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Biomedical subjects

M Fukutomi

Publications and source records attributed to M Fukutomi.

At least 37 records · Page 2Linked to original sources
PubMed1994

[Coronary artery bypass surgery-redo operation particularly in patients with a functioning ITA graft or with a patent atheromatous vein graft].

An experience with redo-CABG in 20 patients is described. The incidence of reoperation in patients undergoing primary CABG in our hospital was 1.4%, relatively low even in Japanese population. The low incidence of redo-CABG in our hospital depends on the relatively short period of follow-up of 14 years, the prevalence of interventional cardiology and the early routine use of ITA grafts. The main cause of reoperation was the failure of a SVG to the LAD in 70 to 80% of the cases. The most important and difficult decision-making in redo-CABG is the selection of surgical approaches and cardioprotective methods in patients with a patent functioning ITA graft, and the management of an atherosclerotic patent SVG. Surgical strategies in these situations are discussed.

Adult↗
PubMed1993

Hypothermic ventricular fibrillation with pulsatile coronary perfusion during repair of ventricular septal perforation following infarction.

Emergency or urgent surgery for ventricular septal perforation (VSP) following acute myocardial infarction still carries a high operative mortality rate. Hypothermic fibrillatory arrest studies without aortic cross-clamping and using continuous pulsatile coronary flow were performed to improve this result. Of 19 patients suffering from VSP, 12 underwent hypothermic (mean(s.d.) blood temperature 23.5(1.7) degrees C) ventricular fibrillation with concomitant pulsatile systemic and continuous coronary perfusion (group 1), and seven underwent deep hypothermic cardioplegic ischaemic arrest with systemic pulsatile perfusion alone (group 2). The two groups were comparable in terms of age, sex, location of infarction, number of coronary arteries involved, interval between infarction and surgery, and preoperative maximum enzyme levels and haemodynamics. Pulsatile flow with a mean(s.d.) pulse pressure of 48(13) mmHg was produced by an intra-aortic balloon pumping device in both groups. Operative exposure in the two groups was comparable. In group 1, mean(s.d.) cardiac output in the early postoperative period (within 3 h of procedure) was significantly higher than in group 2 (4.2(0.9) versus 2.6(0.7)lmin-1m-2, P < 0.01). The 30-day operative mortality rate was significantly lower in group 1 (8% (80% confidence interval 1-29%)) than in group 2 (57% (80% confidence interval 28-83%)) (P < 0.05). On the basis of these results, hypothermic fibrillatory arrest with continuous pulsatile coronary perfusion can be recommended for myocardial protection during surgery for VSP associated with severe heart failure or cardiogenic shock.

Aged↗
PubMed1993

[Cardiac function following left ventricular aneurysm repair--comparison between patch reconstruction and direct closure methods].

Left ventricular function was compared between two groups of patients who underwent patch reconstruction or direct closure of the ventricular wall following resection of a post-infarction left ventricular aneurysm (LVA). There were 15 and 9 patients in the respective groups. Coronary artery bypass grafting was additionally performed in 8 patients (53%) in the patch reconstruction group and 5 patients (56%) in the direct closure group. The size of the patch used for patch reconstruction (including the suture line) was 57 +/- 19% of the resected area. Before and 1-2 months after surgery, equilibrium RI angiography and cardiac catheterization were performed to assess the following hemodynamic parameters: ejection fraction (EF) at rest and during exercise, left ventricular end-diastolic pressure (LVEDP), left ventricular end-diastolic volume index (LVEDVI), cardiac index (CI) and mean pulmonary artery pressure (m-PAP). Preoperatively, there were no differences in each parameter between the two groups. Postoperatively, there were significant improvements in the EF at rest and during exercise (p < 0.01), LVEDVI (p < 0.01) and the LVEDP (p < 0.05). However there no significant changes in CI or m-PAP following the operation. There were also no significant differences observed in the postoperative values between the two groups. However, based upon postoperative left ventriculograms, patch reconstruction was significantly superior to direct closure for reconstruction of a septal aneurysm.

