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Biomedical subjects

K Hisatomi

Publications and source records attributed to K Hisatomi.

At least 37 records · Page 2Linked to original sources
PubMed1999

Effectiveness of preoperatively obtained autologous platelet concentrates in open heart surgery.

BACKGROUND: Autologous blood components have been widely introduced in open heart surgery. However, the effectiveness of autologous platelet products remains controversial. METHODS: Autologous platelet concentrates (PC) were collected from patients (n = 35) scheduled for primary valvular heart surgery 1 to 3 days before the operation and were transfused immediately after cardiopulmonary bypass. Blood loss and platelet-related factors were compared with the control patients who had no PC (n=35). RESULTS: There were no serious complications in harvesting, preservation, and transfusion of autologous PC. The maximal platelet aggregation response significantly improved after its transfusion and tended to be higher with autologous PC stored 1 day than with ones stored 2-3 days. Activation of coagulation and fibrinolytic factors did not significantly differ between the groups. Postoperative blood loss was significantly less in autologous PC group, and seemed to have a negative correlation with platelet aggregation response. CONCLUSIONS: Autologous PC can be safely prepared and are clinically effective in reduction of postoperative blood loss in open heart surgery.

Aged↗
PubMed1998

Penetrating atherosclerotic ulcers in an abdominal aortic aneurysm: report of a case.

We report the case of a 74-year-old man found to have an extensive intramural hematoma (IMH) in the infrarenal abdominal aorta during a follow-up imaging study performed after repair of a DeBakey type II aortic dissection with an aortic arch true aneurysm. Enhanced computed tomographic scan and angiography revealed an extensive IMH and multiple penetrating atherosclerotic ulcers in the abdominal aorta. The patient underwent a successful replacement of the affected abdominal aorta using a collagen-impregnated woven Dacron graft. Atheromatous ulcers are known to occur frequently in patients with advanced atherosclerosis. Hence, the elderly hypertensive patient, being at high risk of developing a variety of aortic disorders, requires careful follow-up imaging studies to assess the aorta on a regular basis.

Aged↗
PubMed1998

Coronary artery aneurysm repaired with saphenous vein patch plasty.

The presence of atherosclerotic coronary artery aneurysms is not always considered to be an operative indication. However, progressively expanded coronary artery aneurysms may have the potential for complications such as rupture or embolism. We present a case of successful repair of a coronary artery aneurysm located above the first septal perforator in the left anterior descending coronary artery using a saphenous vein patch and simultaneous construction of a right gastroepiploic artery graft to the occluded right coronary artery. Follow-up angiography at 6 months after operation revealed complete disappearance of the aneurysm with no luminal stenosis and a preserved large septal branch. The right gastroepiploic artery graft was also found to be widely patent.

Coronary Aneurysm↗
PubMed1998

Intramural hematoma of the thoracic aorta.

OBJECTIVE: This study was designed to clarify the optimal treatment mode of patients with intramural hematoma (IMH) of the thoracic aorta. METHODS: From 1992 through 1997, 51 patients underwent surgical repair or medical treatment of IMH of the thoracic aorta. There were 36 male and 15 female patients, aged between 49 and 79 years with a mean of 67 years. The ascending aorta and/or aortic arch was involved in 18 patients (group I), whereas the descending thoracic aorta was affected in 33 (group II). The presence of intimal disruption in IMH was confirmed in 10 of group I and 13 of group II patients. RESULTS: For group I patients 13 required aortic arch repairs and the remaining 5 underwent conservative therapy including anti-hypertensive medication. Primary indications for immediate surgery were: cardiac tamponade in 5 patients, aortic dissection superimposed on IMH in 2, and persistent pain with an aortic arch aneurysm in 1, respectively. Early elective operations were done for enlarged ulcer in 3 patients and aneurysmal dilatation in 2 of which 1 had a coexisting aortic arch aneurysm. The 2-year survival rate after diagnosis was 94% with an operation-free rate of 25%. Nine of the group II patients experienced surgical intervention of which 8 had intimal disruption, 4 patients received urgent replacement of the descending thoracic aorta for massive pleural effusion and 1 had the aortic arch replaced for a coexisting aneurysm with persistent pain. All other patients underwent conservative treatment and 4 of them had to be shifted to early surgery during the initial hospitalization because of an enlarged ulcer. The 5-year survival rate in group II patients was 63% with an operation-free survival rate of 66%. CONCLUSIONS: On the basis of our experience early operation is recommended for almost all patients with ascending aortic IMH, and medical therapy for those with descending aortic involvement unless complication developed. However, the presence of intimal disruption may require early surgical treatment even in the patients with descending thoracic IMH.

Aged↗
PubMed1998

Bilateral thoracotomy for coronary artery bypass grafting in a patient with unfavorable median sternotomy.

In this report, we describe a patient who underwent coronary artery bypass grafting (CABG) through bilateral thoracotomy and distal median sternotomy, because he had received terminal tracheotomy as a treatment to prevent aspiration pneumonia due to Wallenberg's syndrome. On the first day after the terminal tracheotomy, he suddenly complained of severe anterior chest pain. Emergency coronary angiogram revealed complete occlusion of the proximal right coronary artery (RCA), severe stenosis of the left anterior descending artery (LAD) and the large first diagonal branch. Catheter intervention for RCA was attempted but it was unsuccessful, and therefore he was required to have urgent operation. The patient had received total laryngectomy and terminal tracheotomy two weeks before urgent CABG, and the large hole of the tracheotomy was just placed above the incisura juglaris of the sternum. So high risks of sternal infection and severe mediastinitis after ordinary median sternotomy were considered and we applied the bilateral thoracotomy approach. To our knowledge, this is very rare but effective approach to vascularize both right and left coronary artery and to use both left internal thoracic artery (LITA) and gastroepiploic artery (GEA) graft. It seemed that this approach is safe and effective for cardiac surgery in such situations that median sternotomy is not favorable as in the described patient or in patients having reoperation.

