Biomedical subjects

T Onitsuka

Publications and source records attributed to T Onitsuka.

At least 127 records · Page 7Linked to original sources

PubMed1991

[Mitral and aortic valve replacement with tricuspid annuloplasty in a patient suffering from hereditary spherocytosis].

A 51-year-old woman was admitted with increasing shortness of breath. Preoperative evaluation disclosed MSr + ASr + TR. She had been undergone a splenectomy at 35-year-old for hereditary spherocytosis (HS). The patient underwent successful mitral valve replacement with a No. 25 Björk-Shiley (BS) valve, aortic valve replacement with a No. 21 BS valve, and tricuspid valve annuloplasty by means of membrane oxygenator (COBE). Haptoglobin and poloxamer 188 were used for prevention of hemolysis during extracorporeal circulation. No significant hemolysis occurred intra-or postoperatively. A very rare case of open heart surgery associated with HS was reported.

Aortic Valve↗

PubMed1990

The relation between EEG and mental development following cardiac surgery performed under simple deep hypothermia in children.

In order to assess the accuracy of electroencephalography (EEG), in children who have undergone cardiac surgery under simple deep hypothermia, the relation between IQ or schoolwork achievement and the duration of circulatory arrest was investigated in 75 such children. Abnormal preoperative EEG's were found in 16 per cent of the children while abnormal postoperative EEG's were found in 17 per cent. The children were divided into 4 groups, according to pre- and postoperative EEG results. Schoolwork achievement scores ranged between 3.0 and 3.2, the difference among the groups being insignificant. Moreover, no significant shift in IQ was found among the groups. Finally, regarding the number of children who were able to go on to a higher level of education, including high school then college or university, again no significant differences were found among the 4 groups. In a comparison with the number of such children in neighboring Nagasaki prefecture able to continue on to a higher level of education, no significant differences were seen either. The findings and statistics of this investigation therefore indicate that pre- and postoperative EEG's are not always a reliable reference for assessing the prognosis of cerebral activity.

Achievement↗

PubMed1990

Continuous wave Doppler echocardiographic evaluation of St. Jude prosthetic mitral valves in children.

The function of 9 St. Jude prosthetic mitral valves in 8 children was evaluated by continuous wave Doppler (CWD) echocardiography 28 +/- 22 months after implantation. All valves were apparently functioning normally on clinical examination. Peak flow velocity, mean flow velocity, pressure half-time and mean pressure gradient were determined from the transmitral flow velocity curve by CWD echocardiography. For comparison, the same parameters were examined in 15 normal children and 14 adults who had undergone mitral valve replacement. All measured values were greater in adults and children who had undergone valve replacement than in normal children. There were no differences in any parameter in adults or children in whom prostheses 25 mm or larger had been implanted. Although 3 children in whom prostheses 23 mm or smaller had been implanted had greater values for each parameter than those who received 25 mm or larger prostheses, there were no symptoms or signs of mitral stenosis. These data may be useful as guidelines for normal Doppler characteristics for St. Jude mitral valves in children. In an asymptomatic child whose prosthetic valve developed obstruction by granulation tissue overgrowth, each parameter significantly worsened as the heart rate increased. The changes in these parameters in 2 normally functioning St. Jude valves during atrial pacing were insignificant. The fluctuation of Doppler characteristics with changes in heart rate is useful for differentiating normally functioning prosthetic valves from impending stenosis.

Adolescent↗

PubMed1990

[Surgical treatment of cor triatriatum: report of four cases].

Four cases of cor triatriatum are reported. Cases 1 and 2 had IIA, case 3 had IA, and case 4 had IIIB 1 type of cor triatriatum according to Lucas-Schmidt classification. Cases 1 and 2 were diagnosed by echocardiography preoperatively. They were not performed cineangiocardiography because of pulmonary congestion. Case 3 had type IA so called classical type, which is hemodynamically identical to mitral stenosis and supravalvular stenosing ring. The clinical features are depend on the size of the communication between accessory chamber and true left atrium. As case 4, he had been diagnosed of simple atrial septal defect preoperatively, careful echocardiographic examination was essential for accurate diagnosis. In case 2 with hypoplastic left heart, secondary surgical repair is considered to be desirable followed by balloon dilatation of two atrial septal defects communicated to accessory chamber and to true left atrium. Thus, we expect development of hypoplastic left ventricle.