Aged↗
PubMed1993

[Cell viability assessment of cold-preserved (4 degrees C) and cryopreserved (-196 degrees C) allograft valves by flowcytometric analysis].

We introduced cryopreservation technique to store the allograft valve and subsequently commenced the use of the cryopreserved aortic allograft valve for aortic valve replacement. For the clinical use of the allograft valve, it is essential to evaluate the cell viability. We assessed cell viability of the allograft valve by flowcytometry (FCM), using a fluorescein diacetate (FDA)-propidium iodide (PI) stain. Pulmonary allograft valves were harvested from the cadavers with a consent. Of the 9 valves collected and sterilized in 4 degrees C antibiotic solution for 48 hours, 4 valves were stored under refrigeration (cold-preserved), and the remaining 5 valves were cryopreserved. The warm ischemic time from cardiac death to valve preservation was 7.3 +/- 5.4 hours. The cold-preserved valves were stored at 4 degrees C in the nutrient medium (TC-199, calf serum and HEPES buffer). The cryopreserved valves were frozen by a programmable freezer to -80 degrees C in the same nutrient medium containing 10% dimethylsulfoxide (DMSO), and subsequently stored in liquid nitrogen (-196 degrees C). We assessed the cell viability of the allograft valve leaflet, before storage and at 2 weeks, 1 month and 2 months after the storage. Suspensions of the valve leaflet fibroblasts were double-stained with FDA (1 micrograms/ml) and PI (1 microgram/ml) for flowcytometric analysis of the viable cells (cells showing a chromatic response to FDA but no response to PI). In the cold-preserved group, percentage of the viable cell was 90.3 +/- 3.6% before storage, 62.0 +/- 3.0% after 1 month of storage, and 50.3 +/- 3.7% after 2 months of storage.(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Valve↗
PubMed1993

Successful repair and postoperative management of tetralogy of Fallot in a patient with maple syrup urine disease.

A case of tetralogy of Fallot with maple syrup urine disease (MSUD) treated surgically is reported. This 2-year-old female patient developed neurologic deterioration after intracardiac repair. Postoperative management, which included peritoneal dialysis, intravenous hyperalimentation, and early intestinal alimentation with branched-chain amino acid-free milk was successful. At the present time, two years after the operation, she is doing quite well with a special diet for MSUD. This is the first report on a patient with MSUD who underwent open heart surgery using a cardiopulmonary bypass, stressing the importance of postoperative management.

Cardiopulmonary Bypass↗
PubMed1993

[A successful operation of isolated levocardia with left atrial isomerism, polysplenia and tetralogy of Fallot].

A four-year-old boy who had isolated levocardia associated with left atrial isomerism, polysplenia and tetralogy of Fallot underwent successful corrective surgery. In addition, these anomalies were complicated by interrupted inferior vena cava, azygos continuation, and total anomalous hepatic venous connection. Because of these systemic venous anomalies, cardiopulmonary bypass presented us some problems of venous cannulations. We used 4 direct venous cannulations; i.e., superior vena cava, persistent left superior vena cava through coronary sinus, azygos vein and hepatic vein. Reports of total correction in patients with isolated levocardia associated with tetralogy of Fallot are rare, and we report the case with some reviews of the related literature.

Abnormalities, Multiple↗
PubMed1992

Internal thoracic artery grafting for congenital coronary malformations.

We report 2 patients with congenital coronary anomalies (atresia of left main coronary artery and anomalous origin of the left coronary artery from the pulmonary artery) successfully treated with single or double internal thoracic artery grafting. Because the internal thoracic artery has a potential for circumferential as well as longitudinal development, and because of the uncertainty of ultimate vein graft function, we believe that the internal thoracic artery is the best graft material for the treatment of congenital coronary malformations requiring bypass operation in children, adolescents, or even in adults.

