Transcatheter closure of patent ductus arteriosus with the Inoue single-branched stent graft.
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Biomedical subjects
Toshihiko Saga
Publications and source records attributed to Toshihiko Saga.
Antegrade selective cerebral perfusion with mild hypothermic systemic circulatory arrest during thoracic aortic surgery.
OBJECTIVE: Antegrade selective cerebral perfusion (ASCP) and retrograde cerebral perfusion (RCP) have proven to be reliable methods of brain protection during aortic surgery. These techniques are usually accompanied by systemic circulatory arrest with moderate hypothermia (24-28 degrees C) or deep hypothermia (18-24 degrees C). However, hypothermia can lead to various problems. The present study therefore reports results for thoracic aorta replacement using ASCP with mild hypothermic systemic arrest (28-32 degrees C). DESIGN: Between 1995 and 2003, 68 consecutive patients underwent repair of the ascending aorta and/or aortic arch. Mild hypothermic ASCP was utilized in 31 cases, moderate hypothermic ASCP in 20, and deep hypothermic RCP in 17. Various parameters were compared between the mild hypothermic ASCP, moderate hypothermic ASCP, and RCP. RESULTS: Hospital mortality was 10.3%, with no significant differences observed between any groups. Permanent neurological dysfunction was 8.8%, and no significant differences were observed between any groups. Mild hypothermic ASCP displayed significantly decreased transfusion volume, intubation time, and ICU stay. CONCLUSIONS: Use of ASCP with mild hypothermic systemic circulatory arrest during aortic surgery resulted in acceptable hospital mortality and neurological outcomes. ASCP with mild hypothermic arrest allows decreased transfusion volume and reduced duration of intubation and ICU stay.
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Concomitant aortoaxillary bypass and coronary artery bypass grafting.
The optimal revascularization strategy for patients with subclavian and coronary artery disease has not been established. This study assessed the mid-term clinical outcome of concomitant aortoaxillary bypass and coronary artery bypass grafting in 5 patients. A ring-reinforced polytetrafluoroethylene graft was attached to the ascending aorta and led to the proximal segment of the axillary artery via the pleural cavity. Patients were followed up for 2-10 years (mean, 5.4 +/- 3.4 years). Postoperative aortography and angiography demonstrated patent aortoaxillary and coronary bypass grafts in the short-term follow-up of all patients. Two patients with Takayasu aortitis needed re-operations for recurrent angina and annuloaortic dilatation. Another patient required removal of the aortoaxillary bypass graft because of infection, and subsequently underwent a left femoroaxillary bypass one year after the original procedure. Subclavian steal phenomenon did not occur. Aortoaxillary bypass with coronary artery bypass may be an effective option for patients with co-existing subclavian and coronary artery disease.
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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↗
Delayed cardiac tamponade caused by self-inserted needles.
A 47-year-old female intentionally inserted needles through her chest wall, resulting in cardiac trauma. One week later, cardiac tamponade occurred. The needles were detected and removed successfully by thoracotomy. During the operation, fluoroscopy was used to locate the needles and greatly facilitated their successful removal.
Cardiac Tamponade↗
Renal preservation in low ectopic right renal artery reconstruction during abdominal aortic aneurysm repair: report of a case.
Renal hypothermia achieved using cold (4 degrees C) heparinized Ringer's lactate is an effective method of preventing renal compromise during abdominal aortic surgery. We present the case of a 62-year-old man with an abdominal aortic aneurysm (AAA), complicated by involvement of an ectopic right renal artery with a low abdominal aortic origin and passage across the ventral side of the inferior vena cava. The patient underwent AAA repair and right renal artery reconstruction using renal perfusion with cold heparinized Ringer's lactate, and no deterioration of renal function occurred.
Aortic Aneurysm, Abdominal↗
Successful surgical treatment of mitral regurgitation for complete rupture of the anterior papillary muscle after acute myocardial infarction.
Papillary muscle rupture complicating acute myocardial infarction leads to mitral regurgitation and is associated with significant mortality. We experienced a case involving massive mitral regurgitation caused by complete anterior papillary muscle rupture following acute lateral myocardial infarction. A 75-year-old woman developed heart failure shortly after her admission, and the diagnosis was confirmed by echocardiography and cardiac catheterization. Under intra-aortic balloon pumping, the patient underwent emergency mitral valve replacement and coronary revascularization. Her postoperative course was uneventful, and she was discharged on the 40th postoperative day. We believe that prompt surgical treatment should be performed even in stable patients with ischemic mitral regurgitation, given that deterioration may be sudden and unpredictable especially in cases involving complete papillary muscle rupture.
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Acromegaly with multiple cardiovascular complications--cardiomyopathy, chordae rupture of mitral valve, myocardial infarction and sick sinus syndrome.
A 62-year-old woman had acromegaly and developed congestive heart failure with cardiomyopathy, mitral regurgitation due to chordae rupture, coronary artery disease and sick sinus syndrome. Since congestive heart failure was resistant to medical therapy, mitral valve replacement, aortocoronary bypass surgery and implantation of permanent pacemaker were performed one month after her admission. Although acromegalic patients with cardiomyopathy are usually resistant to therapy, we successfully treated the patient by the surgeries. It appears that all these diseases resulted from an elevated plasma concentration of growth hormone. Untreated acromegaly for more than ten years may contribute to multiple complications such as those in the present patient.
