PubMed Health⌕ Search

Biomedical subjects

T Kazui

Publications and source records attributed to T Kazui.

At least 163 records · Page 9Linked to original sources
PubMed1990

[A case report of successful emergency re-AVR for structural failure of a Hall-Kaster prosthesis].

A rare case of Hall-Kaster prosthetic valve dysfunction was reported. The patient was admitted with acute cardiac failure. She had previously received aortic valve replacement (AVR) using 23A Hall-Kaster prosthesis. Prosthetic valve dysfunction was diagnosed by both cinefluoroscopy and echocardiography. Emergent re-AVR was carried out and dislodgement of the pivot was revealed. Postoperative course was uneventful. Reports of structural failure of the Hall-Kaster (Medtronic-Hall) prosthesis are extremely rare. To our knowledge, this is the first reported case of dislodgement of the disc from the pivot of the Hall-Kaster prosthesis.

Acute Disease↗
PubMed1990

[The relationship between preoperative status and postoperative exercise tolerance after mitral valve replacement].

Treadmill exercise test was performed for the evaluation of exercise tolerance after mitral valve replacement. The duration of maximum exercise tolerance in TR free group had no significant difference as compared with TR combined group. Preoperative RV function in TR combined group was kept relatively good as shown in cardiac index, pulmonary arterial and right atrial pressure. As hemodynamics was improved by TAP (TVR), it may not occur the difference in exercise tolerance between the groups. The duration of maximum exercise tolerance with MS group showed shorter tolerance than that of MR group. This difference in MS group might be considered due to the limitation of LV dilatation by rheumatic cardiac damage. Exercise tolerance after MVR was significantly lowered by atrial fibrillation, cardio-thoracic ratio over 60% and pulmonary vascular resistance over 3.0 Runits.m2.

Exercise Tolerance↗
PubMed1989

Wada-Cutter heart valve: overall experience at the Sapporo Medical College.

We performed cardiac valve replacement using the Wada-Cutter valve in 124 patients during the 9 years between 1966 and 1974: aortic valve replacement in 48, mitral valve replacement in 56, tricuspid valve replacement in 9, and multiple valve replacement in 11. Sixteen patients died within 30 days after operation, and 34 died in the late postoperative period, with a cumulative mortality rate of 40.3%. Postoperative complications included valve thrombosis in 9 patients, thromboembolism in 4, and mechanical valve failure in 5. The Wada-Cutter valve, first described at the Annual Meeting of The Society of Thoracic Surgeons on January 27, 1967, in a discussion on the paper by Cooley and colleagues on mitral valve replacement with a discoid valve, attracted attention for its unique design. Four of the Wada-Cutter valves were incorporated in Liotia's total artificial heart, which was implanted clinically for the first time in Cooley's second-stage heart transplantation. It may not only claim to be the origin of today's most popular tilting-disc heart valves but also has some original concepts with regard to bileaflet and tricuspid tilting-disc heart valves. However, at that time, cardiac valve replacement with this prosthesis resulted in a high incidence of thrombosis without systemic anticoagulation and in mechanical valve failure due to hinge wear of the Teflon occluder. For these reasons, its clinical use was discontinued in 1974. If Pyrolite carbon had been adopted in construction of the valve when it first became available, the valve design could have been useful even today.

Aortic Valve↗
PubMed1989

[A case of left ventricular pseudoaneurysm with severe cardiac failure and premature ventricular beats].

A surgically successful case of left ventricular pseudoaneurysm 10 years after an acute myocardial infarction was reported. A 63-year-old man had an acute inferior myocardial infarction 10 years ago. Recently congestive heart failure and premature ventricular beats developed. He was diagnosed as a left ventricular pseudoaneurysm by echocardiogram, CT scan, and left ventriculogram. After the operation, the symptoms diminished and improvement of left ventricular function was observed. A brief review of the literature is given.

Cardiac Complexes, Premature↗
PubMed1989

[Implications of preoperative angiography and coronary artery bypass grafting for patients with combined coronary artery and great vessels diseases].

Preoperative coronary angiography showed that the significant coronary artery disease (CAD) was present in 47% of patients with thoracic aortic aneurysm (TAA), abdominal aortic aneurysm (AAA), or aortoiliac occlusive disease (A.I). Fifty-seven patients underwent the both coronary artery and great vessel diseases on the simultaneous or sequential stage. As CAD, 13 patients had one vessel disease (VD), 18 had two-VD, 26 had three-VD and 4 of them had left main trunk lesions. As great vessel diseases, 23 patients had A-I, 20 had AAA, 8 had TAA, 5 had TAA+AAA, and 1 had TAA+A-I. There were 4 early deaths (7%) in 57 patients, and 4 (3%) in total 120 coronary and great vessel's operative procedures. The 5-year survival rates were 57.4 +/- 15.5% for TAA, 87.1 +/- 8.5% for AAA and 63.9 +/- 11.1% for A-I, which were not significantly different from those of patients without CAD, respectively except for TAA. The present data suggest that preoperative coronary angiography and CABG in the selected patients may have the beneficial effects on survival and quality of life.