Child↗
PubMed1992

[Aortic valve replacement with fresh or cryopreserved aortic allograft--initial experience in Japan].

Aortic allograft valves were harvested from non-infected (bacterial or viral) cadavers within 24 hours of death with a family consent, and were sterilized by 4 degrees C antibiotic solution for 48 hours. Then, the allograft was preserved in the 4 degrees C nutrient medium (fresh; TC-199, calf serum and HEPES buffer) or in liquid nitrogen (-196 degrees C) after freezing to -80 degrees C by a programmed freezer. 10% dimethylsulfoxide (DMSO) was used for cryopreservation. Following germ-free confirmation, aortic allograft valves were implanted in 5 patients having aortic regurgitation with good results. Three fresh and two cryopreserved allograft valves were used. Although the follow-up term is very short (maximum 1 year) at the present time, the valve function is quite satisfactory, confirmed by cardiac catheterization and echocardiography. This is the first report in Japan with regard to cryopreservation of allograft valves and clinical use of fresh or cryopreserved valves. We believe that realization and progress of allograft preservation by cryo-technique and establishment of the tissue bank are important for the development of cardiovascular surgery in Japan.

Adult↗
PubMed1992

[Delayed sternal closure; a simple sternal splint].

A simple and inexpensive sternal splint for delayed sternal closure was described. Sternal edges were splinted open using an edge-cut disposable syringe. This method has been employed successfully in 10 patients (one adult, 9 children). This syringe splint is a simple, inexpensive and effective method for delayed sternal closure.

Child, Preschool↗
PubMed1990

Surgical treatment of renal cell carcinoma with a tumor thrombus extending into the right atrium.

We experienced surgical treatment on two patients having renal cell carcinoma with a tumor thrombus extending into the right atrium. In these patients, we performed nephrectomy, dissection of lymph nodes and removal of a tumor thrombus using cardiopulmonary bypass. One died of multiple organ failure 42 days postoperatively; the other was discharged from the hospital and is currently doing well 12 months after the operation. Cardiopulmonary bypass combined with hypothermia and low blood flow significantly facilitated removal of the tumor thrombus extending into the right atrium without the risk of pulmonary embolism or brisk hemorrhage.

Aged↗
PubMed1990

[Clinical results, graft patency and flow reserve capacity of multiple coronary artery bypass with bilateral or sequential internal thoracic artery grafts].

Multiple coronary artery bypass grafting (CABG) was performed utilizing the internal thoracic arteries (ITA) in 87 patients ranging in age from 3 to 76 years. Bilateral ITAs were used in 67, sequential grafting was performed in 16, and the combination of both techniques was applied in 4 patients. Twelve patients had coronary arterial obstructions due to Kawasaki disease (mean age 9.7 +/- 3.3 years) and the remaining 75 patients had atherosclerotic coronary artery disease (mean age 53 +/- 10 years). Triple vessel disease and left main trunk disease occupied 85% of the patients. The number of grafts was 2 to 5 per patient with an average of 3.2 +/- 0.7 per patient. In bilateral ITA grafting, the combination of the RITA to LAD and LITA to LCX was most frequently used, and in sequential grafting, the LITA-diagonal artery-LAD was the most common use. There were no early or late mortalities in the present series. The patency rates for the RITA and LITA were 93% and 96%, respectively, and those of sequential grafting were 100% in both the proximal and distal anastomoses. The clinical outcome of multiple CABG with ITAs was quite satisfactory, and the bilateral ITAs could be used in the very wide range of patient's age from 3 to 76 years. In addition, blood flow reserve provided by bilateral ITAs was equivalent to that of the SVG alone or SVG plus ITA on the basis of the result of coronary sinus flow (CSF) measurements during exercise, and thus complete revascularization of the left ventricle could be accomplished by multiple CABG with ITAs.

