[Annuloaortic repair for aortic regurgitation].
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Adolescent↗
Biomedical subjects
K Eishi
Publications and source records attributed to K Eishi.
[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↗
[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↗
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↗
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↗
Superior approach to the left main coronary artery for surgical angioplasty.
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Aged↗
Huge aneurysm of the sinus of Valsalva following infective endocarditis in Behçet's disease.
A huge aneurysm of the sinus of Valsalva with conduction disturbance as a consequence of infective endocarditis in Behçet's disease is reported. The aneurysm extended not only into the ventricular septum but also to the right atrium and ventricle, with a complicated cavity formation. We speculate that complete atrioventricular block occurred due to an enlargement of the aneurysm into the ventricular septum, leading to a direct conduction system injury. Preoperative echocardiography and aortography were insufficient to recognize the extent of the lesion; subsequent operative examination revealed the true size. At operation, it is important to understand the lesion dimensions fully in order that appropriate surgical procedures be performed.
Aortic Aneurysm↗
[Aortic valve replacement with stentless porcine aortic valve].
The Toronto stentless porcine valve (TSPV) is a stentless porcine aortic valve, preserved with glutaraldehyde solution, which has been designed to maintain natural laminar blood flow and improve hemodynamic performance and enhance durability. Aortic valve replacement with TSPV was performed in seven patients. The reason for this indication was advanced age (65 years or more) in six patients and connective tissue disease in another patient. One patient required reoperation because of prosthetic valve endocarditis 4 months after implantation. There were no other valve-related complications. Echocardiographic examination of prosthetic valve function one month after surgery showed no aortic regurgitation in any patient. Transprosthetic gradient was 15.1 +/- 5.0 mmHg. Technical know-how is required for the implantation. The hemodynamic characteristics of the TSPV were excellent. Further follow-up is required to determine durability, but further extensive indication of this valve is expected as a bioprosthesis.
Adult↗
Choice of replacement valve in the elderly.
BACKGROUND AND AIMS OF THE STUDY: Little comparative information exists on the outcome of the valve replacement with bioprostheses or mechanical valves in the elderly. This study was carried out to make such a comparison. METHODS: Follow up data were examined from 219 patients aged > or = 65 years who underwent aortic and/or mitral valve replacement using bioprosthetic (n = 67) or mechanical valve (n = 152) between April 1979 and December 1993. The mean follow up periods were 6.3 +/- 2.8 years after bioprosthesis and 4.9 +/- 2.1 years after mechanical valve implantation. RESULTS: Although the actuarial rate of structural deterioration was higher in patients with bioprosthetic valves than in those with mechanical valves (58% versus 100% freedom at 10 years after surgery, p < 0.01), no such prosthesis-related difference was seen in the subgroup of patients aged > or = 70 (100% versus 100% at nine years, p = N.S.). The actuarial rate of major bleeding was higher after mechanical valve implantation than after bioprosthetic valve placement (90% versus 100% freedom at 10 years, p < 0.05); this lower rate with bioprosthetic valves was maintained in patients aged > or = 70 (78% versus 100% at nine years, p < 0.05). There were no significant differences in the incidences of thromboembolism and bacterial endocarditis between the two valve types. CONCLUSIONS: Structural degeneration of bioprosthetic devices was a major problem in patients aged 65-70 years, but it was essentially negligible in those aged > or = 70 years. Anticoagulant-related bleeding was a major problem with mechanical valves in both age groups. Therefore, for patients older than 70 years, valve replacement with a bioprosthesis appears to be the method of choice.
Age Factors↗
[Extensive indication of mitral valvuloplasty for non-rheumatic mitral regurgitation and postoperative QOL].
Between January 1993 and June 1996, 108 patients with non-rheumatic mitral regurgitation (MR) underwent surgical treatment. Mitral valvuloplasty (MVP) was performed in 94 patients (87%) and mitral valve replacement (MVR) was performed in 14 patients. The patients were reviewed based on the location of the prolapse, active endocarditis, and re-valvuloplasty. The proportion of MVP patients to the total number of cases was 92%, 96% and 94% for prolapse of the anterior mitral leaflet (MVP: n = 22), the posterior mitral leaflet (n = 47) and of both leaflets (n = 15), respectively; it was 60% and 33% in the patients with active infective endocarditis (n = 3) and in reoperation cases (n = 3). Reoperation was required in 2 patients. Other than reoperation cases, 3/4 grade MR was detected by color Doppler echocardiography in 6 patients although they were asymptomatic. Thromboembolism occurred in 3 patients. The event-free rate at 42 months was 80.4%. Concomitant maze procedure was performed in 36 of 39 patients with atrial fibrillation and normal sinus rhythm was obtained in 25 of the 36 patients. Only 6 patients received warfarin anticoagulation after MVP. In current cases with non-rheumatic MR, the MVP could be performed in 87% of all patients and in 94% of the patients with simple prolapse, regardless of the prolapse area. Concomitant maze procedure might provide a better quality of life after MVP.