Coronary Angiography↗
PubMed1998

[Late results of emergency operation in acute type A dissection].

77 cases of acute type A dissection underwent emergency operation during 5 years were studied. There were 37 men and 40 women, and 58 cases in type I, 19 cases in type II on DeBakey type. The grafting for the aorta including the tear was basically performed under selective brain perfusion and deep hypothermic circulatory arrest. The overall hospital mortality rate was 24.7%. However, it was 14% after using GRF glue. The overall actuarial survival rate for 58 patients who survived operation was 87% at 5 years after surgery. Late remnant false lumen-related complications were recognized in four patients (6.9%). For two of them, subsequent operations were performed. Another two patients died of rupture of remnant false lumen during observation. Aortic valve regurgitation was recognized preoperatively in 13 patients. None of them required subsequent operation in late phase. Results and countermeasure for late remnant false lumen-related and aortic valve-related complications were investigated.

Acute Disease↗
PubMed1998

Congenital bicuspid aortic valve: analysis of 63 surgical cases.

BACKGROUND AND AIMS OF THE STUDY: This study reports the clinicopathologic characteristics of congenital bicuspid aortic valves necessitating surgical intervention. METHODS: Among 374 aortic valve procedures during the past 15 years, 63 cases of bicuspid aortic valve were encountered. Patients included 45 males and 18 females; mean age was 53 years (range: 14 to 76 years). RESULTS: Thirty-two patients demonstrated aortic stenosis (AS), 27 aortic regurgitation (AR), and four had both conditions. Patients with AR were significantly younger than those with AS (45 +/- 13 versus 60 +/- 11 years; p < 0.01). Histologic study of the excised valve disclosed severe myxoid degeneration in 16 of 27 patients with AR. These patients underwent surgery at a younger age than the other 11 with calcification and endocarditis (40 +/- 13 versus 52 +/- 10 years; p = 0.01). Based on the macroscopic appearance, the lesions were divided into those with (n = 38) and without (n = 25) raphe. Twenty-one patients (55%) in the former group demonstrated AR, whereas 19 (76%) in the latter group demonstrated AS. Patients with raphe were significantly younger at the time of surgery than those without raphe (50 +/- 15 versus 57 +/- 11 years; p = 0.02). As a complication, ascending aortic aneurysm was observed in six patients. CONCLUSIONS: In a bicuspid aortic valve, calcification with stenosis commonly occurs in most older patients. However, in some young adult patients with raphe, AR may result from myxoid degeneration. The presence of raphe in the bicuspid valve appears to have a significant influence on valve hemodynamics.

Adolescent↗
PubMed1997

Coronary artery revascularization concomitant with vascular surgery.

Patients with vascular disease and coronary disease are usually treated initially by coronary artery bypass grafting (CABG), and vascular surgery is generally performed later. In this study we assessed the feasibility of combined CABG and vascular surgery in a single operation. Between 1988 and 1995, 16 patients received combined operations for vascular and cardiac lesions and the clinical results were assessed. There were no operative or hospital deaths. The mean time for operation was 421 min and the duration of the stay in the intensive care unit (ICU) was a mean of 3.6 days. In one patient with an ischemic left leg, the left internal thoracic artery (ITA) had become a collateral source of the ischemic leg, and the need for preoperative angiography of the ITA in such patients was indicated. The combined operation clearly takes longer than either vascular surgery or CABG alone, but the length of the postoperative intensive care unit stay was essentially the same as that after a single operation and the patient was still managed safely after the combined operation. In patient requiring both operations, the combined procedure therefore appears to be safe and to have a good clinical outcome.

Aged↗
PubMed1997

Traumatic pancreatic duct rupture in a child diagnosed by endoscopic retrograde pancreatography.

We report on a child who sustained blunt abdominal trauma with pancreatic duct rupture diagnosed by preoperative endoscopic retrograde pancreatography (ERP). Duct laceration remained undiagnosed by computerized tomography or ultrasonography. Preoperative ERP is the only known method for the accurate diagnosis of injury to main pancreatic duct. Even in children with pancreatic trauma we recommend ERP before any surgery is attempted to help in decisions on operative strategy.

Abdominal Injuries↗
PubMed1997

Hemodynamic performance of the St. Jude Medical Hemodynamic Plus valve.

The hemodynamic performance of the St. Jude Medical Hemodynamic Plus valve (HP) for a small aortic annulus was compared to that of the standard St. Jude Medical valve (SJM). Doppler echocardiographic parameters were evaluated in patients undergoing aortic valve replacement with either a 19 mm HP (HP19, n = 7), a 21 mm HP (HP21, n = 8), a 19 mm SJM (SJM19, n = 16), or a 21 mm SJM (SJM21, n = 34). The peak and mean pressure gradients and peak flow velocity were significantly (p < 0.05) lower in both patients with the HP21 and those with the HP19 than patients with the SJM21 and those with the SJM19, respectively. The echocardiographic parameters of the patients with the HP19 corresponded closely to those of patients with the SJM21. The left ventricular mass index regressed markedly in patients with the HP19 during the late postoperative period. The results suggested that the hemodynamic performances of certain sizes of the HP were superior to those of the same size SJMs and were considered to be equivalent to those of the next size larger SJM.

Adolescent↗