PubMed Health⌕ Search

Biomedical subjects

Tomio Abe

Publications and source records attributed to Tomio Abe.

At least 73 records · Page 4Linked to original sources
PubMed2003

Simultaneous aortic and mitral valve replacement: predictors of adverse outcome.

BACKGROUND AND AIM OF THE STUDY: Uncertainties remain regarding the influence of several preoperative and intraoperative factors on outcome after double (simultaneous aortic and mitral) valve replacement (DVR). METHODS: Between 1981 and 1999, 132 patients (58 males, 74 females; mean age 53.8 years) underwent DVR with either aortic and mitral bileaflet mechanical valves in 81 patients, aortic tilting disk valve and mitral bileaflet valve in 36, and aortic tilting disk and mitral biological valve in 15. The mean duration of follow up was 7.6 years; cumulative follow up was 860 patient-years (pt-yr). RESULTS: Early mortality was 9.9% (n = 13). Late death occurred in 21 patients (linearized rate 2.4%/pt-yr; freedom rate at 10 years 77.6 +/- 5.4%) including cardiac-related death in 16 patients (linearized rate 1.9%/pt-yr; freedom rate at 10 years 86.9 +/- 4.5%) and valve-related death in 11 (linearized rate 1.3%/pt-yr; freedom rate at 10 years 87.7 +/- 4.3%). Late morbidity included 30 cases of thromboembolism (linearized rate 3.5%/pt-yr; freedom rate at 10 years 70.2 +/- 6.1%), seven bleeding (linearized rate 0.8%/pt-yr; freedom rate at 10 years 95.6 +/- 2.2%), 22 reoperations (linearized rate 2.6%/pt-yr; freedom rate at 10 years 79.4 +/- 5.1%), three prosthetic valve endocarditis, 13 structural valve deterioration, and two paravalvular leakage. Independent determinants of early and late mortality and morbidity, except for valve reoperation, were preoperative patient-related factors of NYHA class IV, left ventricular ejection fraction < or = 40%, mean right atrial pressure > or = 15 mmHg, and mean pulmonary artery wedge pressure > or = 25 mmHg. However, late valve reoperation and all valve-related complications were influenced by a valve-related factor, namely mitral bioprosthesis. CONCLUSION: Earlier surgical management before the development of severe heart failure, myocardial dysfunction and hemodynamic deterioration would improve the results of DVR. Mitral bioprosthesis combined with a mechanical aortic valve should be avoided as it increases the risk of reoperation.

Adult↗
PubMed2003

Batista operation with aortic valve replacement for valvular cardiomyopathy.

We performed a successful Batista operation with aortic valve replacement (AVR), graft replacement of the ascending aorta, and tricuspid annuloplasty for a patient with valvular cardiomyopathy with severe aortic stenosis, an ascending aortic aneurysm, and grade 3 tricuspid regurgitation.

Aortic Aneurysm, Thoracic↗
PubMed2003

Large bronchial cyst causing compression of the left atrium.

We describe here a case with a large bronchogenic cyst treated by surgical resection, who presented with evidence of left atrial overload on electrocardiogram (ECG). The 50-year-old male patient presented with the chief complaint of heaviness in the chest on exertion. An ECG revealed evidence of left atrial overload, and echocardiography and imaging revealed a mass having a maximum diameter of 9 cm on the cranial aspect of the left atrium, caudal to the tracheal bifurcation. The patient was treated by surgical resection of the cystic mass via right anterolateral thoracotomy. His postoperative course was satisfactory and the patient was relieved of his main symptom.

Bronchogenic Cyst↗
PubMed2003

Multidisciplinary treatment by pneumonectomy, PMX and CHDF in a case of pulmonary suppuration complicated with septic shock.

