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Biomedical subjects

K Kawachi

Publications and source records attributed to K Kawachi.

At least 91 records · Page 5Linked to original sources

Usefulness of interlocking detachable coil for embolization of the major aorto-pulmonary collateral artery: a case report.

A 5-yr-old male had undergone a right-modified Blalock-Taussig shunt operation at the age of 1 mo for stenotic patient ductus arteriosus and pulmonary atresia with ventricular septal defect. Before a corrective operation, the angiogram revealed one large major aorto-pulmonary collateral artery from the descending aorta to the right upper lung. Embolization of the major aorto-pulmonary collateral artery was successfully performed using interlocking detachable coils. This is the first reported case of embolization of the major aorto-pulmonary collateral artery using this device.

Angiography↗

Left atrial plication combined with mitral valve surgery in patients with a giant left atrium.

The benefits of performing left atrial plication during mitral valve surgery for patients with a giant left atrium were evaluated by analyzing the short- and long-term surgical results and changes in the left atrial dimension (LAD) and respiratory function of 30 patients. Of the 30 patients, 2 (7%) died of multiple organ failure on postoperative days 26 and 117, but no other deaths occurred during the mean follow-up of 5.9 +/- 2.1 years. Valve thrombosis was observed in one patient and cerebral complications with no residual deficit were observed in two patients, with a 9-year event-free rate of 87 +/- 7%. The LAD decreased significantly from 69.0 +/- 8.5 mm to 53.7 +/- 9.1 mm (P < 0.01) shortly after surgery, and this decreased was maintained even 5 years after surgery (53.3 +/- 11.4 mm). The cardiothoracic ratio decreased from 74.8 +/- 8.3% to 62.8 +/- 9.0% (P < 0.01) and the vital capacity of the lungs increased from 71.1 +/- 18.0% to 82.9 +/- 22.2% (P < 0.01). Thus, we conclude that performing left atrial plication during mitral valve surgery is safe and effective for patients with giant left atrium.

Adult↗

Usefulness of femoro(ilio)-axillar bypass surgery for the treatment of subclavian steal syndrome caused by aortitis syndrome.

In two patients with subclavian steal syndrome associated with aortitis syndrome, retrograde bypass grafting from the femoral or common iliac artery to the axillary artery resulted in the disappearance of symptoms. One patient, a 37-year-old female, was treated with a bypass from the left femoral artery to the left axillary artery with a 10-mm ring-supported double velour knitted Dacron graft. The other patient, a 54-year-old female, with the complication of moderate aortic regurgitation, was treated with a bypass from the left common iliac artery to the left axillary artery with an 8-mm EPTFE graft. These bypass grafts were angiographically confirmed to be patent after the operation. When changes in graft flow in different body positions (supine, sitting, and standing) were examined, using a transcutaneous Doppler flow meter, 5 years after the operation, resting graft flow to the upper extremities showed no consistent changes among the three different positions and was maintained in a stable condition, regardless of the patients' positions. Furthermore, graft flow increased while the left arm exercised. This finding, together with the clinical efficacy, indicates that this mode of retrograde bypass grafting may be effective in some selected patients with this complicated syndrome.

Adult↗

Systolic and diastolic function after patch reconstruction of left ventricular aneurysms.

