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Biomedical subjects

M Sawazaki

Publications and source records attributed to M Sawazaki.

34 records · Page 2Linked to original sources
PubMed1992

[Successful repair of traumatic aortic arch rupture].

The most common site of traumatic aortic tear is at the isthmus, and there have been few reports of successful surgical repair of traumatic rupture of the aortic arch. We have experienced a 18-year-old patient who sustained a blunt chest trauma in a traffic accident. After admission to our hospital, his general condition became stabilized by conservative therapy. But the chest X-ray showed widening of mediastinum and aortography demonstrated leakage of contrast media outside of the aortic arch lumen between the innominate and the left common carotid arteries. The patient underwent reconstructive surgery for the innominate artery with a part of the aortic arch using prosthetic graft with the aid of hypothermic retrograde total body perfusion. He has recovered without any neurological deficit, although the retrograde perfusion time exceeded 100 minutes. It is suggested that the technique of "retrograde total body perfusion" may provide longer time to perform aortic arch repairs than the conventional circulatory arrest does.

Accidents, Traffic↗
PubMed1992

[Surgical treatment of acquired tricuspid stenosis].

There is no definitive surgical procedure for acquired lesions of the tricuspid valve (TV). From Feb, 1978, through March, 1990, the surgical treatment for the organic lesions of TV was performed in 10 patients, repair in 6 and TV replacement in 4. TV was repaired by commissurotomy, annuloplasty or valvuloplasty, or combination of them. When residual significant tricuspid regurgitation (TR) and/or stenosis (TS) was detected by intraoperative pulsed Doppler echocardiography after reparative procedures, TV was replaced. Follow-up periods ranged from 1 to 12 years (mean, 45.3 months). There was no early death, and late death was noted in one patient 32 months after operation. Preoperatively, 7 patients were in NYHA class IV and 3 in class III. Out of survivors, 7 are in class I and 2 in class II because of progression of mitral stenosis or coronary artery disease. Following surgery, the patients exhibited significant decrease in the cardiothoracic ratio (69.3 +/- 7.2 to 56.9 +/- 6.4%; p less than 0.01) and in the mean right atrial pressure (11.4 +/- 3.6 to 8.6 +/- 3.1 mmHg; p less than 0.05). The postoperative right ventriculography showed mild to moderate TR in 3 of 6 patients who underwent TV repair. In conclusion, TV repair could be a reasonable procedure for the organic TV lesions, although careful follow-up is recommended for residual TR.

Adult↗
PubMed1992

[Operative management of Stanford type A aortic dissection using selective cerebral perfusion].

Ten patients underwent surgical treatment for type A aortic dissection from October 1986 to April 1989 using hypothermic cardiopulmonary bypass (CPB) with selective cerebral perfusion (SCP). CPB was begun with femoral artery cannulation. The right axillary artery (RAA) and the left common carotid artery (LCCA) were separately cannulated and perfused with CPB blood by individual pump heads. The average flow to the RAA was 5.4 +/- 1.2 ml/min/kg body weight (mean +/- SD) and 5.6 +/- 2.6 ml/min/kg body weight to the LCCA. The average blood pressure of the superficial temporal artery was 53.1 +/- 15.1 mmHg in the right side and 52.5 +/- 24.7 mmHg in the left. The nasopharyngeal temperature during SCP was maintained at 19.3-24.7 degrees C (mean, 21.1 degrees C). The SCP time ranged from 112 to 197 minutes (mean, 168 +/- 20.8 minutes). There was one operative death. She died of myocardial infarction 3 days after operation. There were two late deaths. One patient died of infection 3 months after operation and another died of cholecystitis 4 months after operation. Cerebral infarction developed in the last patient. Among the 10 patients it was only one neurological sequela, which was surmised to be caused by technical problem in carotid artery cannulation. The good cerebral protection was obtained in our experience by SCP as mentioned above.

Aged↗
PubMed1991

[The significance of internal thoracic artery-left anterior descending coronary artery bypass grafting in postoperative angiographic studies--with reference to indication of ITA and factors of string sign].