A 68-year-old male, who had suffered from pulmonary tuberculosis with cavities on the right upper lobe, developed breathlessness, bloody sputum, right chest pain and fever. His laboratory data on admission showed severe infection or sepsis (WBC 2,600/mL, CRP 40.2 mg/dL), and his respiratory condition rapidly worsened. In the intensive care unit (ICU) he was given continuous hemodiafiltration (CHDF), but his respiratory condition failed to improve and it was therefore decided to perform a right pneumonectomy. His severe hypoxemia was resolved but because high dose catecholamines medication was still required, polymyxin-B immobilized fiber (PMX) and CHDF were performed. The operation was successful and he was transferred from the ICU to a general ward seven days postoperatively. The vicious circle of septic shock presenting in this case was successfully broken by the pneumonectomy and subsequent treatment by PMX and CHDF, which eliminated the causative factors of sepsis. (Ann Thorac Cardiovasc Surg 2003; 9: 319-22)

Aged↗
PubMed2003

[Current status and prospect of T cell costimulatory blockade in transplantation].

Organ transplantation has been widely accepted as a routine medical treatment in Japan. The recent introduction of new immunosuppressive reagents may improve outcome after transplantation. However, further investigations are required to achieve the prevention of chronic rejection and the induction of donor-specific tolerance in clinical transplantation. The potential of costimulatory blockade in controlling allograft rejection is now extensively under investigation. Although costimulatory blockade can prevent rejection and induce tolerance experimentally, there are several issues that need to be clarified before its clinical application. Recently, several novel costimulatory pathways have also been reported. Each costimulatory pathway has distinct and unique immunological roles in T cell activation and down-regulation. Upon the perception of underlying mechanisms, the theoretical and effective use of costimulatory blockade in combination with conventional immunosuppression and/or novel molecular targeting therapies might make a major breakthrough in clinical transplantation.

Animals↗
PubMed2002

Isolated iliac artery aneurysmocolonic fistula with pericolic abscess.

We report the successful management of a 66-year-old man who had common iliac aneurysmosigmoid colon fistula. The initial presentation was abdominal pain, fever, and melena. Digital subtraction angiography showed no evidence of rupture. However, computed tomography scanning revealed fine gas formations in the common iliac artery aneurysm. To reduce the risk of graft infection and prolonged ischemia, we created an extraabdominal femoral-femoral bypass graft, closed the wounds, removed the aneurysm, and closed the colon primarily. The postoperative course and recovery were uneventful.

Aged↗
PubMed2002

Last-intercalated node and direct lymphatic drainage into the thoracic duct from the thoracoabdominal viscera.

OBJECTIVE: We clarified the configuration of the mediastinal lymphatics, focusing on the last intercalated lymph node and the direct drainage vessel to the thoracic duct, based on recent anatomical findings. METHODS: We macroscopically observed the lymphatics during dissections of 205 cadavers in combination with routine histology. We also review the results of injection by other researchers. RESULTS: Efferent vessels draining directly into the thoracic duct or venous angle were frequently found in the following node groups: the right paratracheal node group corresponding to the last intercalated node in 98% of cadavers (201); the brachiocephalic angle node group in 85% of cadavers (174); the right recurrent nerve group in 46% (94); the left superior phrenic node group in 73% (150); the node group at the origin of the left common carotid artery (the preaortico-carotid node) in 37% (76); the pretracheal node group in 25% (51) and the left tracheobronchial node group in 36% (74). Last intercalated nodes appeared common for multiple drainage routes or regional lymphatics. These results were mostly consistent with injection studies by Riquet et al. Direct lymphatic drainage from the esophagus to the thoracic duct was observed in 19% of cadavers (39). Direct lymphatic drainage of lung segments to distant mediastinal nodes is also reviewed. The sentinel node concept is discussed in relation to the above observations. CONCLUSIONS: We hypothesize that the most critical sentinel node, if such usage is allowed, is situated as a guard for a limited specific route and for a common drainage route. We term it the "common terminal node".

Humans↗
PubMed2002

Right-side congenital pericardial defect associated with ischemic heart disease.

We report an unusual right-side congenital pericardial defect with herniation of the right atrium to the right thoracic cavity found intraoperatively in a 73- year-old man undergoing coronary artery bypass grafting for triple-vessel coronary artery disease. The right atrial wall showed fibrous changes due to contact with the defect edge. We suspected that the right coronary artery was obstructed by chronic strangulation of the right atrium. We repaired the defect with a polytetrafluoroethylene patch to prevent it from compressing the bypass graft and coronary arteries.

