Biomedical subjects

Y Fukuhiro

Publications and source records attributed to Y Fukuhiro.

26 records · Page 2Linked to original sources

PubMed1994

[A case of acute retrograde type I dissecting aneurysm of aorta underwent three operations].

A 54-year-old man with an acute retrograde type I dissecting aneurysm of the aorta underwent three operations for four years. The first operation was by the Collins method, the second was a graft replacement of the descending aorta, and the third involved a graft replacement of the ascending aorta and aortic arch, revascularization of the aortic branches and replacement of the aortic valve. In operations on acute retrograde type I dissecting aneurysms of the aorta, the methods of Koster or Collins are in appropriate in cases where sufficient entry treatment is impossible, and graft replacement of the ascending aorta at least is considered to be necessary.

Acute Disease↗

PubMed1993

[An adult case of anomalous origin of left coronary artery from pulmonary trunk: left coronary artery blood flow after closing of origin of left coronary artery].

An adult case of anomalous origin of left coronary artery from pulmonary trunk was reported. The catheterization studies revealed significant amount of left to right shunt in the pulmonary trunk and anomalous origin of left coronary artery from pulmonary artery with well developed and marked tortuously dilated collaterals from the right coronary artery. During surgery, blood flow waveforms of the LAD was measured using pulsed Doppler velocimeter. After temporary closing of the origin of left coronary artery, blood flow of the LAD markedly decreased. A-C bypass grafting to LAD was performed successfully using saphenous vein and graft flow rate was 220 ml/min. These findings suggest that the coronary blood flow through the tortuously dilated collaterals after ligation of the origin of left coronary artery was insufficient to perfuse the left coronary artery.

Adult↗

PubMed1993

[Coronary reoperation--report of 16 cases].

Between January 1975 and July 1992, coronary artery reoperation was performed in 16 of 333 patients who had undergone primary bypass grafting. The interval between the operations ranged from 2 to 147 months. Reoperation was done within one year in two patients, within one to five years in five patients and after more than five years in nine patients. The mean number of bypass grafts was 2.31 per patient in the first operation and 1.75 in the reoperation. The main reasons for the reoperation were an occlusion of the graft in 12 cases and both graft occlusion and new coronary artery disease in 3 cases. In one other case, an emergency right coronary bypass graft done for an acute occlusion during PTCA to an area of right coronary artery stenosis 13 months after two bypass graftings to the LAD and circumflex coronary artery. Fourteen cases had vein graft disease bypassed to the LAD or new coronary artery disease in the LAD and required reoperations of the LAD. In the case with a recurrence of myocardial ischemia after coronary bypass surgery and with bypass grafts to the LAD that were patent, there were no cases requiring reoperation. These findings demonstrate that patency of the grafts to the LAD is an important factor for reoperation after myocardial revascularization surgery.

Age Factors↗

PubMed1992

[Choice of conduit in coronary bypass surgery].

Since 1987, arterial conduits have been used in 78 of 130 cases receiving coronary bypass surgery, including 25 treated by arterial conduits alone. The use of arterial conduits was mainly indicated to the anterior descending coronary artery (LAD), but the saphenous vein had to be used in 39 percent, 47 of 120 cases receiving bypass grafting to the LAD for various reasons including a combination of multiple obstructive arteriosclerosis, multiple bypass graftings in the aged, unstable angina, emergency operation and no suitable artery for a conduit as indicated by preoperative angiography. Hereafter, arterial conduits for coronary bypass grafting to LAD should be used in many more cases to the best possible advantage.

Adult↗

PubMed1992

[Coronary bypass surgery using arterial conduit and its pitfall].

Three patients with spasm of internal mammary arteries and gastroepiploic artery immediately after coronary bypass surgery were reported. On completion of the revascularization, all patients could not be weaned from cardiopulmonary bypass. The flow velocity waveforms of the arterial grafts measured by pulsed Doppler velocimeter showed only small systolic component without diastolic flow and the palpation revealed profound spasm partially in the arterial conduits. Although all patients could be weaned from cardiopulmonary bypass only after insertion of a saphenous vein graft, two of them died on the next day. In all patients, free flow measured prior bypass was considered to be sufficient and a technically satisfactory anastomosis was felt to be performed. If a profound hemodynamic instability as a result of intractable spasm of arterial conduit occurred after completion of coronary bypass surgery, an additional saphenous vein graft should be placed before discontinuation of cardiopulmonary bypass.

Aged↗

PubMed1992

[The influence of increase in heart rate on coronary flow dynamics in the patients with aortic stenosis].

To clarify the causative factors responsible for the development of effort angina in aortic stenosis, the influence of an increase in heart rate by atrial pacing and isoproterenol infusion on the phasic left coronary flow velocity waveforms were studied using a pulsed Doppler velocimeter during cardiac surgery. Coronary flow velocity waveforms in aortic stenosis was characterized by a slowly increased diastolic inflow and an elongation of the time from the onset of diastole to the diastolic peak velocity. An increase in heart rate by pacing brought about a marked decrease in diastolic coronary flow since the slowly increasing diastolic flow was cut with the onset of following systole. On the contrary, after an increase in heart rate by infusion of isoproterenol, diastolic increasing rate in the coronary flow waveform accelerated and diastolic peak velocity markedly increased. As the results, isoproterenol produced a significant increase in diastolic coronary inflow.

Aged↗

PubMed1992

[Four cases of aortic valve replacement in aortitis syndrome].

Four surgically treated cases of aortic valve regurgitation associated with the aortitis syndrome were reported. All patients were female and ranged in age from 38 to 51 years. In two cases, obstructive lesions of the aortic arch branch were seen in aortograms. Three patients had no inflammatory findings at the operation and one was operated on after improvement of inflammatory findings by steroid therapy. Aortic regurgitation was caused by annuloaortic ectasia, and aortic valve replacement was performed by the everting mattress suture method in all cases. One patient with stenosis of the left carotid artery, occlusion of the left subclavian artery, and hypertension died of extended cerebral damage due to suspected low flow cerebral perfusion during cardiopulmonary bypass. The other three patients are doing well 4 months to 11 years after surgery without paravalvular leakage. In cardiac surgery for the aortitis syndrome with an obstructive lesion of the aortic arch branch, deep hypothermic and high flow cardiopulmonary perfusion is required to prevent ischemic brain complications during surgery.

Adult↗

PubMed1991

[Replacement of the ascending aorta and aortic valve with a composite graft using a reversed St. Jude medical mitral valve prosthesis].

Between 1981 and 1989, ten patients underwent replacement of the ascending aorta and aortic valve by a composite graft for an aneurysm of the ascending aorta with aortic regurgitation. The first two cases using an SJM aortic valve prosthesis and Teflon felt-pledgeted mattress sutures for the proximal anastomoses required a coronary bypass graft from the tube graft to the anterior descending coronary artery because of difficulty in completing the graft-left coronary ostial anastomoses. In the subsequent seven cases, an SJM mitral valve prosthesis with a large, soft cuff for a valved conduit was sewn in reverse and a thin wall Teflon roll was used for the Teflon felt of the pledgeted mattress suture in the proximal anastomoses. As a result, anastomoses between the tube graft and coronary ostia were performed easily and successfully in eight patients. One case with Marfan syndrome required reoperation nine years after the first operation for recurrence of the aneurysm of the aortic arch. Thus, the need for careful and continued follow-up is important in the Marfan syndrome.

Aortic Aneurysm↗