Patch repair of mitral valve perforation with excised aortic valve cusp in patient with endocarditis.
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Aortic Valve↗
Biomedical subjects
Yoshitsugu Nakamura
Publications and source records attributed to Yoshitsugu Nakamura.
Post-aortic left innominate vein with aortic arch aneurysm.
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Aged↗
Easy pulmonary vein isolation using epicardial cryoablation.
The maze procedure can be accomplished by several techniques with varying degrees of success. These techniques include cut-and-sew, endocardial cryoablation, and epicardial ablation using heat-producing devices. We describe our surgical modification of pulmonary vein isolation with cryoablation using an epicardial and endocardial approach. This simple and reliable technique, which does not need any special device, will assist in mitral valve surgery for patients with chronic atrial fibrillation.
Aged↗
Pulmonary artery aneurysm with ascending aortic aneurysm concomitant with bilateral bicuspid semilunar valves.
Aneurysm of both the pulmonary trunk and the ascending aorta concomitant with bilateral bicuspid valves is very rare. The reason for the formation of aneurysm with bicuspid semilunar valve is still inconclusive. Surgical repair was performed successfully (ie, aortic valve replacement, graft replacement for the ascending aorta, and plication of the pulmonary artery). Pathology of the pulmonary artery wall did not demonstrate cystic medial necrosis. The hemodynamic turbulence by the bilateral bicuspid valve may cause the formation of aneurysms even at low pressure. This case demonstrates an explanation for aneurysm with the bicuspid valve.
Aneurysm↗
Infective endocarditis associated with Sjogren's syndrome.
Sjögren's syndrome is one of the major autoimmune diseases, however infective endocarditis associated with Sjögren's syndrome has not previously been reported. A patient with Sjögren's syndrome associated with aortic valve regurgitation due to infective endocarditis, underwent successful aortic valve replacement. Patients with Sjögren's syndrome tend to be at a higher risk of intraoral infections due to diminished secretion of saliva. Particular care must be taken of Sjögren's syndrome patients as they can also be at an increased risk of infective endocarditis.
Adult↗
Phenotypic heterogeneity within a new family with the MAPT p301s mutation.
Mutations in the gene encoding the microtubule-associated protein tau (MAPT) cause frontotemporal dementia and parkinsonism linked to chromosome 17. Clinical variability is seen not only among families with different mutations, but also among family members with the same mutation. We investigated a newly identified familial frontotemporal dementia and parkinsonism family. The disease was of early onset and was inherited as an autosomal dominant trait. Clinically, parkinsonism was the prominent and often early feature, and it preceded dementia. Three autopsied cases shared involvement predominantly in the frontal and temporal lobes and also in the subcortical nuclei, including substantia nigra, globus pallidus, and subthalamic nucleus, that microscopically consisted of neuronal loss, microvacuolation, and astrocytic fibrosis. Immunohistochemistry demonstrated neuropil threads, ballooned cells, and glial fibrillary tangles. Sequencing analysis of the MAPT gene showed an alteration in one allele, resulting in a P301S substitution. These findings suggest that the MAPT P301S mutation can cause pathologically subcortical-predominant, neuropil thread-rich, tau-containing lesions, which could result in consistent parkinsonism. Our study confirms the notion that the phenotype observed in affected individuals from P301S MAPT mutation families is heterogeneous and is broader than the phenotypes seen to date in affected family members carrying other MAPT mutations.
Adult↗
A metastatic ball tumor in the right atrium originating from esophageal cancer: report of a case.
A metastatic ball tumor in the right atrium originating from esophageal cancer is extremely rare. A 53-year-old woman had two such tumors without any other types of metastasis. These tumors were associated with severe thrombocytopenia caused by the consumption of platelets. Even after repeated transfusions of platelets and fresh frozen plasma, the thrombocytopenia could not be controlled. Therefore, a surgical resection was performed to improve the thrombocytopenia and avoid sudden death due to a complete obstruction of the right ventricular outflow tract by the tumor. As the throm-bocytopenia did not recur postoperatively, the patient was discharged from hospital. She died, however, of multiple metastases with bilateral pleural effusions 5 months after the surgery.
Carcinoma, Squamous Cell↗
Capillary leakage in cardiac surgery with cardiopulmonary bypass.
Cardiopulmonary bypass causes a systemic inflammatory response, which can lead to capillary leak syndrome. In 15 adults undergoing elective cardiac surgery with cardiopulmonary bypass, we determined the volume and peak time of capillary leakage from the measurements of extracellular fluid volume and circulating blood volume taken preoperatively, at various intervals up to 24 hours after surgery, and on the 7th postoperative day. Extracellular fluid volume rose from 15.5 +/- 2.7 L preoperatively to a peak 4 hours after surgery of 18.3 +/- 3.2 L and remained elevated at 24 hours. Circulating blood volume fell from 4.10 +/- 0.68 L preoperatively to 3.20 +/- 0.58 L at the end of surgery. Fluid administered intraoperatively did not raise the circulating blood volume. Intraoperative fluid balance was positive at 2.62 +/- 0.72 L but negative at all time points postoperatively. There was significant postoperative capillary leakage, increasing from 4.7% +/- 2.3% of body weight at the end of surgery to a peak 4 hours later of 5.4% +/- 2.0% and falling to 2.8% +/- 3.3% at 24 hours. This knowledge of the pattern of change in capillary leakage after cardiac surgery with cardiopulmonary bypass might serve as a valuable guide for postoperative management.
