic balloon pumping were significantly different between the groups. Twenty preoperative and intraoperative variables were analyzed by means of univariate and multivariate analysis. By univariate analysis, male gender, NYHA IV, history of congestive heart failure, renal insufficiency and prosthetic valve stenosis were related to a higher incidence of hospital death. Multivariate analysis revealed that male gender and NYHA IV were risk factors in reMVR, and indicated no differences in intraoperative parameters between survivors and deaths. It is recommended to examine patients with bioprostheses thoroughly and to perform early elective reMVR before a patient develops NYHA IV.

Adult↗
PubMed1994

[Comparative study of type of prosthesis on late results after double valve replacement].

This study was performed to clear the influence of combination of prostheses on late results by comparing our patients. The patients were divided into two groups. Group I patients received a mechanical valve in the aortic position and a bioprosthesis in the mitral position (n = 25): and group II, dual mechanical valves (n = 89). The duration of follow-up ranged from 0.2 to 13.5 years, with a total of 466 patient-years. There was no difference between the two groups in terms of actuarial survival or incidence of reoperations, thromboemboli, or nonstructural dysfunction. Group I, however, had a significantly greater incidence of structural valve deterioration, anticoagulant-related hemorrhage, and all valve-related morbidity and mortality when compared with group II. In conclusion, 1. combining a mechanical valve and a bioprosthesis is disadvantageous: 2. dual mechanical valves have excellent long-term results.

Aortic Valve↗
PubMed1994

[Symbas's operation in a case of congenital fistula of the right coronary artery to left ventricle].

Congenital fistula between a coronary artery and the left cardiac ventricle are extremely rare. Since Blakeway (1918) first described this type of anomaly, only 72 cases have been reported up to the present, within our knowledge. A surgical correction of congenital fistula of the right coronary artery to left ventricle in a 36 year-old woman who suffered from easy fatigability is reported. This lesion was deduced after echocardiography identified a dilated right coronary artery and fluttering of the posterior cusp of the mitral valve throughout the diastole, the diagnosis was confirmed by retrograde aortography and coronary angiography. The fistula was closed by Symbas's operation under cardiopulmonary bypass with cardiac arrest and mild hypothermia. Postoperative recovery was uneventful. Coronary angiography one month after the operation revealed that the right coronary artery was still dilated with thrombus; there were no signs of myocardial ischemia or infarction. This diagnosis and successful treatment were based on careful study of the documentation of the 72 previously reported cases.

Adult↗
PubMed1994

[A successful case report of redo composite graft and total aortic arch replacement for active prosthetic graft endocarditis].

A successful redo composite graft and total aortic arch replacement for active prosthetic graft endocarditis is reported in the 31-year-old female with Marfan syndrome who had undergone Bentall procedure and proximal aortic arch replacement for type A acute aortic dissection 21 months previously. Echocardiography revealed massive vegetation in the composite graft and left ventricular outflow tract, and blood culture suggested Candida endocarditis. The composite graft and arch grafts were completely removed, and the reconstruction was carried out with a new composite graft using Piehler's technique. Finally, the total aortic arch was replaced and the all branches were reconstructed. The post-operative course has been uneventful, and she is now doing well 12 months after the operation without any evidence of recurrence of endocarditis.

Adult↗
PubMed1994

[Clinical study on re-surgery of the combined valvular disease: simultaneous double valve replacement].

Between June, 1984 and December, 1993, 36 patients who underwent simultaneous double valve replacement for re-surgery of combined valvular disease were analyzed in this study. The indications for re-surgery were malfunction of mechanical valve in the aortic position, primary tissue failure of biological valve in the mitral position, deterioration of valvular disease and prosthetic valve endocarditis. Re-surgery was performed ranging from 4 to 15 years, with a mean period of 9.5 years, following initial operation. Early operative mortality was 5.5% (2 cases) and late mortality 8.3% (3 cases). There were no cardiac deaths during the late postoperative period. Despite of technical difficulty due to dissection of the adhesion around the heart and re-replacement of prosthetic valve, the operative mortality and morbidity were relatively low because of the improved operative technique and myocardial protection.

Adult↗
PubMed1993

Left ventricular pseudoaneurysm and intracardiac fistulas after replacement of mitral valve prosthesis.

