Search PubMed⌕ Search

Biomedical subjects

M Endo

Publications and source records attributed to M Endo.

At least 505 records · Page 28Linked to original sources
PubMed1994

Effect of acute lung injury and coexisting disorders on plasma concentrations of atrial natriuretic peptide.

OBJECTIVE: To clarify how plasma atrial natriuretic peptide concentrations vary with the severity of acute lung injury. The influence of coexisting diseases which trigger acute lung injury was also examined. DESIGN: Prospective study. SETTING: Intensive care unit of a university hospital. PATIENTS: Fifty patients who had standard risk factors for acute lung injury including sepsis syndrome, major surgery, prolonged hypotension, aspiration of gastric contents, and burns. Twenty-five of these patients had acute lung injury (group 3) caused by these disorders; the remaining 25 patients had risk factors only (group 2). Ten age-matched normal volunteers were selected as controls (group 1). INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: Plasma atrial natriuretic peptide concentration was measured in these patients and compared with the severity of acute lung injury. In group 3, a significant increase in the mean plasma atrial natriuretic peptide concentration was observed (188 +/- 78 pg/mL, p < .01) compared with group 2 (54 +/- 28 pg/mL) and the age-matched control group (30 +/- 8 pg/mL). This increase was related to the onset of acute lung injury and returned to control concentrations after recovery. Plasma atrial natriuretic peptide concentrations in group 3 correlated highly with a lung injury score representing the severity of acute lung injury (r2 = .45, p < .01), but did not correlate with other cardiopulmonary variables. CONCLUSION: The results suggest that severity of lung injury, but not other predisposing disorders, may be the key factor leading to the increase in plasma atrial natriuretic peptide concentrations observed in these patients.

Analysis of Variance↗
PubMed1994

[Seventy coronary reoperations: indication and results].

Seventy consecutive patients undergoing reoperative coronary artery bypass grafting (re-CABG) were reviewed to determine operative and late results, and indications of re-CABG. There was no operative death (within 30 days after re-CABG) but 3 (4.3%) hospital deaths in patients with emergency re-CABG. Although graft patency rate was acceptable (92.5%), the rate of complete revascularization was only 70%. Including non-cardiac death, the actuarial survival rate at 8 years was 88.2%, and event free rate including all deaths, the third time CABG, PTCA and myocardial infarction was 78.4% at 8 years. At re-CABG, no old arterial grafts and only 4.7% (2/43) of the old saphenous vein grafts to the left anterior descending artery (LAD) were patent without stenosis. Success rate of PTCA was 90.9% in the saphenous vein graft and 95.2% in the internal thoracic artery graft. Restenosis rate was significantly higher in the saphenous vein graft (55%) than the arterial graft (10%) (p < 0.001), and restenosis rate of repeat PTCA to the saphenous vein graft was 100%. In conclusion, re-CABG should be mainly indicated to the patients with persistent symptom and diseased grafts to the LAD, and PTCA to the old saphenous vein graft should be limited to once to avoid acute deterioration requiring emergency re-CABG.

Adult↗
PubMed1994

[Long-term results after cardiac valve replacement: 16 years follow-up of 190 patients].

According to STS/AATS guidelines 1988, we compared the long-term results after cardiac valve replacement (ReAVR 26, ReMVR 127, ReDVR 35, ReTVR 2, total 190 patients) with those after initial valve replacement (AVR 760, MVR 1, 001, DVR 431, TVR 22, total 2,214 patients). Actuarial survival (AS), reoperation free (RF) and freedom from all valve-related events (EF) at the 10th postoperative year were 74.6%, 100%, 70.1% after ReAVR, 84.2%. 97.8%, 75.8% after AVR, 82.9%, 91.4%, 75.8% after ReMVR, 86.5%, 91.7%, 70.7% after MVR. 78.4%, 92.9%, 63.2% after ReDVR, 82.8%, 95.6%, 73.8% after DVR, respectively. There was no significant difference of AS, RF and EF between ReVR and initial VR in any valve position. These results justify our current strategy of cardiac valve re-replacement.

