Search PubMed⌕ Search

Biomedical subjects

K Kosuga

Publications and source records attributed to K Kosuga.

At least 127 records · Page 7Linked to original sources
PubMed1990

Management of multiple cholesterol embolization syndrome--a case report.

A sixty-two-year-old man who underwent coronary angiography and received acute thrombolytic and anticoagulant therapy for acute myocardial infarction developed multisystemic injury, including renal insufficiency and cutaneous manifestations. Fundoscopic examination and skin biopsy specimen led to the diagnosis of multiple cholesterol embolization syndrome (MCES). Discontinuation of anticoagulants and administration of hemostatic (carbazochrome, tranexamic acid, reptilase, and vitamin K) and antihyperlipidemic (cholestyramine and probucol) drugs resulted in temporary improvement of cutaneous and renal disorders and extended survival for about one year. Besides severe aortic atherosclerosis, postmortem examination revealed numerous cholesterol emboli to multiple organs. MCES is a rare but serious complication of left heart catheterization and anticoagulant therapy, and the optimal treatment remains to be established. The authors suggest here that the above-mentioned therapy might be effective for management of MCES.

Anticoagulants↗
PubMed1990

Ultrastructural alterations of right and left ventricular myocytes in tetralogy of Fallot.

We examined the ultrastructure of right and left ventricular myocardial biopsies obtained prior to cardiopulmonary bypass in fourteen patients undergoing total correction of tetralogy of Fallot (TOF). Twelve patients were undergoing primary one-stage repair and two patients had had a previous Blalock-Taussig shunt operation. The ages of the patients ranged from 3 to 35 years. In left ventricular (LV) myocytes, the sarcolemma often formed pouches filled with mitochondria and the muscle fibers showed a disoriented arrangement. In addition, the myofibrils showed hypercontraction and the Z-bands were thickened; the degree of the myofibril contraction was more severe than that in right ventricular (RV) myocytes. These ultrastructural findings are similar to those observed in myocytes under hypoxic conditions. The number of lysosomes in LV myocytes, but not in RV myocyte increased in the older patients. While we have not established a causal relationship between the ultrastructural findings and clinical features in our cases, our observations are consistent with the possibility that early total correction of TOF may be required to prevent the development of hypoxic changes and degeneration of heart muscle.

Adolescent↗
PubMed1990

[Late postoperative results after repair of tetralogy of Fallot].

Two hundred and eighty two survivors after complete correction of tetralogy of Fallot were analyzed in late follow up periods. The method of the reconstruction of right ventricular outflow tract was non-transannular path (NTAP) in 110 patients and transannular patch in 172. In the group of TAP, pulmonary regurgitation occurred in all and the cardio-thoracic ratio was larger than the ratio in the group of NTAP (p less than 0.05). Postoperative ECG at rest showed complete right bundle branch block (CRBBB) in 224 patients and 6 of them showed sudden death in their follow up period. However, there were no sudden deaths in 41 patients without CRBBB. The rate of reoperation after intracardiac repair was 4.25% and the causes were residual pulmonary stenosis and residual ventricular septal defect, and there were no significant differences of the reoperation rate between NTAP-group and TAP-group.

Adolescent↗
PubMed1990

[Report of two operated cases with erythrocyte antibody].

Two operated cases with erythrocyte antibodies were reported. In the first case who required the second open heart operation for mitral stenosis, delayed hemolytic transfusion reaction by erythrocyte antibodies was recognized. The direct and indirect Coombs' tests were negative and the erythrocyte antibodies were not detected preoperatively. Massive blood transfusion during perioperative period precipitated secondary immunoreaction and reproduction of antibodies. An anti-c antibody and anti-E antibody were detected by the serologic studies on the 11th and 16th postoperative day. In the second case, stenotic mitral valve was replaced without homologous blood transfusion, because anti-C antibody was detected preoperatively. We believe that open heart operations without blood transfusion should be done, whenever possible, it should be kept in mind that delayed hemolytic transfusion reaction by erythrocyte antibody may occur after blood transfusion.

