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Biomedical subjects

H Hirose

Publications and source records attributed to H Hirose.

At least 325 records · Page 18Linked to original sources
PubMed1988

[Assessment of pulmonary blood flow after total cavopulmonary shunt operation and the modified Fontan procedure for univentricular heart].

Pulsed Doppler echocardiography was utilized to elucidate the characteristics of pulmonary arterial (PA) blood flow in five patients without apparent pumping chambers in their right heart circulation after right heart bypass surgery for univentricular heart. Two of these patients underwent total cavopulmonary shunt operation, in which the total systemic venous return drained directly into the PA, bypassing the right atrium and ventricle. Three underwent the modified Fontan procedure with atrial partition, in which the right-sided atrium was reconstructed merely as a pathway from the vena cava to the PA, and atrial contraction was nearly entirely excluded. The flow pattern in the PA was biphasic and forward in all five patients. Pulmonary regurgitation was not observed in any of the patients. The first phase of PA flow had its peak during atrial systole; the second, during ventricular systole. Simultaneous observation of PA flow and pressures demonstrated an inverse relation between PA flow and pressure. Pulmonary venous (PV) blood flow pattern was also biphasic and similar to the PA blood flow pattern with time lags. In conclusion, in cases without pumping right heart chambers, PA flow reflects PV flow resulting from contraction and relaxation of the left atrium and ventricle.

Adult↗
PubMed1988

Evaluation of long-term results of bicuspidalization annuloplasty for functional tricuspid regurgitation. A seventeen-year experience with 133 consecutive patients.

Between 1968 and 1985, 133 consecutive patients underwent bicuspidalization annuloplasty for moderate to severe functional tricuspid regurgitation associated with mitral or combined mitral and aortic valve disease. Over this period, the incidence of tricuspid valve replacement was only 2.3% (3/136 patients). There were 18 early deaths (13.5%) in the entire series--three (5.0%) of 60 patients in the last 5 years of the study--and 10 late deaths (8.7%). Actuarial survival rate for the entire series, excluding early deaths, was 91.0% +/- 3.0% at 10 and 17 years. There were seven reoperations (6.1%) on the tricuspid valve, needed because of residual or recurrent mitral valve lesions after the initial operation. Actuarial rates of freedom from reoperation on the tricuspid valve were 93.6% +/- 3.0% (10 years) and 69.7% +/- 16% (17 years) for the entire series: 78% +/- 10% (15 years) for the open mitral commissurotomy plus tricuspid annuloplasty group (44 patients); 90% +/- 9.0% (15 years) for the mitral plus tricuspid annuloplasty group (10); 75.2% +/- 22% (17 years) for the mitral replacement plus tricuspid annuloplasty group (58); and 92.6% +/- 7.0% (16 years) for the combined aortic and mitral valve surgery plus tricuspid annuloplasty group (21). Ninety-eight percent of the survivors were in New York Heart Association class I or II postoperatively. Of 21 randomly selected patients investigated by pulsed Doppler echocardiography, 14 (67%) had no regurgitation or grade 1/4 tricuspid regurgitation and the remaining seven (33%) had grade 2/4 regurgitation postoperatively. Our experiences suggest that bicuspidalization annuloplasty can be a reliable method in the vast majority of patients with functional tricuspid regurgitation.

Actuarial Analysis↗
PubMed1988

Acute liver dysfunction after modified Fontan operation for complex cardiac lesions. Analysis of the contributing factors and its relation to the early prognosis.

Acute liver dysfunction was analyzed in 15 patients who received a modified Fontan operation for single ventricle in nine (atrial isomerism, seven) and tricuspid or mitral atresia in six. Nine patients had elevation of serum glutamic-pyruvic transaminase levels above 1000 U/L during the first week. As an analysis of postoperative liver function during the first week, the highest values of serum glutamic-pyruvic transaminase and total bilirubin and the lowest prothrombin time were scored from 0 to 4 within each parameter, and totaled to give a liver dysfunction score. The liver dysfunction score was 0 to 2 (no or trivial injury) in five patients, 3 to 5 (mild) in two, and 6 to 11 (moderate or severe) in eight (53.3%). The group operated on for single ventricle had a higher incidence (67%) of a liver dysfunction score of 6 or higher than the other group (33%). A multivariate analysis for the prediction of the liver dysfunction score mainly from early postoperative hemodynamics showed the highest correlation with cardiac index, followed by urine output, systolic arterial pressure, and central venous pressure. One patient required plasmapheresis. Four died early (less than 1 month); three of these had a liver dysfunction score of 6 or higher. Those with scores of 6 or above had higher serum glutamic-pyruvic transaminase levels at 1 month after operation than those with scores less than 5. In three patients (single ventricle), hepatic venous oxygen saturation was monitored and showed a marked decrease to below 20% with subsequent acute liver dysfunction. These results indicate that acute liver dysfunction appears to occur in patients with complex lesions after a modified Fontan operation from possible hepatic hypoperfusion and that low cardiac output may be more crucial than high central venous pressure alone.

Acute Disease↗
PubMed1987

Effect of aortocoronary bypass surgery on coronary circulation and myocardial metabolism during atrial pacing.

Eleven patients with coronary heart disease, in whom at least one of several bypass grafts to the left coronary artery was patent, were selected for the study. The hemodynamics, coronary sinus blood flow, myocardial oxygen consumption, and myocardial lactate metabolism were evaluated at rest and during atrial pacing stress test before and after surgery. There were no significant improvements in the cardiac index, pulmonary arterial end-diastolic pressure, and left ventricular ejection fraction after aortocoronary bypass surgery. However, significant improvement of coronary sinus blood flow, myocardial oxygen consumption, and myocardial lactate extraction and consumption were found during postoperative atrial pacing compared with the preoperative findings. These results suggest that successful bypass grafting may improve myocardial lactate metabolism in ischemic lesions and contribute to the postoperative relief of angina.

Cardiac Pacing, Artificial↗
PubMed1987

A rare case of double aortic arch: right thoracotomy and residual retroesophageal aortic arch.

The case of a 2-year-old boy with tetralogy of Fallot and a complete double aortic arch (both arches patent) is reported. The left dominant aortic arch ran retroesophageally to the right and joined with the right smaller arch to form the descending thoracic aorta on the right side. We employed a right thoracotomy and performed a division of the right nondominant arch at the connection with the descending aorta. The surgical implications of an unusual type of double aortic arch are discussed.

Aorta↗
PubMed1987

Modified Fontan operation for single ventricle with common atrium and abnormal systemic venous drainage: usefulness of an additional superior vena cava to pulmonary artery anastomosis.

In two patients (aged 15 and nine years old) with single ventricle, common atrioventricular valve, common atrium, and bilateral abnormally draining superior vena cava (SVC), a modified Fontan procedure was performed together with a SVC to pulmonary artery (PA) anastomosis. This avoided complex intraatrial septation. A bilateral anastomosis was carried out in one patient and a unilateral one in the other, the PA not being divided in either patient. This procedure provided simple intraatrial septation while avoiding possible obstruction of either the pulmonary or systemic blood pathways if complete intraatrial septation had been carried out.

Adolescent↗
PubMed1987

Segmental auto-transplantation of the pancreas.

A total pancreatectomy was performed in a 39-year-old man diabetic with diffuse calcification of the whole pancreas, a pseudocyst and intrapancreatic bile duct obstruction. The body of the excised pancreas was immediately transplanted into the left groin. The postoperative responses of plasma glucagon and insulin were not impaired compared with their preoperative responses. The patient was relieved of unremitting pain and is doing well six months after this operation.

Adult↗