Adult↗
PubMed1989

[Quantitative assessment of myocardial viability following coronary artery bypass grafting using exercise thallium-201 myocardial single photon emission computed tomography and left ventricular regional wall motion].

Using exercise thallium-201 myocardial single photon emission computed tomography (SPECT) and % radial shortening (%RS), 58 patients were evaluated before and after coronary artery bypass grafting (CABG) to quantitatively assess myocardial viability and the effect of CABG. The patient was classified, according to redistribution pattern, as group I with only complete redistribution (20 cases) and group II with including incomplete redistribution (22 cases) and group III with no redistribution (16 cases). 1. Group I was expected complete improvement of ischemic myocardium after CABG but regional left ventricular wall motion was unchanged (sigma i%RS: 142.5 +/- 54.7----138.4 +/- 39.6, sigma a%RS: 201.2 +/- 51.1----238.2 +/- 68.2). 2. Group II was expected to diminish ischemic size after CABG and left ventricular regional wall motion was significantly improved (sigma i%RS: 68.8 +/- 25.9----154.9 +/- 42.6 p less than 0.01, sigma a%RS: 108.4 +/- 62.3----178.9 +/- 77.6, p less than 0.05). 3. Group III was no significant change of ischemic size and left ventricular wall motion after CABG (sigma i%RS: 67.8 +/- 24.1----83.9 +/- 19.2, sigma a%RS: 86.0 +/- 29.0----94.0 +/- 33.9). The present study suggests that quantitative assessment of myocardial viability using exercise thallium-201 myocardial SPECT and %radial shortening was useful method to determine the indication and to assess the effect of CABG.

Adult↗
PubMed1989

[A case report of surgical treatment of dissecting aneurysm of the thoracic aorta (DeBakey IIIb) with chronic renal failure].

The patient has been receiving hemodialysis (H.D.) for chronic renal failure due to polycystic kidney since last February. He suddenly had back pain and short of breath February 8, 1988. He was pointed out to have hypertension and cardiomegaly on chest roentgenogram. He was transferred to our hospital, and suspected dissecting aneurysm. Magnetic resonance imaging was useful for the diagnosis of the dissecting aneurysm and may have a potential advantage in following up the residual false lumen. The patient underwent graft inclusion technique for dissecting aneurysm of the thoracic aorta of type IIIb with an aid of partial femoro-femoral bypass. The water and electrolytes balances were controlled by GI therapy and hemoconcentrator during operation. Since serum potassium level was gradually increasing up to 7.8 mEq/l inducing arrhythmias with coronary arterial spasm postoperatively, H.D. was instituted. The induction of H.D. was easily performed with satisfactory results. Heparin was not used while blood coagulation profiles tended to be low in early postoperative period. He returned to his work this August.

Aortic Dissection↗
PubMed1989

[Clinical study on surgical treatment of aortic arch aneurysm using selective cerebral perfusion or hypothermic circulatory arrest].

To improve the surgical results of aneurysms of the transverse aortic arch, it is essential to select the optimal support technique to protect the cerebral ischemia during the aortic arch occlusion. In the four year period between 1983 and 1987, 21 consecutive patients had surgical correction of aneurysms of the transverse aortic arch at our institution. The causes of aneurysms were dissection (type A) in 16 patients and arteriosclerosis in 5 patients. Seven patients had emergency operation for frank or impending rupture. Two method for cerebral protection were employed during the period of arch exclusion. In Group I, 11 patients underwent selective cerebral perfusion both to innominate and left common carotid arteries via one roller pump at a rate of 600 ml/min (25 degrees C). The average cerebral perfusion time was 70.4 +/- 20.5 minutes. In Group II, 10 patients underwent deep hypothermia (15 degrees C to 20 degrees C) and total circulatory arrest to allow repair of the transverse aortic arch. The concomitant AVR was performed in two patients and CABG in one patient. The average cerebral arrest time was 35.2 +/- 3.4 minutes. Two out of 10 patients had additional cerebral perfusion because cerebral ischemic time exceeded over 45 minutes. There were three early deaths (14.3%) in this series. The causes of early death were bleeding in two patients and renal failure in one patient. There were no cerebral complications in both groups. The duration of extracorporeal bypass necessary for cooling and rewarming phase in Group II was longer than that in Group I.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

[The effects of aorto-coronary bypass grafting on left ventricular diastolic function in patients with left ventricular dysfunction].

