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Biomedical subjects

Junjiro Kobayashi

Publications and source records attributed to Junjiro Kobayashi.

At least 37 records · Page 2Linked to original sources
PubMed2005

Coronary embolism and subsequent myocardial abscess complicating ventricular aneurysm and tachycardia.

A 62-year-old female experienced a ventricular aneurysm and tachycardia caused by coronary embolism from mitral valve endocarditis. The patient underwent endoventricular patch plasty and cryoablation concomitant with valve replacement and survived without any operative complications. Pathological examination suggested that abscess formation played an important role regarding the disruption of the ventricular wall and development of the ventricular aneurysm and tachycardia. In previous reports, a myocardial abscess caused by a septic embolism has only been diagnosed using postmortem examinations as colony growth around the capillary vessels in the myocardium. We considered that our operation was effective and feasible in such an occurrence.

Abscess↗
PubMed2005

Off-pump coronary artery bypass grafting using only arterial grafts in elderly patients.

BACKGROUND: This study aimed to elucidate the safety and feasibility of off-pump coronary artery bypass grafting with only arterial grafts for elderly patients. METHODS: Of 653 patients who underwent off-pump coronary artery bypass grafting from April 2000 to December 2003, 581 patients did so with only arterial grafts. The average age was 66.9 +/- 9.3 years. The patients were divided into the elder group E (75 years old or more: 111 cases) or the younger group Y (younger than 75 years old: 470 cases). The mean follow-up term was 21 +/- 12 months. RESULTS: Additive and logistic EuroSCOREs of group E were significantly higher than those of group Y (p < 0.0001). The number of bypass grafts was 3.3 +/- 0.9 in group E and 3.3 +/- 1.1 in group Y (p = 0.43). The proportion of total revascularization was 74% (82 of 111) in group E and 80% (377 of 470) in group Y (p = 0.15). The number of bilateral implementations of internal thoracic artery was 10 (9.0%) in group E and 196 (42%) in group Y (p < 0.0001). The graft patency rate was 98.7% in group E and 97.8% in group Y (p = 0.96). Hospital mortality was 2.7% (3 of 111) in group E and 0.2% (1 of 470) in group Y (p = 0.095). The causes of death were unrelated to cardiac events. Major adverse cardiac events occurred in 5 patients (5.1%) in group E and in 24 patients (5.6%) in group Y (p > 0.99). CONCLUSIONS: Off-pump coronary artery bypass grafting using only arterial grafts in elderly patients is as safe and feasible as in young patients.

Age Factors↗
PubMed2005

Impact of preoperative and postoperative atrial fibrillation on outcome after mitral valvuloplasty for nonischemic mitral regurgitation.

OBJECTIVE: We sought to determine the impact of preoperative or postoperative atrial fibrillation on survival, stroke, and cardiac function after mitral valvuloplasty for mitral regurgitation. METHODS: Between 1991 and 2003, 1026 patients with nonischemic/noncardiomyopathy mitral valve regurgitation underwent mitral valve plasty in 3 centers; 663 patients remained in sinus rhythm (group A), and 363 patients had atrial fibrillation or flutter preoperatively (group B) with concomitant maze procedures (group BM, n = 163) or without maze procedures (group BN, n = 200). RESULTS: Eight-year freedom from cardiovascular-related death was better in group A (99.3%) than group B (BM: 96.9%, BN: 81.6%) ( P < .001) and also better in group BM than group BN ( P = .007). The adjusted hazard ratio of group B versus group A for preoperative differences was 5.1 (95% confidence interval: 1.8-14.8). Eight-year freedom from stroke was better in group A (99.2%) than group B (BM: 98.2%, BN: 82.6%) ( P < .001) and also better in group BM than group BN ( P < .001). Patients with preoperative atrial fibrillation had larger left atria and left ventricular systolic dimensions. The adjunct maze procedure improved left ventricular systolic dimensions over mitral repair alone (group A vs B: P = .359; group BM vs BN: P = .001). CONCLUSION: Preoperative permanent/persistent atrial fibrillation was associated with a dilated left atrium and reduced left ventricular function in patients with mitral regurgitation. Including the maze procedure with mitral repair improved survival, late cardiac function, and freedom from late stroke.