Coombs Test↗
PubMed1990

[Valve thrombosis of St. Jude Medical prosthesis; report of three cases].

Three cases with valve thrombosis of St. Jude Medical prosthesis (SJM valve) are reported. Incidence of valve thrombosis of SJM valve was 0.15%/patient-year. Cineradiography was useful to make the diagnosis. SJM valves were implanted with the hinges anatomically oriented in mitral position, and in both aortic and tricuspid positions with the leaflet opening parallel to the ventricular septum. Therefore, we recommend that SJM valve should be placed with the hinge antianatomically oriented in mitral position, and in both aortic and tricuspid positions with the leaflet opening to be perpendicular to the interventricular septum, respectively.

Adult↗
PubMed1990

[Four operated cases of traumatic tricuspid regurgitation].

Four cases of tricuspid regurgitation due to nonpenetrating chest trauma are presented. From five to twenty five years after the initial blunt chest trauma, they were admitted because of dyspnea or palpitation on exertion. In all cases echocardiogram showed severe tricuspid regurgitation and enlarged right atrium and ventricle. Cardiac catheterization revealed increased right atrial pressure with high v wave. At operation, their tricuspid valves or chordae tendineae were revealed ruptured without other valvular injury. Ruptured chordae tendineae of the anterior leaflet were in three cases and their valves were replaced with mechanical prosthesis. Tear of the anterior leaflet was in one case and it was sutured directly, but mild tricuspid regurgitation was left after the operation. Twenty cases have been reported in Japan up to date and fifteen of them have surgical treatment; tricuspid valve replacement (TVR) is performed in 10 cases, tricuspid valvuloplasty (TVP) is in 3 cases, suture of ruptured chordae tendineae is in 2 cases. Five cases are treated medically. How to diagnose and how to treat them are discussed. And, in the conclusion, we consider that the surgical treatment is recommended for the case of traumatic tricuspid regurgitation with uncontrollable heart failure.

Adult↗
PubMed1990

[Selection of a prosthetic valve for mitral valve replacement].

The early and the late results of mitral valve replacement were retrospectively evaluated to delineate the concept of selection of the prosthetic valve for the mitral position. The mitral valve was replaced with porcine bioprosthesis (P-B) in 102 patients and with St. Jude Medical prosthesis (SJM) in 341 patients between 1975 and 1987. Operative mortality was 5.3% for the SJM and 8.8% for the P-B group (N.S.). Cumulative duration of follow up was 1479.8 patient-years for the SJM and 888.9 patient-years for the P-B group. Actuarial survival rate was 90% for the SJM at 9 years and 81%, 76% for the P-B group at 10 and 13 years (N.S.). Freedom from valve-related death was 94% for the SJM at 9 years and 94% for the P-B at 13 years (N.S.). Thrombo-embolic complications occurred at an incidence of 0.47%/patient-years (p-y) for the SJM and 0.67%/p-y for the P-B group (N.S.). Freedom from prosthetic valve dysfunction due to primary tissue failure (PTE) lowered rapidly after the seventh postoperative year from 88% to 35% in the P-B group. Prosthetic valve dysfunction free rate was significantly lower in the P-B group compared with the SJM between the seventh post operative year and ninth postoperative year (p less than 0.01). From this analysis, we believe that the SJM prosthesis is suitable cardiac valve prosthesis to the mitral position.

Adolescent↗
PubMed1990

[Left atrial thrombosis after mitral valve replacement].

Thrombosis of the left atrium is a rare but troublesome complication of the mitral valve replacement (MVR). In our series of MVR, seven patients had thrombus formation of the left atrium late after MVR. These seven cases (LAT group) are compared with 53 cases (no LAT group), who are picked up randomly and have no thrombus of the left atrium after MVR, concerning to some risk factors. And the result is that the left atrial volume shows a significant difference between two groups among the risk factors. We consider that the cases with enlarged left atrium have a high risk of thrombus formation after MVR and so they also need a plication of the left atrium at the primary operation.

Adult↗
PubMed1990

[Surgical treatment of massive pulmonary embolism--the time of the operation and its effectiveness].

