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Biomedical subjects

T Tahata

Publications and source records attributed to T Tahata.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Long-term results of mitral valvuloplasty for mitral regurgitation].

From July 1979 to February 1995, 126 patients, including 4 reoperations, aged between 6 months and 77 years underwent mitral valve repair for mitral regurgitation. The patients were divided in two groups, 46 patients aged less than 16 years in pediatric age group and the other 80 patients in a dult group. The methods consisted of asymmetric annuloplasty (Kay-Reed method) in 98 patient, Carpentier-Edwards ring annuloplasty in 14, quadrangular resection of the posterior leaflet with annuloplasty in 9, and chordal and leaflet repair in 5. There was no hospital nor late death in pediatric age group. Three hospital deaths and one late death were in adult group. Follow-up was 96% complete and totaled 812.1 patient years. Reoperations underwent in 3 pediatric patients and 9 adults. At 15 years' follow-up, freedom from reoperation was 91.5 +/- 4.7% in pediatric age group and 67.1 +/- 12.7% in adults. Freedom from event was 63.5 +/- 12.1% in adult group. These results suggest that mitral repair with Kay-Reed method in pediatric age group is favorable for long-term. In contrast, indications for mitral reconstraction with other methods including ring annuloplasty should be extended for aged patients with severely dilated annuls and degenerated leaflets.

Adolescent↗
PubMed1995

[Successful surgical treatment for ruptured distal aortic arch aneurysm into lung].

We report successful aortic arch replacement using continuous retrograde cerebral perfusion (CRCP) for the three cases of ruptured distal aortic arch aneurysm (DAAA) into the left lung. All of them, who had preoperative episodes of hemosputum and hemoptysis, were diagnosed rupture of DAAA into the lung with computed tomography, magnetic resonance image, aortography or transesophageal echo. Following urgent graft replacement of the aortic arch or repair of the rupture on the suture line in the previous arch vessel reconstruction was carried out safely through median sternotomy approach. The left upper lobe of lung adherent tightly to the DAAA wall was not dissected to prevent the lung from bleeding, air leakage and infection. All of them, who awoke smoothly after CRCP, did not developed any pulmonary complications and survived uneventually. We concluded that median approach and not tearing lung from DAAA wall might be key-points for successful operation in cases of ruptured DAAA into lung and that CRCP is an safe and useful method to protect brain in such cases.

Aged↗
PubMed1995

Left ventricular function after mitral valve replacement with or without chordal preservation.

The clinical significance of the chordae tendinae regarding postoperative left ventricular performance was evaluated in 148 patients with mitral regurgitation or mitral stenosis who underwent either mitral valve replacement using St. Jude Medical valve with complete chordal preservation, or with conventional mitral valve replacement, or valve repair. Mitral valve replacement preserving the autologous chordae tendinae (n = 28) or replacing them with Gore-Tex sutures (n = 16) was performed in 44 patients, 24 with mitral regurgitation and 20 with mitral stenosis. Their hemodynamic parameters were compared to those of patients who underwent conventional mitral valve replacement involving 25 with mitral regurgitation and 28 with mitral stenosis, or who underwent valve repair in 24 with mitral regurgitation, or commissurotomy in 27 patients with mitral stenosis. The LV performance was analyzed by cineangiography in the early (mean 1.2 months), and by multiple gated blood scintigraphy (MUGA), or echocardiography (UCG) in the late postoperative periods (mean 5.4 years) in the three groups of patients. In the mitral regurgitation group, the LV ejection fraction (EF) was unchanged in the chordal preserved group, but it was decreased in the conventional replacement and repair groups. The LV contractility index was better in the chordal preserved than in the conventional group. Both the LVEF by MUGA, and LV fractional shortening (FS) by UCG were significantly higher after chordal preservation or repair than after conventional valve replacement. The chordal preserved group exhibited superior LV performance than the conventional group, especially in those with mitral regurgitation and depressed preoperative left ventricular function (EF < 0.50). There were no significant difference between the three groups in patients with mitral stenosis. The results support the concept that maintenance of continuity between the mitral annulus and the papillary muscle has a beneficial effect on postoperative left ventricular performance, especially in patients with mitral regurgitation and depressed preoperative left ventricular function, but had no major effect in patients with mitral stenosis.

