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H Toyohira

Publications and source records attributed to H Toyohira.

At least 55 records · Page 3Linked to original sources
PubMed1996

[Usefulness of Dumon-type endotracheal stent for left main bronchial obstruction caused by thoracic aortic aneurysm--a case report].

We used a Dumon-type endotracheal stent for left main bronchial stenosis occurred after the operation of combined true and Type III dissecant aneurysm. A 65-year-old man with acute Type III dissection with true thoracic aneurysm was operated on by means of arch replacement with thoracic aortic replacement. He complained of dyspnea and the respirator support was not able to discontinued. The cause of dyspnea was oppression of the left main bronchus with remnant thoracic dissecting aneurysm together with a hematoma. A Dumon-type stent was successfully inserted into the left main bronchus under bronchoscopic guide via tracheostomy. It is a choice of conservative therapy after major surgery such as operation of thoracic aneurysm to relieve the bronchial obstruction.

Aged↗
PubMed1996

[Perforation and localized dissection of the left common iliac artery during the modified Bentall procedure: a case report].

We performed the modified Bentall procedure for annuloaortic ectasia in a 41-year-old man with Marfan's syndrome. Approximately 15 minutes after initiation of cardiopulmonary bypass with an arterial delivery via the left common femoral artery, perfusion volume gradually decreased and the abdomen of the patient was distended. Retrograde dissection was strongly suggested. Perforation and localized dissection of the left common iliac artery were recognized. Following repair of the lesion, the modified Bentall operation was carried out. Postoperative course was uneventful. The patient has been well for 22 months after the operation.

Adult↗
PubMed1996

[A case of acute thrombosed aortic dissection (Stanford type A) in association with a true aortic arch aneurysm].

We have experienced a rare case of Stanford type A thrombosed aortic dissection in association with true aortic arch aneurysm. A 73-year-old male with asymptomatic true aortic arch aneurysm had sudden onset of severe back pain. A through examination clarified that he had Stanford type A aortic dissection coexisting with true aneurysm. In operation, we found a tear on intima of the proxymal-part of the true aneurysm. Pathologically, dissection confined to the ascending aorta did not involve the true aneurysm. The replacement of ascending aorta and aortic arch was successfully accomplished. The combination of true aortic arch aneurysm and Stanford type A aortic dissection is rare bibliographically.

Acute Disease↗
PubMed1996

[Surgical results of valve replacement with porcine bioprostheses].

We evaluated the 80 cases of porcine valve replacement, accomplished between April 1975 and December 1980. There were 48 males and 32 females aged between 16 and 60 years old with a mean of 37.4 +/- 11.4. Ten patients underwent aortic valve replacement (AVR), 63 mitral valve (MVR), and 7 AVR plus MVR. Twenty-seven Hancock valves (H) were implanted in aortic (3) and mitral (24) position and 61 Carpentier-Edwards valves (CE) were used in aortic (14), mitral (46), and tricuspid (1) position. The mean duration of follow-up was 9.3 years (0.2-19.2 years) and cumulative follow-up was 747.2 patient years (py). The late mortality was 3.3%/py (25 patients). Actuarial survival rates for all patients at 10 and 15 years were 67%, and 49% respectively. The linearized rates (LR) of structural valve deterioration (SVD) was 7.0%/py. The freedom from SVD for all patients at 10, and 15 years were 47.1%, and 12.4% respectively. There were no differences of free rates of SVD between H and CE. between valve sites implated, and among age at operation. The incidence of occurrence of SVD was gradually increased 6 years after operation. The LR of thromboembolism (TE), anticoagulant-related hemorrhage (ACH), prosthetic valve endocarditis (PVE), nonfunctional valve dysfunction (NVD), and reoperation (RO) were 0.7%/py, 0.1%/py, 0.3%/py, 0.1%/py and 7.4%/py, respectively. The freedom from TE, ACH, PVE, NVD, and RO for all patients at 15 years were 91.3%, 98.1%, 95.6%, 80%, and 6.5%, respectively. The surgical results of glutaraldehyde-preserved porcine bioprostheses was excellent during the first 5 years after operation. A high incidence of SVD has been occurred thereafter. According the indication for valve replacement with bioprotheses is now strictly limited for elderly, child bearing female case, contraindition for therapy of anticoagulants, and some social condition.

Adolescent↗
PubMed1996

[Surgical results of valve replacement with the Björk-Shiley tilting disc valves].

