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Biomedical subjects

K Kosuga

Publications and source records attributed to K Kosuga.

At least 145 records · Page 8Linked to original sources
PubMed1989

[Four successfully operated cases of ball thrombus in the left atrium].

The authors report four cases of the left atrial ball thrombus associated with mitral stenosis. Three of four which had floating ball thrombus in the left atrium presented with syncopal attacks and systemic embolism. Echocardiography was the most effective method for preoperative diagnosis of ball thrombus in the left atrium and mitralstenosis. After having accurate diagnosis of ball thrombus in the left atrium by echocardiogram, all of cases were treated urgently with removal of the thrombus and mitral valve replacement or mitral commissurotomy. During operation, the head down position and slight right lateral position had been maintained to prevent the impaction of the ball thrombus into mitral valve orifice and the immediate cardiopulmonary bypass by ascending aortic, superior and inferior venous cannulation were placed through midsternal splitting incision. Because of high frequency of peripheral embolism and sudden death, left atrial ball thrombus should be recommended to be removed urgently.

Aged↗
PubMed1989

[A case report of successful surgical treatment of fungal endocarditis].

A successfully treated case of fungal endocarditis for native aortic and mitral valves was reported. A 56-year-old male was admitted with high fever, dyspnea on exertion and oliguria. Infective endocarditis, urinary tract infection and acute renal failure were most suspected by findings of physical examination and urinalysis, but repeated blood cultures were sterile. In the course of treatment for urinary tract infection, high fever and leucocytosis recurred and then blood cultures were positive for Candida parapsilosis. Despite intensive antifungal therapy, blood cultures were consistently positive for Candida parapsilosis. Echocardiogram showed vegetation on the aortic and mitral valve. Aortic and mitral valve replacements with prosthetic heart valves were carried out on April, 1986. Cultures of the vegetation on the mitral valve revealed Candida parapsilosis. Intensive administration of antifungal drug was done postoperatively. Postoperative course was uneventful and he was discharged in excellent condition on the 84th postoperative day. During follow-up period of 1 year, the patient has been doing very well and there were no sign of recurrence of fungal infections.

Aortic Valve↗
PubMed1989

[A case report of aortitis syndrome with massive aortic regurgitation (AR), and ostial stenosis of the right coronary artery].

A 55-year-old female with massive aortic regurgitation and ostial stenosis of the right coronary artery due to aortitis syndrome was reported. The patient was admitted to the hospital with anterior chest pain and dyspnea on exertion. Retrograde aortogram showed massive aortic regurgitation and selective coronary angiogram revealed ostial stenosis of the right coronary artery. She was treated with aorto-coronary bypass (A-C bypass) and aortic valve replacement (AVR) with St. Jude Medical prosthetic valve. At operation, ostial stenosis of the right coronary artery due to aortitis syndrome was confirmed. Aortic valve replacement with a prosthetic valve and saphenous vein grafting to the distal right coronary artery were performed. Steroid therapy was started immediately after the operation. She recovered well and no complications was recognized after the operation.

Aortic Arch Syndromes↗
PubMed1989

[Operation methods and results in repeated open heart surgery for acquired valvular disease].

Fifty-six patients who underwent repeated open heart surgery for acquired valvular disease are presented. Their mean ages were 48 years and mean interval between initial and second operation were 6 years. Preoperative functional status (NYHA) were class II in 11, class III in 40 and class IV in 5. The indications for repeated open heart surgery were mitral re-stenosis in eight, mitral and aortic regurgitation after valvuloplasty in 26, artificial valve failure in 32, perivalvular leakage in 2, left atrial thrombus formation in 1 and aggravation of rheumatic changes of non-operated other valves in 3. Dissection of adhesive tissue around the heart was limited to the aortic root for prevention of cardiac injuries and minimizing bleeding. In all cases, myocardial protection was achieved with intermittent infusion of cold crystalloid cardioplegic solution with topical myocardial cooling during single period of aortic clamping. Adequate left ventricular hypothermic protection was obtained by cold physiological saline that was filled in left pleural cavity. Postoperative low cardiac output syndrome was developed in only 2. Three patients (5.4%) died of left ventricular rupture and of multiple organ failure within thirty days and 4 patients (7.1%) died of prosthetic valve endocarditis, cerebral bleeding and sudden death in late follow-up periods. These results suggested that the operative mortality and morbidity for repeated valve surgery with the aid of cardiopulmonary bypass was not different from that for initial valve surgery. So we believe that repeated open heart surgery for acquired valvular disease should be done prior to deterioration of patient's clinical condition.

Adult↗
PubMed1989

Changes in lymphocyte subsets, mitogen responsiveness, and interleukin-2 production after cardiac operations.