Adolescent↗
PubMed1994

[Relation between surgical outcome and preoperative end-systolic volume of the left ventricle in patients with regurgitant valvular heart disease].

The relation between the end-systolic volume index of the left ventricle (ESVI (ml/m2)) and the early and late results after valve replacement were reviewed in 249 patients with pure aortic regurgitation (AR) and 189 patients with pure mitral regurgitation (MR). The patients with AR were classified into 4 groups (A1-A4) and those with MR were classified into 3 groups (M1-M3) according to the ESVI. The ESVI, the number of patients (No of P), early mortality rate (EM) and the actuarial survival rate at 12 years after valve replacement (AS at 12 yr) in each group are shown in the following Table. [table: see text] The actuarial survival rate at 12 years after operation in A1 and A2 were significantly lower than that in A3 and A4. In 57% of the late deaths in A1 and A2 patients, the cause of the death was thought to be rhythm disturbance. In contrast, there were no differences in late survival among the three groups with MR (M1, M2 and M3). The minor axis of the left ventricle at end-diastole and at end-systole (Dd and Ds) and shortening fraction of the left minor axis (FS), evaluated by echocardiography, were normalized early after the operation in A1 patients only. The Dd, Ds and FS in A2 and A3 returned to normal late after the operation. However, in A4, these parameters still remained abnormal. Thus, patients with a deteriorated left ventricle can survive the operation. However, the long-term results in patients with AR with ESVI more than 150 ml/m2 were unsatisfactory.(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Valve Insufficiency↗
PubMed1994

[Coronary intervention in patients less than 40 years of age].

Forty-eight patients less than 40 years of age who underwent coronary intervention (coronary artery bypass grafting, CABG or percutaneous transluminal coronary angioplasty, PTCA) were identified and compared with a control group (patients more than 40 years of age who underwent coronary intervention). In addition, the treatment of hyperlipidemia after coronary intervention was studied in patients who required re-intervention and in those who were event free. There were no early nor late deaths and good early results were obtained in young patients, but late follow-up demonstrated that a re-intervention rate in young CABG patients was significantly higher than that in patients aged over 40 years (23.3% vs 9.3%), while in PTCA patients it was also higher in younger patients than in older patients (5.6% vs 1.3%). However, early results in PTCA patients showed the restenosis rate in young patients was significantly lower than that in older patients (7.7% vs 40.7%). Event free curve showed that earlier re-intervention was necessary for PTCA patients than for CABG patients. Hyperlipidemia was not well controlled by treatment in either group. The use of arterial grafts will improve the late results of younger patients. The patency of grafts and the quality of life of young patients should be the focus of future investigation.

Adult↗
PubMed1994

Extensive use of arterial grafts for coronary artery bypass grafting in Japanese patients.

Between August 1985 and December 1992, 298 patients underwent coronary artery bypass grafting with two or more distal anastomoses using arterial grafts. There were 279 males and 19 females, with an average age of 58.4 years. Thirty-one patients underwent sequential bypass with the left internal mammary artery. The remaining 267 patients received two or more arterial grafts. The three major combinations were the left and right internal mammary arteries (120 cases), the left internal mammary and right gastroepiploic arteries (100 cases) and the left and right internal mammary and right gastroepiploic arterial (43 cases). An additional saphenous vein bypass was constructed in 113 patients, and the average number of distal anastomoses was 2.70 per patient. The operative mortality rate was 1.0% (three patients), and hospital mortality rate 0.7% (two patients). Angiographic patency rate was 97.9% in arterial grafts and 94.3% in venous grafts. There were seven late deaths (three due to cardiac causes), and the 7-year actuarial survival and event-free rates were 92.8% and 86.6%, respectively. In conclusion, the extensive usage of arterial grafts in Japanese patients was accompanied by excellent long-term results without increased operative mortality and morbidity.

Adolescent↗
PubMed1994

[Pulmonary hypertension in aortic valve disease].

