Biomedical subjects

H Horimi

Publications and source records attributed to H Horimi.

34 records · Page 2Linked to original sources

PubMed1992

[Effects of prostaglandin E1 in the treatment of congestive heart failure after mitral valve replacement].

Prostaglandin E1 (PGE1) was intravenously administrated to 3 patients for treatment of postoperative congestive heart failure. Preoperative diagnoses of these patients were mitral valve stenosis (2 cases) and mitral valve regurgitation (1 case), associated with tricuspid valve regurgitation in every case. Mitral and tricuspid valve replacements was performed in one case, and mitral valve replacement and tricuspid annuloplasty in two cases. After infusion of PGE1, the central venous pressure was decreased rapidly and the patients recovered from congestive heart failure. As minimal doses of PGE1 (0.01-0.03 micrograms/kg/min) was infused, neither remarkable systemic hypotension nor fall of PaO2 were observed. It appears that application of small amount of PGE1 can be a useful mean for the treatment of congestive heart failure after valvular surgery.

Alprostadil↗

PubMed1992

[Management of infective endocarditis].

Clinical manifestations and the results of management of infective endocarditis were reported. Of 46 patients, 17 cases received medical treatment alone (group A), and 29 cases underwent surgical interventions (group B). Affected valves were aortic in 29, and mitral in 24. In group B, however, infection occurred on the aortic valve in 22, and on the mitral valve in 11. Aortic valve was more often affected in group B than in group A (p less than 0.05). Embolic complications were observed in 5 of group A, 4 of whom had involvement of cerebral vessels, and in 4 of group B, all of whom had cerebral emboli. Of 8 cerebral embolic episodes, 6 emboli originated from mitral valvular lesions. In group A, 6 (35.3%) died of cerebral accidents or acute heart failure within 30 days after the onset of illness. In group B, 20 cases were operated on at chronic stage, and 9 cases underwent operation at active stage. Various procedures, alleged to be the most favorable, were selected to the individual patient. No mortality was found in the former group, but one patient (11.1%) in the latter group died of multiple organ failure 31 days after surgery. All patients, who were operated on at active stage, received intravenous administration of antibiotics for 6 to 8 weeks after the operation. Comparing the actuarial survival rate of group A and group B, group B was superior to group A for initial 4 years, but no significant difference was discernible thereafter.

Actuarial Analysis↗

PubMed1991

[Surgical treatment and their long-term results of the ascending aortic lesions involving coronary arteries].

Seventeen patients underwent surgical treatment of the ascending aorta, aortic valve, and coronary artery as well. Diagnosis of 13 patients were annulo-aortic ectasia, 3 had dissecting aneurysm (type I: 2, type II: 1), and one had supra-valvular aortic stenosis. In annulo-aortic ectasia, Bentall's method was carried out in 11 cases, and Cabrol's operation was performed in 3, one of the latter group had received Bentall's procedure 4 years prior to the second operation. One patient died of acute myocardial infarction 3 days following operation, who had severe stenosis of the left anterior descending artery not detected by preoperative angiography. During long-term follow up, 2 patients died of cardiac failure. Three patients had dissection of the ascending aorta and coronary artery (right coronary artery: 2, left coronary artery: 1). The aorta was reconstructed, aortic valve was replaced, and coronary artery was revascularized with saphenous vein graft. They have been alive and well up to post operative 6 years. Right coronary ostioplasty as well as aortic valve replacement and extended aortoplasty were attempted in one patient with Williams' syndrome. This patient had been well until sudden death which occured 11 months after the operation.

Adult↗

PubMed1991

[Left atrial thrombus in the early postoperative period after mitral valve replacement].

Left atrial thrombus after mitral valve surgery is believed to be relatively rare. However, we previously reported on cases of left atrial thrombus (LAT) with spontaneous regression in the early postoperative period. Forty two patients who underwent mitral valve replacement were studied using computerized tomography (CT). Early postoperative LAT was found in 11 patients out of 42 (26.2%); all of whom had an uneventful postoperative course. The mean preoperative atrial diameter in the LAT group (81.4 mm) was greater than that in the non-LAT group (57.0 mm). This was the most decisive factor significant enough for discriminating between the two groups. Other factors, including age, sex, length of symptoms, preoperative NYHA classification, cardiac rhythms, preoperative cardiac index, duration of cardiopulmonary bypass, type of artificial valve used, duration of intubation and period prior to anticoagulant therapy were not significant. From March 1988, 10,000 U/day of heparin was administered to 20 of the 42 patients. LAT developed in 2 cases (10%). Of the 22 patients who did not accept heparin therapy, 9 (41%) developed LAT. Of the 11 patients having postoperative LAT, 6 were treated by fibrinolytic therapy (urokinase plus heparin). A decrease in thrombus size was observed in 3 cases, and no change in the other 3. Postoperative anticoagulant therapy with warfarin and dipyridamole was administered to all 11 LAT patients, in 8 cases, LAT disappeared for 3 to 42 months period. We therefore conclude as follows: 1) The incidence of early postoperative LAT was 26.2% (11/42). 2) Postoperative thrombus was more likely to occur in the left atrium with a large diameter. 3) Heparin dose of 10,000 U/day seemed to be an effective prophylactic therapy for LAT. 4) Fibrinolytic therapy with urokinase and heparin was not always favorable in LAT cases. 5) In 8 cases out of 11, LAT was resolved under standard anticoagulant therapy with warfarin and dipyridamole in long-term period.