Aged↗
PubMed2002

Descending or thoracoabdominal aortic aneurysm repair without intercostal vessel reconstruction using contrast magnetic resonance angiography: report of two cases.

Two high-risk patients underwent a graft replacement for descending thoracic or thoracoabdominal aortic aneurysms without the reconstruction of any intercostal and lumbar arteries. The first patient was an 81-year-old woman with asthma and renal dysfunction who was diagnosed to have a descending thoracic aortic aneurysm extending from the Th8 to Th12 level. Contrast magnetic resonance angiography (MRA) demonstrated the Adamkiewicz artery to originate from the left second lumbar artery. The second patient was a 59-year-old man with left ventricular dysfunction due to aortic and mitral stenoses who was diagnosed to have a Crawford type IV thoracoabdominal aortic aneurysm. Contrast MRA showed the Adamkiewicz artery to originate from the left ninth intercostal artery. In general, the reestablishment of the spinal cord's blood supply, whenever possible, is generally considered to be necessary in such patients to prevent spinal cord injury. However, the reimplantation of intercostal vessels is the most complex aspect of this surgical modality, and therefore, it may cause a substantial increase in the cardiopulmonary bypass time. However, at least in some cases, such as the two cases presented herein, the use of contrast MRA was found to reduce the risk in surgery for descending thoracic or thoracoabdominal aortic aneurysms by eliminating the need for any intraoperative management of the intercostal and lumbar arteries.

Aged↗
PubMed2002

Replacement of a thrombosed valve after the Bentall procedure.

A 50-year-old man developed thrombosis in the valve of a Björk-Shiley prosthesis that had been used for composite graft replacement of the aortic valve and ascending aorta 8 years previously. The thrombosed valve was removed, and because of the narrow aortic valve ring, it was replaced using patch enlargement of the aortic annulus without replacement of the conduit.

Blood Vessel Prosthesis Implantation↗
PubMed2002

Composite graft replacement after aortic valvuloplasty in Takayasu arteritis.

A 24-year-old woman had undergone valvuloplasty of the aortic valve and external reinforcement of an aneurysm of the ascending aorta during the active phase of Takayasu arteritis 1 year prior to admission to our hospital. On examination, she was diagnosed as having a large false aneurysm of the ascending aorta with annuloaortic ectasia and severe aortic regurgitation, bilateral common carotid artery aneurysms with a left internal carotid artery saccular aneurysm, and bilateral subclavian artery and right vertebral artery obstructions due to Takayasu arteritis. Because of the risk of rupture, surgical intervention was carried out in spite of the fact that aortitis was in the active phase.

Adult↗
PubMed2002

Traumatic coronary artery dissection.

A 14-year-old boy sustained blunt chest trauma resulting in dissection of the left main coronary artery, postinfarction left ventricular aneurysm, mitral regurgitation, and tricuspid regurgitation. He underwent pericardial patch angioplasty of the left main coronary artery, left ventricular aneurysmectomy, mitral valvuloplasty, and tricuspid annuloplasty. The patient continues to do well 4 years after operation.

Accidents, Traffic↗
PubMed2002

Aortic root remodeling operation: how do we tailor a tube graft?

BACKGROUND: In aortic root remodeling operation, it is difficult to perform graft sizing and tailor a graft appropriately. Thus the aim of this study was to create guidelines for sizing and tailoring that would help to standardize the operation. METHODS: We studied the anatomy of the aortic root and assessed the reliability of three equations reported to assist in graft sizing with aortic root casts obtained from 127 cadavers. RESULTS: Yacoub's equation and ours accurately predicted the diameter at the sinotubular junction. Three cusps of the aortic valve were not equal in size. Sinus height of the aortic root was unpredictable. CONCLUSIONS: Based on these results, we recommend that aortic root remodeling operation should be performed as follows: (1) graft sizing should be performed using Yacoub's way or our way; (2) the tube graft should be cut into three parts in proportion to the size of each cusp; and (3) the position of the commissures in the tube graft should be secured with sutures first, and the depth of the sinuses should be determined later.