Adult↗
Hospital and mid-term outcomes in elderly patients under-going off-pump coronary artery bypass grafting--comparison with younger patients--.
BACKGROUND: Clinical outcomes and problems following off-pump coronary artery bypass grafting (OPCAB) in elderly patients have not been clarified. METHODS AND RESULTS: The surgical results of elderly patients aged 75 years or older (n=50; 38 males, mean age, 78.8 years) were reviewed and compared with those of younger patients (n=95; 79 males, mean age, 63.0 years). The EuroSCORE score was 6.9+/-3.5 in the elderly group and 3.0+/-2.4 in the younger group (p<0.0001). There were no hospital deaths in either group. There was no significant difference in the postoperative complication rate except for atrial fibrillation (40.0% elderly vs 24.2% younger, p=0.0479). Postoperative intensive care unit and hospital stays did not differ. The frequency of blood transfusion was significantly higher in the elderly group (78.0% elderly vs 37.2% younger, p<0.0001). During the mean follow-up of 18.6+/-8.8 months, there was 1 sudden death in the elderly group, but no cardiac deaths in either group. The 32-month cardiac event-free and survival rates were similar for the 2 groups. CONCLUSION: OPCAB provides satisfactory clinical outcomes for elderly as well as younger patients.
Aged↗
The prevalence and severity of cerebrovascular disease in patients undergoing cardiovascular surgery.
OBJECTIVES: The degree of preoperative cerebrovascular disease in patients undergoing cardiovascular surgery has not been well studied. Thus, the purpose of this study was to evaluate the prevalence and severity of cerebrovascular disease in such patients. METHODS: The subjects were 91 patients who underwent cardiovascular surgery. We investigated the prevalence and severity of cerebral infarction (CI), intracranial artery stenosis (ICAS) of > or =50%, cervical carotid artery stenosis (CCAS) of > or =50%, and periventricular hyperintensity (PVH) using magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA). RESULTS: The prevalence of cerebrovascular diseases was: CI, 79 patients (86.8%) [33 had some small infarctions, 38 had multiple small infarctions, eight had broad infarctions greater than 15 mm); ICAS, 17 patients (18.7%)]; CCAS, 30 patients (33.0%) [21 had stenosis of <70%, and nine had stenosis of > or =70% or occlusion]; and PVH, 79 patients (86.8%). CONCLUSION: Patients undergoing cardiovascular surgery have a high prevalence of cerebrovascular disease in varying degrees.
Aged↗
Ischemia of the intestinal mucosa during cardiopulmonary bypass.
Bacterial translocation is believed to occur during cardiopulmonary bypass (CPB) because serum endotoxin concentrations rise. Intestinal ischemia during CPB, however, has never been proven directly. The condition of the intestinal mucosa during CPB was studied by measuring serum diamine oxidase (DAO) activity, an index of intestinal ischemia. Serum DAO activity, blood lactate concentration, and the arterial ketone body ratio (AKBR) were measured intraoperatively in four successive patients who underwent aortic arch replacement by the open distal anastomosis method. DAO activity rose after restoration of blood flow to the lower half of the body, and continued to rise throughout CPB. The lactate concentration also rose, mirroring the change in DAO activity, and returned to nearly normal 12 h after the operation. The AKBR decreased during CPB, with a mean minimum vale of 0.16-0.07 immediately after the restoration of blood flow to the lower half of the body. The parallel rise in DAO activity and serum lactate concentration once blood flow to the lower half of the body was restored implies that ischemic injury to the mucosa of the small intestine occurs during CPB. The continued rise in these parameters throughout CPB is consistent with ongoing injury due to splanchnic hypoperfusion, as reflected in the decrease in the AKBR during the same period.
Aged↗
Mycotic aneurysm of the aortic arch due to Salmonella.
We report the successful treatment of a 79-year-old man with an extremely rare mycotic aneurysm of the aortic arch due to Salmonella. The patient presented with persistent fever, hoarseness, and hemosputum. Computed tomography showed a large saccular aneurysm with a hazy aortic wall in the aortic arch. We conducted emergency total arch replacement, debriding surrounding infectious tissue. Cultures from the aneurysm grew Salmonella enteritidis. Infection recurred 1 week postoperatively, requiring open irrigation and omentum transposition. These surgical procedures, along with appropriate antibiotics, brought infection under control.
Aged↗
Early results of complete off-pump coronary revascularization using left internal thoracic artery with composite radial artery.