Adult↗

PubMed1991

[Serial assessment of left ventricular function after valve replacement for isolated aortic regurgitation].

Between 1978 and 1990, serial echocardiographic studies were performed on consecutive twenty-five patients of isolated aortic regurgitation (AR) before and after aortic valve replacement (AVR). The mean follow up period was 55 +/- 30 months. The serial changes in left ventricular end-diastolic dimension (LVDd), left ventricular end-systolic dimension (LVDs), fractional shortening (FS), and ejection fraction (EF) were assessed. According to preoperative echocardiographic studies, 25 patients were divided into two groups: Group I with LVDs greater than 50 mm and FS less than 25%, Group II with LVDs less than or equal to 50 mm and/or FS greater than or equal to 25%. One year after AVR, echocardiographic studies revealed normalization of LVDd and LVDs in Group II, and persistent left ventricular enlargement with lower FS and EF levels in Group I. However three years after AVR, LVDd, LVDs, and FS and EF of Group I returned to normal levels. It was concluded that in order to normalize the left ventricular function in isolated AR patients, those who had LVDs greater than 50 mm and FS less than 25% required three years after AVR, those patients who had LVDs less than or equal to 50 mm and/or FS greater than or equal to 25%, required only one year after AVR.

Adult↗

PubMed1990

[Dissecting aortic aneurysm in siblings without Marfan's syndrome].

The occurrence of dissecting aortic aneurysm in 2 or more family members is rare. We reported two cases of dissecting aortic aneurysm in one family. Case 1. Brother. A 49-year-old male, was diagnosed to have acute dissecting aortic aneurysm (DeBakey type I) with mild aortic regurgitation. He was operated on by valvuloplasty and closure of the false lumen, and is alive and well at the present time. Case 2. Sister. A 60-year-old female, was diagnosed to have chronic dissecting aortic aneurysm (DeBakey type II). She underwent replacement of the ascending aorta with a Dacron graft. She is alive and well. Neither of these 2 patients nor other family member had any features of the Marfan's syndrome. Histological examination of 2 cases showed the degeneration of smooth muscle in the media. Among their family, mother died of unidentified heart disease.

Aortic Dissection↗

PubMed1989

[Studies on the prevention of postoperative thrombosis with a small dose of recombinant human tissue-type plasminogen activator].

In order to prevent the thrombosis on foreign materials after the cardiovascular operation, the effect of a small dose of recombinant human tissue-type plasminogen activator (t-PA) on the prosthetic material was examined. A polyvinyl-chloride tube was inserted into the left atrium of 12 rabbits. In six animals (group I), t-PA of 2.6 mg was injected into the right atrium, and no drug was used in other six animals (group II) as the control. Polyvinyl-chloride tube was removed from each animal 24 hours after implantation. In the medicated group, no thrombus was found in the tube, however, heavy thrombus formation was recognized around the tube in the control group. No clotting abnormality was shown in the medicated group. The results of this study demonstrate that t-PA will have a remarkable benefit in the prevention of thrombosis on the foreign substance in the cardiovascular system.

Animals↗

PubMed1989

[A case of isolated anomalous return of bilateral superior pulmonary veins].

A 14-year-old girl was admitted for evaluation of heart murmur. Intravenous digital subtraction angiography (DSA) showed the right superior pulmonary vein drained into the superior vena cava and the left superior pulmonary vein drained into the innominate vein. At the operation, an anomalous bilateral superior pulmonary venous return with an intact atrial septum was confirmed. An atrial septal defect was created and the right superior pulmonary vein was baffled into the left atrium with a pericardial patch. The left superior pulmonary vein was divided and anastomosed to the left inferior pulmonary vein with a expanded polytetra-fluoro-ethylene graft. Post-operative DSA showed satisfactory long-term result of the operation.

Adolescent↗

PubMed1989

[Surgical treatment of the malignant mediastinal tumors--with special reference to prosthetic reconstruction of superior vena cava].

Sixteen patients with the malignant mediastinal tumors compromising the superior vena cava (SVC) and brachiocephalic veins (BCV) were treated from April 1974 to March 1987. SVC reconstruction by prosthesis combined with or without tumor resection were performed in 6 cases and removal of the tumor with partial resection of SVC and right BCV in one case. Two patients died within one month and two patients survived over 5 years postoperatively. Tumor resection, removal of the right lung and SVC wall, and patch angioplasty were performed in one patient who died three and one half months postoperatively. Resection of the tumor and left BCV were performed in 4 patients. Segmentally resected left BCV was reconstructed with interposed graft in two, prosthesis was implanted between left BCV and right atrium in one and no venous reconstruction was attempted in one. Three patients are alive and one patient died six and one half years after operation. Exploratory mediastinotomy was carried out in 3 cases and radiation therapy alone in one case. All but one patients died within one year after diagnosis. Though the long term results of the surgical treatment for malignant mediastinal tumor was not satisfactory, extensive resection of the tumor was worth attempting, as the patency rate of the prosthetic venous reconstruction was improved.

Adolescent↗

PubMed1988