Left ventricular function after patch reconstruction for postinfarction left ventricular aneurysms is largely unknown. In this study, 16 patients with an anteroseptal-lateral left ventricular aneurysm were treated by reconstruction of the left ventricle using a Dacron patch. Coronary artery bypass grafting was performed concomitantly in 9 patients. The size of the patch used was 57% +/- 19% of the resected myocardial scar area, including the sewing cuff area to be sutured. In these patients, the ejection fraction increased significantly from 0.28 +/- 0.12 to 0.39 +/- 0.12 (p = 0.007) at rest and from 0.32 +/- 0.14 to 0.41 +/- 0.10 (p = 0.008) during exercise. The left ventricular end-diastolic pressure and left ventricular end-diastolic volume index were reduced significantly from 14 +/- 7.0 to 8 +/- 3.2 mm Hg (p = 0.032), and from 178 +/- 116 to 92 +/- 21 mL/m2 (p = 0.016). The peak filling rate was improved significantly from 1.2 +/- 0.47 to 1.8 +/- 0.6/s (p = 0.048) postoperatively. The ratio of the peak flow velocity during the atrial kick phase to the peak flow velocity in the rapid filling phase, at the level of the mitral valve, improved (p = 0.016) after operation and remained improved up to 16 to 24 months after operation. Patch reconstruction of the left ventricle resulted in the recovery of systolic and diastolic function soon after operation, which has persisted into the late postoperative period.

Blood Pressure↗

Effect of warm ischemia and cryopreservation on cell viability of human allograft valves.

Fibroblast viability of the allograft valve leaflet has been suggested to affect clinical durability. Warm ischemic time is thought to be one of the critical determinants of cell viability. We assessed cell viability of allograft valves by flow cytometry, using a fluorescein diacetate-propidium iodide stain to characterize the effects of warm ischemia and cryopreservation on viability. Twelve human pulmonary valves with harvest-related warm ischemic times (range, 70 to 520 minutes; mean +/- standard deviation, 225 +/- 157 minutes) were studied by flow cytometry. We assessed cell viability of the allograft valve leaflets before and 30 days after storage. A significant negative correlation was found between warm ischemic time (x minutes) and cell viability (y%) before (y = -0.024x + 96.7; r2 = 0.62; p = 0.002) and after 30 days of storage (y = -0.036x + 94.0; r2 = 0.86; p = 0.001). Cell viability of the cryopreserved allograft valves was well preserved (> 70%) with a warm ischemic time less than 520 minutes (8.7 hours).

Adult↗

Size-reduced cryopreserved pulmonary valve allograft for an RV-PA conduit: technical modification and functional evaluation.

Cryopreserved pulmonary allografts harvested from adults at the time of kidney donation were size reduced and used in two children with pulmonary atresia and ventricular septal defect. A technical modification for the creation of size-reduced pulmonary allograft conduits is described. Postoperative ultrasonic and cineangiographic assessments revealed excellent function of the pulmonary bicuspid valved conduit with a minimal pressure gradient and essentially no regurgitation. Although the long-term fate of cryopreserved bicuspid pulmonary valve and conduit is unknown, this conduit provides excellent handling characteristics that render allograft conduits preferable to synthetic conduits. In addition, the remodeled bicuspid pulmonary allograft conduits have exhibited excellent hemodynamic characteristics and are a reasonable alternative to other types of conduits when an appropriate size allograft is not available.

Adult↗

[Konno's operation for residual aortic stenosis following Nick's operation--a case report].

A 43-year-old woman successfully underwent the Konno's operation as a reoperative procedure for residual aortic stenosis following the Nicks' operation. The patient had had congenital valvular and subvalvular aortic stenosis and a patent ductus arteriosus previously divided. At age 33, she had undergone the Nicks' operation (posterior ring enlargement) and aortic valve replacement with a 19 mm Bicer valve prosthesis 9 years 6 months prior to the reoperation. The preoperative left ventricular-aortic pressure gradient was 120 mmHg which decreased but remained about 60 mmHg after the Nicks' procedure. The patient again developed heart failure and frequent episodes of atrial fibrillation which required repeated hospital admissions. Approximately 10 years following the original procedure, the Konno's operation (anterior ring enlargement) was performed using a 23 mm St. Judes Medical aortic prosthesis to manage residual aortic stenosis. The postoperative course was uneventful and the left ventricular-aortic pressure gradient reduced to 16 mmHg. We conclude that the Konno's operation can be safely performed for residual aortic stenosis following the Nicks' operation.

Adult↗

[Rest and exercise performance of allografts, Bicer valves and St. Jude Medical valves in the aortic position].