Actuarial Analysis↗
PubMed2005

Mitral valve repair and cryo-Maze procedure in Ehlers-Danlos syndrome.

A 48-year-old man presented with typical features of Ehlers-Danlos syndrome, such as soft and hyperextensible skin, subcutaneous nodules, clubbed feet, and a mild degree of pigeon chest. In addition, his past history revealed congenital dislocation of the hip joint, retinal detachment, and repeated episodes of congestive heart failure due to severe mitral regurgitation and atrial fibrillation. We subjected the patient to surgical repair of the mitral valve combined with the maze procedure, which proved successful.

Atrial Fibrillation↗
PubMed2005

Successful excision of a cystic tumor of the atrioventricular nodal region.

Cystic tumor of the atrioventricular nodal region is a rare cardiac primary tumor that can cause heart blockage and sudden death. Antemortem diagnosis and successful excision of the atrioventricular nodal region are extremely rare. A 45-year-old woman who presented with palpitations is reported. Electrocardiography revealed first-degree atrioventricular block. Echocardiography, computed tomography, and magnetic resonance imaging scans revealed a cystic mass attached to the interatrial septum. Complete surgical excision of the mass was achieved, although placement of a permanent pacemaker was required for complete heart blockage. Histopathological examination revealed the mass to be a cystic tumor of the atrioventricular nodal region. A 5-year follow-up has revealed no sign of recurrence.

Atrioventricular Node↗
PubMed2005

Infective tricuspid valve endocarditis with pulmonary emboli caused by Campylobacter fetus after tooth extraction.

We describe a case of infective endocarditis caused by Campylobacter fetus accompanied by pulmonary emboli. A 52-year-old man was referred to our hospital due to febrile temperatures with a history of dental treatment followed by eating raw meat. Computed tomography revealed multiple infiltrations and a nodule with low attenuation area and feeding vessels. A mobile mass, possible vegetation, attached to the tricuspid valve was detected by transthoracic echocardiography. Two blood cultures disclosed Campylobacter fetus. Long-term antibiotic therapy was given, curing the infection with valvuloplasty. We presented the possibility that infective Campylobacter fetus endocarditis after dental treatment was caused by eating raw meat.

Campylobacter Infections↗
PubMed2005

[Influence of DPC on cardiovascular surgery].

After a new medical expense system "DPC (Diagnosis Procedure Combination)" had been introduced in 2003, the change in the medical treatment fee was evaluated according to each cardiovascular surgical field. Application of the DPC is limited to hospitalization fee in the general ward by a fixed daily amount The former payment system remains for operation, anesthesia, and some invasive examinations such as cardiac catheterization, therefore, the influence of the DPC introduction on cardiovascular surgery was minimum. A lot of problems are still left, however, for the classification of diagnosis, especially in a congenital heart disease, and the fee setting of intensive care. It is required also to reconsider serious cases, advanced complications and methods of life support. In the field of cardiovacular surgery, the treatment is so risky and so expensive, that more detailed analysis should be necessary by establishment of data base system.

Cardiovascular Surgical Procedures↗
PubMed2004

Accelerated graft disease in a composite saphenous vein with internal thoracic artery in a chronic renal dialysis patient.

A 59-year-old man with 18-year history of renal dialysis due to chronic nephritis suffered coronary artery disease, which was complete occlusion of the right coronary artery and diffuse 90% stenosis of the proximal left anterior descending artery. Off-pump coronary artery bypass grafting was performed. Saphenous vein (SV) was anastomosed with left internal thoracic artery (ITA) as a T-graft. Left ITA was anastomosed to the left anterior descending artery. The end of SV was sewn on the posterior descending artery. Coronary and graft angiography performed 2 weeks after the operation showed good patency with good distal run-off of both left ITA and SV. Three months after the operation, he was admitted with unstable angina. Angiography revealed accelerated SV graft stenosis without any change of prior coronary disease. However, angiography 7 months after the operation revealed complete obstruction of the SV graft when he was admitted because of recurrent anginal pain.

Angina Pectoris↗
PubMed2004

Rationale of off-pump coronary artery bypass grafting for left main trunk disease.

