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Biomedical subjects

K Eishi

Publications and source records attributed to K Eishi.

At least 19 recordsLinked to original sources
PubMed2001

Survival and sinus rhythm maintenance after modified Cox/maze procedure and mitral valve operation in patients with chronic atrial fibrillation.

OBJECTIVE: Sinus rhythm gained after the Cox/maze procedure concomitant with mitral valve operation has demonstrated long-term attrition during the follow-up, no information exists on whether the type of mitral valve operation--(repair vs. replacement)--affects this sinus rhythm maintenance rate. We retrospectively studied patients undergoing concomitant mitral valve operation and Cox/maze procedure to answer this question. METHODS: Between April 1993 and August 1995, 87 consecutive patients--35 men and 52 women (mean age: 59.3 years)--with chronic atrial fibrillation and mitral valve disease underwent the modified Cox/maze procedure and concomitant mitral valve operation, with 56 having mitral valve repair (repair group) and 31 mitral valve replacement (replacement group). Patients were followed up and changes in rhythm studied retrospectively. RESULTS: Follow-up for a mean 51.3 +/- 11.6 months was completed in 82 of 83 long-term survivors (99%). Repair group surgery survival was 98.1 +/- 1.9% at 1 year and 94.2 +/- 3.2% at 5 based on the Kaplan-Meier method. Replacement group surgery survival was 85.7 +/- 5.9% at 1 year and 82.9 +/- 6.4% at 5. Probability in sinus rhythm maintenance for the repair group at 1 year was 88.6 +/- 5.4% and at 5 years was 67.6 +/- 9.1%. Probability in sinus rhythm maintenance for the replacement group at 1 year was 95.7 +/- 4.3% and at 5 years was 65.0 +/- 11.1%. CONCLUSIONS: Medium-term results after the Cox/maze III procedure concomitant with mitral valve operation are good. The attrition of sinus rhythm maintenance appears similar by the completion of 5-year follow-up.

Atrial Fibrillation↗
PubMed2001

Annuloaortic repair in the treatment of aortic regurgitation and aortic root pathology.

We developed a new technique of aortic root repair which may be able to eliminate the potential problem of leaflet damage, resulting from the direct contact of the aortic leaflets with synthetic vascular grafts during systole. This report describes our technique of annuloaortic repair and the operative results. Between February 1995 and October 1998, 13 patients underwent annuloaortic repair. The patients included 8 males and 5 females (mean age 50 years). Four patients had grade IV/IV aortic regurgitation (AR), 5 had III/IV AR, 2 had II/IV AR, and 1 had no AR preoperatively. Regarding the preoperative functional status, 1 patient was classified as New York Heart Association class IV, 5 were class III, 6 class II, and 1 class I. Concomitant cardiovascular procedures were performed in 12 cases. Aortic valvuloplasty or annuloplasty was performed in 7 patients. Both operative and short-term postoperative results with pre- and postoperative echocardiographic findings were studied retrospectively. The mean total cardiopulmonary bypass time was 212 min. The mean aortic cross-clamp time was 130 min. Circulatory arrest was induced in 5 patients. Postoperatively, 7 patients had no AR. Three patients had grade I/IV AR and 3 had grade II/IV AR. Perioperative changes in aortic annulus, mid-sinus portion, and sinotubular junction diameters were determined echocardiographically in 5 patients. The preoperative diameters were 2.7 +/- 0.4, 5.4 +/- 0.5, and 4.7 +/- 1.0 cm, respectively. The postoperative diameters were 2.3 +/- 0.5, 4.2 +/- 0.5, and 3.5 +/- 0.5cm, respectively. Ten patients were class I and 2 were class II. This technique of annuloaortic repair with or without aortic valvuloplasty is applicable to a certain subset of patients with aortic root disease and AR. Both the indications for this procedure and the long-term results should be confirmed.

Adolescent↗
PubMed2001

[Long-term results of aortic valve replacement].

In order to improve the quality of life after cardiac valvular surgery, new procedures and new prostheses have been developed in the past decade. Surgeons have many alternatives for the individual patient. However, some may only represent a trend without any clinical advantage, some may increase the surgical risk, and some may have limited indications for specific types of heart disease. Therefore the selection of the procedure and prosthesis is very important. The new mechanical valves have a thinner ring and cuff, providing a larger orifice for patients with a small aortic annulus, and enlargement procedures are now rarely required. Second-generation biological valves have been used for more than 15 years. In the aortic position in elderly patients, the rate of freedom from structural deterioration is over 90% at 15 years. The stentless valve is the most notable newer prosthesis and has significant hemodynamic advantages, associated with good myocardial remodeling.