Operation was performed on a 61-year-old woman with left ventricular pseudoaneurysm, left ventricular-right atrial fistula, and left ventricular-coronary sinus fistula after mitral valve replacement. The diagnostic and therapeutic approaches to these complications are described briefly, and the literature on intracardiac fistula after mitral valve replacement is reviewed.

Cardiomyopathies↗
PubMed1993

[A coronary aneurysm of left main trunk associated with localized dissecting aneurysms of thoracic and abdominal aorta].

A 47-year-old man who had undergone surgery of a dissecting thoracic aortic aneurysm was admitted for a localized, dissecting abdominal aortic aneurysm. Preoperative coronary arteriogram incidentally showed a coronary artery aneurysm (CAA) of the left main trunk. Prior to the operation for abdominal aortic aneurysm, that for the CAA was performed under standard cardiopulmonary bypass conditions with antegrade and retrograde coronary sinus cold blood cardioplegia. A longitudinal incision of the aneurysmal wall was made for the removal of a small thrombus and, the ostia of the left anterior descending artery (LAD), circumflex artery (LCX), intermediate artery (IM) and main trunk were closed from the inside of the aneurysm. The aneurysmal wall was closed without resection of the whole aneurysm. Finally, coronary artery bypass grafting to LAD, LCX and IM was performed. Postoperative course was uneventful with patency of all grafts. The retrograde coronary sinus cardioplagia is effective to prevent thromboembolism of distal coronary arteries due to the antegrade cardioplagia.

Adult↗
PubMed1993

[Surgical treatment of aortic arch aneurysm associated with coronary artery disease].

Graft replacement of the aortic arch aneurysms and concomitant coronary artery bypass grafting (CABG) were performed in the consecutive seven patients for the past five years between 1987 and January 1992, including three (43%) emergency operations. The etiology of aneurysms was atherosclerosis in 4, and aortic dissection in 3. There were one early death (14%) due to MRSA pneumonia, and one late death due to rupture of the abdominal aortic aneurysm 8 months postoperatively. Respiratory failure was frequently complicated immediately after the surgery. Vein grafts were anastomosed to coronary artery during the initial core cooling, and sequential cardioplegia was given through the bypass grafts. Selective cerebral perfusion was carried-out during the reconstruction of the transverse aortic arch and arch vessels in all cases. To achieve sufficient myocardial protection, and to get good postoperative hemodynamics and long-term survivors, it was important to perform the simultaneous CABG at the time of the repair for the aortic arch aneurysm in cases complicated with coronary artery disease.

Adult↗
PubMed1993

[Surgical treatment of aortitis syndrome associated with annuloaortic ectasia and the stenotic lesion of the aortic arch vessels].

A 37-year-old woman was admitted to our hospital for treatment of aortitis syndrome. Her aortogram showed critical stenosis of the innominate artery, occlusion of other arch vessels, and annuloaortic ectasia (AAE). We performed endarterectomy and patch plasty to the innominate artery using a saphenous vein graft. Graft replacement of the ascending aorta and AVR (modified Wheat's operation) were also performed at one stage. Deep hypothermic cerebral circulatory arrest was used as a method for cerebral protection. During operation, the lowest rectal temperature was 17 degrees C and the cerebral circulatory arrest time was 36 min. The postoperative course has been uneventful. In a postoperative aortogram, the innominate artery was well perfused. She has been free of complaint and been doing well for 2 years since the operation.

Adult↗
PubMed1993

[Composite valve graft replacement for aortic root aneurysm or dissection].

Fifty four patients who had aneurysms (n = 35) or dissections (n = 19) associated with aortic regurgitation underwent the replacement of the ascending aorta and aortic valve by composite valve graft during 15-year period between September 1976 and December 1991. Of these, 49 (90.7%) patients had an annuloaortic ectasia and 26 (48.1%) had the Marfan syndrome. The methods of coronary artery reattachment to the graft were as follows: direct reattachment (original Bentall's technique) in 45 patients, aortic button technique (Carrel's patch technique) in 6, Cabrol's technique in 2 and Piehler's technique in 1 patients. Seven patients with a DeBakey type I dissection had concomitant replacement of the aortic arch with an aid of selective cerebral perfusion. The overall hospital mortality rate was 12.9%, and it has significantly decreased to 6.7% since we adopted a cold cardioplegia, preclotting the graft with albumin autoclave technique and coronary artery reattachment using conventional over-and-over and interrupted mattress sutures with pledgets during the last 10-years. The mean duration of follow-up period was 58.6 months. The actuarial survival rate at 10 years for all patients was 76.4%; for those with dissection, 78.4%; and for patients with Marfan syndrome, 70.4%. Reoperation for the prosthesis-related complications was necessary in only one patient, although operations on the remainder of aorta were required in 5 patients. Actuarial freedom from these operations at 10 years was 74.1%, but it was 69.3% for the subgroup with Marfan syndrome. The present data indicates that composite valve graft technique is an useful method for patients with aortic root aneurysms or dissections.

