[Atrial septal defect].
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Diagnosis, Differential↗
Biomedical subjects
F Iwaya
Publications and source records attributed to F Iwaya.
[Persistent left superior vena cava].
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Diagnosis, Differential↗
Postoperative alteration in the size of Dacron vascular prostheses implanted in the infrarenal abdominal aorta.
The degree and significance of postoperative alteration in the size of Dacron grafts in the infrarenal abdominal aorta was assessed by computed tomography. We studied a total of 41 knitted Dacron fabric grafts, comprising 28 Gelseal triaxial grafts and 13 Hemashield Microvel grafts, and 29 woven Dacron fabric (Veri-Soft Woven) grafts which were used to replace the infrarenal abdominal aneurysms. These three types of Dacron fabric dilated immediately after replacement to 1.4-1.5 times the manufactured size, but did not dilate further after the surgery.
Aortic Aneurysm, Abdominal↗
In vitro evaluation of a pulsatile assist device for a centrifugal pump using a new principle.
To induce a pulsatile flow in a centrifugal pump, we developed a new device (pulsatile assist device for centrifugal pump: PADCP) using a new concept. This device consists of a flexible polyurethane tube with an air chamber which is connected to the arterial side of the centrifugal pump circuit directly. A mock circulation system was used for evaluation of this PADCP. Thirty to 40 mm Hg of pulse pressure was obtained under 3-6 L/min of flow rate. By increasing the driving pressure of the PADCP from 200 to 600 mm Hg in a mock system, 4-48 mm Hg of pulse pressure was gained accompanied by a decrease in pump flow and increased left atrial pressure. The decreased pump flow and increased left atrial pressure were recovered easily by increasing the flow rate of the centrifugal pump. Pressures at the proximal site of the PADCP were less than 500 mm Hg. The PADCP was useful to induce a pulsatile flow in a centrifugal pump.
Blood Flow Velocity↗
[A case of adult Wilms' tumor with vena caval involvement].
The patient was a 35-year-old female with the chief complaint of macrohematuria. Computerized tomographic (CT) scan, ultrasonography and magnetic resonance imaging (MRI) revealed the presence of a large and inhomogeneous mass in the left kidney, and a tumor thrombus growing in the inferior vena cava. Angiography also showed a hypervascular tumor in the left kidney. The chest X-ray and CT scan demonstrated multiple metastatic lesions in the bilateral lungs. Radical nephrectomy and thrombectomy was performed under the diagnosis of left renal tumor with its invasion of inferior vena cava. Pathological findings revealed that this tumor was nephroblastoma, and its type was clear cell sarcoma of the kidney (CCSK). The patient received chemotherapy according to National Wilms' Tumor Study (NWTS) IV chemotherapeutic drug regimen. In general, CCSK is known to have poor prognosis. However, doxorubicin has been reported to have a relatively good antitumor effect for CCSK. However, in this case, the evaluation after the first course of chemotherapy was progressive disease, because some new lesions appeared, although most old pulmonary metastatic lesions were reduced.
Adult↗
[A case of ruptured thoracoabdominal aortic aneurysm complicated with high aortic occlusion].
We report a rare case of 76-year-old man who developed ruptured thoracoabdominal aortic aneurysm complicated with abdominal high aortic occlusion. His left limb was amputated due to Buerger's disease. CT showed that the aneurysm extended from the descending thoracic aorta to the upper part of the abdominal aorta and its had a maximum width of 68 x 83 mm. Angiogram revealed the aortic occlusion at the level of the left renal pelvis. We performed emergency operation, which was aneurysmectomy and replacement with artificial vascular graft, under femoro-femoral and subrenal aortic extracorporeal bypass. Because of the severe calcification at the subrenal aorta and the weak pulsation of the left renal artery, the bypass was placed from the aortic graft to the right lower limb and the left renal artery was reconstructed. Abdominal aortic occlusion might increase his hypertension and might cause aneurysmal change on the proximal aortic wall.
Aged↗
[A case of left ventricular outflow tract obstruction after repair of ostium primum defect].
