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Biomedical subjects

A Seki

Publications and source records attributed to A Seki.

At least 127 records · Page 7Linked to original sources
PubMed1989

[A case of successful surgery of atrial septal defect combined with coronary artery bypass grafting].

A 66-year-old man, who had atrial septal defect (ASD) associated with severe coronary artery disease, underwent closure of ASD and concomitant coronary artery bypass grafting (LIMA-LAD & SVG-RCA). Response to surgery was excellent, with improvement of cardiac function and returning to NYHA functional class I, while, preoperatively, the patient had been limited due to symptoms related both to large left to right shunt flows (Qp/Qs 3.04) and to left ventricular dysfunction because of severe myocardial ischemia as well as previous inferior myocardial infarction. SAD is the most common form of congenital heart disease requiring surgery in adults, accordingly it should be remembered that some of the elderly patients with ASD might have obvious or occult coronary artery disease at the time of diagnosis and operative intervention.

Aged↗
PubMed1989

[Medication compliance in cardiovascular disease].

The medication compliance of 674 patients with cardiovascular disease was evaluated by interview. Of all 674 patients, 441 (65.4%) reported taking over 95% of prescribed drugs, 193 (28.6%) took 75 to 94%, 29 (4.3%) took 50 to 74% and 11 (1.6%) took under 50%. The medication compliance of patients with valvular disease (n = 60) was better than that of patients with coronary heart disease (n = 251), arrhythmias (n = 58) or hypertension (n = 356). Among patients with valvular disease, the medication compliance of those taking Warfarin was better than that of those not taking it. Among patients with coronary heart disease, the medication compliance of vasospastic angina pectoris was better than that of patients after aorto-coronary bypass surgery. The level of medication compliance was not influenced by age under 79 years old, but it was slightly decreased over 80 years old. The level of medication compliance remained about the same regardless of the number or drugs, but it was closely related to the timing of dosing. The medication compliance was best with dosing in the morning. A questionnaire form about "quality of life", revealed no significant association between "quality of life" and the medication compliance. In conclusion, it was emphasized that it is the physician's responsibility to teach, motivate, and encourage patients to maximize compliance.

Adult↗
PubMed1989

[A seven-year course after Fontan operation in an older adult with tricuspid atresia].

Tricuspid atresia (TA) is a uncommon cardiac anomaly. Most patients with TA will develop severe hypoxia due to insufficient pulmonary flow at an early age and long-term survival without any surgical intervention may not be expected. A 38-year-old male with TA (type Ib) was referred with the complaints of increasing cyanosis and easy fatigability. After diagnosis was confirmed through the cardiac catheterization, modified Fontan operation was performed. In the procedure atrial septal defect was repaired by a patch, stenotic pulmonary valve was closed and prosthetic graft was inserted between the right atrium and the main pulmonary arterial trunk. In literatures about adult with TA, left ventricular dysfunction was generally reported. However, in our case postoperative course was uneventful and his symptoms improved dramatically. After the discharge from hospital, he has done well. But in the cardiac catheterization performed 7 years after operation, the cardiac index was slightly decreased and a significant stenosis along the left anterior descending coronary artery was incidentally discovered. In each laboratory examination after operation slight polycythemia was disclosed.

Cardiac Catheterization↗
PubMed1988

[Progression of coronary artery stenosis and compensatory development of collaterals: analysis of data of 25 patients who developed complete occlusion].