OBJECTIVE: Off-pump coronary artery bypass grafting (OPCAB) remains controversial in patients with left main trunk (LMT) disease because of a concern about the ability to tolerate hemodynamic instability. This study examined the safety of OPCAB for LMT disease compared with conventional coronary artery bypass grafting (CABG). METHODS: Between April 1997 and December 2002, 257 consecutive patients with LMT stenosis who underwent CABG were enrolled. There were 98 patients who received CABG with the aid of cardiopulmonary bypass (CCAB group), and 159 patients who received OPCAB (OPCAB group). RESULTS: There was no patient who converted to on-pump intraoperatively due to hemodynamic instability. Both intraoperative blood loss and blood transfusion incidence were lower in the OPCAB group. Postoperative course was similar, however, pulmonary complications were less observed postoperatively in the OPCAB group. No hypoperfusion syndrome was seen postoperatively in both groups. The average number of anastomosis was 3.2+/-1.1 in the CCAB group and 3.2+/-1.0 in the OPCAB group (p=0.645). Total arterial OPCAB with an aorta no-touch technique was achieved in 142 patients (89.3%) in OPCAB group. Postoperative angiography was performed in 95 patients in CCAB (96.9%), and in 141 patients in OPCAB (89.8%). Although graft patency of arterial grafts was good in both groups (100% in CCAB and 98.3% in OPCAB), saphenous vein graft patency was slightly lower in both groups (93.4% in CCAB and 76.5% in OPCAB) compared with arterial grafts. CONCLUSION: OPCAB allows a safe and effective treatment of LMT disease.

Aged↗
PubMed2004

Comparison of off-pump and on-pump coronary artery bypass grafting in midterm results.

OBJECTIVE: Off-pump coronary artery bypass grafting (OPCAB) has become a procedure of choice for surgical treatment of coronary artery disease. Although early advantages of OPCAB were confirmed in comparison with conventional on-pump coronary artery bypass grafting (CABG), late cardiac complications are still controversial. We examined midterm results of OPCAB compared with standard CABG. METHODS: Between July 1997 and April 2002, 736 consecutive patients who underwent isolated CABG were retrospectively reviewed. The OPCAB group (Group I) comprised 357 patients (49%), and the on-pump CABG group (Group II) 379 patients (51%). Their preoperative, intraoperative, and follow-up data were analyzed. RESULTS: The mean number of distal anastomoses and the early graft patency were not greatly different between the two groups. The actuarial survival rate at 3 years was not significantly different between Group I (98.3%) and Group II (98.2%) (p = 0.71). The frequency of cardiac events was 4.2%/patient-year in Group I and 2.6%/patient-year in Group II (p = 0.12). The actuarial event free rates were not different between the two groups (p = 0.61). The cardiac event free rates at 3 years were significantly (p = 0.011) higher in patients with complete revascularization (96.7%) than without complete revascularization in Group I (69.2%) and in Group II (92.7% versus 85.9%, p = 0.026). CONCLUSIONS: Midterm clinical outcome in OPCAB is as good as conventional on-pump CABG. Incomplete revascularization caused cardiac events more frequently than complete revascularization both in OPCAB and on-pump CABG in the intermediate follow-up.

Cardiopulmonary Bypass↗
PubMed2004

Rationale for off-pump coronary revascularization to small branches--angiographic study of 1,283 anastomoses in 408 patients.