Adult↗
Surgical treatment for prolapse of the anterior mitral leaflet.
BACKGROUND AND AIMS OF THE STUDY: Mitral valvuloplasty (MVP) for the prolapse of the anterior mitral leaflet (AML) is more difficult than that for the posterior mitral leaflet. The introduction of artificial chordae (November, 1986) and the concomitant maze operation (November, 1992) were surgical 'turning points' in our 17 years' experience. METHODS: In total, 163 surgical cases of AML prolapse based on the above turning points, and carried out between 1979 and 1996, were reviewed. These included 110 MVP and 53 mitral valve replacements. MVP was performed in only 46% (29/63) of patients before October 1986 (Group I); in 72% (42/58) of patients between November 1986 and October 1992 (Group II); and in 93% (39/42) of patients after November 1992 (Group III). RESULTS: Reoperation was required in nine patients. The reoperation-free rate after MVP was 79% at 17 years in all cases, 82% at 17 years in Group I, 86% at 10 years in Group II and 97% at four years in Group III. Besides reoperation cases, grade 3/4 mitral regurgitation (MR), assessed by color Doppler echocardiography, was detected in seven patients. The event-free (reoperation, MR, thromboembolism) rate was 69% at 17 years in all cases, 78% at 17 years in Group I, 71% at 10 years in Group II and 92% at 4 years in Group III. A concomitant maze operation was performed in 19 of 20 current patients with atrial fibrillation. The percentage of sinus rhythm after operation in Group I, II and III was 53%, 60% and 84%, respectively. CONCLUSIONS: During 17 years' experience, mortality and morbidity after MVP for AML prolapse were satisfactory. With the use of artificial chordae, we have been able to perform MVP in more than 90% of current patients with AML prolapse. Further, a concomitant maze procedure could provide a higher incidence of postoperative sinus rhythm.
Actuarial Analysis↗
Clinical usefulness of the effective regurgitant orifice area determined by transesophageal echocardiography in patients with eccentric aortic regurgitation.
BACKGROUND AND AIMS OF THE STUDY: The aortic regurgitant jet is frequently eccentric, and Doppler color flow mapping techniques of the distal jet is influenced by this eccentricity. The aim of the present study was to determine whether the effective regurgitant orifice area (EROA), determined by the proximal isovelocity surface area (PISA) method using multiplane transesophageal echocardiography (m-TEE), could be used to evaluate the severity of aortic regurgitation (AR) in patients with an eccentric jet. METHODS: Forty-eight patients with eccentric AR were studied. Values of EROA determined by the PISA method were compared with results from cross-sectional area (CSA), vena contracta (VC) width, aortic angiography, and regurgitant fraction. RESULTS: Values of EROA correlated well with results from CSA (r = 0.73, p < 0.001), VC (r = 0.74, p < 0.001), angiographic grade (rs = 0.90 p < 0.001), and regurgitant fraction (r = 0.84, p < 0.001) in patients with eccentric aortic regurgitation. Values of EROA > 0.27 cm2 were always associated with a regurgitant fraction > 0.4, while EROA values < 0.27 cm2 were always associated with a regurgitant fraction < 0.4. CONCLUSIONS: We conclude that, in patients with an eccentric jet, measurement of EROA values by the PISA method using m-TEE is a reliable method of assessing the severity of AR.
Aorta, Thoracic↗
Long-term results of artificial chordae implantation in patients with mitral valve prolapse.
BACKGROUND AND AIMS OF THE STUDY: In terms of valve-related complication and ventricular function, mitral valve repair (MVR) is superior to valve replacement. To date, chordae shortening and transposition have been used for diffuse prolapses. We have used artificial chordae implantation for MVR since 1986, and here review our long-term results. METHODS: Pericardial strips were used in nine patients, and e-PTFE (Gore-Tex) sutures in 58. A degenerative lesion was present in 69% of cases, endocarditis in 16% and rheumatic valvulitis in 7%. Implantation of artificial chordae was indicated for treatment of diffuse prolapse. Annuloplasty was performed in patients with or without prosthetic ring. RESULTS: Actuarial survival rate was 78% for the pericardial chordae group at nine years, and 94% for the Gore-Tex chordae group at eight years. Thromboembolic events occurred in two pericardial chordae patients, and three Gore-Tex chordae patients required reoperation. Freedom from reoperation was 100% for pericardial chordae after nine years and 96% for Gore-Tex chordae after eight years. Quality of life among survivors is good: 83% are in NYHA class I, 89% are free from anticoagulation, and 60% require no medication. Mitral valve orifice area, estimated echocardiographically, was similar in both groups at discharge and at follow up. CONCLUSIONS: MVR with artificial chordae provided satisfactory valve function for up to nine years. Gore-Tex chordae are less prone to deterioration than pericardial chordae. Follow up observations support the use e-PTFE chordae to correct diffuse leaflet prolapse.