Aortic Valve↗
PubMed2001

Notes to avoid failure in mitral valvuloplasty.

Mitral valvuloplasty can be applied in many situations and is quite effective in many cases. However, since it requires surgical skill based on knowledge and experience, there is a risk for recurrent surgery and reoperation was necessary in 5-8% of all cases in the first three years. 80-95% required no reoperation in ten years. Reoperation was performed mostly in cases of active endocarditis and extensive anterior leaflet prolapse. Reasons for reoperation were incomplete repair, tissue injury on sutured portion, recurrent annulus dilatation, reprolongation of chordae and hemolysis. To attain better surgical results in of mitral valvuloplasty the basic technique should consist of the resection and suture method and the fragile portion should be sutured with a patch. Careful attention should be paid to attaining a good coaptation of leaflet at the end of repair, sufficient remodeling of dilated annulus and to careful suturing of the prosthetic ring. It is also important to have an experienced operator perform transesophageal echocardiogram, and if more than 2 cm2 residual regurgitation is observed, immediate examination and treatment should be performed. In case of mitral regurgitation after surgery, careful assessment for reoperation can contribute to good late surgical results.

Aftercare↗
PubMed2000

Medium-term results after the modified Cox/Maze procedure combined with other cardiac surgery.

OBJECTIVE: Long-term results after the modified Cox/Maze III procedure combined with other cardiac procedure for the treatment of organic heart disease and chronic atrial fibrillation (AF) has not been clarified. This report describes our medium-term results after such operation. METHODS: Between March 1993 and August 1995, 104 consecutive patients with chronic AF underwent the modified Cox/Maze III procedure combined with other cardiac procedure. There were 100 long-term survivors. There were 45 men and 55 women, with ages ranging from 21 to 77 years (mean 59.7). Patients were followed up and changes in rhythm, need for pacemaker implantation, and the incidence of CNS (central nervous system) complications were retrospectively studied. RESULTS: The follow-up was complete in 103 patients and 99 long-term survivors (99%). The mean follow-up period was 44.6 +/- 1.1 months. In the immediate postoperative period, 73 patients regained sinus rhythm (SR group), 21 patients were in AF (AF group), and six patients underwent pacemaker implantation because of sick sinus syndrome (SSS). During the follow-up period, eight patients died. One- and 5-year survival rates (Kaplan-Meier) after surgery was 95.1 +/- 2.3 and 87.8 +/- 3.4% for the entire group. Preoperative NYHA class was 2.5 +/- 0.7 and medium-term NYHA class was 1.5 +/- 0.5. (P < 0.001) Changes in rhythm for the SR group were followed. Fifty-two patients of the SR group stayed in SR (72%), 16 patients converted back to AF (22%), and four patients had newly-developed SSS (6%) at follow-up period. Probability in SR maintenance for SR group at 1 year was 88.8 +/- 3.7% and at 5 years was 64.8 +/- 7.5%. Five patients experienced the CNS complication during the follow-up period. Two of the AF group and two of the SR group patients developed cerebral/cerebellar infarction. One of the SR group patients experienced small cerebral bleeding. CONCLUSIONS: The medium-term results after the modified Cox/Maze III procedure concomitant with other cardiac procedure are good with improved functional status and good survival rate. However, there seems to be gradual but constant attrition in the rate of SR maintenance in SR group.

Adult↗
PubMed2000

[A case of aconitine poisoning saved with cardiopulmonary bypass].

"Torikabuto" is a kind of plant which contains deadly poison. Its ingredient is aconitine alkaloids. We report a case of aconitine poisoning with fatal arrhythmia and acute pulmonary edema who was saved with cardio pulmonary bypass. A 41-year-old male ate to mistake "Torikabuto" for wild plant. He developed symptoms of dysarthria and admitted to our hospital. He developed ventricular tachycardia and fibrillation soon after his admission. Then he developed cardiogenic shock. He was resuscitated and supported with a percutaneous cardio pulmonary bypass. Ventricular tachycardia disappeared 24 hours after admittion. About 1 week later, cardio pulmonary bypass was terminated and about 3 months later, he discharged from our hospital.