We report a 3-year-old girl with left ventricular outflow tract obstruction after repair of ostium primum defect. The girl had closure of an ostium primum defect performed at the age of 1 year. Two years later, she developed left ventricular hypertrophy with systolic ejection murmur. Echocardiography showed discrete stenosis of the left ventricular outflow tract. Cardiac catheterization showed a peak systolic gradient of 63 mmHg across the left ventricular outflow tract. At the reoperation, the fibrous tissue was excised and myectomy was done. After the operation the peak systolic gradient across the left ventricular outflow tract disappeared. Since there is a possibility of occurrence of the left ventricular outflow tract obstruction after repair of atrioventricular septal defect, long term follow up is mandatory.
Child, Preschool↗
[A case of left atrial myxoma with ventricular septal defect and patent foramen ovale].
A 51-year-old female was referred to our institute because of chest oppressive feeling. Echocardiography and magnetic resonance imaging revealed a left atrial tumor with ventricular septal defect. At operation patent foramen ovale was recognized. After excision of the tumor including intraatrial septum, which defect was repaired using a Teflon patch, and the ventricular septal defect was closed directly.
Female↗
[Left main coronary artery stenosis following aortic valve replacement using a solid coronary perfusion catheter: report of two cases].
We experienced two cases of iatrogenic left main coronary artery stenosis (IOCS) following double (aortic and mitral) valve replacement (DVR). The solid coronary perfusion catheter may attribute IOCS, with grave consequence. There have been no IOCS since the time we exchanged a solid catheter for a soft one. One case, she was successfully treated percutaneous transluminal coronary angioplasty (PTCA), because she developed angina pectoris about 5 years after PTCA. But she developed angina pectoris again and angiographically left main coronary was severe stenotic. So she was undergone aorto coronary bypass grafting (CABG) to the left anterior descending. The other case, he developed angina pectoris about 3 months after DVR. He was treated with PTCA. Angiographically left mine coronary artery stenosis reduced 50% from 90%. Generally the treatment of IOCS is CABG, but we performed PTCA for 2 patients. Because we thought it was very hazardous for us to perform them open heart surgery. When it is very hazardous to perform patients open heart surgery, they need to be performed PTCA.
Angioplasty, Balloon, Coronary↗
[A successful removal of the left ventricular lipoma].
We reported a rare case of left ventricular lipoma, which arose nearby the papillary muscle in the left ventricular wall. It was disclosed by echocardiography and nearly diagnosed by computed tomography and magnetic resonance images. We successfully removed the tumor. It measured 3.8 x 1.5 x 1.3 cm and 3.6 g. Microscopically, it was not encapsulated and consisted of mature adipose tissue. But, it did not invaded the cardiac muscles. In conclusion, the tumor detected lipoma. Postoperative course is uneventful, and the patient has been followed by serial echocardiography.
Adolescent↗
[Two operated cases of mitral stenosis (MS) associated with left atrial ball thrombus].
Mitral stenosis associated with left atrial ball thrombus is rare. Removal of left atrial ball thrombus and mitral valve replacement was performed in two patients successfully. The rate of thromboembolism was high in patient who has left atrial ball thrombus. Also, sudden death was reported in these cases due to incarceration of ball thrombus in the mitral orifice (hole-in-one thrombus). We concluded that we should operate the MS associated with left atrial ball thrombus as soon as possible.
Female↗
[Two cases of congenital cardiac anomaly associated with esophageal atresia].
Two cases of congenital cardiac anomaly associated with esophageal atresia and tracheo-esophageal fistula were presented. One case was HLHS, and the other was TAPVR. Esophageal procedures were performed earlier than cardiac procedures in both cases. Primary anastomosis for esophageal atresia just after birth in the latter case. Corrective procedures for cardiac anomalies were performed at 36 days and 35 days after birth, respectively. The HLHS case died perioperatively and the TAPVR case survived the operation and is alive one year postoperatively.
Esophageal Atresia↗
[A case of straddling tricuspid valve associated with VSD].
