Biomedical subjects

K Nakagiri

Publications and source records attributed to K Nakagiri.

22 records · Page 2Linked to original sources

PubMed1996

Non clamping anastomosis of the ascending and arch aneurysm using retrograde cerebral perfusion.

Twelve consecutive patients requiring surgery for replacement of ascending aortic aneurysms (n = 3), ascending arch aortic aneurysms (n = 2), or type A aortic dissections (n = 7) were treated without aortic cross clamping. Retrograde cerebral perfusion (RCP) with circulatory arrest (mean RCP time: 46.0 +/- 15.9 minutes, range 20 to 65 minutes) and continuous retrograde cardioplegia (mean cardiac ischemic time: 134.4 +/- 39.7 minutes, range: 40 to 180 minutes) were employed. In the patients with aortic dissection, the intimal tear at the origin of the brachiocephalic artery (BCA) was resected completely, the aortic wall was trimmed and closed with Teflon felt. The distal anastomosis was created using an open technique. Air and debris were completely evacuated by returning blood from the cerebral vessels and femoral artery. Then the artificial graft was clamped, and cardiopulmonary bypass resumed. The proximal anastomosis was performed during rewarming. The operations were elective in seven cases, and emergent in five cases. Graft replacement of the ascending aorta was performed in ten patients (including two BCA reconstructions). The remaining two patients were treated by patch repair (n = 1), primary anastomosis (n = 1). There were no perioperative deaths. One patient had a transient neurological deficit. The distal false lumen was occluded completely in five of seven patients with aortic dissections. The other two patients had a secondary tears in the descending aorta. Thus retrograde cerebral perfusion and continuous retrograde cardioplegia without aortic cross clamping is an effective technique in the replacement of the ascending and arch aorta.

Adult↗

PubMed1996

A new simplified method for laser sinus node modification without electrophysiological technique.

As the treatment of inappropriate sinus tachycardia, beta-adrenoreceptor blockade therapy is the most common method for pharmacological heart rate control, but it is occasionally limited by side effects of the drugs, especially in patients with cardiac dysfunction. On the other hand, cryoablation or surgical exclusion of the sinus node have not been accepted generally for their necessity of permanent pacemaker implantation. Modification of the sinus node function is a new method of nonpharmacological treatments, although the skillfull and troublesome technique is required. In this study, the efficacy and safety of laser sinus node modification without electrophysiological technique were investigated as a new simplified method. In six mongrel dogs, the laser-tissue interactions by epicardial Nd-YAG laser irradiation were investigated by measuring the diameter and the depth of the irradiated lesions. Laser irradiations were performed from the head to the tail on the sinus node areas directed only by terminal groove for the visual landmark without electrophysiological technique until about 25% decrease in heart rate occurred in other six open-chest dogs.

Animals↗

PubMed1995

[A case of type A acute aortic dissection successfully treated with a ringed intraluminal graft: a new technique of graft insertion].

A-77-year old woman was hospitalized at our hospital presenting with severe chest and back pain. A computed tomographic scan revealed acute type A aortic dissection and intraoperative ultrasound showed an entry near the brachiocephalic artery. Selective cerebral perfusion using flexible 12 Fr balloons was performed for brain protection. The distal aorta was trimmed just proximal to the entry using felt strips and a 24 mm ringed intraluminal graft (ILG) was inserted under it successfully. The patient did well after the operation. Insertion of a ringed ILG is a simple and easy technique, however if an entry is located near the aortic arch, insertion is difficult because of intimal retraction to the arch. And an additional intimal tear sometimes occurs at the site of tape ligation. The method which we presented seemed to provide safer insertion of the proximal ring without these problems.

Acute Disease↗

PubMed1994

[Change of mitral regurgitation before and after myocardial revascularization--is mitral repair required for ischemic mitral regurgitation?].

In twenty seven patients, intraoperative change of ischemic mitral regurgitation before and after coronary artery bypass grafting (CABG) was assessed using transesophageal echocardiography. The size of mitral regurgitation (MR) was determined by the area of MR color flow on the doppler echocardiogram. After CABG, MR area decreased in 20 patients (average: 3.7 cm2-->1.5 cm2), unchanged in one patient and increased in 6 patients (average: 17 cm2-->2.9 cm2). The change of MR area corresponded with the change of mitral annular diameter in 23 patients but uncorresponded in 2 patients. MR areas correlated exponentially with mitral annular diameters and the fair linear relation was observed between the postoperative to preoperative ratio of MR area and the postoperative increase in mitral annular diameter with the correlation of r = 0.81. When the larger MR area or mitral annular diameter before CABG was observed, the larger MR area after CABG remained, but annular diameter before CABG had more effect on postoperative MR area. No significant correlation was found between MR area and infarcted region, revascularized region, segmental wall motion etc. In conclusion, when the moderate or marked mitral annular dilatation was found in association with prominent ischemic mitral regurgitation, mitral annuloplasty with CABG should be considered.

Adult↗