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Biomedical subjects

M Hachida

Publications and source records attributed to M Hachida.

At least 73 records · Page 4Linked to original sources
PubMed1995

Different functional recovery of the left ventricle after valve replacement for aortic regurgitation: correlation between grade of ventricular arrhythmia and long-term mortality.

Although aortic valve replacement for aortic regurgitation relieves left ventricular volume overload, ventricular size often remains abnormal after operation, particularly in the setting of marked or prolonged preoperative left ventricular dysfunction. The aim of this study is to assess the relationship between the grade of ventricular arrhythmias before operation and the recovery of left ventricular function after aortic valve replacement. Between January 1980 and August 1993, 229 patients with pure aortic regurgitation underwent aortic valve replacement at our institution. In this group, 50 patients (21.8%) who showed left ventricular end-systolic volume index (LVESVI) of 150 ml/m2 or greater received 24-hour ambulatory electrocardiographic recordings before and after operation. According to the preoperative grade of ventricular arrhythmias, the patients were divided into three groups. Group A included 20 patients with severe and frequent ventricular premature beats (VPBs). Group B included nine patients with severe and non-frequent ventricular premature beats (VPBs). Group C included 21 patients with non-severe and non-frequent VPBs. Left ventricular end-systolic dimension (LVDs), end-diastolic dimension (LVDd) and fractional shortening (LVFS) were measured in each echocardiogram before, and one year and five years after operation. LVDd significantly decreased at one year after operation in all three groups. At one year after operation, LVDs significantly decreased in group B (42.0 +/- 7.6 mm) and group C (42.6 +/- 8.6 mm), while LVDs showed no significant change in Group A (55.4 +/- 11.1 mm). After five postoperative years, further significant decrease of LVDs was found in group C (32.4 +/- 7.1 mm).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Current strategy of circulatory support for profound heart failure.

The purpose of this study is to assess the current strategy of mechanical circulatory support for profound heart failure. In the last 10 years, 37 patients with profound heart failure underwent mechanical circulatory support after open heart surgery and 9 patients with non-cardiotomy cardiogenic shock received emergency circulatory support. All patients showed severe cardiac failure and/or fatal ventricular arrhythmia and required circulatory support as a life-saving measure. After cardiovascular surgery, 12 of those patients underwent venoarterial bypass (VAB), 13 had biventricular bypass (BVB), 8 had left ventricular bypass (LVB) and the remaining 4 patients received left ventricular assist device (LVAD). And 9 patients with non-cardiotomy cardiogenic shock received percutaneous cardiopulmonary support (or PCPS) as an emergency assist system. Weaning and discharge rates of the patients by the type of circulatory supports were 41.7% and 25.0% with VAB, 69.3% and 46.2% with BVB, 87.5% and 37.5% with LVB, 75.0% and 50.0% with LVAD, and 44.4% and 11.1% with PCPS, respectively. Clinical results of post-cardiotomy circulatory support (64.9% of weaning and 37.8% of discharge) were acceptable, but the patients with non-cardiotomy cardiac failure needed early application of more advanced circulatory support.

Adult↗
PubMed1995

[Relation between preoperative ventricular arrhythmias and postoperative results in aortic valve regurgitation].

Sudden death is a well known complication of aortic valve regurgitation and remains a common cause of late mortality after aortic valve replacement. Although malignant arrhythmias have been suggested as the cause of these outcome, there has been little information concerning the frequency and severity of ventricular arrhythmias in patients with aortic valve regurgitation. In order to evaluate the relation between the severity and/or frequency of ventricular arrhythmias and late postoperative results in patients with pure aortic valve regurgitation, 24-hour ambulatory electrocardiographic recordings were obtained before surgery in 107 patients without coronary artery disease. Grading of ventricular arrhythmias was based on a Lown method and compared with hemodynamic data. Ventricular premature beats were observed in 101 patients (94.4%) before operation. Multiformity was found in 10 patients (9.3%) couplets in 19 patients (17.8%) and ventricular tachycardia in 32 patients (29.9%). Patients with severe ventricular arrhythmias (Lown grade 3 or 4: 57.0%) had a higher left ventricular end systolic volume index (LVESVI) 153.1 +/- 76.4 ml/m2 vs 96.5 +/- 35.0 ml/m2 (p = 0.0001); a higher left ventricular end diastolic volume index (LVEDVI) 257.0 +/- 85.4 ml/m2 vs 206.5 +/- 58.3 ml/m2 (p = 0.0009); a lower left ventricular ejection fraction (LVEF) 43.4 +/- 12.5% vs 54.2 +/- 9.8% (p = 0.0001). LVESVI was not related to the severity of ventricular arrhythmias, but was significantly related to the frequency (p < 0.05). All patients with late death were belonging to Lown grade 3 or 4 in severity and more than 30 beats per hour in frequency (28.6%). This study indicates that ventricular arrhythmias are common in patients with aortic valve regurgitation.(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Valve↗
PubMed1995