The correlation between progression of atherosclerotic lesions and the compensatory development of collaterals which prevent ischemic events, particularly myocardial infarction, were examined in patients who underwent repeated coronary angiography (CAG) after medical therapy. Twenty-five patients with lesions in their coronary arteries perfusing the viable myocardium during the first study, which progressed to total occlusion in the second study, were evaluated. The subjects' mean age was 55.1 years, and the mean time interval between the two studies was 44.1 months. CAG was performed in the chronic stage of myocardial infarction or the stable phase of angina pectoris, but three patients underwent repeated CAG studies during the acute phase of myocardial infarction. The percent diameter of the narrowing in the lesion was assessed according to the AHA system. Concerning the sites of lesions with progression to complete occlusion, 14 (56%) were located in the proximal segment of the left anterior descending artery (segment 6 or 7), and six lesions were in the main trunk of the right coronary artery (segment 1, 2 or 3). In 11 patients with stable angina, associated lesions showed progression from 90 or 99% stenosis to complete occlusion. Seven patients with lesions exhibiting 99% stenosis had collaterals, and four patients with lesions exhibiting 90% stenosis had no collaterals during the first study. However, good collaterals were demonstrated in all patients in the second study. Seven patients had episodes of newly developed unstable angina. The lesions in five of the seven patients progressed from 75% or 90% stenosis to complete occlusion, and in one patient with triple vessel disease the lesion progressed from 99% stenosis to complete occlusion in the second study. The former five patients did not have collaterals in the first study, but development of collaterals was demonstrated in all seven patients in the second study. Seven patients had episodes of myocardial infarction, and in six of these, the lesions progressed from 75% or less stenosis to complete occlusion.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1988

Echocardiographic findings in nine patients with cardiac amyloidosis: their correlation with necropsy findings.

The echocardiographic abnormalities of nine patients with cardiac amyloidosis were correlated with their postmortem findings. All had congestive heart failure and autopsy-proven amyloidosis. M-mode echocardiographic features included (1) small or normal left ventricular (LV) dimensions; (2) thickened interventricular septa and posterior LV walls (89%); (3) left atrial enlargement (89%); and (4) reduced LV distensibility (78%, 100%) and contractility (22%, 44%). Serial M-mode echocardiography revealed that cardiac amyloidosis was initially manifested as diastolic LV dysfunction rather than systolic dysfunction. The final stage of this disease was characterized by severe impairment of both systolic and diastolic LV functions. Two-dimensional echocardiography provided additional features: (1) a more accurate diagnosis of pericardial effusion (67%) and (2) a characteristic "granular sparkling" appearance of the ventricular wall (55%). In four of five cases, these hyperrefractile myocardial echoes corresponded to scattered amyloid deposits histopathologically. There was no correlation between the types of amyloid deposits and the hyperrefractile myocardial echoes. Thus, cardiac involvement in systemic amyloidosis could be non-invasively assessed by M-mode and two-dimensional echocardiography.

Adult↗
PubMed1988

Primary coronary artery dissection: its incidence, mode of the onset and prognostic evaluation.

The incidence, mode of the onset and prognosis of primary coronary artery dissection in 1,445 consecutive patients with myocardial infarction undergoing coronary angiography were elucidated in the present study. Primary coronary artery dissection was observed in four patients (0.28%). The first case was a 28-year-old man, who developed angina at rest, followed by inferior myocardial infarction. His coronary angiogram showed dual lumina in the proximal to distal segments of the right coronary artery, which were separated by a flap. A left ventriculogram showed severe impairment of contraction (akinesis) in its inferior segment. Six years later, he was classified as New York Heart Association (NYHA) functional class I. The second case, a 54-year-old man, developed vasospastic angina followed by inferior myocardial infarction. His coronary angiogram showed a similar dissection from the proximal to distal segments of the right coronary artery. A left ventriculogram showed akinesis of the inferior segment and a coronary angiogram five years later showed marked resolution of the dissection. Twelve years after the infarction, he was classified as NYHA functional class I. The third case, a 46-year-old woman, experienced sudden onset of inferior myocardial infarction. Her coronary angiogram showed dissection from the middle to distal segments, and the posterior descending branch of the right coronary artery. A left ventriculogram showed akinesis of the inferior segment, and three years later, she was asymptomatic. The fourth case, a 28-year-old woman, developed anterior myocardial infarction following delivery. Her coronary angiogram revealed dissection from the proximal to middle segments of the left anterior descending artery. A left ventriculogram showed akinesis in the anteroseptal segment and dyskinesis in the apical segment. She died suddenly four years after her myocardial infarction. Thus, primary coronary artery dissection is not extremely rare and it may have been associated with coronary vasospasm in at least two of these four cases.

Adult↗
PubMed1988

[Bacterial intracranial aneurysms associated with infectious endocarditis--report of 3 cases].

