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Biomedical subjects

A Furuse

Publications and source records attributed to A Furuse.

At least 55 records · Page 3Linked to original sources
PubMed1997

Thoracoscopic cardiomyoplasty: a canine feasibility study.

BACKGROUND: Thoracoscopy may be effective in reducing the surgical stress of cardiomyoplasty. The feasibility of thoracoscopy in cardiomyoplasty was investigated. METHODS: Cardiomyoplasty by thoracoscopy and by the open method through a thoracotomy was performed in dogs. After 8 to 10 weeks of preconditioning, the hemodynamic effect of burst stimulation was measured. RESULTS: Cardiomyoplasty by thoracoscopy took 90 +/- 21 minutes (mean +/- standard deviation), whereas cardiomyoplasty by the open method took 67 +/- 10 minutes (p < 0.05). As a result of burst stimulation, aortic pressure, descending aortic flow, and left atrial pressure increased by 15.1% +/- 6.5%, 8.6% +/- 6.3%, and 3.8% +/- 4.6%, respectively, in the dogs that received the cardiomyoplasty by thoracoscopy, whereas those indices increased by 16.5% +/- 6.9%, 9.8% +/- 5.9%, and 4.8% +/- 4.2%, respectively, in dogs that received cardiomyoplasty by the open method. No significant difference between the two groups was shown in any index. CONCLUSIONS: Cardiomyoplasty by thoracoscopy was technically practical, and its hemodynamic effect was similar to that of the open method. The feasibility of cardiomyoplasty by thoracoscopy was thereby suggested.

Animals↗
PubMed1997

Four-channeled aortic dissection and rupture.

A four-channeled aortic dissection is quite rare, which is a highly life-threatening situation predisposing to aortic rupture. We report a successful management of a four-channeled aortic dissection and an aortic rupture in a 59-year-old woman with Marfan's syndrome 11 years after an initial Bentall procedure for DeBakey type I dissection. The total arch and the descending thoracic aorta were replaced under deep hypothermia and circulatory arrest.

Adult↗
PubMed1997

Sinus node function after mitral valve surgery via the transseptal superior approach.

OBJECTIVE: The transseptal superior approach can offer an excellent view of the mitral valve but the incision almost always transects the sinus node artery. The purpose of this study was to evaluate the sinus node function after mitral operation by this approach. PATIENTS AND METHODS: We reviewed the electrocardiograms of 76 patients who underwent mitral valve operations either via transseptal superior approach or via right lateral atriotomy. Nine patients who maintained the sinus rhythm for more than one year after surgery via the transseptal superior approach were selected for electrophysiological study to evaluate the sinus node function. RESULTS AND CONCLUSIONS: Postoperative electrocardiographic and electrophysiological studies revealed that the sinus node function after the transseptal superior approach was relatively well maintained for more than one year after the operation. The influence of the transseptal superior approach on the sinus node function in the mid-term postoperative period was apparently mild and did not cause a serious problem. However, some of the patients did show abnormal data in terms of sino-atrial conduction time and intrinsic heart rate. Therefore, further follow-up of the sinus node function is necessary in patients who underwent mitral surgery through the transseptal superior approach.

Aged↗
PubMed1997

Mutations in the CLCN5 gene in Japanese patients with familial idiopathic low-molecular-weight proteinuria.

Familial idiopathic low-molecular-weight proteinuria (FILMWP) is a renal proximal tubulopathy that occurs predominantly in males. FILMWP is characterized by mild proteinuria consisting of low-molecular-weight proteinuria, aminoaciduria and relatively conserved renal function, but without rickets. To determine whether FILMWP is related to the CLCN5 gene, which is responsible for Dent's disease and two related disorders, we analyzed the CLCN5 gene from four Japanese families with FILMWP. We identified two novel mutations: one was a single base insertion at codon 520 serine in exon 10 and the other was a single base deletion at codon 403 tyrosine in exon 8. These mutations caused a shift in the reading frame, resulting in synthesis of truncated CLC5 proteins that lacked 220 (29%) and 314 (42%) amino acids, respectively. These mutations were demonstrated to cosegregate with the disease in two families, respectively. We conclude that the CLCN5 gene is responsible for this proximal renal tubulopathy in some Japanese families and that FILMWP is possibly a variant of Dent's disease.

Alleles↗
PubMed1997

Fibrous tissue overgrowth and prosthetic valve endocarditis: report of a case.

Mechanical valve stenosis without restricted occluder motion and paravaluvular leakage developed in a patient who had undergone patch closure of partial atrioventricular septal defect and replacement of the left atrioventricular valve 13 years previously. Dense calcification of the supravalvular region was shown in a cineradiogram, whereas transthoracic and transesophageal echocardiography failed to reveal any obstructive mechanism. Elevated transprosthetic pressure gradient with unrestricted occluder motion suggested prosthetic valve stenosis resulting from fibrous tissue overgrowth, although this was not visualized by the modern diagnostic imaging tools. Reoperation confirmed calcified fibrous tissue overgrowth obstructing the mechanical valve inflow. Examination of resected tissue revealed prosthetic valve endocarditis due to alpha-streptococcus. Paravalvular leakage accompanying fibrous tissue overgrowth may indicate the presence of prosthetic valve infection even if the clinical manifestations are scarce.