Adult↗
PubMed1992

Selective cerebral perfusion during operation for aneurysms of the aortic arch: a reassessment.

Thirty-two consecutive patients with thoracic aortic aneurysms who required aortic arch reconstruction were operated on with the aid of extracorporeal circulation and selective cerebral perfusion between January 1986 and August 1990. For selective cerebral perfusion, blood was infused into both the innominate and left common carotid arteries at a rate of 10 mL.kg-1.min-1 using a single roller pump separately from the systemic circulation. In 9 patients treated before March 1987, the operations were performed without open aortic anastomosis (group 1), whereas in 23 patients treated from March 1987 onward we used open aortic anastomosis (group 2). The extracorporeal circulation and cardiac arrest times were significantly longer in group 2, but there was no significant difference in the cerebral perfusion time. Early death occurred in 1 patient in group 1 and 2 in group 2. No serious cerebrospinal neurological complications occurred in either group, and there were similar rates of postoperative hepatic and renal dysfunction in both groups. The present data suggest that selective cerebral perfusion and open aortic anastomosis are useful methods for thoracic aortic aneurysm operation requiring complex repair of the aortic arch.

Adult↗
PubMed1992

[Comparison of long-term results of surgical and nonsurgical therapy in acute aortic dissection].

The early and long-term results of both surgical and nonsurgical therapy for 160 patients with acute aortic dissection in our institution were analyzed. Of the 83 patients with acute type A aortic dissection, 47 received surgery during acute stage, 10 received it in the chronic stage, and 26 received nonsurgical therapy. Of the 77 patients with acute type B aortic dissection, 27 received surgery during acute stage, 22 received it in the chronic stage, and 28 received nonsurgical therapy. Ten-year survival rates for patients receiving surgery during the acute stage were 62% for type A and 64% for type B dissection. This survival rate for type A patients was significantly higher than that for type A patients not receiving surgery, but the corresponding difference for type B patients was not significant. Present data indicate that immediate surgical intervention is indicated in patients with acute type A dissection, and elective operation in the subacute stage in patient with uncomplicated type B dissection following medical therapy in the acute stage.

Acute Disease↗
PubMed1992

[Adjunctive methods during surgery for thoracoabdominal aneurysms--effect of selective visceral arteries perfusion incorporated with partial femoro-femoral bypass].

In this study, we report the effect of selective perfusion to the visceral arteries during aortic cross-clamping at surgery for thoracoabdominal aortic aneurysms with an adjunct of femoro-femoral (F-F) extracorporeal bypass. The total series comprising 28 patients were divided into 3 groups according to the perfusion mode to the celiac and the renal arteries, i.e., group I; the arteries were continuously perfused by the extracorporeal bypass, group II; aortic cross-clamp excluded the branches from the bypass flow but selective perfusion was employed, and group III; the liver or the kidneys were subjected to ischemia. As a result, group III developed hepatic failure at the incidence of 50% which was characterized by hepatocellular damage followed by cholestatic dysfunction. As for postoperative renal function, this group revealed persistently high level of serum creatinine, and 60% of this series resulted in renal failure. On the contrary, group II showed a comparable effect to group I on the preservation of hepato-renal function, and there were no differences in the incidence of hepatic or renal failure between the two groups. Multiple organ failure was a predominant cause of hospital death, and it developed only in the cases with aortic cross-clamp time more than 90 minutes. However, avoiding ischemia achieved in group I or II significantly reduced the incidence of MOF and its related deaths. It is concluded that selective perfusion system incorporated with an aid of F-F partial bypass was a useful measure to protect vulnerable organs from ischemia and to reduce postoperative mortality and morbidities.

Adult↗
PubMed1992

[The evaluation of pre and intraoperative factors influencing the false lumen after graft replacement surgery to the extended dissecting aneurysm].