To determine the effects of aorto-coronary bypass grafting on left ventricular diastolic function in patients with low ejection fraction (EF less than or equal to 0.40), 17 patients were studied. They were divided into two groups, Group I: 8 patients without previous myocardial infarction, Group II: 9 patients with previous myocardial infarction. Left ventricular diastolic function was assessed by maximum negative dp/dt, constant T, diastolic compliance and 1/3 functional filling. In conclusions, when ejection fraction is depressed (EF less than or equal to 0.40), myocardial revascularization improves left ventricular diastolic function in patients without previous myocardial infarction, but not with previous myocardial infarction.

Aged↗
PubMed1989

[Quantitative analysis of myocardial revascularization on left ventricular diastolic function].

To evaluate the effects of myocardial revascularization on left ventricular diastolic function, we studied three groups of subjects. Group I consisted of 10 patients without any previous myocardial infarction. Group II consisted of 10 patients with previous myocardial infarction. The control group consisted of 8 normal subjects, all with no evidence of cardiac disease as determined by cardiac catheterization. Left ventricular diastolic function was assessed by maximum negative dp/dt, constant T, diastolic compliance and 1/3 fractional filling before and after surgical revascularization. (1) Constant T, maximum negative dp/dt and diastolic compliance: There was no significant difference among groups I, II and the control group preoperatively, and the variables were not improved postoperatively. (2) 1/3 fractional filling: 1/3 fractional fillings in groups I and II were significantly lower (p less than 0.05, p less than 0.01) than the control group preoperatively, and it was significantly improved in group I, but unchanged in group II postoperatively. In conclusion, myocardial revascularization improves left ventricular diastolic function in the patients without previous myocardial infarction. The effects of myocardial revascularization, however, in the patients with prior myocardial infarction do not bring about an enhancement of left ventricular diastolic function.

Adult↗
PubMed1989

[Total graft replacement of the thoracoabdominal aorta with reconstruction of visceral branches, intercostal and lumbar arteries in expanding chronic dissecting aneurysms of the thoracoabdominal aorta].

Four patients with expanding chronic dissecting thoracoabdominal aneurysm underwent total replacement of the thoracoabdominal aorta with reconstruction of all visceral branches, intercostal and lumbar arteries with the aid of femoro-femoral bypass. During aortic cross-clamping, selective celiac and both renal arteries perfusion was performed to prevent the organ ischemia. Somatosensory evoked potentials monitoring or spinal cord evoked potentials monitoring was also performed to detect the spinal cord ischemia. Surgical technique employed in this series was direct anastomosis of onlay patch graft to the normal true lumen from which visceral branches and intercostal and lumbar arteries arise. The celiac artery and left renal artery arise from the false lumen in some cases were reconstructed with graft interposition or direct anastomosis to an opening made in the onlay patch graft. All patients survived the operation, and are leading normal life late in the postoperative period except one who developed partial paraplegia. Total graft replacement of the thoracoabdominal aorta may be a valid technique for the treatment of expanding aneurysms of the dissecting thoracoabdominal aorta.

Adult↗
PubMed1989

[Surgical management of acquired tricuspid valve disease--the effects and comparison of tricuspid annuloplasty (De Vega) and tricuspid valve replacement].

A total of 92 patients with tricuspid valvular disease (TR) had surgical repair of DeVega's annuloplasty in 80 patients (87%) and of valve replacement in 12 patients (13%) from January, 1978, to March, 1988. All of those patients were diagnosed by cardiac catheterization and angiogram, clinical findings and in recent cases, pulsed and color Doppler echocardiography were applied. Eighty-nine of 92 patients (97%) were in NYHA class III or IV before operation. There were 7 early death (8.5%) with DeVega procedure and one death (8.3%) in TVR and late deaths were noted in 3 patients (3.6%) (DeVega's procedure) and one (8.3%) in TVR. Two patients after DeVega procedure at 5 and 6 years were required re-operation of TVR because of recurrent mitral valvular disease. Seventy-seven of 80 survivors were in NYHA class I or II postoperatively. Twenty-seven randomized selected patients after DeVega's annuloplasty were investigated by pulsed and color Doppler echocardiography, 17 of them (63%) had no regurgitation and the remaining 10 patient had mild to moderate regurgitation. This study suggests that DeVega's annuloplasty has a simple and reliable procedure in patients with functional TR and results in excellent hemodynamic and functional effects postoperatively.