The records of 6 patients undergoing pulmonary embolectomy for massive pulmonary embolism (MPE) at Kurume University Hospital during 17 years were reviewed to determine the management of surgery. The patients consisted of 2 men and 4 women. The patients' ages ranged from 29 to 68 years (mean age, 49.3 years). The records showed that one patient died of brain death after operation and the others survived. All the patients complained of chest pain, anterior chest discomfort and dyspnea. Sudden syncope was observed in 2 patients. Artificial mechanical ventilation was performed preoperatively on 3 patients. Right ventricular load was demonstrated on electrocardiograms and ultrasonograms. Pulmonary angiograms were attempted on two patients and one of them had cardiac arrest during this examination. MPE was suspected by perfusion defect of 50% to 80% of pulmonary vasculature demonstrated on lung perfusion scintigram in 4 patients. Open pulmonary embolectomy with cardiopulmonary bypass (CPB) was performed on all patients using crystalloid cardioplegia and topical cooling. Intraoperative pulmonary angiograms were performed in 4 patients to prevent residual thromboemboli. Since most thromboemboli originate below the level of the vena cava, acute double ligation of the vena cava just below the renal vein was performed to control recurrent embolism. Oral anticoagulant, warfarin, was administered for 3 months after embolectomy as prophylaxis against postoperative recurrent embolism. It is our opinion that an aggressive attitude toward pulmonary embolectomy on CPB is necessary to save lives of MPE patients. This surgical procedure is very easy and safe.

Adult↗
PubMed1990

[Surgical treatment of supravalvular aortic stenosis].

Five surgically treated cases of supravalvular aortic stenosis were reported. Preoperative cardiac catheterization revealed marked left ventricular-aortic pressure gradient ranged from 20 to 180 mmHg (median, 80.2 mmHg) and retrograde aortogram showed localized (hourglass type) supravalvular aortic stenosis in all cases. A traditional diamond shaped patch aortoplasty was used to relieve supravalvular aortic stenosis in 1 case and an extended aortoplasty was used in last 4 cases. Pressure gradients were almost disappeared postoperatively with good surgical result. The extended aortoplasty is considered to be more reasonable than the traditional aortoplasty in relieving constriction symmetrically and restoring normal relationship of the aortic valve cusps and coronary ostia. The operative indication and selection of the operative procedures for supravalvular aortic stenosis were briefly discussed.

Adolescent↗
PubMed1990

[Arterial thrombosis associated with Crohn's disease: a case report].

In the English literature, only 27 cases of arterial thrombosis associated with Crohn's disease have been described. The present case appears to be the first reported case in the Japanese literature. A 43-year-old man was treated for intestinal obstruction caused by Crohn's disease and complicated by superior mesenteric vein thrombosis by surgical resection of 150cm of small bowel in June 1981. In March 1983, the right external iliac artery had become occluded and part of the left external iliac artery had assumed an irregular shape and the right ilio-femoral bypass surgery using PTFE was carried out. Three months later occlusive ileus reoccurred and angiograms showed that the superior mesenteric and right hepatic arteries had 30% and 20% stenosis respectively. Small bowel in 50cm in length was resected with subsequent administration of salicylazosulfapyridine at a dose of 3g per day. There was no reappearance of bowel symptoms. The patient again complained of numbness in the right leg in February 1988 and a left external iliac-right common femoral crossover bypass operation was carried out using a ringed 8mm Dacron graft. Intraoperatively, it was found that the left external iliac and the right common femoral arteries had intimal thickening but no atherosclerosis.

Adult↗
PubMed1989

[Clinical study of the effect to myocardial protection with crystalloid cardioplegic solution during open heart surgery in infants under age 3 months].