Chordae Tendineae↗
Mitral valve dysfunction resulting from thickening and stiffening of artificial mitral valve chordae.
BACKGROUND: There is little information about changes in mitral valve function caused by thickening and stiffening of artificial chordae during follow-up. Using serial echocardiographic examination, we evaluated thickening and stiffening of artificial chordae and the effect of those changes on mitral valve function. METHODS AND RESULTS: Between November 1986 and November 1993, 40 patients underwent mitral valve repair with artificial chordae using glutaraldehyde-tanned xenograft pericardium (GTXP) or polytetrafluoroethylene suture (PTFE). Seven GTXP patients and 20 PTFE patients underwent serial echocardiographic examination after surgery and were included in the final analysis. Thickening and stiffening of the artificial chonlae were classified according to echocardiographic changes after surgery: grade 1, no change; grade 2, thickening and/or stiffening without impairment of the motion of the mitral valve leaflet; and grade 3, thickening and stiffening that impaired motion of the mitral valve leaflet. The mean follow-ups in patients with GTXP and PTFE were 6.0 and 3.6 years, respectively. During follow-up, there were 2 GTXP patients with grade 2 thickening and stiffening and 4 patients with grade 3. There were 6 PTFE patients with grade 2 thickening and stiffening and 2 patients with grade 3. Grade 3 occurred earlier in GTXP than in PTFE patients (P < .05). Mitral valve area in GTXP patients decreased from 2.5 +/- 0.4 to 2.1 +/- 0.3 cm2 (P < .05); however, mitral valve area in PTFE patients showed no significant change during follow-up (2.1 +/- 0.4 to 2.0 +/- 0.4 cm2, P = NS). CONCLUSIONS: Although mitral valve repair with artificial chordae is useful, more attention should be paid to mitral valve function resulting from thickening and stiffening of artificial chordae.
Adult↗
Factors affecting rhythm after the maze procedure for atrial fibrillation.
BACKGROUND: The maze procedure failed to abolish atrial fibrillation (AF) in 14% of patients with underlying organic cardiac lesions. Identification of contributing risk factors will improve results either by treatment of such factors or by avoidance of high-risk patients. METHODS AND RESULTS: We analyzed 192 consecutive patients with AF undergoing three variations of the maze procedure performed simultaneously with correction of valvular diseases (n = 165), congenital anomalies (n = 19), isolated AF (n = 7), and ischemic disease (n = 1). Twenty-six preoperative factors and two postoperative cardiac size parameters were analyzed by multivariate analyses between patients with successfully ablated AF (n = 165) and those who remained in AF (n = 27) after the maze procedure. Among all factors, postoperative left atrial dimension was the most potent in predisposing patients to persistent AF. Duration of AF left atrial dimension, and cardiothoracic ratio were identified as preoperative risk factors, whereas modifications of the maze procedure and pathogenesis and location of underlying disease failed to have a significant prognostic impact on rhythm after surgery. Individual risk analysis using the three preoperative variables revealed that left atrial size reduction to normalize its dimension played a pivotal role in determining rhythm after the maze procedure. CONCLUSIONS: Results favor earlier performance of the procedure before these risk factors develop, after which omission of the procedure or extensive left atrial plication may be appropriate. This requires further study.
Adolescent↗
Serial doppler echocardiographic evaluation of bioprosthetic valves in the tricuspid position.
OBJECTIVES: This study sought to evaluate bioprosthetic valve dysfunction in the tricuspid position by serial Doppler echocardiography. BACKGROUND: Few reports on the long-term results of tricuspid valve replacement with bioprosthetic valves are evaluated by serial Doppler echocardiography. METHODS: Between September 1979 and December 1993, 95 patients underwent tricuspid valve replacement with bioprosthetic valves at our facility. Sixty patients who underwent serial Doppler echocardiographic examination at intervals of at least 2 years after operation were included in the final analysis. These patients were followed up from 1.5 to 13.0 years (mean 5.8 +/- 2.5). RESULTS: The actuarial rates of freedom from bioprosthetic valve stenosis and regurgitation at 10 years were 46% and 51%, respectively. The prevalence of bioprosthetic valve stenosis and regurgitation increased progressively in a linear manner beginning 1 or 2 years after tricuspid valve replacement. Right heart failure developed during follow-up in 20 of the 25 patients with bioprosthetic valve dysfunction. CONCLUSIONS: The long-term durability of bioprosthetic valves in the tricuspid position was substantially lower in our study than that reported in previous studies. Tricuspid bioprosthetic valve dysfunction increased progressively in a linear manner beginning 1 to 2 years after tricuspid valve replacement.