Adult↗
PubMed1994

Successful repair of the right atrial isomerism, double outlet right ventricle, common atrioventricular canal, pulmonary stenosis, and total anomalous pulmonary venous connection.

A 6-year-old boy was successfully operated on for double outlet ventricle, common atrioventricular canal with severe valvular regurgitation, right atrial isomerism, L-loop ventricles, total anomalous pulmonary venous connection, and pulmonary stenosis with hypoplastic left pulmonary artery. The interventricular rerouting from the left ventricle to the ascending aorta was performed with a spiral patch, the interatrial switching was performed by a Mustard patch, the common atrioventricular orifice was partitioned and valve repair was performed, and an 18-mm valved conduit was inserted between the right ventricle and the pulmonary artery. Although the patient had a small residual ventricular septal defect and pulmonary stenosis, the patient is alive and well.

Abnormalities, Multiple↗
PubMed1994

Protective effect of continuous retrograde cerebral perfusion on the brain during deep hypothermic systemic circulatory arrest.

Deep hypothermic circulatory arrest has been widely used as an adjunct for surgery of the aortic arch to protect the brain and other vital organs. We introduced the use of continuous retrograde cerebral perfusion via the superior vena cava during deep hypothermic circulatory arrest in 1987 and have used it in 33 patients. Continuous retrograde cerebral perfusion times ranged from 10 to 89 minutes (mean 40.2 +/- 22.5), and minimal nasopharyngeal temperatures ranged from 14 to 25 degrees C (mean 17.4 +/- 2.0). Two patients with a ruptured aneurysm died during operation due to bleeding and two other patients, with continuous retrograde cerebral perfusion time of 24 and 35 minutes, died 1 month postoperatively due to preoperative liver cirrhosis and sepsis. Two patients suffered from stroke. The remaining 27 patients, including 6 with from 60 to 82 minutes of continuous retrograde cerebral perfusion, had no complications related to continuous retrograde perfusion. During continuous retrograde cerebral perfusion, 66 pairs of blood samples from the perfusate and from the drainage back to the arch vessels were obtained. Analysis of these samples revealed that partial pressure of oxygen, saturation of oxygen, and oxygen content significantly decreased (p < 0.001), and partial pressure of carbon dioxide (CO2) and CO2 content significantly increased (p < 0.001). The nasopharyngeal temperature gradually increased at the rate of 0.01 to 0.03 degree C/min, but was maintained below 20 degrees C. These results reflect the fact that the aerobic metabolism of the brain is maintained during continuous retrograde cerebral perfusion due to oxygen and substrate availability. This technique offers the potential of metabolic support to the brain during deep hypothermic circulatory arrest and prolongs the safe time limits of deep hypothermic circulatory arrest in surgery of the aortic arch.

Adult↗
PubMed1994

[Intraoperative pulmonary angioscopy to undergo pulmonary embolectomy for acute massive pulmonary embolism].

An urgent pulmonary embolectomy on a patient under intraoperative angioscopy for the treatment of massive pulmonary embolism was performed and successfully saved the patient. The case was a 19-year-old man who had been bedridden over along period of time. He developed pulmonary embolism immediately after the initiation of walking rehabilitation. Although anticoagulation therapy was immediately carried out, hemodynamics deteriorated, and as a result, it became necessary to treat this patient with the urgent surgical procedure. Under extracorporeal circulation with the clamping of the aorta, the pulmonary artery was opened. Following embolectomy for the left pulmonary artery, the right pulmonary artery, where the presence of clots had not been confirmed with the naked eye, was inspected using an flexible fiberoptic choledochoscope 4.9 mm in diameter. Consequently, amount of clots were removed using forceps or an aspirating tube. The patient recovered from hypoxemia after surgery. The use of intraoperative angioscopy in the pulmonary artery proved to be very useful to examine the presence of emboli up to tertiary branches of pulmonary artery.

Acute Disease↗
PubMed1994

Mitral valve replacement with maintenance of mitral annulopapillary muscle continuity in patients with mitral stenosis.