BACKGROUND: Off-pump coronary artery bypass grafting (OPCAB) has gained wide acceptance in tandem with the development of the stabilizer and associated operative techniques. However bypass grafting to the small branches of a beating heart is technically demanding and remains controversial. In the present study we evaluated the graft patency and quality of anastomoses to small coronary arteries by early postoperative angiography. METHODS: Between March 2000 and December 2002 a total of 1,328 anastomosed sites to coronary branches were studied angiographically in 404 patients representing 88.6% of all cases who underwent OPCAB in this period. The coronary artery branches were categorized as large (>1.5 mm, group L: 1,028 anastomoses sites) or small (< 1.5 mm, group S: 300 sites) by intraoperative measurement. As in situ grafts the internal thoracic artery (ITA) and the gastroepiploic artery (GEA) were used at 504 and 28 distal anastomosis sites respectively. The radial artery (RA) was used as a composite graft for 739 distal anastomosis sites. Sequential bypass grafting was performed at 388 anastomosis sites in side-to-side fashion. Arterial grafts were used in 96.1% of total bypass grafting. RESULTS: The percentage of male gender was 78.3% in group S and 87.2% in group L (p = 0.025). The ITA was used in 43.7% of group L and 18.3% of group S (p < 0.0001). The RA was used in 49.4% of group L and 77% of group S (p < 0.0001). The overall patency and stenosis free rates (FitzGibbon Type A) were 97.2% and 96.2%. Graft patency and stenosis free rates in group S (96.7% and 93.3%) were as good as those in group L (97.5% and 97.1%). In group S, the patency and stenosis free rates of SV grafts were 71.4% and 57.1%. On the other hand, those of ITA grafts were 100% and 98.3% (p = 0.53 vs. saphenous vein graft [SVG]) and RA grafts were 95.8% and 92.1% (p = 0.61 vs. SVG) respectively. In group S, the graft patency and stenosis free rates of bypass to the obtuse marginal (OM) (93.7% and 87.5%) were slightly lower than those to other implantation sites left anterior descending (LAD: 100% and 97.3%; PL: 96.5% and 92.3%; DI: 98.0% and 96%; PDA: 97.0% and 97.0%; right coronary artery [RCA]: 100% and 100%) although there was no statistical significance. The graft patency and stenosis free rates were slightly better with side-to-side anastomosis than with end-to-side anastomosis (side-to-side: 98.1% and 95.8% vs. end-to-side 96.3% and 86.3%) in group S. CONCLUSIONS: OPCAB to small coronary artery branches with arterial grafts provided satisfactory graft patency and stenosis free rates.

Anastomosis, Surgical↗
PubMed2004

Competitive flow in arterial composite grafts and effect of graft arrangement in Off-Pump coronary revascularization.

BACKGROUND: We sought to investigate the incidence of competitive flow in arterial composite grafts and to delineate the effect of the location of moderately stenotic branch, the extent of the revascularized territories and the arrangement of in situ and free arterial grafts in off-pump coronary artery bypass grafting (OPCAB). METHODS: Three hundred eighteen patients who underwent OPCAB with aorta no-touch technique using the composite graft with totally arterial materials between December 2000 and March 2003 were studied. A total of 362 composite grafts were used. We reviewed their coronary angiography before and early after operation. Competitive flow was defined as the phenomenon that at least one of the distal anastomotic sites of the composite graft was not opacified in in situ graft angiography, but clearly opacified in native coronary angiography. The number of distal anastomoses was 3.47 +/- 0.93 per patient and 2.87 +/- 0.81 per composite graft. RESULTS: Early patency rate of the distal anastomotic sites of composite grafts was 98.7%. Competitive flow was found in 53/362 (14.6%) composite grafts, and graft occlusion occurred in 13/362 (3.6%) composite grafts. In the multivariate analysis of 362 composite grafts, 75% stenosis in right coronary artery (RCA) territory (p < 0.0001) and the number of distal anastomoses (p = 0.004) were significant predictors of competitive flow and graft occlusion. Multivariate analysis of 318 patients demonstrated that 75% stenosis in RCA territory (p < 0.0001) and the total number of distal anastomoses (p = 0.003) were statistically significant predictors of competitive flow and graft occlusion. The use of more than two in situ grafts and the shape of composite graft (branched or straight) did not have significant correlation with the outcome. CONCLUSIONS: Coronary artery revascularization using composite arterial grafts provided satisfactory early patency rates with an acceptable incidence of competitive flow. Because the implication of competitive flow in an arterial composite graft may differ from that in conventional bypass grafts unpredictably, long-term follow-up is mandatory.

Aged↗
PubMed2004

Total arterial off-pump coronary artery bypass grafting for revascularization of the total coronary system: clinical outcome and angiographic evaluation.