Calcinosis↗
PubMed1997

Mitral valve repair through combined left atrial and ventricular approach for congenital mitral stenosis.

A 3-year-old boy underwent mitral valve repair for congenital mitral stenosis through combined superior-septal atriotomy and apical left ventriculotomy. The operation was performed safely with excellent exposure of the subvalvular apparatus by the ventricular approach, while sufficient visualization of the valvular lesion was obtained by the atrial approach. Postoperative echocardiography demonstrated normal left-ventricular motion and no residual mitral stenosis.

Cardiac Surgical Procedures↗
PubMed1997

Surgical repair for atrial septal defect in patients over 70 years of age.

Atrial septal defect (ASD) is the most common congenital heart anomaly encountered in adults. For patients over 60 years old, acceptable operative mortality and symptomatic improvement following surgery have been reported. We reviewed patients with ASD aged over 70 years and studied their preoperative hemodynamics, the surgical procedures used and the results. Between January 1994 and December 1996, 18 patients over the age of 40 years underwent surgical repair of ASD. Four patients were over 70 years of age (Group A). The other 14 patients were studied as a control group (Group B). We compared the preoperative clinical status, hemodynamic data, and surgical results between the two groups. The postoperative clinical status of Group A was studied during the follow-up period. The NYHA functional class of the elderly patients was greater than that of the middle-aged patients. None of the elderly patients had pulmonary hypertension. Moderate or severe tricuspid valve regurgitation (TR) due to annular dilatation was found, and tricuspid annuloplasty was performed in all four elderly patients. There were no operative or hospital deaths in either group. The NYHA functional class and TR improved in all the aged patients after surgery. In order to prevent progressive tricuspid annular dilatation due to an intraatrial left to right shunt, surgical closure of ASD should be performed for physically active adult patients.

Adult↗
PubMed1997

Regional myocardial stiffness measured by a new tactile sensor system.

Numerous investigators have attempted to measure regional wall stress directly. However, the measurement systems and devices employed have been too complex for accurate quantification in situ. We have developed a new tactile sensor system for measuring accurately myocardial stiffness in situ and validated its use for estimation of myocardial contractile function. The tactile sensor was placed on the left ventricle of five mongrel dogs, (weighing 12-17 kg) and myocardial stiffness (g/mm2) was measured. Dobutamine (5.0 micrograms/kg/min) and propranolol (0.25 mg/kg) were sequentially administrated intravenously, and the change in myocardial stiffness was monitored. Myocardial stiffness followed a time course similar to that of left ventricular pressure, indicating a close relationship with wall stress. Baseline end-systolic stiffness in 5 dogs was 2.38 +/- 0.19 g/mm2. After administration of dobutamine, end-systolic stiffness increased to 3.26 +/- 0.32 g/mm2 (p < 0.01). After the administration of propranolol, end-systolic stiffness decreased significantly to 1.83 +/- 0.19 g/mm2 (p < 0.01), compared with the baseline values. Regional myocardial stiffness of a beating heart can be measured precisely using our new tactile sensor system. End-systolic stiffness is a useful index for accurate quantification of the regional myocardial contractile state.

Animals↗
PubMed1997

Mitral valve repair with extensive resection of the anterior leaflet for regurgitation due to Barlow's disease. Report of a case.

We recently performed mitral valve repair for a case of mitral regurgitation due to Barlow's disease, which is relatively rare in Japan. Both the anterior and posterior leaflets were affected by advanced myxomatous change, and appeared markedly thickened and redundant. Although extensive resection of the anterior leaflet is not a generally accepted method, nearly one fourth of the anterior leaflet was resected in this case. Now, at 36 months after the operation, there is only trivial regurgitation and the patient is doing well and without symptoms. We believe that extensive resection of the anterior leaflet can be a useful treatment for repair of a redundant anterior leaflet with excess tissue.

Cardiac Surgical Procedures↗
PubMed1997

Tactile sensor method for thoracoscopic detection of intrapulmonary nodules.

We have developed a tactile sensor which can be used to quantify the hardness of objects and applied it to thoracoscopic surgery for the localization of small invisible nodules in the lung. The hardness properties of objects can be obtained as changes in the resonance frequency of the tactile sensor (delta f). When the sensor probe is moved over the lung surface, a delta f curve is depicted on the computer screen. When the sensor tip passes the area just above a target nodule, a spike is evoked in the delta f curve. In thoracoscopic surgery, tactile sensor was employed to detect a total or 42 nodules, 32 indeterminate and 10 metastatic, in 37 patients. All except two of these detected nodules, had been preoperatively demonstrated with computed tomography. Each nodule was detected successfully by recognizing the spot on the pleura, at which the spike of delta f curve was evoked, and resected thoracoscopically. All of the indeterminate nodules were diagnosed intraoperatively; 28 benign tumors and 4 primary carcinomas. In conclusion, our tactile sensor method can be a viable alternative for thoracoscopic detection of small and invisible pulmonary nodules.

