Biomedical subjects

T Tahata

Publications and source records attributed to T Tahata.

At least 55 records · Page 3Linked to original sources

PubMed1992

Analysis of left ventricular motion after mitral valve replacement with a technique of preservation of all chordae tendineae. Comparison with conventional mitral valve replacement or mitral valve repair.

The postoperative regional left ventricular motion of 22 patients with a diagnosis of mitral regurgitation, and who underwent mitral valve replacement with preservation of chordae tendineae, were retrospectively analyzed by cineangiography in the early postoperative period and by multiple-gated cardiac blood pool scintigraphy in the mid-to-late postoperative period. The operation consisted of the division of the anterior leaflet into anterior and posterior segments, the shifting and reattachment of the divided segments to the mitral ring of the respective commissural areas, and the use of a low-profile bileaflet prosthetic valve. Control groups consisted of 28 patients with mitral regurgitation who underwent mitral valve replacement with a conventional technique and 16 patients who underwent mitral valve repair. Compared with the conventional mitral valve replacement group, the radial shortening of the left ventricle of the chordae-preserved mitral valve replacement group was greater at the apical septal, inferoapical, anterobasal, and anterolateral portions, whereas the radial shortening of the repair group was greater than that of the chordae-preserved group only at the inferolateral portion. The ejection fraction of the whole left ventricle was statistically greater in the chordae-preserved group, and also regional ejection fraction of the chordae-preserved mitral valve replacement group was greater at the apical septal, inferoapical, inferolateral, anterobasal, and anterolateral portions than that of the conventional mitral valve replacement group at these portions. On the other hand, the postoperative regional and global motion was identical to that of the mitral valve repair group except at the inferolateral portion. The result of this study supports a concept that maintenance of continuity between the mitral anulus and the papillary muscle has a beneficial effect on postoperative left ventricular performance.

Adult↗

PubMed1992

[Delayed onset of heparin induced thrombocytopenia--a case report].

A 64-year-old man underwent CABG. 18000 unit of bovine lung heparin was used during operation for extracorporeal circulation and small amount of heparin was injected until the 5th postoperative day to keep intravenous line patent. His postoperative course was uneventful until the 10th postoperative day when marked ecchymosis developed on his eyelid. Laboratory data showed marked thrombocytopenia (1.3 x 10(4)/microliters) and disseminated intravascular coagulation. The diagnosis of heparin-induced thrombocytopenia (HIT) was confirmed by platelet aggregation test with heparin. Gabexate mesilate and platelet-concentrates were administered and platelet count returned to normal within a week. HIT usually occurs during administration of heparin. In this case, it occurred 5 days after we stopped heparin. Delayed onset of HIT might be related to delayed metabolism of heparin due to postoperative fluid shift.

Coronary Artery Bypass↗

PubMed1991

Bidirectional cavopulmonary anastomosis using vertical vein for right isomerism, pulmonary atresia, and TAPVR.

An 8-year-old girl who was diagnosed as having right atrial isomerism, pulmonary atresia, butterfly-shaped juxtaductal pulmonary arterial stenosis, total anomalous pulmonary venous return of the supracardiac type, regurgitant common atrioventricular valve, and univentricular heart of the right ventricular type underwent bilateral, bidirectional cavopulmonary anastomosis using a vertical vein and anastomosis between the common pulmonary venous trunk and atrium. The surgical procedure in this patient is described.

Anastomosis, Surgical↗

PubMed1991

Propranolol for intractable hemolysis after open heart operation.

Postoperative intravascular hemolysis occurring in 2 patients was alleviated by propranolol. One patient underwent mitral valve replacement and had development of intractable hemolysis due to a paravalvular leak. The other patient underwent ventricular septal defect closure and had hemolysis caused by the Dacron patch. Both patients were given oral propranolol, and the degree of hemolysis decreased substantially. Although the exact mechanism of the propranolol effect on mechanical intravascular hemolysis is unclear, propranolol is thought to reduce the shearing stress between erythrocytes and the foreign material by slowing the velocity of the circulation.

