Search PubMed⌕ Search

Biomedical subjects

Kazuaki Fukahara

Publications and source records attributed to Kazuaki Fukahara.

7 recordsLinked to original sources
PubMed2005

Ischemic changes in evoked spinal cord potentials during profound hypothermic circulatory arrest in thoracic aortic surgery.

PURPOSE: We examined the changes in evoked spinal cord potentials (ESCP) during profound hypothermic circulatory arrest to estimate the safe ischemic time. METHODS: We monitored ESCPs during surgery for descending thoracic or thoracoabdominal aneurysms in five patients. Evoked spinal cord potential recordings were obtained before cooling (baseline), then every few minutes during circulatory arrest, and at the end of the operation. RESULTS: After circulatory arrest, the amplitude of ESCPs decreased with time. We calculated the simple linear regression between the amplitude of ESCPs and the circulatory arrest time by the least-squares method, and found a highly linear relationship between amplitude and arrest time in all five patients. The time until disappearance of ESCPs was estimated as 50.7 +/- 20.4 min (95% level of confidence). CONCLUSION: When an ESCP disappeared, ischemic spinal cord injury had occurred. This demonstrates the potential value of estimating the time of disappearance of ESCPs to prevent ischemic spinal cord injury during descending thoracic aortic surgery.

Aged↗
PubMed2004

Abdominal surgery following coronary artery bypass grafting using an in situ right gastroepiploic artery graft.

OBJECTIVE: The usefulness of the gastroepiploic artery (GEA) as arterial grafts in coronary artery bypass grafting (CABG) has been studied extensively. We report our experience performing abdominal surgery after CABG using in-situ GEA. METHODS: The subjects were eight patients who underwent abdominal surgery after CABG with an in situ GEA graft. The surgical indications were malignant tumors in five patients, an infrarenal abdominal aortic aneurysm in two patients and a diaphragmatic hernia in one patient. The interval from the CABG to the abdominal surgery ranged from 3 to 19 months. RESULTS: Operations included distal gastrectomy in two cases, total gastrectomy in one case, local excision of the stomach in one case, and excision of the transverse colon in one case. Aorto-biiliac artery bypass was performed in two cases, and the diaphragmatic hernia was reconstructed using standard techniques. When the skeletonization method has been used to harvest the GEA, GEA grafts were easily identified during a laparotomy, and the abdominal procedure was performed using routine methods. One patient died of cancer, and the other patients are alive 1 year 2 months to 4 years 5 months after surgery. No patient reported recurrence of angina. CONCLUSION: The risk of abdominal reoperations should be considered when using the in situ right GEA for CABG. We recommend the skeletonization method for GEA harvest to decrease the difficulty during second abdominal operations.

Aged↗
PubMed2004

[Arrhythmias].

The success of the radiofrequency catheter ablation procedure for most types of supraventricular and ventricular tachycardia largely eliminated the role of surgical therapy of arrhythmias. However, there remains a subset of arrhythmia patients in whom urgent surgical treatments are required. In this review we mention recent developments of the urgent surgical treatment for arrhythmias. In cases with complete atrioventricular (AV) block and ventricular fibrillation which associated with sudden death, temporary cardiac pacing and cardiac defibrillation using direct current (DC) cardioversion must be immediately induced and followed by implantation of permanent cardiac pacemaker or implantable cardioverter defibrillator (ICD), if necessary. In addition to usual cardiac pacing therapy, novel pacing therapy has been developed recently for the patients with symptomatic heart failure. Cardiac resynchronization therapy (CRT) using biventricular pacing is an emerging therapy for improvement of cardiac function in patients with heart failure in association with intraventricular conduction delay. To prevent the sudden death in patients with heart failure, biventricular pacing combined with ICD are also implanted and its efficacy are reported. With the exception of the pacing therapy, curative surgical treatments are limited in drug-refractory atrial fibrillation and ventricular fibrillation/tachycardia after myocardial infarction requiring Dor's type operation. In any case surgical treatment must be performed promptly and suitably with lower invasive methods.

Arrhythmias, Cardiac↗
PubMed2004

Recent topics on the surgical treatment for atrial fibrillation.

After the introduction of endocardial radiofrequency catheter, only two arrhythmias, atrial fibrillation and ischemic ventricular tachycardia require surgical procedures. In this review, we describe recent advancements and problems of surgical treatment for atrial fibrillation. On the basis of multiple-circuit re-entry theory, Cox developed the maze operation with the aim of interrupting the re-entry circuit. Although this procedure has become the gold standard technique for the surgical treatment of atrial fibrillation with approximately 90% success rate, several modifications have been made over time. To obtain a more physiological atrial transport function, radial approach technique or bilateral appendage-preserved maze procedures were developed and to simplify surgical procedures, maze operation with cryo-ablation or radiofrequency-ablation were created. Other topics are concerned with surgical target or approach to atrial fibrillation. Ectopic focus theories from pulmonary veins have been widely recognized recently and the surgical isolation of pulmonary veins orifices is performed with various energy sources. In addition to standard cut-and-sew surgical technique, cryoablation, unipolar or bipolar radiofrequency ablation, or microwave ablation were induced with endocardial or epicardial approach for the achievement of less invasive cardiac surgery. As atrial fibrillation leads to frequent mortality, cardiac surgeons have to treat atrial fibrillation with other cardiac disease more frequently to obtain better quality of operative results.

Atrial Fibrillation↗
PubMed2003

Successful heart-lung transplantation in a patient with kyphoscoliosis.

The association is well established between congenital heart disease and spinal deformities such as scoliosis or kyphosis, but data are not available for risks and the outcome of heart surgery in patients with spinal deformities. We report a case of successful orthotopic heart lung transplantation in a patient with complex congenital heart disease and severe chest deformity who had undergone previous spinal fusion surgery for progressive right convex thoracic kyphoscoliosis.

Adolescent↗
PubMed2002

[Current status of surgery for the treatment of arrhythmia].

The success of the radiofrequency catheter ablation procedure for most types of supraventricular and ventricular tachycardia largely eliminated the role of surgical therapy of arrhythmias. However, there remains a subset of arrhythmia patients in whom the catheter approach has not been successful and types of arrhythmias with high recurrence rates following initially successful catheter ablation procedures where surgery can provide more definitive therapy. On the other hand, collaborations therapy with surgery and catheter procedure has become more important. For example, some of the new treatment strategies are based on the replacement of the surgical incisions of the Maze procedure using intraoperative radiofrequency coagulation thereby preventing functional determined reentrant circuits. It can be expected that intraoperative ablation for arrhythmia will become an important curative treatment strategy.

Arrhythmias, Cardiac↗