BACKGROUND: We assessed the clinical outcome and conducted an angiographic study of total arterial off-pump coronary artery bypass grafting for revascularization of the total coronary system. METHODS: Of 382 consecutive patients who underwent off-pump coronary artery bypass between April 2000 and December 2002, 235 patients (193 men and 42 women, mean age 66 +/- 9 years) with three-vessel disease underwent off-pump coronary artery bypass with all arterial grafts. A total of 872 vessels were bypassed (average number of grafts 3.7 +/- 0.8). The internal thoracic arteries, radial arteries, and gastroepiploic arteries were used for revascularization of 306, 542, and 24 coronary arteries, respectively. Two hundred twenty-five patients underwent revascularization with composite grafts that were connected to the in situ internal thoracic artery (Y configuration 181, I configuration 55, K configuration 27, X configuration 3, T configuration 1); 10 patients underwent revascularization with all in situ grafts. RESULTS: Three (1.3%) hospital deaths and 1 late death occurred. There were no occurrences of clinical underperfusion syndrome or new intraaortic balloon pump insertion. Cerebral infarction occurred in 2 patients (0.8%). Early postoperative angiography was performed on 833 grafts in 223 patients (95%); the overall patency rate was 98%. Stratified by coronary distribution, the patency rate was 99% (218/221) in the left anterior descending artery, 97% (84/87) in the diagonal artery, 99% (70/71) in the obtuse marginal artery, 98% (262/268) in the posterolateral artery, 98% (167/170) in the posterior descending artery, and 100% (16/16) in the right coronary artery. CONCLUSIONS: Total arterial off-pump coronary artery bypass yielded good clinical results and an excellent patency rate of revascularization for the total coronary system.

Adult↗
PubMed2004

Consequence of atrial fibrillation and the risk of embolism after percutaneous mitral commissurotomy: the necessity of the maze procedure.

BACKGROUND: We sought to investigate the incidence and risk of embolism after percutaneous balloon mitral commissurotomy (PMC) and delineated the necessity of the maze procedure in patients with atrial fibrillation (AF). METHODS: Clinical records of 326 patients, who underwent PMC between April 1988 and March 2003, and 162 patients, who underwent mitral valve surgery (MVS) combined with the maze procedure (MVS/maze) in the same period, were reviewed. We examined the consequence of cardiac rhythm and the incidence and risk of embolism after PMC. Next our current criteria for indication of the maze procedure, which included duration of AF less than 10 years, voltage of f wave on electrocardiography greater than 0.1 mV, cardiothoracic ratio less than 70%, and left atrial dimension less than 70 mm, were applied to all patients. These criteria were satisfied by 190 patients of PMC (PMC group) and 114 patients of MVS/maze (MVS/maze group) and the early and late results of the two groups were compared. RESULTS: Thirty-eight patients suffered from embolic complications after PMC. Of these 33 patients experienced AF before intervention. The actuarial embolism-free rate at 10 years was 81.9% in patients with AF before PMC and 92.9% in patients with sinus rhythm before PMC (p = 0.01). Univariate predictors of embolism after PMC included previous embolic history (p = 0.01), AF (p = 0.01), pressure gradient (p = 0.01), age (p = 0.03), and mitral valve area (p = 0.04). Multivariate analysis identified AF as the independent predictor of embolism in the late follow-up period (p = 0.03). In a comparative study of the selected patients the actuarial AF-free rates after MVS/maze were 89.9% at 1 year and 85.7% at 5 years and were significantly higher than those of 17.3% at 1 year and 4.2% at 5 years after PMC (p < 0.0001). The actuarial embolism-free rate in the MVS/maze group was 98.0% at 5 years and was significantly higher than that of 84.8% at 5 years and 82.4% at 10 years in the PMC group (p = 0.01). CONCLUSIONS: PMC alone is not sufficient with regard to sinus rhythm recovery and prevention of embolism. Surgical treatment concomitant with the maze procedure may be beneficial for patients with AF.

Atrial Fibrillation↗
PubMed2004

Should the transverse aortic arch be replaced simultaneously with aortic root replacement for annuloaortic ectasia in Marfan syndrome?