Internal thoracic artery (ITA) graft for myocardial revascularization has shown superior long-term patency. However, several reports pointed out that the flow capacity of ITA was questionable and the string sign of ITA graft was sometimes observed in the findings of postoperative angiography when the stenosis of the coronary artery was of a lesser degree. We studied pre- and postoperative angiographic findings of 101 patients who underwent ITA grafting to the left anterior descending coronary artery. Postoperative angiography showed that the blood flow from the ITA graft ran through the site of anastomosis only towards the distal end when preoperative stenosis of the native left anterior descending coronary was less than 75%. ITA flow ran bidirectionally (retrogradely and antegradely) when stenosis was within 75 to 90%. Many cases with stenosis of greater than 90% showed the progression of the native lesion, that is, total obstruction of the left anterior descending coronary artery. It becomes clear by statistical study that the postoperative progression of native proximal lesion of the left anterior descending coronary artery correlates neither with the morphological state of the coronary artery nor sites of lesions, but the severity of stenosis. A conclusion has been drawn from angiographic study, that the blood flow from the ITA graft run into two directions; towards the distal and the lesion of the left anterior descending coronary artery, if the free flow through ITA was about 60 ml/min and at the same time, preoperative stenosis of coronary artery was 75% or more.

Adult↗
PubMed1991

[Myocardial revascularization using bilateral internal mammary arteries for total occlusion of LMCA in an adult case: sequelae of Kawasaki's disease in childhood].

A 43-year-old female patient suffering from effort angina underwent coronary artery bypass grafting. Coronary arteriogram demonstrated complete occlusion of the left main, proximal circumflex (Cx), and proximal left anterior descending coronary arteries (LAD) and a nonocclusive fusiform calcified aneurysm of the proximal right coronary artery (RCA). The left coronary artery system opacified via collateral vessels from the RCA. No other abnormalities were found in the entire aorta and its major branches. Myocardial revascularization was performed using the right IMA to bypass to the Cx and the left IMA to bypass to the LAD successfully. Prior to the operation, she had neither coronary risk factors nor inflammatory signs, though she had experienced fever of unknown origin lasting about a week when she was 11 years old. Accordingly we supposed that such coronary arterial lesions might have arisen from Kawasaki's disease in her childhood.

Adult↗
PubMed1990

[Late results after total correction of tetralogy of Fallot: over 10 year follow-up].

Late results after total correction of tetralogy of Fallot over ten year follow up of 84 patients were discussed. No late death was experienced and 95.1% of these patients are now in NYHA class I. Reoperations were performed in 7 cases (8.3%) in which six had had residual shunt and one had had sick sinus syndrome and had VVI pacemaker implantation. Ten cases had over 90% of ratio of right ventricular pressure to systemic pressure in systole in their cardiac catheterization about 40 days after correction. In spite of this high pressure ratio, all cases are now in NYHA class I. We conclude that there is a possibility of enabling to preserve pulmonary valve function by adopting smaller criteria than the Pacifico's criteria.

Adolescent↗
PubMed1990

[Mediastinal infection after open cardiac surgery].

Mediastinal infection is a rare but life-threatening complication after open cardiac surgery. Of 852 patients undergoing cardiac operations performed with a median sternotomy between January of 1981 and August of 1989, 19 patients (2.2%) developed deep sternal infections with mediastinitis, and 6 of them (31.6%) died. Tissue cultures were obtained from all but three patients, and staphylococcus aureus was the most frequent infecting organism associated with high mortality rates (3/8). 18 patients were managed with debridement and irrigation as the primary treatment, but 4 of them developed infective endocarditis during the course of irrigation treatment and then died. After 1987, 6 patients, who didn't gain wound closure with irrigation alone, were treated with reconstructive techniques, one with pectoral muscle flap closure, another with rectus myocutaneous flap mobilization, and the remainder with omental transfer respectively. All of them achieved eradication of infection as well as wound closure. Then we have advocated early debridement and mobilization of viable tissues such as omentum into the mediastinum.

