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Biomedical subjects

Tohru Shinohara

Publications and source records attributed to Tohru Shinohara.

5 recordsLinked to original sources
PubMed2004

Surgical treatment of infective endocarditis complicated by intracranial hemorrhage in a patient with hypertrophic obstructive cardiomyopathy.

A patient with hypertrophic obstructive cardiomyopathy developed mitral regurgitation due to infective endocarditis. The patient, a 29-year-old man with a 16-year history of a severe obstructive form of hypertrophic obstructive cardiomyopathy (left ventricular outflow gradient more than 100 mmHg), was admitted with bacteremia. During medical therapy with antibiotics for six months, the patient suffered an intracranial hemorrhage without a mycotic aneurysm and developed severe mitral regurgitation due to the infective endocarditis. One month after clinical stability of the cerebral damage, the patient underwent a combined mitral valve replacement and transaortic septal myectomy. Postoperative echocardiography revealed that the left ventricular outflow gradient had decreased to 15 mmHg. Ten months after the combined operation, the patient was well and asymptomatic.

Adult↗
PubMed2004

Spontaneous closure of ventricular septal defects followed up from <3 months of age.

BACKGROUND: This study evaluates the incidence and timing of spontaneous closure (SC) of ventricular septal defect (VSD) using Doppler color flow mapping. METHODS: A total of 225 infants (mean age 30 days) were diagnosed with uncomplicated VSD: 31 (14%) subpulmonary VSD, 159 (70%) perimembranous, and 35 (16%) muscular. The patients were divided into two groups according to the presence or absence of congestive heart failure (CHF). SC was confirmed with color Doppler. RESULTS: Surgical closure was performed in 59 patients (26%). SC occurred in 107 patients (48%); three (10%) of 31 with subpulmonary VSD, 75 (47%) of 159 with perimembranous VSD, and 29 (83%) of 35 with a muscular VSD. Average age at SC was 19 months. In three SC patients with a subpulmonary VSD, there was no aortic valve prolapse and no aortic regurgitation. SC occurred in 96% of SC patients with a perimembranous VSD by the age of 6 years, and in 93% of those with a muscular VSD by the age of 3 years. In patients without CHF, the rate of SC was 72%; 23% in subpulmonary VSD, 74% in perimembranous, and 85% in muscular. SC occurred in only 23% of patients with a perimembranous VSD with CHF. Mean age at the final examination was 6.9 years in 59 patients with a VSD remaining open, and 63% of patients with a perimembranous VSD remaining open had an aneurysm of the ventricular membranous septum. CONCLUSIONS: The SC rate of VSD by mean age of 6.9 years was 48%, but it was 72% in patients without CHF. In patients with CHF, SC was seen only in patients with a perimembranous VSD. The rate of SC was 10% in subpulmonary VSD. The authors contend that SC probably occurred by growth of muscular septum surrounding VSD. Muscular VSD spontaneously closed earlier than perimembranous VSD.

Echocardiography, Doppler, Color↗
PubMedDate not supplied

Myocardial ischemia in Kawasaki disease: evaluation with dipyridamole stress technetium 99m tetrofosmin scintigraphy.

BACKGROUND: The coronary artery abnormalities in Kawasaki disease (KD) often cause myocardial ischemia. Previous publications have described the use of thallium 201 myocardial perfusion imaging to determine the extent of ischemia in patients with KD. The technetium perfusion agents offer better resolution and may offer additional information about ventricular function in these patients. This study was performed to evaluate myocardial perfusion in patients with KD through use of technetium 99m tetrofosmin (TF) in conjunction with dipyridamole vasodilator stress. METHODS AND RESULTS: Eighty-six patients with KD aged 11.5 +/- 6.4 years and 20 age-matched control patients without heart disease were studied. Among 86 patients with KD, significant coronary artery stenosis (>or=75%) was observed in 20, coronary aneurysm without stenosis in 37, and no coronary lesions in 29. After administration of high-dose dipyridamole infusion (0.70 mg/kg), 74 to 370 MBq TF was injected and 148 to 740 MBq TF was injected at rest 4 hours later. Single photon emission computed tomography images were obtained more than 30 minutes after TF injection. Regional myocardial hypoperfusion was observed in 18 patients who had coronary artery stenosis of 75% or greater (sensitivity, 90%, and specificity, 100%). Two patients did not demonstrate ischemic changes in coronary artery stenosis in group I; one had good collateral flow. There were no TF injection-related complications. CONCLUSIONS: Tetrofosmin myocardial perfusion imaging can detect regional hypoperfusion in children with KD.

Adolescent↗