Humans↗
PubMed1997

Thoracoscopic implantation of a pacemaker lead: experimental study.

We have performed five thoracoscopic pacemaker lead implantations into the porcine myocardium. A small opening, approximately 2 cm in diameter, was made thoracoscopically in the pericardium overlying the apex of the left ventricle, avoiding phrenic nerve injury. Three screw-in type or two stab-in type standard sutureless unipolar epicardial electrodes were introduced through a trocar, and then screwed or stabbed into the myocardium near the apex of the left ventricle, avoiding the coronary vessels. Hemorrhage and arrhythmia were negligible during the procedures. Electrical tests of the pacing threshold and lead impedance after implantation of the leads revealed acceptable values in each lead. We conclude that thoracoscopic implantation of pacemaker leads is feasible, and may be used as a minimally invasive option when conventional transvenous techniques are unavailable or contraindicated.

Animals↗
PubMed1997

[Preventive concomitant aortic root replacement for annuloaortic ectasia in a patient with Marfan syndrome undergoing mitral valve replacement for mitral regurgitation].

A 28-year-old woman presented with Marfan syndrome combined with severe mitral regurgitation and annuloaortic ectasia. The ascending aorta was dilated to 48 mm in diameter without aortic regurgitation. Considering the increased operative risk due to complication with aortic dissection, simultaneous replacement of the mitral valve and aortic root were performed. Her postoperative course was uneventful. Several options of the surgical treatment for Marfan syndrome are discussed.

Adult↗
PubMed1997

[A patient with mitral stenosis due to infective endocarditis].

A 51-year-old woman presented with mild stenosis of the mitral valve which had become thickened and rigid due to infective endocarditis, manifesting as persistent fever of up to 40 degrees C and general fatigue of a few days' duration. A harsh systolic murmur was heard. Multiple blood cultures revealed alpha-streptococcus. Echocardiography disclosed asymmetric septal hypertrophy (interventricular septal thickness/posterior wall thickness, 19/14 mm) and systolic anterior wall motion of the mitral valve. Continuous wave Doppler ultrasonography showed a peak left ventricular outflow tract pressure gradient of 170 mmHg. Transesophageal echocardiography revealed vegetations on the anterior mitral leaflet, aortic valve and interventricular septum along the left ventricular outflow tract. In particular, the anterior mitral leaflet was thickened and moved poorly. The calculated mitral valve areas was 1.5 cm2 and peak diastolic left atrium-left ventricle pressure gradient was 7 mmHg. A specimen of the mitral valve did not reveal commissural adhesion, but the anterior mitral leaflet showed marked fibrous thickening caused by scarred vegetation. Based on these findings, the diagnosis was hypertrophic obstructive cardiomyopathy complicated by infective endocarditis and "mitral stenosis". Valvular regurgitation is a common complication of active and healed infective endocarditis. In contrast, infective endocarditis rarely causes valvular stenosis except for stenosis caused by large fungus vegetation.

Cardiomyopathy, Hypertrophic↗
PubMed1997

[Heart and lung surgery '86-'96].

During a period between April 1, 1986 and December 31, 1996, a total of 3,190 cardiothoracic operations were performed in our department. The overall mortality was 4.1%. The prerequisite for successful accomplishment of clinical research was discussed in detail.

Blood Vessel Prosthesis Implantation↗
PubMed1997

[Improvement of cardiac function by aortic valve replacement for chronic aortic regurgitation with carbomedics heart valve].

Cardiac function after aortic valve replacement for chronic aortic regurgitation with CarboMedics heart valve was evaluated repeatedly by echocardiography and some examinations in 27 cases. There was no late death and all patients belonged to NYHA I functional class postoperatively. Systolic and diastolic dimensions of left ventricle, left ventricular mass index, cardiothoracic ratio and SV1+RV5 on electrocardiography improved significantly within half a year and those improved results remained thereafter. Fractional shortening of left ventricle also improved gradually and the difference reached statistical significance one year later. This investigation revealed reduced systolic function or eccentric myocardial hypertrophy were often reversible. Average values of systolic diameter and fractional shortening late after operation were within normal range even in cases whose preoperative systolic function were severely depressed. Left ventricular mass index decreased markedly although postoperative values were still out of normal range in most cases. These results suggest that aortic valve replacement can be indicated even in cases of aortic regurgitation with severely impaired preoperative cardiac function.

Adolescent↗