Postoperative left ventricular performance was evaluated in patients with mitral stenosis who underwent mitral valve replacement with maintenance of the continuity of the mitral anulus and papillary muscles. Mitral valve replacement with preservation of autologous chordae tendineae (n = 7) or their replacement with expanded polytetrafluoroethylene sutures (n = 14) was performed in 21 patients with mitral stenosis. Hemodynamic parameters were compared with those of 28 patients who underwent conventional mitral valve replacement and 27 patients who underwent open mitral valve commissurotomy. No deaths occurred in the early or late follow-up period. All hemodynamic parameters were improved after the operation, and no significant differences were detected among the three groups with regard to postoperative cardiac index or mitral valve area. No significant differences were observed in left ventricular end-diastolic volume index, end-systolic volume index, or contractility index, but the postoperative left ventricular ejection fraction in the chordal preservation and open commissurotomy groups was greater than that in the group having conventional mitral valve replacement. Postoperative regional shortening was greatest at the diaphragmatic portion in the chordal preservation group and at the long axis in the open commissurotomy group. In the mid-term postoperative period, although no differences were noted among the three groups in echocardiographic data or global ejection fraction measured by multigated equilibrium radionuclide angiography, the regional shortening at the anterolateral portion of the left ventricle in the chordal preservation and commissurotomy groups was greater than that in the group having conventional mitral valve replacement. Postoperative radionuclide angiography during exercise failed to demonstrate any difference between the ejection fraction in the chordal preservation group and that in the group having conventional mitral valve replacement.

Adult↗
PubMed1993

Replacement of chordae tendineae using expanded polytetrafluoroethylene (ePTFE) sutures during mitral valve replacement in patients with severe mitral stenosis.

Since September 1991, 20 patients with mitral stenosis underwent mitral valve replacement and chordal replacement with expanded polytetrafluoroethylene (ePTFE) sutures. The continuity between the papillary muscles and the mitral annulus was maintained by four mattress sutures of ePTFE, which connected the stumps of the papillary muscle heads to the mitral annulus at the 2, 4, 8, and 10 o'clock positions. Low profile bileaflet prosthetic valves were inserted. There was no mortality either in-hospital or during follow-up. There was no valve related morbidity, such as valve structural failure, thromboembolism, anticoagulant related hemorrhage, prosthetic valve endocarditis, or posterior left ventricular rupture. The technique of replacing chordae tendineae is described in detail.

Chordae Tendineae↗
PubMed1993

Comparative evaluation of left ventricular performance after mitral valve repair or valve replacement with or without chordal preservation.

The clinical importance of preserving the chordae tendineae during mitral valve replacement was assessed by comparing the postoperative left ventricular performances in 68 patients who underwent mitral valve replacement (MVR) with complete chordal preservation (n = 19), conventional MVR (n = 25) or mitral valve repair (n = 24) and had full hemodynamic assessment before and after surgery. The pre- and postoperative left ventricular performances were analyzed using cineangiography, multiple-gated cardiac blood pool scintigraphy (MUGA), and echocardiography. In the early postoperative period, cineangiography revealed that the end-systolic volume index (ESVI) and the end-diastolic pressure were significantly higher in the conventional MVR group. The left ventricular ejection fraction was unchanged in the chordal preservation group, but was decreased in the mitral repair and conventional MVR groups. The end-systolic circumferential left ventricular wall stress (ESS) was significantly decreased in the chordal preservation and mitral repair groups, but was unchanged, and thus higher, in the conventional MVR group. The postoperative left ventricular contractility index (ESS/ESVI) was better in the chordal preservation than in the conventional MVR group. In the late postoperative period, both the left ventricular ejection fraction as measured by MUGA and the left ventricular fractional shortening as measured by echocardiography were significantly higher in the mitral repair and chordal preservation groups than in the conventional MVR group. This study supports the concept that the maintenance of continuity between the mitral annulus and the papillary muscles has a beneficial effect on postoperative left ventricular performance.

Adult↗
PubMed1993

[Development of left atrial thrombus after excellent mitral valvuloplasty for chronic severe mitral regurgitation].

We report two cases with chronic severe mitral regurgitation and atrial fibrillation in whom left atrial thrombus was detected by transesophageal echocardiography after excellent mitral valvuloplasty. The reason why thrombus developed after valvuloplasty is that preoperative severe mitral regurgitation made the left atrial blood less stagnant than it was after surgery. Thus, even when mitral valvuloplasty achieves excellent results in patients with severe chronic mitral regurgitation and atrial fibrillation, anticoagulation and left atrial appendage ligation should also be considered.