144 surgical patients with isolated aortic valve disease were reviewed to determine the incidence and the mechanism of pulmonary hypertension (PH). The hemodynamic data revealed PH (pulmonary artery systolic pressure of 40 mmHg or more) in 18 patients (12.6%). There was a positive correlation between left ventricular end-diastolic pressure (LVEDP) and pulmonary artery pressure. After operation the pulmonary artery pressure normalized in all cases but 2 patients in early post-operative period. In patients with aortic stenosis with PH, LVEDP/LVEDVI ratio was higher than that of patients without PH, which showed left ventricular diastolic dysfunction. In patients with aortic regurgitation with PH, the cause of elevated LVEDP was not only severe long-standing regurgitation with ventricular dysfunction, but also the imbalancement of compensation by dilated ventricle with preserved left ventricular function.

Adult↗
PubMed1994

[Sequential coronary artery bypass grafting using arterial conduits].

Fourty one patients underwent sequential coronary artery bypass grafting (CABG) using in situ arterial conduits as sequential bypass grafts. Included were sequential bypass from diagonal branch to left anterior descending artery (LAD) using the left internal thoracic artery (LITA) in 29 patients, skip bypass from segment 7 to segment 8 (AHA classification) of LAD using LITA in 5 patients and sequential bypass to the distal branches of the right coronary and circumflex arteries using the right gastroepiploic artery in 7 patients. There were no hospital deaths and only one patient who received skip bypass died of heart attack a couple of years after-operation. The overall patency rate was 95% (77/81). Reoperations were done in three patients all of whom received sequential bypass using LITA. It was characteristic that the distal anastomoses of sequential graft occluded in 7 of 9 patients and those proximal anastomoses were patent. This procedure is one available and reliable option for multiple coronary bypass grafting. However, if the arterial conduits are too small in caliber to use for sequential grafts, they should be used as individual grafts.

Adult↗
PubMed1994

[True aneurysm of mitral valve secondary to aortic valvular infective endocarditis].

A case of the mitral valve aneurysm with aortic valvular infective endocarditis is reported. A 30-year-old male who had the history of Streptococcus viridans endocarditis underwent aortic and mitral valve replacement. The aortic valve was bicuspid and had the perforation in its non-coronary cusp, and histology in its specimen showed post-inflammatory vascularization and disorganization of architecture. A gigantic aneurysm was visible in the anterior leaflet of the mitral valve, but both anterior and posterior leaflets had no inflammatory change in histology. In this case, the "jet" of blood produced by aortic valve perforation involved the mitral valve. This aneurysmal change was so called "jet lesion" secondary to aortic valve endocarditis.

Adult↗
PubMed1994

Coronary artery bypass grafting with the right gastroepiploic artery and evaluation of flow with transcutaneous Doppler echocardiography.

From December 1988 to December 1992, 174 patients (160 men, 14 women, mean age 59.7 years, range 38 to 79 years) underwent coronary artery bypass grafting with the right gastroepiploic artery. The graft was anastomosed to the right coronary artery (n = 137), the circumflex artery (n = 18), the left anterior descending artery (n = 23), and the diagonal artery (n = 1). Three early deaths (1.7%) and one late death (0.6%) occurred. Graft patency and flow were evaluated noninvasively in 44 of the patients, selected at random between 1990 and 1993. They underwent transcutaneous Doppler echocardiographically to detect postoperative gastroepiploic artery flow. The patients were divided into two groups on the basis of the angiographic study: group I, good patency (n = 38); group II, poor flow in the graft or more than 75% stenosis of the anastomosis (n = 6). Biphasic Doppler flow signals were identified in 39 patients (88.6%) (group I, 35/38; group II, 4/6). The ratio of diastolic to total flow measured by time-velocity integral was 0.68 +/- 0.07 in group I and 0.32 +/- 0.09 in group II (p < 0.001). We conclude that the right gastroepiploic artery is an effective graft and that Doppler echocardiography may be a useful tool to noninvasively evaluate the patency and flow of the gastroepiploic artery graft as a coronary artery graft.

Adult↗
PubMed1994

[Surgical treatment of infective endocarditis in patients with congenital heart disease].