[The modified Bentall's operation for the prosthetic valve malfunction with annuloaortic ectasia due to aortitis syndrome--a successful case of the operation on steroid therapy].

A 23-year-old female was undergone the modified Bentall's operation for the prosthetic valve malfunction with annuloarotic ectasia due to aortitis syndrome. For she was in active inflammatory phase at the first admission to our hospital, the glucocorticoid steroid therapy was started to control the inflammation. After the good control was induced, the re-operation was done. In the operation, the prosthetic valve was detached from the annular ring and the motion was restricted by small thrombus and the remnant of right coronary cusp, and the right coronary orifice was not noticed. The right coronary artery was not able to be reconstructed, and slightly ischemic change was occurred postoperatively. She was treated by glucocorticoid steroid also in the postoperative period. Her postoperative course has been uneventful of three years.

Adult↗
PubMed1995

[Experimental study on organ perfusion by intraaortic balloon counterpulsation with double balloon catheter].

Newly-developed catheter for the intraaortic balloon counterpulsation with cardio-renal assist was examined on animal model. The catheter consists of two balloon segments between which the celiac trunk, the superior mesenteric artery and the renal artery are to be placed. Statistical comparison on each hemodynamic element was carried out between the catheter (DBC), conventional single balloon catheter (SBC) of the same balloon volume as DBC and no assist (None) groups. There were no significant changes between SBC and DBC in cardiac output, femoral arterial flow and central venous pressure. Renal arterial flow and urinary output were significantly increased in DBC (None 14.4 +/- 3.9, SBC 22.6 +/- 5.6, DBC 31.0 +/- 6.9 ml/min in renal arterial flow, None 33 +/- 9, SBC 64 +/- 14, DBC 78 +/- 20 ml/h in urinary output, p < or = 0.05). After the remodeling adjust to the human stature, a clinical application would be considered.

Animals↗
PubMed1995

[Surgical results of aortitis syndrome (Takayasu disease) combined with annuloaortic ectasia].

From March 1973 to December 1994, 8 patients (2 males and 6 females) aged 34.4 +/- 7.8 years, underwent composite graft replacement (CGR) for aortitis syndrome combined with annuloaortic ectasia (AAE) in our institute. Five patients showed active aortitis syndrome and steroid therapy was administrated to 2 of them. The mean value of the C-reactive protein (CRP) was 1.6 +/- 1.8 before the operation. The maximum diameter of the ascending aorta was 67.1 +/- 10.3 mm (range 53 to 85 mm). Stenosis and/or ectasia of the neck vessels were recognized in 5 cases, as well as the coronary artery in 2 cases. Isolated CGR was performed in 6 cases, and combined with single CABG to LAD in 1 case and with total arch replacement in 1 case. The enlarged ascending aorta was replaced with main graft using the exclusion method and interposed grafts for coronary arteries were sutured with pledgetted mattress sutures all around the coronary ostia. In patients with stenosis of neck vessels, oxygen saturation of the jugular vein was monitored during extracorporeal circulation for surveillance of cerebral ischemia. There was 1 early death due to pulmonary failure. Seven cases survived without any complications during 4-132 months (mean 83.4 months) of the follow-up period. After the operation, 3 cases required steroid therapy during 4-50 months. We concluded that preoperative control of active inflammation, selection of operative procedures, timing for the operation, and the long-term precise management of the intractable disease were essential for successful treatment of aortitis syndrome with AAE.