Cardiac catheterization was performed to measure pressure gradients and hemodynamic parameters at rest and during supine bicycle exercise in 37 patients with aortic valve replacements, using allograft valves. Bicer prosthetic valves and SJM prosthetic valves of 19 to 27 mm diameter. Fourteen patients had an allograft valve replacement, 17 a Bicer valve, and 6 a St. Jude Medical valve. Patients were comparable for age, valve size, body surface area and left ventricular systolic function. There were no statistical differences among three groups for body surface area, left ventricular end-systolic and end-diastolic volume indices, exercise cardiac index, exercise heart rate, or workload achieved. In all 37 patients left ventricular and ascending aortic pressures were measured simultaneously according to the Brockenbrough method. In a 21 mm valve size, the mean pressure gradient was higher for Bicer and St. Jude Medical prosthetic valves than for allograft valves, both at rest (8.0 +/- 3.5 mmHg for Bicer, 5.0 +/- 1.4 mmHg for St. Jude Medical versus 0 +/- 0 mmHg for allograft; p < 0.05) and during exercise (11.0 +/- 4.9 mmHg, 10.0 +/- 2.8 mmHg versus 0 +/- 0 mmHg, respectively: p < 0.05). In a 23 mm size, there were no significant differences among three groups for resting mean pressure gradient, but during exercise the mean pressure gradient was higher for Bicer and St. Jude Medical prosthetic valves than for allograft valves (8.4 +/- 9.3 mmHg, 5.5 +/- 4.4 mmHg versus 0 +/- 0 mmHg; p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

[Morphological examination of the lung tissue ablated with Nd;YAG laser in the treatment of bullous pulmonary disease].

We conducted a morphologic examination of ablated pleurae and bullae to assess the efficacy of Nd;YAG laser irradiation to the lung tissue for the treatment of bullous pulmonary disease. Pleurae and bullae from surgically resected lung tissue to treat pulmonary carcinoma were ablated using a Nd;YAG laser at a power of 10 watts and 1.5 seconds within a 1-centimeter-diameter circle (about 0.2 joule/cm2). Samples were analyzed by light microscopy and scanning electron microscopy. Nd;YAG laser irradiation caused elastic fiber-contraction and gel from collagen both in pleurae irradiated once and in bullae irradiated three times. We conclude that Nd;YAG laser irradiation can be applied to ablate pleurae and bullae into a tight and continuous structure which is important in preventing air leak from the pulmonary parenchyma.

Emphysema↗

[Surgical repair of bilateral atrioventricular valves in corrected transposition of the great arteries].

The patient was a 50-year-old man who had an SLL-type corrected transposition of the great arteries (C-TGA) accompanied by significant regurgitation of the bilateral atrioventricular valves, atrial septal defect (ASD), persistent left superior vena cava, atrial fibrillation, and ventricular extrasystoles. The systemic tricuspid valve was repaired with a 28 mm Carpentier-Edwards ring (C-E ring) for the mitral valve, while the systemic mitral valve was repaired with a 32 mm C-E ring for the tricuspid valve. Simultaneously, the associated ASD was closed. Although mild tricuspid valve regurgitation persisted postoperatively, his general condition greatly improved. The report of valve repair for both atrioventricular valves in C-TGA is rare, and only 6 such cases have been reported in the Japanese literature.

Heart Valve Prosthesis↗

Efficacy and limitation of a left ventricular assist system in a patient with dilated cardiomyopathy accompanying multi-organ dysfunction.