We evaluated the Björk-Shiley tilting-disc (BS) valve replacement up to the longest duration for about 12 years. The study was started in November 1982 and ended in September 1991. There were total number of 206 with 117 males and 89 females aged between 18 and 71 with a mean of 51.6. Eighty three patients had isolated aortic valve replacement (AVR), 92 had isolated mitral valve replacement (MVR), and 31 had AVR plus MVR. One hundred and fourteen spherical-disc valves were replaced in the aortic, 112 spherical and 11 monostrut in the mitral position. The mean duration of follow up was 6.5 years for a total of 1330.6 patient years (PY). Forty-one patients (3.8%/PY) died later, and 14 out of 41 died of valve-related complications. Actuarial survival rates for all, AVR, MVR and DVR at 10 years after operation were 71.2%, 73.5%, 73.9% and 55.4%, respectively. The linearized rates of thromboembolism (TE), thrombosed valve (TV), anticoagulant-related hemorrhage (ACH), prosthetic valve endocarditis (PVE), hemolysis (H), and reoperation (RO) were 1.2%/PY, 0.2%/PY, 0.7%/PY, 0.2%/PY, 0.1%/PY, and 0.2%/PY, respectively. The rates of freedom from TE, TV, ACH, PVE, H, and RO and 10 years after operation were 83.5%, 98.5%, 94.0%, 98.4%, 99.0% and 95.6%, respectively. The major causes of postoperative mortality and morbidity were TE, TV, and ACH. One hundred and fifty-six out of 161 patients showed an improvement in NYHA functional class post operatively. The surgical results of valve replacement with the BS valve was excellent and acceptable one. Intensive management with a special reference of anticoagulant therapy is necessary for a long-term management of the patients with mechanical valve replacement.

Adolescent↗
PubMed1995

Simultaneous repair of an abdominal aortic aneurysm and resection of bronchogenic carcinoma: report of a case.

A 69-year-old man successfully underwent simultaneous repair of an abdominal aortic aneurysm and resection of bronchogenic carcinoma during the same operation. Pulmonary lobectomy was performed following complete closure of the abdomen after aneurysmectomy to prevent any contamination. If the patients are carefully selected, an operation for abdominal aortic aneurysm and bronchogenic carcinoma can be safely performed with the advantage of treating both lesions simultaneously and thus sparing the patients from having to undergo the physical and psychosomatic pain, as well as the risk, of a second operation.

Aged↗
PubMed1995

Acute aortic dissection in a patient with osteogenesis imperfecta.

A case of osteogenesis imperfecta complicated with acute type A aortic dissection is presented. Emergency graft replacement of the ascending aorta was performed successfully despite the anticipated difficulties with tissue friability. Therefore, such an operation is suggested to be worthy of consideration and feasible in patients with osteogenesis imperfecta.

Acute Disease↗
PubMed1995

Infective mitral valve endocarditis after percutaneous transvenous mitral commissurotomy.

Infective mitral valve endocarditis developed in a 40-year-old female patient after a percutaneous transvenous mitral commissurotomy (PTMC). The echocardiogram demonstrated a vegetation in the anterior leadflet of the mitral valve and moderate aortic insufficiency. The patient underwent replacement of the infected mitral and incompetent aortic valves. Infective mitral valve endocarditis should be recognized as a potentially lethal complication after PTMC. The important measures to prevent bacteremia during PTMC and the appropriate role of operation are discussed.

Adult↗
PubMed1995

[Isolated aortic valve regurgitation due to degeneration of the valve leaflet--a clinical study].

From 1989 through 1993 thirty-eight patients underwent aortic valve replacement at our institution for isolated aortic regurgitation (AR) caused by idiopathic degeneration of the valve. There were 32 male and 6 female patients aged between 33 and 74 years with a mean of 59 years. Preoperative New York Heart Association functional class, cardiothoracic ratio, cardiac index, and left ventricular end-diastolic pressure were 2.6, 57%, 3.1 L/min/m2, and 18 mmHg, respectively. Cross-sectional echocardiography clarified aortic valve prolapse in seven patients. Excised valvular cusps were thin, redundant and translucent in association with cuspal fenestration in 9 cases and idiopathic commissural disruption in 2 cases. Histological study revealed significant disruption of the fibrosa and cystic degeneration of the spongiosa layer filled with mucopolysaccharide. Actuarial survival rate, including 3 operative deaths, was 89% at 3 years after AVR with no apparent valve related complications. Idiopathic degeneration of the aortic valve is a common cause of AR, occurring in half of the surgically treated patients. We emphasize the importance of this lesion as a cause of AR.