We investigated the effect to myocardial protection with crystalloid cardioplegic solution (Kurume solution I (S-I)) during open heart surgery in 21 infants less than 3 months old. The mortality was 28.6% (6 cases) including 2 patients having peroperative severe acidosis or shock. It was suggested that about half of them died of inadequate myocardial preservation. Comparing factors in the deaths with the survivors, there were significant differences between them in extracorporeal circulation time (ECCT) (196.7 +/- 50.1 min versus 133.2 +/- 45.8 min, p less than 0.01) and aortic-cross clamping time (ACCT) (120.0 +/- 45.8 min versus 78.3 +/- 30.5 min, p less than 0.05). In survivors, 86.7% of them required the effective dose (more than 6 micrograms/kg/min) of catecholamine and 33.3% presented low cardiac output syndrome (with the dose of more than 10 micrograms/kg/min and more than for 48 hours). The incidence of LOS was related to ECCT and ACCT. Thus it seemed that infant was more susceptible than older patient to the effects of ECC and the operation was carried out safely with ECCT less than 150 minutes and ACCT under age 3 months, it is necessary to use the cardioplegic solution fitting immature myocardium and to design operative technique and assist device for open heart surgery to shorten ECCT and ACCT.

Cardiac Surgical Procedures↗
PubMed1989

[Surgery for aortic aneurysms with coronary disease].

Between 1981 and 1988, 52 patients with dissecting aneurysms were operated and four of them (7.7%) had right coronary dissections that were repaired by Bentall's method with or without right coronary bypass grafting (CABG). Three (8.5%) of 35 patients with thoracic aneurysms had coronary disease. Among them, two had one vessel disease (1VD) and one had 2VD; two underwent temporary axillofemoral bypass grafting (AFBG) without CABG and one underwent extracorporeal circulation with CABG. Eight (5.6%) of 142 patients with abdominal aneurysms had coronary disease. They consisted of three patients with 1VD, two with 2VD and three with 3VD; their ejection fraction rates were 0.46 to 0.75. Three of them underwent temporary AFBG and one first underwent CABG but later underwent abdominal aortic graft replacement. In conclusion, patients with good coronary distal run-off and a low ejection fraction rate (under 0.5) should initially undergo CABG, but for those with poor run-off, temporary AFBG is better to prevent cardiac afterload.

Aged↗
PubMed1989

[Operative results of tricuspid valve replacement with St. Jude Medical prosthesis].

Since 1974, 14 patients underwent tricuspid valve replacement (TVR) with prosthetic heart valves. Hardy's operation was undergone in 2 patients with Ebstein's anomaly and mitral valve surgery or multiple valve surgery were undergone in 9 patients with rheumatic valvular disease, concomitantly. Four types of prosthetic heart valves were used in the tricuspid position, i.e. 2 Starr-Edwards prostheses, 1 Hancock xenograft, 1 Björk-Shiley prosthesis and 12 st. Jude Medical prostheses. The operative mortality rate was 14.3% (2/14) and 2 hospital deaths were due to low cardiac output syndrome. Twelve survivors have been followed with a maximum follow-up of 13 years and the mean of 4.7 years. There were 3 late deaths due to congestive heart failure and prosthetic valve endocarditis (PVE) of the aortic Björk-Shiley prosthesis. There was 1 PVE of the tricuspid Starr-Edwards prosthesis and 1 thrombosis of the tricuspid Björk-Shiley prosthesis, but no thrombosis and no other valve-related complications of SJM prostheses in the tricuspid position. The post-operative NYHA function class improved satisfactorily in 9 survivors. Judging from our relatively satisfactory post-operative results in TVR cases using SJM prostheses, SJM prosthesis in the tricuspid position is one of advisable prosthesis to get satisfactory hemodynamic improvement post-operatively.

Adult↗
PubMed1989

[A case report of double orifice mitral valve (DOMV) associated with incomplete endocardial cushion defect (ECD)].

A case of DOMV associated with incomplete ECD in a 17-year old girl is presented. Preoperatively, the mitral valve was suspected to have two orifice divided by the bridging tissue with sector echocardiography. DOMV is very rare congenital malformation, and 25 cases of DOMV are reported in Japan. Two of them were diagnosed as DOMV preoperatively with sector echocardiography. Sector echocardiography is useful to diagnose DOMV and to know the shape of it preoperatively.

Adolescent↗