Adult↗
PubMed1990

[Tricuspid annuloplasty--modified technique].

A modification of the DeVega's tricuspid annuloplasty (TAP) in the treatment of tricuspid regurgitation (TR) is described. Using a double-ended 2-0 Ethibond suture buttered with a Teflon felt pledget, a double suture line is begun at the center of the annulus of the anterior tricuspid valve leaflet. The two suture lines 2 to 3 mm apart are run around the edge of the annular ring of the anterior and posterior tricuspid valve leaflets, going over the posteroseptal commissure by 1.5 cm. A tiny piece of Teflon felt is placed at the end of the sutures. The annulus is narrowed to sungly allow passage of a prove with a diameter of 28 or 30 mm. The tricuspid function is assessed by injecting saline into the right ventricle through the right atrium. Between March 1986 and July 1989, 28 patients with functional TR secondary to mitral valve diseases have been operated on by this technique. There are one early and one late deaths, none being related to tricuspid valve annuloplasty. All 26 survivors had a significant drop in right atrial pressure and an associated improvement in clinical status. Follow-up of the 27 patients who survived this TAP ranges from 2 to 38 months (mean 17 months). This annuloplasty is a safe, effective and readily teachable method for the surgical management of TR.

Adolescent↗
PubMed1990

[Mitral valvuloplasty for mitral regurgitation due to torn chordae of the posterior leaflet].

Four patients with mitral regurgitation due to torn chordae of the mitral posterior leaflet underwent mitral valvuloplasty. Standard operation was McGoon's procedure which was sometimes combined with Kay's annulorrhaphy. There were no sign of mitral insufficiency and/or stenosis in all patients revealed by the post-operative cardiac catheterization and all of them are on good health. Then, our plans of mitral posterior valvuloplasty for mitral regurgitation are as follows: A resected area is not beyond 33% of the posterior leaflet and the target mitral valve area after valvuloplasty is 2.8 cm2.

Adult↗
PubMed1989

[A case of successful surgery for atrial septal defect accompanied with angina pectoris].

A 59-year-old patient with atrial septal defect (ASD) and angina pectoris due to 99% stenosis of the anterior descending coronary artery (LAD) was successfully treated by closure of ASD and coronary artery bypass grafting (CABG) to the LAD #7 with a saphenous vein graft. Preoperatively, the right ventricle was overloaded with high pulmonary arterial pressure (52 mmHg) and anterior segmental wall motion of the left ventricle was reduced probably due to myocardial ischemia. Combined operation, ASD closure and CABG, made these impairments normal and resulted in disappearance of the chest pain and reinstatement to his former job.

Angina Pectoris↗
PubMed1989

[A case of membranous septal aneurysm associated with infective endocarditis].

A 43-year-old man with membranous septal aneurysm associated with infective endocarditis was reported. In this case, the stream of the shunt through VSD was directly oriented toward the atrial surface of the tricuspid anterior cusp and made it unusual form. The focus of infective endocarditis was located on that cusp, and he underwent tricuspid valve replacement with VSD closure. The post-operative course was uneventful. We discussed the tricuspid anterior cusp deformed by the jet stream of the shunt and the relationship between the aneurysm and the infective endocarditis.

Adult↗
PubMed1989

[A case of two staged operation of pericardial abscess after left-ventricular aneurysmectomy].

A 54-year-old man who had undergone the left ventricular aneurysmectomy and double saphenous vein bypass grafting for the old myocardial infarction suffered from the pericardial abscess 6 years after the first operation. He was operated upon the persistent drainage of the lesion and returned to his daily life. Two years after the 2nd operation, he recognized pulsatile bleeding from the fistula and was admitted to our hospital. He underwent the radical operation for the cardio cutaneous fistula under the cardiopulmonary bypass. The post operative course was uneventful and he has continued to do well. We discussed the treatment for this kind of complication and stressed the limited usage of Teflon felt and other artificial materials.

Abscess↗