Aconitine↗
PubMed1999

Mitral valve repair by Carpentier-Edwards physio annuloplasty ring.

A semi-flexible annuloplasty ring (Physio-ring) was clinically used in 30 cases of mitral valve insufficiency. The Physio-ring has the characteristics in which the anterior section is rigid and has a saddle-shaped curve, while the posterior section is flexible to allow for changes in size and shape of the anulus during ventricular contraction. The patients were aged from 23 to 73 years (mean 53.8 +/- 12.5). The cause of mitral valve insufficiency was degenerative (in 24 patients), rheumatic (2), ischemic (1), endocarditis (1), congenital + degenerative (1), and traumatic (1). On the 6-month post-implant echocardiogram, 96.6% had grade 0 or +1 regurgitation. The effective valve orifice area was 2.61 +/- 0.82 cm2 (n = 19). There was no late death. However, there was 1 (3.3%) hospital death after the patient had received a simultaneous coronary artery bypass grafting, and then developed low output syndrome after surgery. Although there was no device-related complication, hemolysis of undetermined cause was observed in 1 (3.3%) patient. The findings from this study indicated a low incidence of device-related complication, while excellent valvular function was maintained.

Adult↗
PubMed1999

Double valve repair and maze procedure for degenerative valvular disease and chronic atrial fibrillation.

A 61-year-old male with degenerative aortic valve regurgitation, mitral valve regurgitation and chronic atrial fibrillation underwent a combined reparative procedure consisting of aortic valve repair, mitral valve repair and maze procedure. Surgery was successful and postoperatively the patient is in NYHA class I, without anticoagulation. To the best of our knowledge, this is the first clinical report of this combined reparative surgery. As advances are made in valve repair surgery, it is expected that similar combined procedures will be performed more frequently in future. The benefits of avoiding valve replacement and anticoagulation after such combination treatment is discussed.

Aortic Valve Insufficiency↗
PubMed1999

[Aortic valve papillary fibroelastoma in a patient with mitral valve regurgitation].

Papillary fibroelastoma is a rare cardiac tumour. We describe a patient with mitral valve regurgitation and aortic valve papillary fibroelastoma. The patient was 62-year-old woman. She was referred to us for surgical treatment of mitral valve. Preoperative echocardiography showed rheumatic mitral valve regurgitation (Sellers grade III) and it also demonstrated mobile masses of the aortic valve. At operation, mitral valve was repaired by a posterior annuloplasty. Through the aortotomy, small tumors were found to be attached to each cusps of the aortic valve and they were successfully removed. The histopathologic diagnosis was papillary fibroelastoma of the aortic valve. The postoperative course was uneventful.

Aortic Valve↗
PubMed1998

[Early recovery after valvular heart surgery].

There have been published not a few reports concerning the early recovery from heart surgery. But most of them were restricted in CABG cases. We report our efforts and its results about the early recovery from valvular heart surgery. To make a contribution to the early recovery we have made some efforts since 1995, including normothermic perfusion, low-dose fentanyl and introduction of terminal warm blood cardioplegia. As the results, the tracheal intubation period was shortened from 12.6 +/- 5.3 (hour) to 6.7 +/- 4.1. The number of the cases who had tracheal extubation in the operative day increased from 27% to 84%. The postoperative cardiac function was satisfactory and there were no abdominal or neurologic disturbances among the patients those who were entered into the early recovery protocol. We obtained satisfied early recovery in safe after valvular heart surgery.

Aortic Valve↗
PubMed1998

[Mid-term evaluation of cryopreserved aortic allograft].

Recently aortic root replacement and free-hand aortic valve replacement with cryopreserved allograft are accepted and established as useful procedures in USA and Europe. Otherwise allograft aortic valve failure due to structural valve degeneration, progressive loss of leaflet extensibility or progressive aortic root dilatation are reported. Aortic root replacement and free-hand aortic valve replacement with cryopreserved allograft were performed on three patients in the Department of Cardiovascular Surgery, NCVC between March of 1992 and March of 1994. We evaluated the mid-term function of implanted allograft. Case 1, 2, 58-year-old male and 42-year-old male with aortic regurgitation due to Aortitis had modified Bentall procedures with composite graft and had redo surgery for aortic regurgitation due to graft detachment with cryopreserved allograft using "aortic root replacement". Case 3: 54-year-old male received a cryopreserved allograft for aortic stenosis/regurgitation using "free-hand technique". Postoperative echocardiogram showed excellent valve function without regurgitation any calcification in all cases. However chest computed tomography suggested the new calcification of allograft wall at 15 months after operation in Case 1 who was administered steroid agents, despite no calcification in Case 2 during 17 months follow-up.