We evaluated the residual false lumen of type I and IIIb dissecting aneurysm by CT, MRI and angiography postoperatively. The 19 patients with type I dissecting aneurysm were included eleven men and eight women, the average age was 55.8 +/- 10.2 years old. The 20 patients with type IIIb dissecting aneurysm were included sixteen men and four women, the average age was 56.2 +/- 8.5 years old. The rate of distal patent false lumen was 52.6% of type I and 35% of type IIIb dissecting aneurysm after graft replacement surgery. In type I dissecting aneurysm, the rate of distal patent false lumen was 40% of acute stage vs 66.7% of chronic stage, 66.7% of ascending and partial arch replacement vs 46.2% of ascending and total arch replacement, and 90% of graft inclusion technique vs 11.1% of graft exclusion technique. The distal patent false lumen was the lowest (12.5%) with type I dissecting aneurysm of ascending and total arch replacement using graft exclusion technique. In type IIIb dissecting aneurysm, the rate of patent false lumen was 66.7% of acute stage vs 29.4% of chronic stage, 30% of graft exclusion technique vs 40% of graft inclusion technique. The size of false lumen preoperatively were larger (11.1 +/- 4.5 cm2) in patients with distal patent false lumen than that (6.7 +/- 3.2 cm2) of in patients with distal occlusive false lumen.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Effects of blood-diltiazem-nitroglycerin-cardioplegia in coronary artery bypass grafting].

Forty-seven patients who underwent coronary artery bypass grafting using blood cardioplegia (BCP) were studied clinically. They were divided into 3 groups based on concentration of diltiazem (DTZ) and nitroglycerin (NTG). Group I (n = 12); DTZ 5 mg plus NTG 5 mg in BCP 1,000 ml, Group II (n = 10); NTG 25 mg in BCP 1,000 ml, Group III (n = 25); DTZ 5 mg plus NTG 25 mg in BCP 1,000 ml. From the standpoint of serum enzyme analysis, there was no significant difference between 3 groups, however, the incidence of perioperative myocardial infarction (PMI) and perioperative coronary spasm (PCS) were significantly higher in Group I than that in other groups. The present data suggests that intramyocardial concentration of NTG in Group II and III were 5 times higher than Group I. Increased dose of NTG in BCP would be benefit for myocardial protection in CABG.

Adult↗
PubMed1992

[Concomitant graft replacement of the total aortic root and the transverse aortic arch for type A aortic dissection associated with annuloaortic ectasia].

Between April 1988 and February 1992, eight patients with type A aortic dissection associated with annuloaortic ectasia (AAE) underwent the concomitant graft replacement of the total aortic root and the transverse aortic arch at our institution. The acuity of the aortic dissection was acute stage in 3 patients and chronic stage in 5 including 3 cases of re-do operation. All operations were performed with an aid of extracorporeal circulation, blood cardioplegia, selective cerebral perfusion and open distal anastomosis. The operative techniques employed in this series consisted of total aortic root replacement using a composite graft (Bentall, Cabrol or Piehler's technique), and total arch replacement using en bloc arch reconstruction or three vessels graft replacement. One patients underwent re-do operation for coronary anastomotic false aneurysm following Bentall operation and aneurysmal dilatation of the false lumen at the aortic arch, and died of LOS because of the prolonged myocardial ischemia. Other seven patients survived the operation, and lead the normal life at the present time. The present data suggests that type A aortic dissection associated with AAE involving aortic arch could be treated by concomitant graft replacement of the total aortic root and the transverse aortic arch.

Adult↗
PubMed1992

[Total aortic arch graft replacement using a prosthetic graft with three branches for acute type A aortic dissection].

Between March 1991 and August 1991, six consecutive patients underwent the replacement of the both ascending aorta and total aortic arch using a prosthetic graft with three branches for acute type A aortic dissection involving the aortic arch. Preoperative complications included cardiac tamponade in 5 cases, aortic regurgitation in 2, and shock state in 3. All operations were performed with the aid of extracorporeal circulation, selective cerebral perfusion, and open aortic anastomosis within 3 days after the onset. One patient died of rupture of the aortic anastomosis secondary to mediastinitis two weeks after the operation. All patients gained their own consciousness after the operation without any serious cerebral complications. The present data suggest that acute type A aortic dissection involving the aortic arch could be treated by replacing both the ascending aorta and aortic arch using a prosthetic graft with three branches with an aid of the extracorporeal circulation, selective cerebral perfusion and open distal anastomosis.

Acute Disease↗