From 1981 to March 1993, 21 patients underwent surgical treatment for infective endocarditis (IE) associated with congenital heart disease (CHD). We evaluated the surgical results with regard to various factors, including microorganisms, pre- and postoperative complications, the correlation between CHD and the infective focus in the valve, the operative methods and surgical results. Underlying CHD included ventricular septal defect (VSD) in 15 (71.5%), persistent ductus arteriosus (PDA) in 2 (9.5%), tetralogy of Fallot (TF) in 2 (9.5%) and incomplete endocardial cushion defect (IECD) in 2 patients (9.5%). Microorganisms were detected in 71.4% of the patients, including streptococcus in 11 patients (52.4%), staphylococcus in 2 (9.5%) and gram-negative bacillin in 2 (9.5%). Embolism or infarction was noted preoperatively in 5 patients (23.8%) and was located in the kidney in 4 patients, the leg in 2, and in the liver and lung in 1 patient each. Among 15 patients with VSD, the lesion of IE was seen on the left side of the heart in 11 patients, on the right side in 3 and on both sides in 1. The PDA and IECD were seen on the left side in 2 patients each, but the IE focus of the 2 patients with TF was on the left side in one and on both sides in the other patient. Aortic valve replacement was performed in 17 patients, mitral valve replacement in 3, tricuspid valve plasty in 2, tricuspid annuloplasty in 1 and pulmonary valve resection in 2 patients. The operative mortality was 4.8% and there were no reoperations or late deaths.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Surgical treatment of ischemic mitral regurgitation].

Mitral regurgitation secondary to ischemic heart disease carries a significant mortality even after emergent open heart surgery. We report on 16 patients with mitral regurgitation associated with ischemic heart disease. The pathological findings were chorda elongation and papillary muscle dysfunction (PMD group) in 12 patients, and papillary muscle rupture (PR group in 4 patients. Preoperative characteristics were severe left ventricular failure in PMD group and high incidence of renal failure, in associated with high age in PR group. In PMD group, mitral plasty was performed in 10 patients out of 12 patients. In PR group all patients underwent mitral valve replacement. Thirteen patients underwent mitral surgery combined with coronary artery bypass grafting. No operative death was seen, one hospital death and 3 late deaths occurred. Three late deaths were seen in PMD group due to sudden death in 2 cases and arrhythmia in 1 case. One hospital death in PR group was due to multi-organ failure. We suggested incorporating these therapeutic concepts may introduce satisfactory results in surgical treatment for ischemic mitral regurgitation.

Aged↗
PubMed1994

Long-term outcome of myocardial revascularization in patients with Kawasaki coronary artery disease. A multicenter cooperative study.

The long-term outcome of myocardial revascularization by coronary artery bypass grafting in patients with severe coronary obstruction caused by Kawasaki disease is largely unknown. A multicenter follow-up study was performed in 1991. A total of 168 patients with Kawasaki disease (127 male [75.6%] and 41 female patients [24.4%]) who had undergone coronary bypass grafting were enrolled. Obstructive coronary artery disease affected the left main trunk in 11.8%, the right coronary artery in 77.6%, the left anterior descending in 87.6%, and the left circumflex in 25.9%. Old myocardial infarction was noted in 46.0% of the patients. Fifty-four patients (32%, 12.4 +/- 9.8 years) underwent bypass grafting with saphenous vein grafts alone. The remaining 114 patients (68%, 9.8 +/- 7.1 years) received at least one internal thoracic artery graft to the left anterior descending coronary artery. Gastroepiploic artery grafts were used in 12 patients. There were no significant differences between the saphenous vein and internal thoracic artery groups in the mean age at operation (12.4 versus 9.8 years), female ratio (22% versus 25%), the number of patients over 20 years of age (9.3% versus 9.6%), previous history of infarction (51.9% versus 41.2%), impaired left ventricular function (ejection fraction < 0.5) (13.0 versus 11.4%), left main trunk disease (11.1% versus 10.5%), the number of vessels involved (2.2 +/- 0.8 versus 2.0 +/- 0.6 per patient), or the mean number of grafts used (1.7 +/- 0.7 versus 1.7 +/- 0.7 per patient). The operative death rate was also the same in the two groups (1.9% versus 0%), but the late cardiac death rate was significantly higher in the saphenous vein graft group (13.0%) than in the internal thoracic artery group (0.9%) (p < 0.003). Actuarial analysis showed a significantly higher survival in the internal thoracic artery group (98.7% +/- 1.2% versus 81.6% +/- 7.0%, p < 0.05) at 90 months after the operation. Late death was strongly related to the absence of an internal thoracic artery graft (p < 0.003) and to the age at the time of operation (p < 0.05). The actuarial patency rate was significantly higher for arterial grafts (77.1% +/- 1.1%, n = 151) than for vein grafts (46.2% +/- 6.3%, n = 126) 85 months after the operation (p < 0.003). Arterial grafts were used for the non-left anterior descending coronary arteries in only 41 of 155 grafts (26.5%); in contrast, vein grafts were used in 85 of 133 grafts (63.9%) (p < 0.005 to 0.001).(ABSTRACT TRUNCATED AT 400 WORDS)