Three cases of bacterial intracranial aneurysms associated with infective endocarditis are reported. All of the patients were successfully treated by various combinations of cardiac surgery, neurosurgery and chemotherapy with antibiotics. Case 1: A 39-year-old female was admitted with the complaint of sudden onset of severe headache following persistent fever of several month's duration. CT scan revealed a left frontal old hematoma and angiography detected an aneurysm located in the frontal ascending branch of the left middle cerebral artery. After 2 weeks' antibiotic therapy, the second angiography showed the aneurysm to be decreased in size. The third angiography, performed 2 weeks after cardiac valve replacement for infective endocarditis, demonstrated complete resolution of the aneurysm. Case 2: A 19-year-old male entered hospital with high fever and chills. In addition to infective endocarditis, CT scan and angiography revealed an aneurysm arising from the distal portion of the left posterior cerebral artery. The patient was treated with high dose antibiotics and then his general condition improved. However, angiography examined 4 weeks after the initial study demonstrated the aneurysm to be apparently enlarged. Therefore, the aneurysm was excised before cardiac surgery. Repeated angiography after valve replacement showed no further aneurysm. Case 3: A 30-year-old female was admitted on the diagnosis of infective endocarditis and meningitis. CT scan showed abnormal density areas in the right frontal lobe and the left temporal lobe.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

[The effects of the internal mammary artery-coronary artery bypass surgery: with special reference to improvement of the regional wall motion of the left ventricle].

The internal mammary artery (IMA) has been used extensively for coronary artery bypass grafting because of its excellent long-term patency recently. However, the flow capacity of the IMA has been discussed and previous studies showed that the IMA should be used in the grafting of small coronary arteries or those with limited run-off. In this paper, we studied the ejection fraction and regional wall motion of the left ventricle in 19 patients undergoing coronary revascularization with the IMA and the normal group without ischemic heart disease. Preoperative analysis of these data showed the values were below the those of normal group. After surgery, left ventricular ejection fraction and regional wall motion improved and there were no difference between two groups. Although the graft flow through the IMA has been discussed since Green's pioneer work, our observations suggest that the IMA flow meets the myocardial demand adequately in the postoperative period.

Adult↗
PubMed1987

Congenital central alveolar hypoventilation (Ondine's curse): a case report and review of the literature.

Congenital central alveolar hypoventilation (C-CAH), so called Ondine's curse, is known to be quite a rare neuropathology that has been reported in only 23 cases to date. C-CAH was diagnosed in a 2-year-5-month-old infant. In the treatment of C-CAH, we implanted a right unilateral diaphragm pacemaker in the infant and his respiratory status was remarkably improved after diaphragm pacing. Twenty-three reported cases of this disorder are reviewed in the literature.

Child, Preschool↗
PubMed1987

High renin hypertension in the elderly.

This paper describes clinical features of high renin hypertension in the elderly. Peripheral plasma renin activity ranged from 0 to 20.1 ng/ml/hr in 59 hypertensive in-patients aged 70 to 86. The patients were divided into 2 groups: 9 cases with plasma renin activity greater than or equal to 3.0 ng/ml/hr (high renin group) and the remaining 50 with plasma renin activity less than 3.0 ng/ml/hr (control group). The development of hypertension differed between the 2 groups. Six of the high renin group (66.7%) had a history of acceleration of previously mild hypertension, while only 3 of the control group (6.0%) had this history (p less than 0.01). The frequencies of high diastolic blood pressure (greater than or equal to 120 mmHg), massive proteinuria (at least 3.0 g/day), hypokalemia (serum potassium less than or equal to 3.0 mEq/L) and high serum cholesterol (greater than or equal to 250 mg/100 ml) were significantly greater in the high renin group than in the control group (p less than 0.01, respectively). Renovascular hypertension was suspected in 6 patients from the high renin group (66.7%), as compared with 1 of the control group (2.0%) (p less than 0.001). There was massive proteinuria in 3 of 6 patients with renovascular hypertension in the high renin group and 2 showed nephrotic syndrome. Thus, two-thirds of the elderly patients with high renin hypertension had probable renovascular hypertension with a history of rapid progression of hypertension.

Aged↗