Acromegaly↗
Cardiac tamponade secondary to rupture of a distal aortic arch aneurysm.
We report the rare rupture of a distal aortic arch aneurysm protruding into the pericardial cavity. A 70-year-old woman who suddenly lost consciousness and was transferred to our hospital by ambulance in profound shock was found in emergency computed tomography and echocardiography to have a dilated distal aortic arch and massive pericardial effusion. Suspecting that a distal aortic arch aneurysm had ruptured, causing cardiac tamponade, we undertook an operation. We found a defect in the aneurysmal wall leading to the pericardium near the main pulmonary artery that was plugged temporarily with an atheromatous mass. We conducted total arch replacement successfully under selective cerebral perfusion and moderate hypothermia.
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Intravascular extraction of permanent pacemaker leads.
PURPOSE: Cardiac leads that became infected, fail, or are otherwise problematic present difficulties in the management of patients. In this report, we assess our intravascular countertraction technique. METHOD: Between February 1990 and January 2001, 13 leads were removed from 11 patients using the intravascular countertraction technique. The reasons for lead extraction were pacemaker infection and lead dysfunction. RESULTS: In two of these patients, the ventricular leads could not be completely removed. The complete success rate was 85% and the overall success rate was 92%. There were no serious complications such as cardiac rupture, vein injury, or death, and there were no clinical signs of pulmonary embolism. In one of the patients whose ventricular leads could not be removed completely, the ventricular lead was stretched from its previous round shape, but tricuspid valve regurgitation did not occur during the 3-year follow-up period. In the other patient, the distal electrode was left in the subclavian vein. However, this residual distal electrode did not migrate, and there were no clinical signs of any recurrence of infection. CONCLUSIONS: The present study suggests that to remove leads successfully, the largest locking stylet that can be easily passed to the lead's tip through the coil lumen should be chosen in order to avoid valve injury, which can sometimes occur when a ventricular lead's locking stylet is left in the coil lumen.
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Pretreatment of donors with endothelin receptor antagonist TAK-044 improves cardiac functional recovery following preservation with University of Wisconsin solution.
OBJECTIVE: Previous studies suggest that endothelin-1 (ET-1) plays a role in myocardial ischemia/reperfusion injury. Although administration of an endothelin receptor antagonist to the recipient has been shown to improve myocardial function after ischemia/reperfusion in a rat heart transplantation model, the effect of administering an endothelin receptor antagonist to the donor has not yet been examined. This study was designed to investigate the effects of pretreating donors with an ET(A)/ET(B) endothelin receptor antagonist (TAK-044) on myocardial function after cold preservation of a rat heart. DESIGN: Male rats were pretreated with normal saline (control group, n = 8), TAK-044 (TAK group, n = 8, 1 mg/kg). Following cardiac arrest using cardioplegia, we washed out the coronary vascular beds with cold University of Wisconsin solution followed by 6-h preservation. After preservation, the hearts were mounted on a Langendorff apparatus to estimate aortic flow (AF), coronary flow (CF), cardiac output (CO), systolic pressure (SP), heart rate (HR), and rate-pressure product (RPP: HR x SP). The concentration of lactate dehydrogenase (LDH) and creatine phosphokinase (CPK) within the coronary perfusate during reperfusion was measured. RESULTS: AF, SP, and CO were significantly greater in the TAK group than in the control group (p = 0.0045, 0.004, and 0.0295, respectively). CONCLUSION: Pretreatment of donors with a nonselective endothelin receptor antagonist (TAK-044) improved cardiac functional recovery following preservation and may be beneficial for prolonged myocardial preservation.
Adenosine↗
Two cases of a free-floating ball thrombus in the left atrium.
A free-floating ball thrombus in the left atrium is an unusual occurrence that may cause fatal systemic emboli or left ventricular inflow obstruction, often resulting in sudden death. The first of 2 cases was a 59-year-old female with mitral stenosis and chronic atrial fibrillation who presented with severe dyspnea. Transthoracic echocardiography revealed a free-floating ball thrombus and emergency thrombectomy and mitral valve replacement were performed successfully. A second thrombus, which was not found at preoperative examination, was attached to the anterior mitral leaflet and may have been the source of the free-floating ball thrombus. The second case was a 79-year-old female with chronic renal failure who underwent mitral valve replacement 11 years prior to admission. She had been dependent on hemodialysis for 10 years, and had suffered several recent transient cerebral ischemic attacks. Computed tomography showed a ring-shaped, high-density area in the left atrium and transthoracic echocardiography revealed a floating ball thrombus in the left atrium. Thrombectomy was performed, but the patient died as a result of postoperative pneumonia 2 months later. Case 2 appears to be the first reported case of a ball thrombus in a hemodialysis patient who had previously undergone mitral valve replacement.
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