Anemia, Hemolytic↗

PubMed1991

[Tricuspid endocarditis related to a residual ventricular septal defect: a case report of successful tricuspid valvuloplasty].

A 5-year-old girl presented infected tricuspid valve related to a residual ventricular septal defect. Antibiotic therapy produced a satisfactory initial improvement. However, subsequent deterioration with uncontrolled infection, in spite of alterations of the antibiotic regime, necessitated surgical intervention. Because the lesion was localized to the anterior leaflet of the tricuspid valve, partial excision of this leaflet and patch was undergone with a sustained clinical improvement with minimum residual valvular incompetence. This experience supports the concept that tricuspid valvuloplasty is the method of choice in the treatment of patient with regional right-sided infective endocarditis.

Child, Preschool↗

PubMed1991

[A technique for distal anastomosis in replacement of the ascending aorta and aortic valve with a composite graft: application of an open aortic anastomosis under retrograde cerebral perfusion and deep hypothermic systemic circulatory arrest].

Between 1987 to 1990, six patients underwent replacement of the ascending aorta and aortic valve with a composite graft which was not wrapped with aneurysmal aortic wall; annuloaortic ectasia in 4, aortitis with acute onset of aortic regurgitation in 1, and acute aortic dissection with aortic regurgitation in 1. In 2 patients, "open aortic anastomosis" under deep hypothermic systemic circulatory arrest and retrograde cerebral perfusion was utilized for distal anastomosis of the graft to the resected aortic arch. Three patients required no transfusion. One patient with annuloaortic ectasia and severely dilated left ventricle died from ventricular fibrillation in ICU. One patient with aortitis died from stroke due to occlusion of bilateral carotid arteries 3 years postoperatively. The other 4 patients are alive and favorable. It is our belief that this technique still maintains simplicity and facilitates the secured anastomosis and minimized bleeding.

Adolescent↗

PubMed1991

[Left atrial myxoma associated with ruptured chordae tendineae].

A rare case of left atrial myxoma associated with ruptured chordae tendineae is presented. The patient was 70-year-old woman, and was diagnosed to have a left atrial myxoma. The myxoma was extirpated together with the atrial septum from which tumor developed. After removal of the myxoma, a ruptured strut chordae tendineae of anterior leaflet was also detected and resutured to the original papillary muscle. The cause of the torn chordae is presumed to be so-called "wrecking ball effect", and to be myxomatous degeneration of the valve.

Aged↗

PubMed1991

[Report of a case with a delayed hemolytic transfusion reaction after open heart surgery].

A case of delayed hemolytic transfusion reaction (DHTR) caused by blood transfusions after open heart surgery was reported in a 61-year-old woman. She had undergone mitral annuloplasty 8 years before. She underwent the 2nd mitral and tricuspid annuloplasty for recurrent mitral and tricuspid regurgitation in 1988. After the reoperation, she developed severe hemolytic anemia with fever. The anti-Jka antibody was detected in her serum by the blood antibody screening test. She was diagnosed to have a DHTR. She was treated conservatively and recovered.

Anemia, Hemolytic↗

PubMed1990

Palliative reconstruction of right ventricular outflow tract in tetralogy with hypoplastic pulmonary arteries.

Twenty-five symptomatic patients with tetralogy of Fallot underwent palliative reconstruction of the right ventricular outflow tract without closure of the ventricular septal defect. Their ages ranged from 5 months to 20 years (mean age, 3.5 years). Eight patients had had 13 prior systemic-pulmonary arterial shunts. There were six hospital deaths (24%). Three patients needed a repeat right ventricular outflow reconstruction. There was one late death. The other patients manifested clinical improvement; hematocrit decreased from 0.54 to 0.43 (p less than 0.01) and arterial oxygen saturation increased from 63.0% to 83.2% (p less than 0.01). The size of the pulmonary artery, defined as the ratio of the sum of the diameter of the right and left pulmonary arteries to the diameter of the descending aorta, increased from 0.72 to 2.06 (p less than 0.01). Sixteen patients underwent a corrective operation 2.4 years after palliation. The results of palliative right ventricular outflow tract reconstruction suggest that it may be an optional strategy for the treatment of symptomatic patients who have tetralogy of Fallot with severely hypoplastic pulmonary arteries.