Adult↗
PubMed1998

Serial Doppler echocardiographic evaluation of Carpentier-Edwards pericardial valve dysfunction: comparison with Ionescu-Shiley valve.

BACKGROUND: Doppler echocardiography is a valuable noninvasive method for evaluating of the occurrence and degree of either prosthetic valve stenosis or regurgitation. By using serial Doppler echocardiographic examination, we evaluated the incidence and the mode of the Carpentier-Edwards pericardial valve (CEPX) dysfunction compared with that of the Ionescu-Shiley valve (IS). METHODS AND RESULTS: After aortic and/or mitral valve replacement, 80 patients with CEPX and 111 with IS underwent Doppler echocardiography at intervals of at least 2 years after surgery. The average durations of follow-up were 6.1 +/- 2.9 years for patients with CEPX and 7.2 +/- 3.0 years for those with IS. Bioprosthetic valve stenosis was defined as reduced excursion of the bioprosthetic valve leaflets and peak gradient > or =60 mm Hg after aortic valve replacement and mean gradient > or =7 mm Hg after mitral valve replacement. Bioprosthetic valve regurgitation caused by bioprosthetic valve dysfunction was defined as grade > or =3 transvalvular regurgitation. In the aortic position, although there was no significant difference in the actuarial rate of freedom from bioprosthetic valve stenosis between patients with IS and those with CEPX (10 years after surgery, 88% +/- 7% vs 90%, NS), bioprosthetic regurgitation caused by bioprosthetic valve dysfunction occurred less frequently in patients with CEPX than in those with IS (10 years after surgery, 86% vs 54% +/- 9%, p < 0.05). In the mitral position, bioprosthetic valve stenosis occurred more frequently in patients with CEPX than in those with IS (10 years after surgery, 54% +/- 11% vs 72% +/- 8%, p < 0.01). Although grade > or =3 transvalvular bioprosthetic regurgitation occurred later in patients with CEPX than in those with IS, there was no significant difference in the actuarial rate of freedom from that regurgitation between patients with CEPX and those with IS (10 years after surgery, 63% +/- 10% vs 54% +/- 7%, NS). CONCLUSIONS: For aortic valve replacement, CEPX has good long-term durability because of the low incidence of bioprosthetic regurgitation. For mitral valve replacement, long-term durability of CEPX is poor, although medium-term durability is satisfactory.

Aortic Valve↗
PubMed1998

Improved success rate of the maze procedure in mitral valve disease by new criteria for patients' selection.

OBJECTIVE: We have carried out the maze procedure for atrial fibrillation (AF) as a combined operation with mitral valve surgery in a consecutive fashion until December 1994 (period 1). Therefore, the success rate in sinus rhythm conversion remained unsatisfactory. We have selected the patients according to arbitrarily decided new criteria since January 1995 (period 2), and examined the results prospectively. METHODS: Between May 1992 and February 1997, we carried out the maze procedure in 220 patients as a combined operation with mitral valve surgery. During period 2, we carried out the maze procedure in 63 cases who satisfied all the new criteria (voltage of f-wave in V1 lead > 0.1 mV, cardiothoracic ratio (CTR) < 70%, LA dimension < 70 mm), and 37 patients out of these criteria. Success was defined as sinus rhythm restoration without sick sinus syndrome. RESULTS: There were 4 hospital deaths (1.8%) and 4 late deaths (1.8%). Success rate was significantly (P = 0.0089) higher in period 2 (82%) than in period 1 (65%). Success rate was significantly higher in patients within criteria than out of criteria both in period 1, period 2, and total (77 versus 48%, P = 0.018; 90 versus 66%, P = 0.004, and 83 versus 55%, P = 0.0001). CONCLUSION: The maze procedure is highly reliable when combined with mitral valve surgery if patients are selected properly.

Adult↗
PubMed1998

[Supervised cardiac rehabilitation for the patients with the disturbance of the motor function after cardiac surgery: the significance of physical therapists' participation].