Adult↗
PubMed1995

Long-term outcome of left ventricular dysfunction after surgery for severe aortic stenosis.

Thirteen patients with severe aortic stenosis and left ventricular dysfunction (ejection fraction < 0.50, Group A) received echocardiographic evaluation before, and early and late after isolated aortic valve replacement. The results were compared with those of 11 aortic stenosis patients without left ventricular dysfunction (Group B). Using two-dimensional echocardiography, left ventricular diastolic internal diameter (LVIDd), left ventricular systolic internal diameter (LVIDs), left ventricular wall thickness (interventricular septum + posterior wall: LVWT), left ventricular fractional shortening (FS), left ventricular mass index (LVMI) and left ventricular end-systolic wall stress (ESWS) were assessed before (Pre), at one month (Early) and 4-7.6 (mean 5.5 +/- 1.0) years (Late) after operation. In the early postoperative period in Group A, significant decrease was observed in LVIDd (5.4 +/- 0.8 to 4.5 +/- 1.0 cm, p = 0.010), LVWT (3.3 +/- 0.7 to 2.9 +/- 0.7 cm, p = 0.027) and LVMI (336 +/- 149 to 222 +/- 112 g/M2, p = 0.013). From the early to late postoperative period FS showed significant improvement in both groups (0.23 +/- 0.12 to 0.32 +/- 0.12 in Group A, p = 0.025 and 0.27 +/- 0.07 to 0.36 +/- 0.07, p = 0.014). However, changes of other parameters were not significant and LVMI in Group A remained twice as high as the normal value. It is concluded from the above results, that LV contraction in aortic stenosis patients with preoperative left ventricular dysfunction improved during the late postoperative period. Although LVMI in the early postoperative period significantly decreased as compared with the preoperative value, it showed no further improvement and remained at an abnormally high level. Therefore, early surgical treatment of severe aortic stenosis before appearance of LV dysfunction should be recommended for postoperative recovery from LV hypertrophy.

Aged↗
PubMed1994

Successful reconstruction of aorto-left atrial fistula following aortic valve replacement and root enlargement by the Manouguian procedure.

Successful reconstruction of the aortic annulus for perivalvular leak following combined valve replacement was performed in two patients, 6 and 7 years postoperatively, using Manouguian's operation. A fistula was seen at the junction of the aortic annulus and the superior or inferior margin of the patch used for enlargement. This fistula was closed from both sides; from the left atrium with reinforced Teflon pledgets and from the aorta using a patch. Successful reconstruction of the aortic annulus was made, and no regurgitation was seen after the operation.

Aorta↗
PubMed1994

[The rescue effect of FK506 in refractory rejection after cardiac transplantation].

The patient with dilated cardiomyopathy (NYHA class 4) under went cardiac transplantation at University of California, Los Angeles. Severe cardiac rejection was revealed one month after the transplantation. Steroid therapy was not effective, the rejection was resolved with OKT3 therapy and Anti-thymocyte globulin. Moreover, severe rejection was seen five months later. Steroid therapy was not effective. Cyclosporine administration was substituted for FK506 (0.02 mg/kg/day). After the induction of FK506, the number of CD8 positive cells decreased and cardiac rejection was successfully resolved. As side effect of FK506, bradycardia with heart rate of 50/min for 4 minutes appeared. However, it was well-controlled when the trough level of FK506 was reduced to less than 8 ng/ml.

Adult↗
PubMed1994

[Preservation of fresh homograft using TC199 solution in rat].