Aged↗
PubMed1993

[The protective effect of continuous retrograde cerebral perfusion on the central nervous system during deep hypothermic systemic circulatory arrest].

Deep hypothermic circulatory arrest (DHCA) was introduced as an adjunct for operations involving aortic arch lesions in 1970's and has since been widely used. Profound hypothermia protects the brain and other vital organs by reducing metabolic rate. We initiated the use of continuous retrograde cerebral perfusion (CRCP) via the superior vena cava during DHCA in 1987. We studied 15 patients who required DHCA and CRCP during repair or replacement of the aortic arch. CRCP times ranged from 11 to 78 (mean +/- S.D.; 37.3 +/- 21) minutes, and minimal nasopharyngeal temperatures ranged from 13.7 to 25 (17.7 +/- 2.6) degrees C. Two patients died one month postoperatively due to preoperative disease. Three patients, who were in shock preoperatively due to cardiac tamponade, developed acute renal failure postoperatively. The remaining patients were weaned from the respirator by the 2nd postoperative day. No patient had CRCP-related complications. During CRCP, the partial pressure of oxygen (PO2), saturation of oxygen (SO2), and oxygen content significantly decreased (p < 0.001), and the partial pressure of carbon dioxide (PCO2) and CO2 content significantly increased (p < 0.001) between retrogradely perfused blood and blood draining from the arch vessels. These results most probably reflected that the aerobic metabolism of the brain was maintained by CRCP while the central nervous system was maintained in a hypothermic state, with oxygen and substrate availability, wash-out of metabolites, and buffering capacity and oncotic pressure of the blood maintained. This technique offers the potentials of sufficient metabolic support to the brain during DHCA and prolonged safe time limits of DHCA.

Adult↗
PubMed1992

Acute pulmonary edema after Blalock-Taussig anastomosis.

Acute pulmonary edema developed in 2 patients after a Blalock-Taussig shunt procedure. Both patients had a univentricular heart complex with pulmonary stenosis. One patient underwent a modified Blalock-Taussig shunt using a polytetrafluoroethylene tube and the other underwent a classic Blalock-Taussig anastomosis. Acute pulmonary edema after the Blalock-Taussig shunt is rare, but once it has occurred, immediate treatment is obligatory.

Acute Disease↗
PubMed1992

Deep hypothermic systemic circulatory arrest and continuous retrograde cerebral perfusion for surgery of aortic arch aneurysm.

From 1987 to February 1991, we have repaired or replaced the aortic arch in ten patients using deep hypothermic systemic circulatory arrest with continuous retrograde cerebral perfusion (CRCP). CRCP can be implemented using the bypass connecting the arterial and venous lines of the extracorporeal circuit to reverse the flow into the superior vena cava cannula after induction of circulatory arrest. CRCP flow required to maintain an internal jugular vein pressure of 20 mmHg ranged from 100 to 500 ml/min. After completion of suturing of the aortic arch graft, air is evacuated retrogradely from the open arch vessels prior to reestablishing the usual arterial return. Two patients died, one from sepsis and the other from liver cirrhosis 1 month postoperatively. CRCP times ranged from 11 to 56 min, and minimal nasopharyngeal temperatures ranged from 16 degrees to 18 degrees C. The difference in oxygen content between the perfused blood and the blood draining from the arch vessels during CRCP most likely reflected the steady-state metabolism of the brain during the deep hypothermic state. This technique offers advantages including the need for dissecting and clamping the arch branches, providing sufficient metabolic support to the brain during deep hypothermia, and eliminating embolism of particulate debris from the aortic arch.

Adult↗
PubMed1992

Replacement of a thrombosed St. Jude Medical prosthesis in pulmonary position after repeated thrombolytic therapy.

A 49-year-old man who had undergone repair of tetralogy of Fallot underwent replacement of a thrombosed St. Jude Medical prosthesis in pulmonary position after intravenous thrombolytic therapy. Dysfunction of the prosthetic valve was detected clinically by change of heart sound and the appearance of a new diastolic murmur. Cinefluoroscopy confirmed fixation of both leaflets. Although thrombolytic therapy using urokinase was successful twice, the prosthesis was replaced with a Carpentier-Edwards bioprosthesis due to recurrent prosthetic dysfunction.

Adult↗