OBJECTIVE: The purpose of this study was to determine, on the basis of the late fate of the intact aortic arch with abnormal tissue after aortic root replacement, whether the intact aortic arch should be replaced prophylactically at the time of aortic root replacement for annuloaortic ectasia in Marfan syndrome. METHODS: A retrospective review was performed in 85 patients with Marfan syndrome who underwent aortic root replacement for annuloaortic ectasia with or without aortic dissection (mean age 37 years, range 19-61 years). These 85 patients were divided into four groups according to the postoperative condition of the residual aorta. In group I (n = 47), the patients underwent aortic root replacement for annuloaortic ectasia with or without localized dissection in the ascending aorta. In these patients the residual aorta, including the aortic arch, was therefore intact. In group II (n = 10), the aortic arch was intact, although the descending thoracic aorta was dissected because of the preoperative type B dissection. In groups III and IV, the patients had type A dissection involving the transverse arch associated with annuloaortic ectasia. In group III (n = 13), residual dissection existed in the descending thoracic aorta after concomitant total arch replacement. In group IV (n = 15), the aortic arch and the descending thoracic aorta were dissected. RESULTS: There were 5 early deaths (3 in group I, 1 in group II, and 1 in group III). Subsequent operations were required in 10, 5, 6, and 7 cases in groups I, II, III, and IV, respectively. Regarding the aortic arch, only 2 of 53 survivors of the initial hospitalization with an intact aortic arch (groups I and II) underwent subsequent total arch replacement for the onset of dissection in the aortic arch, and 4 of 14 survivors of the initial hospitalization with a residual dissecting arch (group III) needed subsequent total arch replacement. Actuarial freedom from arch repair among patients with an intact aortic arch (91% at 15 years) was significantly higher than that among patients with a residual dissecting arch (49% at 15 years, P =.0078). CONCLUSIONS: The incidence of new dissection in the residual intact arch after aortic root replacement was extremely low. Therefore prophylactic replacement of the intact arch does not appear to be necessary at aortic root replacement for annuloaortic ectasia in Marfan syndrome.

Actuarial Analysis↗
PubMed2004

Modified cavoatriotomy for combined PAPVC repair and maze procedure.

In patients with partial anomalous pulmonary venous connection (PAPVC) to the superior cavoatrial junction, the standard right-sided left atriotomy does not allow sufficient access to the mitral valve and the left atrium. And the injury and traction of the sinus node and sinus node artery should be avoided for prevention of the cardiac rhythm disturbance after operation. We herein report a useful approach to repair the sinus venosus atrial septal defect with PAPVC of the right pulmonary veins to the superior cavoatrial junction in patients also requiring mitral valve replacement and the maze procedure.

Atrial Fibrillation↗
PubMed2003

Failure to prevent progressive dilation of ascending aorta by aortic valve replacement in patients with bicuspid aortic valve: comparison with tricuspid aortic valve.

BACKGROUND: Patients with bicuspid aortic valve (BAV) have been frequently complicated with ascending aortic dilation possibly because of hemodynamic burdens by aortic stenosis (AS) or regurgitation (AR) or congenital fragility of the aortic wall. METHODS AND RESULTS: To clarify if the aortic dilation could be prevented by aortic valve replacement (AVR) in BAV patients, we studied 13 BAV (8 AR dominant, 5 AS dominant) and 14 tricuspid aortic valve (TAV) patients (7 AR, 7 AS) by echocardiography before and after AVR (9.7+/-4.8 years). We also studied 18 BAV (11 AR, 7 AS) without AVR. Diameters of the sinuses of Valsalva, sinotubular junction and the proximal aorta were measured. The annual dilation rate was calculated by dividing changes of diameters during the follow-up period by the body surface area and the observation interval. We found that aortic dilation in BAV patients tended to be faster than that in TAV patients, although a significant difference was found only at the proximal aorta (0.18+/-0.08 versus -0.08+/-0.08 mm/(m2/year), P=0.03). BAV patients with and without AVR showed similar progressive dilation. AR dominant group showed tendency of more progressive dilation than AS dominant group in BAV, although it did not reach statistical significance. TAV patients did not show further aortic dilation after AVR. CONCLUSIONS: AVR could not prevent progressive aortic dilation in BAV. Since the aorta did not dilate in TAV, progressive aortic dilation in BAV seems mainly due to the fragility of the aortic wall rather than hemodynamic factors.

Adult↗