A case of straddling tricuspid valve associated with VSD was presented, who was diagnosed as VSD with pulmonary hypertension but not diagnosed as straddling in preoperative state. Two-dimensional echocardiography did not demonstrate a small right ventricle and overriding of tricuspid valve to the ventricular septum. Operative findings were as follows; the VSD was common A-V canal type and anomalous chordae of septal leaflet of tricuspid valve crossed through the VSD and attached to the contralateral side of the ventricular septum. We tried to preserve the anomalous chordae to prevent tricuspid regurgitation, so that we carried out patch closure of VSD. To avoid injury conduction system stitches were placed from upper margin of the VSD, and to keep away tricuspid regurgitation we plicated a depression of septal leaflet which caused by anomalous chordae in VSD patch closure. In postoperative state, A-V block did not arise and tricuspid regurgitation was shown a little as well as preoperative state.
Heart Septal Defects, Ventricular↗
[Two cases of atrial septal defect with absence of right superior vena cava and persistent left superior vena cava].
Two women (16-year-old, 54-year-old) of atrial septal defect with absence of right superior vena cava and persistent left superior vena cava were successfully operated on. Electrocardiographic findings show coronary sinus rhythm and atrial fibrillation. When we closed atrial septal defect cannulated to persistent left superior vena cava via the coronary sinus directly, sick sinus syndrome was not appeared postoperatively.
Adolescent↗
[Recurrent surgery for pulmonary venous obstruction after total correction of TAPVC (IIb)].
A 15-months-old boy underwent the intra-cardiac repair with a glutaraldehyde-preserved equine pericardium for total anomalous pulmonary venous connection (Darling's type IIb). Because of rapidly progressive dyspnea, tachycardia and respiratory acidosis, he required emergent reoperation at 234 postoperative days. The pseudointima was thickened heavily and detached from glutaraldehyde-preserved equine pericardium. New channel was created with a piece of EPTFE sheet to prevent obstruction of pulmonary venous flow. However, about four months after second surgery, cough and tachycardia progressed again remarkably. Intra-atrial channel was obstructed between EPTFE sheet and the partition from pulmonary venous orifice to the atrial septal defect in the third operation. The intra-atrial channel was enlarged by cut-back method using EPTFE sheet again. His postoperative hemodynamics were satisfactory
Adolescent↗
[A case of ruptured aneurysm of Valsalva sinus into right atrium with peculiar findings on aortography].
A 24-year-old man with ruptured aneurysm of sinus of Valsalva into the right atrium originating from the noncoronary sinus is presented. On aortography through the ascending aorta the right atrium in systolic phase and the right ventricle in diastolic phase were opacified. We considered ruptured aneurysm like a streamer (wind sock) entered into the right ventricle in diastolic phase and into the right atrium in systolic phase. Post-aneurysmectomy course was uneventful, and radiographic examination revealed complete repair of the aneurysm.
Adult↗
[A case report of perforated aneurysm of mitral valve with aortic regurgitation].
The patient was a 71-year-old male who complained of palpitation and tachycardia. The echocardiogram showed a bulging of the anterior mitral valve leaflet toward the left atrium that persisted throughout cardiac cycle. The cine angiogram showed deformity of the anterior mitral valve leaflet with severe mitral regurgitation and mild aortic regurgitation. At operation, a perforated aneurysm was recognized at the anterior mitral valve leaflet without thrombus and vegetation. The size of aneurysm was 40 x 25 x 25 mm. The patient underwent MVR + AVR, and the postoperative course was uneventful. Pathological examination of the anterior mitral valve leaflet revealed scar-like fibrosis and old inflammatory change. It was judged a true aneurysm of mitral valve, because the structure of endocardium was kept.
Aged↗
[Disseminated intravascular coagulation (DIC) after artificial valve replacement: especially tricuspid regurgitation].
To investigate disseminated intravascular coagulation (DIC) after valve replacement, we studied DIC score in 80 patients with combined cardiac valvular disease. Thirty-three patients with (TR group) and 47 patients without (control group) tricuspid regurgitation were compared. 1) TR group, that included patients with severe cases, showed a significantly longer operative time and greater bleeding volume (p less than 0.01). 2) The DIC score was significantly higher in TR group. Administration of gabexate mesilate to patients with DIC improved their platelet counts. These results indicate that patients with combined cardiac valvular disease with tricuspid regurgitation have a hemorrhagic tendency and are subject to DIC. Administration of gabexate mesilate is useful for DIC.
Adult↗