We studied 104 patients after cardiac operations to search for changes in peripheral blood lymphocyte subsets, mitogen responsiveness, and interleukin-2 production. Mononuclear cells obtained from 10 patients with cholecystectomy were examined as control samples. Cultures for phytohemagglutinin and interleukin-2 production were incubated in microtiter plates for 24 hours with cells labeled with tritium thymidine used as target cells. Lymphocyte subsets were measured by using monoclonal antibodies. The results obtained with preoperative blood samples were compared with those from the first, third, and seventh days after operation. In patients having cardiac operations, mitogen responsiveness was low on both the first and the seventh days after operation and interleukin-2 production was markedly depressed (greater than 90% depressed) on the first postoperative day. However, in control samples from patients having cholecystectomy, lymphocyte subsets, mitogen responsiveness, and interleukin-2 production showed no significant changes. Improvement in interleukin-2 production occurred immediately in patients without blood transfusion from random donors and reached normal levels by postoperative day 3. However, interleukin-2 production remained depressed on day 3 in all patients with transfusion from random donors and remained significantly diminished even on day 7 in such patients in New York Heart Association classes III and IV. We conclude that heart operations for which cardiopulmonary bypass is used are associated with depression of cellular immunity, including interleukin-2 production. Furthermore, it appears that both blood transfusion from random donors and the general preoperative condition of the patients contribute to suppression of measures of cell-mediated immunity.

Adult↗
PubMed1989

[Cineradiographical significance for diagnosis and treatment of thrombosed Björk-Shiley prosthesis in the aortic position].

In the periods between February 1973 and December 1987, 377 Björk-Shiley valve prostheses have been implanted in the aortic position in our institute. The maximum opening angle of the prosthesis have been cineradiographically measured in 30 cases. The maximum opening angle of the convexo-concave valve having an opening angle of 60 degree (CC 60) was measured as 58.8 +/- 1.9 degree and that of the monostrut valve having an opening angle of 70 degree was 69.4 +/- 2.1 degree. During this period we have experienced 6 cases of thrombosed Björk-Shiley prosthesis. They have shown restriction of the opening from 26 to 58.9 degree and restriction of the closing from 9.2 to 41.8 degree. Thrombolytic treatment was successful in case with thrombosed Björk-Shiley prosthesis which showed restriction of the opening angle on cineradiogram. 4 cases with restriction of the closing angle on cineradiogram were treated operative thrombectomy. Three of them have had uneventful reoperative course in the follow up period of 8 years. We believe that cineradiography is very useful for not only diagnosis but also decision of management for thrombosed Björk-Shiley prosthesis in the aortic position.

Adolescent↗
PubMed1989

[Case reports of fistula formation between aortic pseudo-aneurysms and atria after Bentall's operation].

Fistula between aortic pseudo-aneurysm and atrium occurred in two patients ten or thirteen years after initial Bentall's operation. Their chief complaints were edema of lower extremity, oliguria and dyspnea. Because the pseudo-aneurysm and fistula was suspected by continuous murmur and echocardiogram, cardiac catheterization and aortography were performed to make accurate diagnosis. In these cases, both the fistula and the leakage at the site of initial anastomosis were repaired as soon as the diagnosis was made. To our knowledge, there have been no such reports of aortic pseudo-aneurysm penetrating into the atrium after Bentall's operation.

Adult↗
PubMed1989

[Bioprosthetic valvular dysfunction in mitral position: three cases of commissural detachment].

Three cases of commissural detachment in Carpentier-Edwards (C-E) porcine xenografts are reported. All patients had undergone mitral valve replacement (MVR) with C-E porcine xenograft for rheumatic mitral valvular disease 6 to 10 years ago and developed congestive heart failure gradually that required replacement of C-E porcine xenograft. The removed C-E porcine xenografts showed commissural detachments and showed no cusp teaps or cusp perforations. On the basis of the results of our 120 patients with porcine xenograft in the mitral position, we emphasize that the incidence of prosthetic valve dysfunction due to primary tissue failure increases rapidly after the sixth postoperative year.

Adult↗
PubMed1989

[Late results of mitral valve replacement with porcine bioprosthesis].