Actuarial Analysis↗
Rationale of the Cox maze procedure for atrial fibrillation during redo mitral valve operations.
OBJECTIVE: The frequency of reoperation for mitral valve diseases with chronic atrial fibrillation has increased steadily. This study examined the rationale for using the Cox maze operation for atrial fibrillation during redo mitral valve operations. METHODS: Between June 1992 and July 1995, we performed the maze procedure in 42 patients as a concomitant operation with redo mitral valve surgery (maze group). Associated procedures were tricuspid valve surgery in 27 patients and aortic valve surgery in 15 patients. The mean age at operation was 57.3 +/- 9.7 years, and the mean interval from the previous operation was 14.3 +/- 10.5 years. The mean follow-up period after the maze procedure was 25.5 +/- 10.8 months. Atrial fibrillation was present at the time of the previous operation in 29 patients (69%). RESULTS: Neither hospital death nor late death occurred. Sinus rhythm was regained in 28 patients (67%), and an atrial A-wave was detected in 21 patients (50%) by pulsed Doppler study. Patients in whom sinus rhythm was restored had a shorter history of atrial fibrillation (9.0 +/- 6.0 years vs 15.9 +/- 4.6 years, p = 0.0009), a larger f-wave on lead V1 of the electrocardiogram (0.18 +/- 0.10 mV vs 0.10 +/- 0.08 mV, p = 0.017), and a smaller cardiothoracic ratio (63% +/- 8% vs 67% +/- 5%, p = 0.049) than patients with persistent atrial fibrillation. During the same period, 54 patients underwent mitral valve reoperation without the maze procedure (control group). The aortic crossclamp and cardiopulmonary bypass times were slightly longer (p = 0.048 and p = 0.012) in the maze group (133 +/- 28 minutes and 221 +/- 43 minutes) than in the control group (126 +/- 65 minutes and 197 +/- 78 minutes). There was no significant difference in the amount of chest tube drainage or transfusion between the two groups (890 +/- 510 ml and 2120 +/- 1600 ml, respectively, in the maze group and 840 +/- 480 ml and 2140 +/- 1760 ml, respectively, in the control group). It was not necessary to reopen the chest for bleeding significantly more often in one group than in the other (14% in the maze group and 7% in the control group), and it was possible to operate without transfusion with the same frequency in the two groups (17% in the maze group and 20% in the control group). CONCLUSION: These results suggest that the maze procedure should be considered in selected patients who have a high possibility of regaining sinus rhythm during redo mitral valve operations.
Adult↗
Ten-year experience with the Carpentier-Edwards pericardial xenograft in the tricuspid position.
We reviewed the cases of 66 patients who underwent 67 tricuspid valve replacements with Carpentier-Edwards pericardial xenografts between April 1985 and January 1994. Average patient age at time of operation was 52 years (range 8 to 71 years). Concomitant mitral or aortic valve replacements were performed in 46 patients. There were 10 operative deaths and 6 late deaths. Actuarial survival at 9 years was 75.4% +/- 5.7%. Prosthetic valve endocarditis occurred twice in one patient. Reoperations for tricuspid regurgitation and for concomitant procedures (maze operation and repair for leak of the mitral prosthesis) were performed in two patients. In both cases, examination of the explanted prostheses showed that the tricuspid regurgitation was the result of nonstructural dysfunction caused by fibrous pannus formation on the cusps of the ventricular side. Among the survivors, 47 patients (92%) were in functional class I or II. Prosthetic valve function was studied by color Doppler echocardiography. Among 38 patients, tricuspid regurgitation more than grade 3/4 or transprosthetic gradient more than 5 mm Hg was found in 11. One patient had right heart failure and the others had no symptoms. In 10 years of experience with the Carpentier-Edwards pericardial xenograft, mortality and morbidity after tricuspid valve replacement were satisfactory. Echocardiographic examination revealed subclinical prosthetic dysfunction in 35% of patients who were followed up for longer than 5 years, however, and we believe that these patients should receive careful follow-up.
Adolescent↗