There are sporadic instances of patients with the motor function disturbance of non-cardiac origin after cardiac surgery, and these patients may need prolonged post-operative cardiac rehabilitation. We established our cardiac rehabilitation program for post-operative patients and a total of 124 patients underwent the post-operative cardiac rehabilitation program (male 73, female 51, average age 60). Among them, 12 patients (9.7%) received the physical therapy for the disturbance of motor function post-operatively. These 12 patients were retrospectively studied. Physical therapies performed were the exercise therapy to improve the range of motion to prevent contracture in 3 patients with peroneal nerve palsy and drop foot, the exercise therapy for pre-operative or post-operative hemiplegia in 6 patients, the instruction of exercise for lumbago in 1 patient with spinal cord disease, respiratory physical therapy in 1 patient, and myotherapy for arthritis in 1 patient. Treatment with physical therapy was very useful in rehabilitating these patients. Active participation of physical therapists in cardiac rehabilitation for patients with the disturbance of motor function after cardiac surgery is possible. It is expected that their participation may improve the quality of life in this subset of patients.

Adult↗
PubMed1998

[Effectiveness of surgical repair of mitral regurgitation concomitant with dilated cardiomyopathy].

Dilated cardiomyopathy (DCM) is often accompanied by severe mitral regurgitation (MR) which deteriorates the clinical course. Mitral reconstruction for severe MR may improve the symptoms and prognosis. Five patients with DCM and one patient with dilated phase of hypertrophic cardiomyopathy underwent mitral reconstruction for severe MR (4 males, 2 females, mean age 50 +/- 17 years) from 1983 to 1995. Their New York Heart Association (NYHA) functional class and findings of echocardiography and cardiac catheterization were compared before and after surgery. Five patients underwent annuloplasty and one patient underwent mechanical valve replacement. There was no operative or in-hospital death. NYHA class improved from 3.2 to 1.8 (p < 0.05). The degree of MR was reduced from 3.5 to 1.2 (p < 0.05), and left ventricular end-diastolic pressure decreased from 18 +/- 7 to 13 +/- 8 mmHg (p < 0.05). Left ventricular fractional shortening, ejection fraction and cardiac index (2.4 +/- 0.4 to 2.7 +/- 1.1 l/min/m2) did not change significantly. Two patients died within one year due to exacerbation of congestive heart failure (2.5 month later) or sudden death (6 months later). Three patients died at 21 months, 5 and 8 years after the operation (renal insufficiency, heart failure, sudden death, respectively). Mitral reconstruction improved the symptoms in patients with DCM and severe MR in the short term. However, 5 of 6 patients died in the intermediate or long-term. Mitral reconstruction may be a therapeutic option for early outcome in patients with refractory congestive heart failure due to DCM and severe MR.

Adult↗
PubMed1997

Pulmonary autograft implantation in the dilated aortic annulus.

The application of the pulmonary autograft (Ross) procedure in the treatment of dilated aortic annulus is still controversial, because technical errors of implantation are more likely to occur as the host annular diameter increases. The Ross procedure was successfully employed in a 28-year-old woman with a dilated aortic annulus after simple annular plication. The annulus was plicated beneath the three commissures where the pulmonary autograft was subsequently attached. The diameter of the annulus was reduced from 32 to 26 mm. This technique may provide a number of advantages compared with aortic valve replacement, especially for women of child-bearing age.

Adult↗
PubMed1997

Surgical management of Behçet's aortitis: a report of eight patients.

BACKGROUND: Behçet's aortitis is one of the most severe manifestations of Behçet's disease. However, there have been few reports of this rare entity. This article we describe our experience with surgical treatment of Behçet's aortitis in 8 patients. METHODS: From May 1978 to February 1995, we operated on 8 patients with Behçet's aortitis. All patients were followed up for a total of 54.4 patient-years (mean, 6.8 years). RESULTS: There were no operative deaths, but 1 patient died in the hospital of ventricular fibrillation. Another death occurred as a result of pseudoaneurysm rupture 10 months after operation. Fourteen operations were performed on eight patients: a second operation was performed on four patients, and a third operation was performed on two patients. The translocated Bentall procedure, a modified Bentall procedure, was performed six times. One patient required a second operation for graft detachment, but the others have done well without further surgical intervention. Aortic valve replacement was performed six times, and three reoperations were needed after aortic valve replacement. CONCLUSIONS: The translocated Bentall procedure may be effective for Behçet's aortitis, but further investigation is necessary.

Adult↗