Forty one long-term survivors over 10 years after isolated mitral valve replacement (MVR) were analysed. At first operation, MVR was performed with the porcine bioprosthesis in all 41. However, 28 porcine bioprostheses in 27 patients were replaced with St. Jude Medical (SJM) prosthesis at second or third operation. These 41 survivors were followed from 10 to 13 years (mean 12.0 years). Cumulative duration of follow-up is 490.9 patient-years. Thrombo-embolic accident occurred in 4 patients and the linearized incidence of postoperative systemic thrombo-embolism is 0.8% per patient-year. Twenty nine reoperations were necessary in 27 patients: in 23 because of valve dysfunction due to primary tissue failure, in 2 because of left atrial thrombosis, in 1 because of valve endocarditis, in 1 because of perivalvular leak. Actuarial freedom from valve dysfunction is 35.0% at 13 years. Degeneration of the cusp of the porcine bioprosthesis remains the chief cause of valve failure leading to reoperation and may represent a major problem.

Adult↗
PubMed1988

The surgical treatment of aortic regurgitation secondary to aortitis.

We describe the operative and perioperative management of 11 patients with aortic regurgitation due to aortitis. All patients required aortic valve replacement because of severely uncoapted cusps secondary to dilatation of the ascending aorta. The right coronary ostium was narrowed in 5 patients and consequently necessitated a smaller coronary tip for the administration of cardioplegic solution. To implant the prosthetic valve, pledgeted 2-0 Tevdek sutures were placed through the aortic valve annulus either from the ventricular side or from outside the aortic wall. Steroids were administered to 4 patients preoperatively and 8 patients postoperatively. Postoperative dehiscence of the prosthesis was seen in 1 of the 3 patients not given any steriods. We conclude that it is important to arrest the inflammatory reaction before operation and if the aortic valve must be replaced, to reinforce the implanted prosthesis with pledgeted sutures. Also, we suggest the possible importance of steroid therapy.

Adult↗
PubMed1988

Cardiac myxoma: morphologic, histochemical, and tissue culture studies.

Twenty-one cases of cardiac myxoma exhibiting a variety of histologic findings were investigated by light and electron microscopy, tissue culture, and immunohistochemical studies for factor VIII-related antigen (FVIII-RA) and Ulex europaeus 1 (UEA-1) lectin. The cardiac myxoma cells revealed variable cellular arrangements, and some tumor cells revealed vascular-like channels. Immunohistochemically, FVIII-RA was found only in the endothelial-like cells covering the vascular-like channels or slits, whereas UEA-1 lectin reacted not only with myxoma cells having luminal structures or network-like arrangements but also with single cells. On electron microscopy, some myxoma cells revealed differentiation into cells forming vascular structures. In tissue culture, the tumor cells were polygonal and proliferated with extensions of the cytoplasmic processes. Arrangements suggesting vascular channels or slits were not observed. In a coculture of tumor cells and blood clot, the tumor cells covered the surface of the clot. However, angiogenesis was not observed in the tissue culture study. The results of our studies were inconclusive regarding the histogenesis of cardiac myxomas, but it was considered that cardiac myxoma is a neoplasm arising from mesenchymal cells with vasoformative characteristics.

Adult↗
PubMed1988

[Valve replacement in infective endocarditis with mycotic cerebral aneurysm. Report of a case with successful operation].

A 49 year-old woman was hospitalized with headache and left-sided weakness. Computed tomographic scan and carotid angiogram revealed mycotic aneurysms of the bilateral middle cerebral artery with intracranial bleeding. Although all blood cultures were sterile, her physical examination suspected mitral regurgitation due to infective endocarditis and mycotic cerebral aneurysms. Severe congestive heart failure developed immediately after successful clipping for ruptured mycotic aneurysm of the right middle cerebral artery and then mitral valve replacement with prosthetic valve was performed 3 months after craniotomy. At operation, infective endocarditis on the mitral valve was confirmed. Her postoperative course was uneventful and the second craniotomy for aneurysm of the left middle cerebral artery has been planning.

Aneurysm, Infected↗
PubMed1988

[Cardiac valve surgery in the elderly].

Cardiac valve surgery was performed in 54 patients over the age of 60 between January 1982 and December 1986. This included 24 mitral, 23 aortic, 7 multiple valve surgery and 2 thrombectomies and 1 leakage repair of the aortic prosthetic valves. We reviewed these cases comparing with 60 younger patients under the age of 59 with particular emphasis on preoperative state, operative mortality, postoperative course and late results. In older patients, lower renal function and fewer red blood cell count than younger patients were revealed preoperatively. Postoperatively, tendency to have low cardiac output syndrome and have much more complications such as acute renal failure, respiratory insufficiency and psychosis were seen in older patients. There were 7 hospital deaths and 1 late death in older patients, but in 6 of 7 hospital deaths, the causes of deaths were non-cardiac. Clinical improvement was quite satisfactory in older patients equally to younger patients. So it was concluded that age alone should not be regarded as a contraindication to surgical treatment in older patients.

Acute Kidney Injury↗