A left ventricular assist system (LVAS, Toyobo CO., LTD., Japan) was used to provide life support for 190 days in a 44-year-old male patient with end-stage dilated cardiomyopathy. Before LVAS implantation, heart failure and cardiogenic shock with multi-organ dysfunction progressed despite the use of intra-aortic balloon pumping (18 days), mechanical ventilatory support (15 days), continuous veno-venous hemofiltration (two days) and intravenous administration of catecholamines. Before LVAS implantation, the patient had marked hepatic and renal dysfunction (total bilirubin 6.1, BUN 73 and serum creatinine 3.1 mg/dl). Those functions returned to normal (total bilirubin 1.2, BUN 11 and serum creatinine 0.6 mg/dl) one month after implantation. He was complicated by multiple cerebral embolisms occurring on the 9th, 57th and 175th postoperative days and died 190 days after surgery. Autopsy showed thrombi attaching to the diaphragm of the blood pump and multiple embolisms in the kidney and the spleen. By scanning electron microscopic examination, initial thrombi with attached erythrocytes were seen on the diaphragm surface without intimal lining formation. In conclusion, LVAS support can be useful for patients with end-stage heart disease complicated by multi-organ dysfunction. However, the LVAS may cause thromboembolic complications over the prolonged use.

Adult↗

Percutaneous transluminal coronary angioplasty of the left internal thoracic artery graft: a case report in a child.

A 9-year-old girl who had undergone previous coronary artery bypass surgery at the age of 3.5 years for stenoses of the left anterior descending and right coronary arteries resulting from Kawasaki disease presented with recurrent exertional angina. Stenosis was found at the anastomosis of the left internal thoracic artery to the left anterior descending artery. Percutaneous transluminal coronary angioplasty was successfully performed. This is the first reported case of percutaneous transluminal coronary angioplasty of an internal thoracic artery graft in a child.

Angioplasty, Balloon, Coronary↗

Intravenous leiomyomatosis extending into the right atrium.

Intravenous leiomyomatosis, also called benign leiomyoma, is a rare tumour that originates from a uterine myoma and spreads intravenously. A 54-year-old woman who had experienced faintness after a hysterectomy for uterine myoma 10 years earlier presented with this lesion. Ultrasonographic, computed tomographic and angiographic examination revealed a long tumour that originated in the uterus and extended into the right atrium through the right internal iliac vein and inferior vena cava. On the basis of a diagnosis of intravenous leiomyomatosis the neoplasm was extirpated by a one-stage cardiotomy and laparotomy with the aid of cardiopulmonary bypass. Retrospective histological analysis of the excised uterus revealed tumorous thrombosis in the venous cavity of the tunica muscularis. Some 26 cases in which open-heart surgery has been undertaken for intracardiac tumour thrombosis have been reported. These and the case described here are reviewed and analysed. In the present case, a full view of the tumour was obtained before surgery, and the lesion removed by a one-stage procedure using median sternotomy (cardiotomy) and laparotomy. Reports of one-stage procedures are few; only eight (30%) of 27 cases.

Cardiopulmonary Bypass↗

[Mitral annuloplasty for mitral regurgitation due to dilated cardiomyopathy--a case report].

A 74-year-old woman who had had severe mitral regurgitation (MR) due to dilated cardiomyopathy (DCM) was referred to our hospital for surgical management because she had suffered from congestive heart failure (CHF) of NYHA functional class IV in spite of maximal medical treatment. We have successfully performed mitral annuloplasty (MAP) using a Carpentier annuloplasty ring. Her postoperative course was good and her symptom improved to NYHA functional class II to III one year after the operation. However, the left ventricular functional improvement was minimal. The regurgitant fraction decreased from 0.62 to 0.11 after the operation but the left ventricular ejection fraction also decreased from 0.26 to 0.11. We had an impression that MAP could be considered as one of the procedures for severe MR due to DCM, if CHF was not controlled by any medications.

Aged↗

[Reoperative coronary artery bypass grafting in patients with patent internal thoracic artery grafts].