Adolescent↗

PubMed1990

Multiple congenital aneurysms of the atria.

Aneurysms of both the left and right atria are very rare congenital abnormalities. A 3-year-old boy underwent operation with preoperative diagnosis of aneurysms of both atria and supraventricular tachyarrhythmia. The multiple aneurysms were resected during cardiopulmonary bypass. The patient was asymptomatic after operation and has maintained sinus rhythm.

Child, Preschool↗

PubMed1989

Annuloplastic reconstruction for common atrioventricular valvular regurgitation in right isomerism.

Two patients who had common atrioventricular valvular regurgitation associated with right isomerism, univentricular heart of the right ventricular type, transposition of the great arteries, pulmonary stenosis, and both systemic and pulmonary venous anomalies underwent common atrioventricular valvular annuloplasty. They also underwent bilateral, bidirectional cavopulmonary shunt. A Carpentier's ring was used in patient 1 and a polytetrafluoroethylene tube was used in patient 2 to reduce the diameter of the common atrioventricular annuli. Postoperative catheterization confirmed complete elimination of regurgitation of the common atrioventricular valve in both patients.

Child↗

PubMed1989

Rupture of a Dacron aortic prosthesis into the jejunum.

A 55-year-old man was admitted to the hospital with massive melena and shock. He had a history of Dacron Y graft reconstruction for aortoiliac atheroscerotic occlusive disease 10 years before admission. At emergency laparotomy the jejunum was adherent to the graft. After separation a fistulous communication was detected between the two. A longitudinal tear in the stem of the graft was found. The graft was reconstructed with a Gore-Tex (Gore-Tex registered trademark of W.L. Gore & Associates, Inc., Elkton, Md.) patch. His postoperative course was uneventful.

Aorta↗

PubMed1989

[Long-term evaluation of the superior vena cava-pulmonary artery anastomosis in cyanotic heart disease].

We followed up thirty-three patients, to whom the superior vena cava-pulmonary artery anastomosis (Glenn procedure) was undergone between April 1966 and March 1988. There were eighteen patients with single ventricle and nine with tricuspid atresia, two with pulmonary atresia with intact ventricular septum and four with other complex anomalies. Seven patients (21%), including six with single ventricle, died 0.3 to 14.9 years after operation. Regurgitation of common atrioventricular valve was the cause of death in three patients. Serum hemoglobin level fell down from 19.3 +/- 2.2 g/dl preoperatively to 15.3 +/- 1.9 g/dl after operation but increased gradually to the preoperative level about ten years later. The actuarial survival rate at ten years is 80%. Reoperation was performed in 9 patients and reoperation free rate at 10 years is 78%. This analysis suggests that Glenn procedure is still good palliative operation for ten years, although some patients will be necessitated the second operation in future.

Adolescent↗

PubMed1989

[Report of a case of an atypical huge patent ductus arteriosus].

An atypical huge patent ductus arteriosus (PDA) associated with extreme pulmonary hypertension in a 6-month old female infant was reported. The left 3rd intercostal thoracotomy revealed huge PDA which has an appearance of pulmonary-ductus-descending aorta-trunk (PDDT) on the left side. The right side of the ductus continued to the aortic arch without demarcation between the ductus and the aorta. The median sternotomy clarified the ascending aorta, normal aortic arch, and main pulmonary artery. However, the top of the main pulmonary artery seemed to be fused with the aortic arch. The diagnosis of distal type of aortopulmonary window with wide communication was made and the total circulatory arrest with deep hypothermia and the intracavitary patching for separation of systemic and pulmonary blood flow seemed to be required for the complete repair. Total repair was decided to be postponed one week later and the chest was closed. The patient died of multi-organ failure originating from acute respiratory failure 23 days after exploratory thoracotomy without being repaired. Postmortem examination revealed a huge PDA freely communicating with the ascending aorta and the aortic arch. This is a report of an atypical huge PDA rarely seen and the conventional division or ligation is unfeasible. The circulatory arrest with deep hypothermia and intracavitary patching are obligatory for the surgical repair.