The surgical replacement of human vessels using fresh allografts (homograft) has been reported as useful means. Nevertheless, little is known about preservation effect and immunological consequences using TC199 solution. In this study, defined inbred strains of rats were used. The aorta was extracted from Buffalo rats and preserved for 1, 2, and 3 weeks in TC199 solution at 4 degrees C. The preserved graft was then implanted into the Buffalo rats heterotopically, in the abdominal aorta, in the autotransplant group (AUTO) and into the Lewis rat in the allotransplant group (ALLO). The graft patency and histology including immunohistochemical stain (IgG, IgM, and C3 complement) were assessed at 2 weeks after transplantation. In AUTO, the patency was 100% with grafts 1 and 2 weeks' preservation, and 80% with 3 weeks' preservation. In the ALLO, patency was 100% with grafts with one week's preservation, 80% in those with 2 weeks' preservation and 0% those with in 3 weeks' preservation. Histology revealed that fibroblasts and endothelial cells were significantly deteriorated in 3 weeks' preservation in auto transplantation, however, they were well-maintained in 2 weeks' preservation. In the allo-transplantation group, histological deterioration began after 2 weeks preservation. Immunohistochemical staining showed significant deposits of IgG, IgM and C3 in ALLO. Significant infiltration of antibodies was seen in deteriorated tissue due to prolongation of the preservation periods. These results suggested that freshly preserved allograft was antigenic and 2 weeks preservation using TC199 solution was possible in the rat model.

Animals↗
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

[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

[Pre and postoperative management of a patient after cardiac transplantation performed in UCLA].

The patient with dilated cardiomyopathy (NYHA grade 4) underwent cardiac transplantation at University of California, Los Angeles. Postoperative management in our institute consisted 1) cardiac biopsy, 2) measurement of blood concentration of cyclosporin, 3) serum anti-CMV titer, 3) echo cardiography, 4) counts of lymphocyte subsets. Cardiac rejection (Ib) was observed 2 months after transplantation and steroid pulse therapy (methylprednisone 500 mg/day) was performed for 3 days. Blood concentration of cyclosporin was decreased with administration of probucol and increased with diltiazem. Presently, the patient is stable and back to normal work.

Cardiomyopathy, Dilated↗
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

[Rescue effect of 15-deoxyspergualin for acute rejection on heart transplantation--using a rat model].

15-Deoxyspergualin (DSG) attracts a lot of attention as an immunosuppressive drug which has less side effects these days. In the present study, we researched the rescue effect of DSG for acute rejection on heart transplantation (HTX) by using rat models. We performed 40 heterotopic heart transplantation models. We injected them DSG (group A: 5 mg/kg/day, group B: 10 mg/kg/day) intravenously through 3 days, starting from the 3rd day the 4th day, and the 5th day after HTX. Our previous study showed the pathology on the 3rd day after HTX corresponded to mild rejection, the 4th day to moderate rejection, and the 5th day to severe rejection. One day after the injection was completed, the recipients were sacrificed. The rescue effect was histopathologically assessed by H-E stain, and the action mechanism of DSG was considered by immunohistochemical stain using monoclonal antibodies, which were against CD4 positive cells, CD8 positive cells, and macrophages. In result, the rescue effect of DSG was significant in all groups, in comparison with controls, which had no immunosuppression. And the rescue effect of group B was superior to group A. We also found using a immunohistochemical technique, that DSG inhibited the accumulation of CD4 and CD8 positive cells. We concluded the rescue effect of DSG for acute rejection on HTX was significant, especially in 10 mg/kg/day even in the severe rejection. And the suppression of helper and cytotoxic T cells accumulation might be one of the action mechanisms of DSG.

Acute Disease↗
PubMed1994

[Reoperations on valvular disease: an analysis of outcome].

To evaluate risks and complications of reoperation on valvular disease, we reviewed data on 186 patients who underwent reoperations because of prosthetic valve malfunctions, pregression of valvular disease after open mitral commissulotomy and previous valvular replacement. Overall hospital mortality was 4.8% (9/186 patients). The common causes of death was low cardiac output syndrome (3 pts.) and respiratory failure (3 pts.) and others (3 pts). Hospital mortality was different according to the risk factors. There was no significant difference between the operative procedures; AVR (6.2%), MVR (3.2%), DVR (8%), TVR (0%) and MVR + TVR (9%). Furthermore, advanced age, valve position, renal failure, preoperative %FS, LVDd and diagnosis of prosthetic valve malfunction did not appear to be significant risk factor. However, preoperative respiratory failure and emergency operation showed significant increase of hospital mortality in comparison with other factors. On the basis of this reports, hospital mortality and late survival indicated that reoperation should be performed early as the potentially safe condition.

Disease Progression↗