Adult↗
PubMed1995

[Significance of combined use of anticoagulants and antiplatelet agents in the early stage after prosthetic valve replacement].

Patients who had undergone prosthetic valve replacement were treated with warfarin (anticoagulant) alone or in combination of ticlopidine (200 mg/day) or aspirin (81 mg/day) (anti-platelet agents). The study of blood coagulation factors and platelet aggregation were carried out with these cases. 1) The patients (n = 24) receiving warfarin for 21 days after prosthetic valve replacement revealed marked increases in PIVKA-II and vitamin K1-epoxide. The protein C activity was significantly lower than that before the operation. High levels of more than 5 ng/ml of TAT were found before operation and after warfarin administration for 21 days. 2) Warfarin did not affect platelet aggregation, whereas ticlopidine inhibited ADP-induced platelet aggregation and aspirin inhibited both collagen-induced and arachidonic acid-induced aggregation. In conclusion, combined use of anticoagulants and antiplatelet agents after prosthetic valve replacement will suppress not only the blood coagulation but also the platelet aggregation systems.

Adult↗
PubMed1995

[Pulmonary embolectomy for massive pulmonary embolism].

Surgical cases of massive pulmonary embolism remain rare in Japan. To discuss the surgical problems, clinical courses of 4 patients who underwent pulmonary embolectomy under cardiopulmonary bypass at our hospital for the last six years were reviewed. There were 2 men and 2 women; ranging from 41 to 72 years (mean age, 63 years), 1 of whom had deep venous thrombosis of the lower extremity as a predisposing factor. The initial disease recurred in 2 patients. Shock occurred in 3 patients preoperatively, 2 of whom had sudden syncope. Cardiac arrest occurred before and during pulmonary arteriography (PAG) in 1 patient. The systolic pulmonary arterial pressure rose to between 60 and 80 mmHg in all patients except for 1 of whom it was not measured. The diagnosis was established in 3 patients by PAG and clinically in the remaining recurrent patient. Thrombolysis was not effective in all patients, then pulmonary embolectomy was performed between four hours and five days after the onset of the disease. One patient with preoperative cardiac arrest died of low output syndrome and severe respiratory failure, but 3 survived with clinical improvement. Development of the prompt and noninvasive diagnostic procedure, rapid cardiopulmonary support in severe cases and an early decision to operate are required to improve the operative results. Partial resection of the lung was obliged due to massive endobronchial hemorrhage after embolectomy in 1 recurred patient. Compression of the lungs and embolectomy using a balloon catheter should be performed carefully to prevent injuring pulmonary arteries. Implantation of an inferior vena cava filter may be beneficial for the selected patient to prevent recurrence of the disease.

Adult↗
PubMed1995

[Surgical treatment for complete rupture of anterior papillary muscle after acute myocardial infarction].

A 64-year-old male patient with postinfarction complete anterior papillary muscle rupture and massive mitral regurgitation is presented. The diagnosis was suspected clinically and confirmed by transesophageal echocardiography. One week after the episode of acute myocardial infarction (AMI) the patient had a sudden onset of severe congestive heart failure with pulmonary edema and was transferred to our hospital. The patient underwent an emergency mitral valve replacement with a SJM29M prosthetic valve. Histological examination revealed an acute coagulation necrosis of the anterior papillary muscle without specific inflammatory change. To our knowledge this is the second case with successful surgery for a complete rupture of the anterior papillary muscle following AMI in Japan.

Echocardiography, Transesophageal↗
PubMed1995

[Valvular surgery for the patients 70 years old or older].

From January 1986 to June 1993, twenty one patients aged 70 years or older with valvular heart disease underwent open heart surgery. There were 12 males and 9 females with a mean age of 71.2 years (range 70 to 76). Eight patients were in NYHA class III, and 4 in class IV preoperatively. AVR was performed in 10 patients, MVR, MVR with TAP, OMC, AVR with MAP, DVR with TAP in 4, 4, 1, 1, and 1, respectively. Mechanical and bioprosthetic valves were replaced in 11, and 9 patients respectively. There were 6 early death (4 operative, 2 hospital). Longer duration of cardiopulmonary bypass (p < 0.05) and aortic crossclamp time (p < 0.05) were the risk factors independently for early mortality. Follow-up of 15 hospital survivors was 100% (8 months-7.7 years, mean: 3.2 years) and cumulative follow-up was 47.6 patients years (PY). There was one late death, and one prosthetic valve endocarditis (2.1%/PY). No other valve-related complications was occurred. Actuarial survival rate and freedom from valve-related morbidity at seven years were 83.3%, and 93.3%, respectively. These results show that operative mortality of valvular disease in elderly patients remains high, but the late results is acceptable one. Valve surgery for these elderly patients is reasonably acceptable.