OBJECTIVE: Off-pump coronary artery bypass (OPCAB) using the left internal thoracic artery (LITA) with a composite radial artery (RA) was employed for arterial revascularization in order to minimize neurological complication. METHODS: Sixty-one patients underwent OPCAB using the LITA with a composite RA. Angiography was performed in all patients at two weeks postoperatively. RESULTS: The mean number of distal anastomoses was 3.2 +/- 0.4. A Y-composite graft was used in 55 patients, and K-composite graft was used in the other 6 patients. There was no hospital death, no neurological complication nor deep sternal infection. Furthermore, there was no episode of perioperative myocardial infarction nor hypoperfusion syndrome. Patients have been angina-free during a mean follow-up period of 1 year. The graft patency of the LITA to the left anterior descending artery (LAD) was 100% (61/61 anastomoses). The RA became occluded in 4 patients, and the patency rate was 95.6% (130/136 anastomoses). String or coronary-coronary bypass resulting from flow competition was observed in the LITA of 6 patients and in the RA of 13 patients. The string of the LITA occurred in the segment distal from the anastomosis with the composite RA. The string or coronary-coronary bypass was observed more often in cases in which the recipient coronary artery had less than 75% stenosis. CONCLUSION: OPCAB using only the LITA with a composite RA can be successfully and safely performed in patients with multivessel disease. Late postoperative follow-up of the flow competition is necessary to delineate the significance of flow competition.
Aged↗
Three-dimensional computed tomography of thoracic aortic aneurysm.
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Aortic Aneurysm, Thoracic↗
Combined carotid endarterectomy and cardiac surgery for concomitant carotid and cardiac disease.
OBJECTIVES: Carotid artery disease is one of the important factors of neurological complications after cardiac surgery. In this study we present our surgical experience and discuss its implication for patients with carotid and cardiac disease. METHODS: Five patients underwent combined carotid endarterectomy (CEA)/cardiac surgery including thoracic aortic repair. There were three male and two female patients, with a mean age of 67+/-10 years (range, 54-75 years). All patients had an 80% or greater stenosis in the unilateral internal carotid artery. Three patients had coronary artery disease and underwent combined CEA/off-pump coronary artery bypass grafting (OPCAB). One patient had an aortic valve stenosis (AS) with repeated syncope and chest pain, and underwent combined CEA/aortic valve replacement. The remaining patient had an extremely large aortic arch aneurysm (90 mm) and underwent combined CEA/total arch replacement. RESULTS: There were no surgical or hospital deaths. No perioperative complications including myocardial infarction and stroke occurred. During the follow-up period, lasting from 2 months to 27 months (mean, 13 months), there were no late deaths, neurological complications nor cardiac events. CONCLUSIONS: Combined CEA/cardiac surgery offered an acceptable morbidity in these complex patients. Due to the preliminary nature of our study, further follow-up and experience with our management strategy are necessary.
Aged↗
Multiple off-pump coronary revascularization with "aorta no-touch " technique using composite and sequential methods.
BACKGROUND: Although off-pump coronary artery bypass grafting (OPCAB) has been widely applied in patients who are considered high risk for cardiopulmonary bypass (CPB), there is still a risk of stroke during the operation because of the ascending aortic partial clamp for proximal anastomosis. In the present study, we report the initial results of an "aorta no-touch " technique using an in-situ graft and composite and sequential grafting methods. METHODS: Between March 2000 and April 2001, 120 patients underwent OPCAB with this technique. The age of patients ranged from 47 to 86 years, with a mean age of 65.7 +/- 8.7 years. On average, 3.12 +/- 0.77 grafts per patient were completed. More than 4 distal anastomoses were performed in 32 patients (27%). As in-situ grafts, 140 internal thoracic arteries (ITAs) and 9 gastroepiploic arteries were used. The radial artery (RA) was used as a Y composite graft in 91 patients, as an I composite graft in 25, and as a K composite graft in 2. Sequential bypass grafting was performed using the RA in 60 patients, the saphenous vein (SV) in 6, the ITA in 4, and the gastroepiploic artery (GEA) in 3. Arterial grafts were used in 92% (345/374) of total bypass grafts. Distal anastomosed sites were 119 left anterior descending arteries (LADs) (32%), 90 posterolateral branches (24%), 64 posterior descending arteries (17%), 49 diagonal branches (13%), 39 obtuse marginal branches (10%), and 13 right coronary arteries (3.5%). RESULTS: There was no operative death or stroke. Early postoperative angiography revealed 95.5% (321/336) graft patency with 100% patency (119/119) of ITA to LAD grafts. Graft patency of the ITAs and RAs (98.5% and 95.9%) were significantly better than that of the GEA (79.0%, p = 0.0064 and p = 0.030) and saphenous vein (82.3%, p = 0.011 and p = 0.048). CONCLUSION: OPCAB performed with the aorta no-touch technique using an in-situ graft and composite and sequential grafting methods provides excellent early clinical results and graft patency.
Aged↗