Ductus Arteriosus, Patent↗

PubMed1989

[Successful mitral valve repair and myocardial revascularization in an infant with anomalous origin of the left coronary artery from the pulmonary artery].

An 8-month-old girl of anomalous origin of the left coronary artery from the pulmonary artery associated with severe mitral regurgitation underwent radical operation. She had been in serious cardiac and respiratory failure. Aorto-left coronary arterial continuity was established by intrapulmonary arterial tunnel using Takeuchi's technique. Mitral annulus was plicated by modified Kay's technique. Post-operative course was uneventful.

Coronary Vessel Anomalies↗

PubMed1988

Mitral valve replacement with preservation of chordae tendineae and papillary muscles.

An operative technique for mitral valve replacement (MVR) with preservation of the chordae tendineae to the anterior leaflet as well as the posterior leaflet is reported. This technique consists of the division of the anterior leaflet into anterior and posterior segments, the shifting and reattachment of the divided segments to the mitral ring of the respective commissural areas, and the use of a low-profile bileaflet prosthetic valve. A comparison of left ventricular function data between patients having operation with this technique and those having operation with the conventional method of MVR revealed significantly better improvement in cardiac index (p less than 0.06), left ventricular end-systolic volume index (p less than 0.05), and left ventricular ejection fraction (p less than 0.10) in the former group. Left ventricular wall motion improved in the anterolateral (p less than 0.01) and apical areas (p less than 0.02) in patients operated on with our technique. Maintenance of continuity between the mitral annulus and papillary muscles is expected to have a beneficial effect on postoperative left ventricular performance in spite of increased afterload.

Adult↗

PubMed1988

Intractable hemolysis caused by perivalvular leakage following mitral valve replacement with St. Jude Medical prosthesis.

Nine patients with intractable hemolysis caused by perivalvular leakage following mitral valve replacement with a St. Jude Medical prosthesis are presented. All patients had dark-colored hemoglobinuria, which appeared from 1 day to 44 days after the operation, with moderate or severe hepatorenal insufficiency. One patient died of multiorgan failure. The other 8 patients underwent reoperation, and all survived. Reoperation revealed that all leakages were tiny and had no adverse effect on hemodynamics. In all the patients having reoperation, hemoglobinuria disappeared immediately after the procedure. Surface-scanning electron microscopy of the sewing cuff of the St. Jude Medical prosthesis revealed the rough surface structure of the sewing ring. Because of this irregular, shaggy surface structure, greater shearing forces against erythrocytes can be generated when there is perivalvular leakage.

Adolescent↗

PubMed1988

Evaluation of corrective surgery for tetralogy of Fallot from late results by multivariate statistical analysis.

From 1966 to 1985, 469 pediatric patients with the tetralogy of Fallot (mean age, 4.9 years) were corrected (hospital mortality 11.9%). There were 9 late deaths (1.9%). In 186 patients, hemodynamic studies were performed 2-14 years postoperatively (mean age, 10.4 years). An increased cardiothoracic ratio (CTR) of 60% or more was found in 42 patients with impaired postoperative physical activity. The factors affecting the late results were investigated in relation to CTR by the quantification method of multivariate analysis. As for the enlarged CTR, pulmonary regurgitation was more of a contributing factor than pulmonary stenosis. In pulmonary regurgitation, the pulmonary artery area index (PAAI) and reconstruction of the right ventricular outflow tract (RVOT) were highly significant factors. For pressure gradient, the VSD site was the most significant factor. These analyses suggest that preservation and/or reconstruction of the pulmonary valve, or trans-annular patching with the necessary minimal area for the RVOT (PAAI) not to exceed 4 cm2/m2 at the time of operation is important for satisfactory late results.

Adolescent↗