Adolescent↗
PubMed1989

[Evaluation of left ventricular function in the patients with aortic regurgitation following aortic valve replacement by radionuclide cardiography].

Twenty patients undergoing AVR were subjected to this study and divided into the early and the late groups. 6 healthy adults were dealt as the control group. The EF, PER, 1/3 EF, TPE were compared among these three groups both at rest and during exercise. The detailed responses to the exercise were measured by %delta between at rest and during exercise. Furthermore, the LV function in the filling period were examined by the 1/3 FF and RFR at rest. This study suggests that although the left ventricular function and contractile reserve to the exercise remained insufficient in the early postoperative phase, nearly complete recovery of the reserve could be obtained in the later phase, while the left ventricular function in the rapid filling period was significantly decreased in both early and late postoperative phase.

Adolescent↗
PubMed1989

[Clinical evaluation of low cardiac output syndrome following adult open heart surgery].

Between April, 1984 and December, 1988, 450 adult patients underwent open heart surgery for the valvular heart disease (VHD) and ischemic heart disease (IHD) in our institution. As the postoperative complication, LOS was observed in 33 patients with VHD (14.2%), and in 27 patients with IHD (12.4%) with no significant difference between the two groups. Treatment for LOS employed in this series consisted of pharmacological therapy in 11 patients, IABP in 42, IABP+veno-arterial bypass (VAB) in 5, right heart bypass (RHB)+IABP in 1 and left ventricular assist device (LVAD)+IABP in 1. All patients who were treated by the pharmacological therapy were alive and were discharged. Eighty-one % of the patients who were assisted with IABP were able to weaned off IABP, and 57% of the patients were alive and were discharged. All patients who were assisted with IABP+VAB died of LOS within 3 days after the operation. One patients who was assisted with RHB+IABP for pulmonary hypertension after emergency re-MVR and the other patient with LVAD+IABP for LOS after emergency CABG were able to be weaned off the assisted circulation and were discharged from the hospital. The salvage rate of patients with IHD by mechanical assisted circulation was generally higher than that of patients with VHD. Because of the limitation of IABP or VAB effect on the hemodynamic, LVAD directly assisted cardiac function would be indicated for severe LOS following open heart surgery without delay.

Adult↗
PubMed1989

[Long-term results of cardiac valve replacement: a 10- to 25-year retrospective study].

A total of 149 patients who underwent cardiac valve replacement between January, 1964 and June, 1979 in our institution have been survived more than 10 years postoperatively. The prosthetic valves primary employed in this series were both mechanical valve such as Starr-Edwards, Smeloff-Cutter, Wada-Cutter, Lillehei-Kaster valves and biological valve such as Hancock valve. Of these, 69 patients (46%) implanted with Starr-Edwards or Wada-Cutter valve were not anticoagulated postoperatively, and 52 (53%) underwent reoperation mainly for valve-related complications or aggravated other valve lesions during the follow-up period. One hundred and thirteen patients were confirmed to be alive at the end of June, 1989, with the follow-up period of 10 to 25 years. Of these, 98 patients (87%) are in the NYHA I or II at the present time. Other twenty-two patients were dead and fourteen were lost to follow-up over 10 years after operation. Although cardiac valve replacement may improve the longevity and the quality of life, available prosthetic valves were not ideal both in material and design. The increased risk of thrombogenesis of mechanical valve and the limited durability of biological valve necessitated re-replacement in the long-term period. Therefore, in addition to selection of the appropriate valve prosthesis, and optimal prevention of valve-related complications, early diagnosis and treatment of these complications are important to improve the long-term results of cardiac valve replacement.

Adolescent↗
PubMed1988

Surgical treatment of abdominal and thoracic aortic aneurysms in aged patients.

A total of 378 patients with aortic aneurysm, consisting of 128 with abdominal aortic aneurysm (AAA) and 250 with thoracic aortic aneurysm (TAA), underwent operation in our institution during the past 20 years. Of these patients, 58 with AAA and 63 with TAA were 65 years old or over. Preoperative complications tended to be observed more frequently in the aged patients than in the younger, 'non-aged' patients. The early mortalities in the aged group were 5% for elective AAA operation, 40% for emergency AAA operation, 11% for elective TAA operation and 41% for emergency TAA operation. The 5-year survival rates in the aged group were 78.3 +/- 5.8% for AAA and 63.4 +/- 4.0% for TAA, which were not significantly different from those in the non-aged group, respectively. Postoperative complications tended to occur more frequently in the aged patients than in the non-aged patients both for AAA and TAA. The present data suggest that aggressive surgical treatment for aortic aneurysm in the aged is warranted unless other serious organ failure exists.

Aged↗