The incidence of reoperative coronary artery bypass grafting (reCABG) is recently increasing. However, there has been no report of reCABG in patients with patent internal thoracic artery (ITA) grafts in Japan. We performed reCABG in three such patients with patent ITA grafts. The first patient was a 49-year-old male who had undergone a 2 CABG (left ITA-LAD, SVG-DX 1), 8 years and 7 months prior to the 2nd operation, he received a re 2 CABG (GEA-RCA, RITA-SVG-DX 1) with a patent prior LITA-LAD graft. The second patient was a 65-year-old female who had undergone CABG in which the LITA had been erroneously anastomosed to the DX 2 in place of the LAD. Three year later, the reCABG (RITA-LAD) was performed with a patent prior LITA-DX 2 graft. The third patient was a 51-year-old male who had undergone 3-CABG (RITA-LAD, LITA-DX, SVG-RCA). The RITA was closed most probably due to technical errors and his angina recurred. Tree year after the first operation, he received a re 3-CABG (GEA-LAD, SVG-RCA, SVG-OM) with a patent prior LITA-DX graft. In each patient, PTCA had been tried twice, twice and once prior to redo operations. Their post-redo courses were uneventful, and they were discharged free from angina. In such cases it is important to manage with care the patent ITA grafts at reoperation. Biplane ITA angiograms are quite helpful to evaluate the course of grafts in relation to the sternum. To cover the ITA graft with a GORE-TEX membrane may also be useful for easy identification of the graft at redo operations.

Aged↗

[Efficacy of GRF (gelatin-resorcin-formalin) glue on surgery for type A aortic dissection].

The tissue biological adhesive GRF glue has been used in our department to have dissected aortic layers adhered and to reinforce the dissected aortic stumps during surgery for aortic dissection. From May 1992 to August 1993, 12 patients were operated for type A aortic dissection; 4 patients with acute dissection and 8 patients with chronic dissection. There were 5 men and 7 women whose ages ranged from 51 to 69 years with an average of 60.6 years. Replacement of the ascending aorta alone was performed for 6 patients. Replacement of both the ascending aorta and transverse arch was carried out for 4 patients, and replacement of the ascending aorta, transverse arch and the descending aorta was accomplished in 1 patient. Primary repair was performed for 1 patient with intraoperative acute dissection that occurred during surgery for mitral valve. There were no operative or hospital deaths. Preoperative aortic regurgitation was present in 5 patients. Following gluing the aortic root dissection, aortic regurgitation disappeared in all patients confirmed by postoperative aortograms. The use of GRF glue significantly reduced the average amount of intraoperative bleeding from 2893 ml to 1169 ml and also significantly reduced the use of Teflon felt strips for the proximal anastomosis. We believe that use of GRF glue can improve the surgical outcome for acute and chronic aortic dissection.

Aged↗

[Myocardial protection during multiple coronary artery bypass grafting--a comparison of antegrade and combined antegrade-retrograde cardioplegia].

We compared the effectiveness of antegrade cardioplegia (A group, 100 cases) and combined antegrade-retrograde cardioplegia (A + R group, 66 cases) on myocardial protection in patients undergoing coronary artery bypass grafting for more than 3 vessels. The two groups were similar in patients' age, the extent of coronary artery diseases and preoperative risk factors, cardiac output and ejection fractions. The mean number of grafts was 3.3 in A group and 3.6 in A + R group (p < 0.05). The mean number of ITA grafts used was 1.2 in A group and 1.4 in A + R group (p < 0.05). Aortic cross-clamp time was 114 minutes in A group and 138 minutes in A + group (p < 0.01). The serum CK-MB concentration on postoperative day 1 was 38 IU/L in A group and 25 IU/L in A + R group (p < 0.05). The left ventricular stroke work index 3 hours after reperfusion was 33 gm min/m2 in A group and 43 gm min/m2 in A + R group (p < 0.05). The maximum dose of catecholamine required was similar in two groups. Intra-aortic balloon pump was used in 11 patients (11%) in A group and in 2 patients (3.6%) in A + R group (p < 0.05). We conclude that the combined method of intermittent antegrade and continuous retrograde perfusion of cardioplegic solution provides better myocardial protection than intermittent antegrade cardioplegia alone for multivessel coronary artery bypass surgery.

Aged↗