Adult↗
PubMed2002

Less-invasive thoracic aortic aneurysm repair.

To minimize surgical trauma, we performed graft replacement of a descending aortic aneurysm through a minithoracotomy (12 cm) with the use of thoracoscopy and special vascular clamps. Contrast magnetic resonance angiography can be useful for preventing postoperative paraplegia by revealing the Adamkiewicz artery. The patient was satisfied with the postoperative comfort and good cosmetic result. Further refinement of the technique and instrumentation would make this technique a valuable adjunct to conventional thoracic aortic surgery.

Aged↗
PubMed2002

Thoracoabdominal or descending aortic aneurysm repair after preoperative demonstration of the Adamkiewicz artery by magnetic resonance angiography.

OBJECTIVE: The outcome of thoracoabdominal or descending aortic aneurysm repair after preoperative demonstration of the artery of Adamkiewicz (ARM) by magnetic resonance angiography (MRA) was investigated. METHODS: Between January 2000 and December 2001, 40 consecutive patients who had aneurysms of the thoracoabdominal or descending aorta underwent preoperative MRA to visualize the ARM. Thirty-two patients underwent replacement of the aneurysms, and 25 patients (TAAA, 11; TAA, 14) underwent replacement of the aneurysms with preoperative detection of the ARM. Only intercostal or lumbar arteries in aneurysms, which were detected as the origin of the ARM, were reattached to the graft. The results of thoracoabdominal aortic aneurysm operations in 11 patients in whom the ARM was preoperatively detected (group I) were compared with the results of TAAA operations in 26 patients in whom the ARM was not preoperatively detected (group II). RESULTS: MRA demonstrated the ARM in 29 (73%) of the 40 patients. The laterality of the arteries originated from the left side in 29 (100%) and between Th9 and Th12 in 25 (86%), between Th9 and L1 in 28 (97%) of the 29 patients. No spinal cord injury occurred in patients (TAAA and TAA) in whom the ARM had been preoperatively detected. Major complications following TAAA operations included paraplegia (0% in group I and 8% in group II), respiratory failure (9% in group I and 23% in group II), and renal failure requiring hemodialysis (18% in group I and 22% in group II). Operation times were 439+/-99 min in group I and 620+/-200 min in group II (P=0.008). CONCLUSIONS: Preoperative detection of the ARM is possible by MRA and is very useful for reducing the incidence of ischemic injury of the spinal cord and for reducing the time of an operation for repair of an aneurysm of the thoracoabdominal or descending aorta.

Aged↗
PubMed2002

Configurations of the segmental and subsegmental bronchi and arteries in the right upper lobe of the human lung with special reference to their concomitant relations and double subsegmental arterial supply.

The basic, concomitant topographical relation between the segmental bronchus and artery shows derived figures in the dorsolateral part of the cranial portion of the mammalian lung, especially in humans. However, the pulmonary arterial supply has not been investigated well in the subsegmental level, even in humans. One or two subsegments of S2 received a double arterial supply from both the superior and inferior pulmonary trunks in 39.8% of the right upper lobes of 194 human lung dissections, whereas 20.6% did so in S3, although the latter cases were limited to one of the two subsegments. Moreover, we found several arterial patterns that were significantly frequently observed in a specific group of the bronchial tree in S2 and/or S3. Invasion of an additional artery of inferior trunk origin seemed to happen at the same time in both segments even without complementary territorial relations with the essential segmental artery of the superior trunk origin. S2 and S3 in the human right lung seemed to be the best fields for reconsideration of the basic rules in the lung segment system in mammals as a result of their having the largest sets of variations. We speculate that the discrepancy between the bronchial and arterial ramification patterns, which was frequently found in S2 and S3, is a result of a hypothetical secondary increase of the comparative volume of this area in evolution and/or development of the lung.

Aged↗