Adolescent↗

PubMed1990

[Open heart surgery of a patient with Basedow's disease: a case report].

A case of open heart surgery of Basedow's disease was presented. A 46-year-old female was admitted for mitral regurgitation with heart failure. She suffered from Basedow's disease ten years ago, and was treated with MMI. With this treatment, her thyroid function became normal and did well over the last four years. When open heart surgery (MVR) was performed, examination of her thyroid gland revealed mild hypothyroidism, and the operation could be performed without any thyroidal trouble. We conclude, in case of heart disease with Basedow's disease, the operation can be performed without any thyroidal trouble if the thyroid function is controlled well to euthyroid for a long term. Euthyroid condition lasted 4 years in this case.

Female↗

PubMed1990

[Renal function after aortic reconstruction for aortic dissection: special reference to the renal blood flow from false lumen].

Relationships between preoperative renal blood flow and postoperative renal dysfunction after aortic reconstruction for aortic dissection of DeBakey I and IIIb type were discussed. The incidence of renal dysfunction after surgery was not so high and renal failure was transient. Renal dysfunction occurred in the cases with true lumen oppressed by false lumen at chronic stage. Sometimes, abnormal findings were showed in CT scanning and/or renogram even in serum creatinine or BUN value was normal. In conclusion, our data showed justification of anastomosis of distal artificial graft to true lumen in acute stage. But in chronic stage, it is very important in point of selection of operative method to recognize how renal blood flow was preserved and to know the location and size of reentry before surgery.

Adolescent↗

PubMed1990

[Case report of the superior approach for correction of the supracardiac type of total anomalous pulmonary venous drainage (TAPVD) in the neonatal period].

An eleven-day-old newborn with cyanosis and respiratory distress was admitted. Intubation and catecholamine administration had already done. Blood pressure was 80/50 mmHg, heart rate was 160/min. Urine volume was only 7 ml per 4 hours with diuretics. The diagnosis of supracardiac type of TAPVD was done by echo cardiography. Without cardiac catheterization, emergent operation was performed. After median sternotomy, the mobilization of the aorta was done. Under cardiopulmonary bypass the aorta was retracted to the left, the superior vena cava to the right and the common pulmonary venous trunk (CPV) was identified through the transverse sinus. Parallel incision were made in the left atrium and CPV, and extended to the vertical vein. An anastomosis using continuous suture was fashioned. She had a good postoperative course. The superior approach through the transverse sinus affords excellent exposure of the CPV and left atrium in situ in the neonatal period, if the mobilization of the aorta is completed, and the heart is not compressed or displaced. This approach is useful for supracardiac type of TAPVD.

Female↗

PubMed1990

[A case of coronary sinus rupture following retrograde coronary perfusion for myocardial protection].

A 48-year-old woman was admitted to our hospital suffering from chest and back pain. The aortogram and CT scanning revealed aortic dissection (DeBakey II type). Six days after onset, the emergent operation was carried out under the cardio-pulmonary bypass. Myocardial protection was made by retrograde coronary sinus perfusion (RCSP) with cold GIK. The ascending aorta was replaced with an artificial graft including the entry. Massive bleeding in the pericardial space and the rupture of coronary sinus was recognized immediately after declamping of the aorta. Repair was made successfully under induced electric ventricular fibrillation. Care for RCSP was discussed.

Coronary Vessels↗

PubMed1989

Reinforcement of the anastomosis between the fragile arterial vessel and the prosthetic graft. A headband method.

A new method of anastomosis was devised, intended for the reinforcement of the anastomosed area between the fragile vessel of the patient and the prosthetic graft in cardiovascular surgery. This method, which may be called a headband method, consists of suturing a small prosthetic graft wrapping the anastomosed area together with the arterial vessel in the manner of a headband. Fourteen cases have been evaluated at follow-up periods ranging from 24 to 40 months. All cases proved successful without noteworthy complications.

Anastomosis, Surgical↗

PubMed1989

[Omentum in the management of thoracic surgery: especially its application to tracheobronchial surgery].