Adult↗
PubMed1990

[Surgery for postinfarction ventricular septal perforation under hypothermic fibrillatory arrest with pulsatile perfusion].

Surgery were performed by 2 different methods of myocardial protection in 17 patients with postinfarction ventricular septal perforation (VSP) from 1982 to 1989. Ten consecutive operations were performed using hypothermic fibrillatory arrest with pulsatile perfusion (VF group). Pulsatile flow was produced by an intra-aortic balloon pumping device. Other 7 consecutive VSP operations were performed using cardioplegic arrest (CP group). In the VF group, the mean age was 67 years (range 54 to 78 years), and VSP was located in the anterior wall in 7, in the inferior wall in 2, and in the anterior and inferior walls in 1 patients. The operation was performed 2.5 days after the onset of VSP. In the CP group, the mean age was 71 years (range 50 to 78 years), and VSP was located in the anterior wall in 6 and in the inferior wall in 1 patient. The operation was performed 4.7 days after the onset of VSP. Cardiogenic shock developed after septal rupture in 50% of the patients in the VF group and 71% in the CP group (N.S.). Prior to the operation, no significant differences were found in hemodynamic status between the 2 groups. Cardiac index in the VF group was higher than that of the CP group (p less than 0.05) shortly after cardiopulmonary bypass. The operative mortality rate was 10% in the VF group and 57% in the CP group. From these clinical results, hypothermic fibrillatory arrest with pulsatile perfusion can be beneficial as a method of myocardial protection during surgery for VSP and presently this has become the method of choice in our department.

Aged↗
PubMed1990

Bilateral internal mammary artery grafts for coronary artery bypass operations in children.

We performed myocardial revascularization with bilateral internal mammary arteries in eight children for coronary artery complications consequent to Kawasaki disease. Subjects included seven boys and one girl, ranging in age from 3 to 13 years (mean age, 8.3 +/- 3.4 years). The body surface area ranged from 0.65 to 1.65 m2 (average, 1.08 +/- 0.35 m2). Three patients had a previous myocardial infarction. The right internal mammary artery was anastomosed to the right coronary artery and the left internal mammary artery was sutured to the left anterior descending artery in all patients. The patients received an average of 2.4 grafts. Magnifying loupes of 3.5 X were used for anastomosis with 8-0 monofilament polypropylene sutures. Subjects were followed up from 12 to 38 months (23 +/- 10.8 months) after operation. All were doing well with no recurrence of angina, and body development was normal, including the sternum and thorax according to chest x-ray films and computed tomography of the chest. Patency of the bilateral internal mammary arteries was 100% in the early (within 1 month) postoperative period and remained so in the late (over 1 year) postoperative period. Anastomotic junctions between the internal mammary artery and the coronary artery developed well angiographically in the late postoperative period. The internal mammary artery is the graft of choice for pediatric myocardial revascularization because of its excellent long-term patency and growth potential. Bilateral internal mammary arteries should be used whenever indicated, and the use of bilateral internal mammary arteries did not adversely influence chest wall development in the children.

Adolescent↗
PubMed1990

[Surgery of aortic valvular disease with congenital bicuspid or quadricuspid aortic valve].

Twelve patients (age 18 to 69 years old) with surgical treatment for congenital bicuspid aortic valve and one (age 26 years old) for quadricuspid aortic valve were reported. These 13 patients occupied 12.3% of the total number of patients with aortic valve replacement during the same period. Among the patients with bicuspid aortic valve, 10 patients were male (83%) and 2 were female (17%). Seven patients exhibited aortic stenosis and 5 showed predominant aortic regurgitation. The mean age of patients with aortic stenosis was higher than that of patients with aortic regurgitation. (63.3 years vs 32.0 years old). Infective endocarditis occurred in 2 patients (17%). Three patients had pure aortic regurgitation without evidence of endocarditis. One 26-year-old female patient who had a quadricuspid aortic valve presented with aortic regurgitation associated with PDA. All patients underwent aortic valve replacement with no early and late deaths.