Actuarial Analysis↗
PubMed1994

[Directions for reoperation of patients with Björk-Shiley convexo-concave valve prosthesis, based on long-term experience].

Although a high incidence of strut fracture of the Björk-Shiley convexo-concave (C-C) valve prosthesis has been reported, it is still controversial whether the prosthesis functioning normally should be replaced electively. To clarify our policy for this issue, we reviewed 28 patients who had undergone mitral valve replacement with a C-C valve prosthesis, and evaluated long-term results according to STS guidelines. The incidence of valve-related complications expressed as % patient-year were; structural deterioration 0.30, nonstructural dysfunction 0.30, thromboembolism 1.20. There were no thrombosed valves, anticoagulant-related hemorrhage or prosthetic valve endocarditis. The actuarial free rate after valve replacement with the C-C at 10 years, constructed by the Kaplan-Meier method, were compared with those with St. Jude Medical (SJM) valve prosthesis. (1) Actuarial survival: 77.9 vs 87.3 (NS), (2) Reoperation-free: 91.6 vs 98.0 (p < 0.05), (3) thromboembolism-free: 83.7 vs 83.9 (NS), (4) Event-free (hospital death+reoperation+valve-related complications: 71.2 vs 77.7 (NS). The long-term results with the C-C were compatible to those with a SJM valve prosthesis. However, if a strut fracture occurs, it is very difficult to save the patient's life. The hospital mortality of re-replacement of valve prosthesis during the last 10 years, at our institute, was 2.6%, which is almost equal to the cumulative risk of strut fracture of the C-C valve after 10 years (3.0%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Anomalous origin of the left coronary artery from the pulmonary artery with rheumatic mitral stenosis--a successful surgical case].

A 43-year-old woman in whom anomalous origin of the left coronary artery from the pulmonary artery, associated with rheumatic mitral stenosis, was surgically corrected. She underwent aortic implantation of anomalous left coronary artery and mitral valve replacement. It was feasible to obtain a sufficient length of the left main trunk excising a large cuff of pulmonary artery wall surrounding the ostium of anomalous left coronary artery, without transecting pulmonary artery. This surgical case is first reported about BWG syndrome associated with rheumatic valvular disease.

Adult↗
PubMed1994

[A case report of surgical treatment for coronary aneurysm following repeated PTCA].

A 53-year-old man who developed coronary artery aneurysm following repeated percutaneous transluminal coronary angioplasty (PTCA) was reported. At the first coronary angiography, the severity of coronary stenosis was 95% at areas #6 and #7. The first PTCA provided sufficient coronary dilatation, but 3 months later, PTCA was needed again because of the recurrence of stenosis. This second PTCA provided sufficient dilatation, but the coronary dissection remained. Eight months after the second PTCA, the patient suffered from recurrent angina. The repeated coronary angiography showed 95% stenosis of the original lesion and coronary aneurysm formation (4 mm in diameter) at the area of dissection which developed at the former PTCA site. Therefore, coronary artery bypass surgery with left internal thoracic artery to area #8 was performed.

Aortic Dissection↗