Omentum is now not only policeman of the abdomen but also of the thorax. We applied omental pedicle flap in the management of 14 patients with thoracic surgery including chest wall reconstruction, empyema, thoracic skeletal infection and tracheobronchial problems. Especially, tracheobronchial reconstruction using omental pedicle flap for the patient combined with lung cancer (T4N2M0 STAGE IIIB) and asthma under steroid therapy was reported. The case was 71-year-old man with complaint of hemosputum. He had 5-6 year history of bronchial asthma with disturbed pulmonary function of % VC 44%, FVC1.0% 37%. Bronchoscopic study revealed the tumor invading the right side of trachea originating from right upper bronchus with histological diagnosis of moderately differentiated squamous cell carcinoma. Preoperatively, he experienced a heavy asthma attack which was controlled by steroid administration. Following extended right sleeve upper lobectomy, we applied omental pedicle flap around the reconstructed portion for the protection of infection, impaired wound healing due to postoperative steroid therapy and strong tension at anastomoses. Postoperative course was satisfactory. We suggest omental pedicle flap is an effective surgical armamentarium in the management of tracheobronchial surgery for the patient with strong anastomotic tension, immunocompromised condition, preoperative irradiation at bronchial stump and use of drug causing delayed wound healing (steroid, anticancerous drug etc).

Aged↗

PubMed1989

[Myocardial protection of temperature].

The effects of myocardial temperature on 120-minute preserved hearts were studied on heterotopically transplanted hearts of rats of isogeneic strain. Rats were divided in the following groups; the control group, the 0 degree C preservation group, the 5 degrees C group, the 10 degrees C group, the 15 degrees C group and the 20 degrees C group. Experiments were divided into the acute stage experiments and chronic stage experiments. The former included electron microscopic studies of the myocardium of heart transplants and serum enzymes of recipients. In the chronic stage experiments, the percentage of fibrosis was compared as an index of success. No hearts of the 20 degrees C group resuscitated, and by the indices of acute stage experiments, the 10 degrees C group and the 15 degrees C group showed considerable impairment; other groups showed less damage of the same degree. The chronic stage experiments indicated that the 0 degree C group was best, followed by the 5 degrees C group in the increasing order of temperature, evaluated by the rate of fibrosis. It may be concluded that hypothermia close to the freezing point has the best protective effects on the myocardium. Cold injury, even if present, may be transient and not harmful when ischemia is about 120 minutes. Comprehensive evaluation of various factors contributing isograft survival should include not only various methods examined in the acute stage but also an over-all evaluation of fibrosis in the chronic stage, since the myocardium of the graft shows a variability of findings in the acute stage.

Animals↗

PubMed1989

[Right ventricular regional wall motion and function after tetralogy repair].

The right ventricular (RV) function is very important after correction of tetralogy of Fallot (TOF) similarly to left ventricular (LV) function. The influence to RV contraction caused by RV outflow tract patch after repair of TOF is serious. There are a few literatures about contraction mode of RV but we can't see any reports about regional RV wall motion before and after surgery of TOF. This paper is the first report about RV regional wall motion and function after 20 cases of tetralogy repair. We would emphasize the following points. 1) Regional wall motion of RV at antero-basal and anterolateral is getting worse but is improved at anteroapical of RV. 2) Appropriate rate of RV systolic pressure to LV systolic pressure just after weaning from cardiopulmonary bypass and rate of patch length to RV length is below 0.5 and 0.4 respectively. 3) There is positive correlation between RV ejection fraction and wall motion at anteroapical of RV.

Child↗

PubMed1988

Tricuspid regurgitation due to chest trauma: an unusual laceration around the annulus of the anterior leaflet.

A 70-year-old male with tricuspid regurgitation due to a blunt chest trauma inflicted 16 years previously underwent prosthetic valve replacement. At surgery, a tear, which produced tricuspid regurgitation, was found around the annulus of the anterior leaflet of the tricuspid valve. Since this area has not been reported as a location for heart trauma-producing tricuspid regurgitation, a possible mechanism of tricuspid regurgitation is discussed in this patient.

Aged↗

PubMed1988

Clinical application of a new vital staining method for the conduction system during heart operations.

A new method for vital staining of the conduction system during heart operations, the iodine gas method, was used in 12 patients. The right bundle branch stained well in all cases, and could be confirmed by the naked eye. The conduction system was not damaged by the staining procedure. The iodine gas used in this method had no adverse effects on thyroid function (thyroxine, triiodothyronine, thyroxine binding globulin, protein bound iodine) or liver function (serum glutamate oxaloacetate transaminase, serum glutamate pyruvate transaminase, lactic dehydrogenase). This method, therefore, was found to be valuable and without complication for preventing conduction disturbances during cardiac operations.

Cardiac Surgical Procedures↗

PubMed1988