Adult↗
PubMed1989

[Coronary artery bypass surgery with internal mammary artery grafts: clinical and angiographic results].

We report clinical and angiographic results of coronary artery bypass grafting (CABG) surgery in 307 patients. IMA grafts can be utilized in the wide ranges of patient ages and/or coronary lesions including left main trunk disease, and have good adaptive capability to coronary flow demand with very low probability of atherosclerotic changes. Postoperative (5.2 +/- 4.4 months) patency rates for IMA grafts and SVG were 96% and 86%, respectively; a significant difference (p less than 0.001). From the benefits of this graft, the use of IMA has become a routine procedure in our CABG surgery and the rate of multiple bypasses with IMA grafts has increased recently. The late cardiac events have significantly (p less than 0.05) decreased in patients with the IMA graft than in those without it. We believe that the use of IMA has improved the quality of CABG in Japanese patients and this operative modality can bring better late results than multivessel PTCA.

Adolescent↗
PubMed1989

[Surgical treatment of postinfarction ventricular septal perforation--the difference between a cardiogenic shock group and a congestive heart failure group].

Twelve patients with postinfarction ventricular septal perforation (VSP) were divided into 2 groups based upon the preoperative status and the time interval between the operation and the occurrence of VSP after acute myocardial infarction (AMI). Group I were in cardiogenic shock unresponsive to either pharmacologic supports or IABP, and needed an emergency repair of VSP. The other group (group II) were in congestive heart failure responding to some extent to pharmacologic supports and IABP, and VSP of this group was repaired on the elective or semiemergency basis. Group I comprised of 7 patients, 5 males and 2 females, with a mean age of 65.9 +/- 12.6 years, and group II included 5 patients, 2 males and 3 females with an averaged age of 72.6 +/- 3.4 years. The mean time duration between AMI and the operation, and between the occurrence of VSP and the operation were 3.1 and 1.6 days in group I and 13.4 and 8.0 days in group II. The operative mortalities were 57% in group I and 0% in group II, a remarkable difference. The reasons why group I had a poor prognosis were analysed and were found as follows: (1) group I sustained a larger AMI of anteroseptal area together with the lateral and/or inferior infarctions more often than group II. (2) Group I had frequently multiple organ failure (MOF) even prior to operation due to cardiogenic shock. (3) Group I had severer right ventricular failure than group II, in which the right atrial pressure was markedly elevated. In group I, the right heart failure remained and was prolonged even after surgery reflected by the RAP/LAP ratio over 1 and finally resulting in MOF. To improve surgical results in group I, the operation should be undertaken on the emergency basis before MOF is completed, and patch reconstruction of the left ventricular free wall is recommended in patients with a wide AMI and a high positioned anterior septal perforation. When RV failure is dominant, not only a LV assist device but also a RV assist device may also improve the results.

Aged↗
PubMed1989

[Clinical experiences with a new membrane oxygenator with low priming volume (D702 MASTER FLO 51), studies during pulsatile and constant flow perfusion].

The newly developed oxygenator "D702" is a compact hollow fiber membrane oxygenator with a priming volume of 170 ml. The maximum flow allowance is 4 liters per/minute. We used this oxygenator in 16 patients (11 infants and children, and 5 adults) undergoing various open heart surgery, and function of this oxygenator was studied. Pulsatile cardiopulmonary bypass was performed in 8 patients and nonpulsatile constant flow perfusion was employed in the remaining 8 patients. Our clinical experience showed excellent maintenance of PaO2 and PaCO2 during both pulsatile and constant flow bypasses. A low pressure drop was encountered across the membrane oxygenator, and therefore, this oxygenator is applicable for pulsatile cardiopulmonary bypass. The D702 is a very useful and applicable for a wide range of patients from infants to adults with a small body structure.

Adolescent↗