Aged↗
PubMed1995

[Double valve replacement with mechanical prostheses--an operative results].

From January 1980 to December 1993, sixty eight patients underwent double valve replacement with mechanical prostheses. There were forty males and twenty-eight females with a mean age of 49.6 years (ranging from 30 to 68 years). They were classified 10 of NYHA class IV, 28 of class III. Twelve patients had previous cardiac operation. TR was identified in 20 patients. DVR was performed in 53 patients, DVR + TVR in one, DVR + TAP in 13. Twenty-two had St. Jude Medical (SJM) prostheses and 46 had Björk-Shiley (BS) prostheses. Early death before 30 postoperative days occurred in 6 patients (8.8%). MOF was the most frequent cause for early death. The risk factors for early death were the NYHA class IV, infective endocarditis, longer duration of cardiopulmonary bypass, necessity of postoperative IABP support. Other factors such as emergency operation, previous operation, tricuspid valve surgery, duration of aortic cross clamp time were not the predictors for early death. Cumulative follow-up was 284.0 patient years (PY). The rate of late survival was 74.1% (40 patients). Linearized rates of thromboembolism (TE), prosthetic valve endocarditis (PVE), hemolysis (H), reoperation (RO) were 2.8%/PY, 0.7%/PY, 0.4%/PY, 1.1/PY respectively. The free rates from TE, PVE, H, RO at nine years were 75.6%, 96.2%, 93.1%, and 89.8%, respectively. The cumulative survival rates at 14 years were 53.2% in over-all patients, and 64.3% in hospital survivors. We conclude that the early surgery is recommended for the patients with multiple valvular heart disease. The late outcomes of DVR with SJM or BS mechanical prosthesis is an acceptable one.

Adult↗
PubMed1995

[Management of patients with closing aortic dissection].

Acute aortic dissection is a catastrophic event requiring immediate diagnosis and definitive treatment, while the clinical characteristics of closing aortic dissection are not well known. From Jan. 1991 through Dec. 1994 a total of 24 patients with closing aortic dissection (CAD) was managed at our institution. There were 19 men and 5 women, ranging in age from 49 to 74 years with a mean of 65 years. All patients presented with a sudden onset of severe chest and back pain. Twenty patients had a history of hypertension with a wide mediastinal silhouette on chest X-ray. The diagnosis of CAD was established by contrast computed tomographic (CT) scans in all patients with no evidence of patent false lumen. The descending thoracic aorta was involved in 17 patients and the ascending in 5. Conservative medical management was initially attempted for all. Seven patients (Stanford type A/B: 2/5) ultimately required surgical intervention, and 2 patients died. The follow-up was 100% complete with a mean term of 14.6 months. The overall survival rate was 74% at 3 years after the initial presentation. Based on our clinical experience, all patients with CAD need careful antihypertensive therapy and frequent follow-up studies to assess the aorta.

Aged↗
PubMed1995

[Ventricular septal defect with severe pulmonary hypertension: the role of open biopsy in determination of operative indication: a case report].

A 51-year-old man having ventricular septal defect with severe pulmonary hypertension is reported. Operative indication that is denied was finally decided by open lung biopsy. He had pulmonary arterial pressure of 120/42 (70) mmHg. The ratio of pulmonary to systemic systolic pressure was 0.91, the ratio Of pulmonary to systemic flow was 1.26, the ratio of pulmonary to systemic vascular resistance was 0.34, and pulmonary vascular resistance was 14.2 unit x m2. For the reason of difficulty, in determination of operative indication through hemodynamic study, he received open lung biopsy. Histological assessment from biopsy specimen revealed severe occlusive pulmonary vascular disease exhibiting grade IV on the Heath Edwards classification. Open lung biopsy occasionally be selected in case with difficult determination of operative indication in severe pulmonary hypertension is a useful tool.

Biopsy↗
PubMed1994

Impalement injury of the thorax: report of a case.

We report herein the case of a 33-year-old man who survived an impalement injury of the thorax involving the heart, esophagus, and spinal cord. The patient was transported to our hospital with the impalement object left in situ and it was extracted under cardiopulmonary bypass in an operating room. The important principles of surgical management contributing to the successful outcome of such patients are discussed following the presentation of this case.

Adult↗