Search PubMed⌕ Search

Biomedical subjects

N Shiiya

Publications and source records attributed to N Shiiya.

At least 73 records · Page 4Linked to original sources
PubMed1998

[Long-term results of operation for acute type A aortic dissection].

We report results of surgical treatment in 30 patients with acute type A aortic dissection. The average age of the 25 patients without the Marfan syndrome was 59.2 (range 51-76), and male/female ratio was 11/14. The average age of the five patients with the Marfan syndrome was 36.8 (range 27-48), and male/female ratio was 2/3. As an adjunct, we used deep hypothermic circulatory arrest during ascending aortic replacement, while selective cerebral perfusion was employed during aortic arch replacement. Operative procedures for the non-Marfan patients included 14 ascending aortic replacement and 11 ascending and aortic arch replacement, while the Marfan patients underwent extensive aortic replacement that included three aortic arch replacement combined with the Bentall operation, one extensive replacement from the ascending aorta to the descending thoracic aorta and one ascending and aortic arch replacement. One patient died early after the operation and the early mortality rate was 3.3%. No patient developed new brain complication related to the operation. During the follow-up period, three patients died and two patients required a total of three subsequent distal operations. Cumulative survival rate was 89% at one year, 85% at three years, 85% at five years. Cumulative cardiovascular event-free rate was 89% at one year, 85% at three years, 77% at five years. Early and long-term results of surgical treatment for acute type A aortic dissection was satisfactory. This seems to result from the use of deep hypothermic circulatory arrest and selective cerebral perfusion as an adjunct and application of aortic arch replacement when the aortic arch is dilated or intimal tear is located in the aortic arch or more distally.

Aged↗
PubMed1998

Pancreaticoduodenal artery aneurysm with celiac trunk occlusion. Report of a case.

A case of superior mesenteric artery branch aneurysm is described. A 43-year-old female patient was hospitalized after the incidental discovery of a low echogenic mass next to the superior mesenteric artery trunk. A selective superior mesenteric arteriography confirmed aneurysms of the inferior pancreaticoduodenal artery and an aortogram demonstrated occlusion of the celiac trunk. Bypass between the abdominal aorta and the common hepatic artery and resection of aneurysms were performed. The possible etiology and operative procedure are discussed.

Adult↗
PubMed1998

Successful repair of cardio-Behçet's disease with aortic and mitral regurgitation.

A case of Behçet's disease with cardiac involvement of aortic and mitral regurgitation is presented. The patient underwent aortic and mitral valve replacement, along with plication of the ascending aorta. Histological examination revealed chronic inflammation with degenerative changes, consistent with Behçet's disease. Anti-inflammatory therapy using prednisolone was maintained throughout the postoperative period. This is the first case of cardio-Behçet's disease surgically treated for both aortic and mitral valves with a successful long-term survival.

Aortic Valve Insufficiency↗
PubMed1997

Extensive replacement of the aorta from the ascending aorta to the supraceliac abdominal aorta during a one-stage operation.

A successful replacement of the aorta from the ascending aorta to the supraceliac abdominal aorta in one operation is herein reported. The patient was 66-year-old woman who had DeBakey type I chronic aortic dissection with a pre-disseminated intravascular coagulation (DIC) condition. The image diagnosis revealed a markedly enlarged false lumen with a narrow true lumen in the ascending aorta extending to the diaphragm level while below the diaphragm level, the aortic dilatation was mild. The operation was performed through both a thoracoabdominal incision and a median sternotomy to expose the whole thoracic aorta, and the aorta was replaced from the ascending aorta to the supraceliac abdominal aorta. Selective cerebral perfusion was used for cerebral protection and this was a useful adjunct since no time limitations were thus required during repair of the aortic arch. Although the patient developed several complications postoperatively, she eventually recovered and was discharged from the hospital without any neurological disorders.

Aged↗
PubMed1997

Inflammatory abdominal aortic aneurysms and atherosclerotic abdominal aortic aneurysms--comparisons of clinical features and long-term results.

A total of 274 patients with abdominal aortic aneurysms due to atherosclerosis (AAA) and 16 patients with inflammatory abdominal aortic aneurysms (IAAA) were reviewed to compare and contrast the clinical characteristics of the 2 groups. The AAA group comprised 243 men and 31 women with a mean age of 69.2 +/- 0.4 (range 51-86) years. The IAAA group comprised 15 men and 1 woman with a mean age of 67.4 +/- 2.0 (range 53-81) years. Most patients with IAAA (12/16; 75.0%) had pain at presentation, whereas only 37 out of 274 patients (13.5%) with AAA had pain (p < 0.001). Fifty out of 274 patients (18.2%) with AAA were asymptomatic, the most common principal complaint being a pulsatile tumor, which was found in 150 out of 274 patients (54.7%; p < 0.005 vs IAAA). Regarding laboratory findings of inflammation, preoperative erythrocyte sedimentation rate values were elevated in 15 out of 16 (93.8%) patients, and C-reactive protein values were elevated in 13 out of 16 (81.3%) patients with IAAA. The incidence of perioperative complications was similar in the 2 groups. The 30-day postoperative mortality among AAA patients was 6.2% (17/274 cases), including 12 cases of non-ruptured and 5 cases of ruptured AAA; in contrast, no early deaths occurred among patients with IAAA. The cumulative 5-year survival rate was 80.2% for IAAA patients and 74.6% for AAA patients (NS). The results of our review suggest that careful diagnosis and intra- and postoperative management could lead to patients with IAAA having a similar survival rate to those with AAA.

Aged↗
PubMed1997

[A case report of primary repair for thoracic and thoracoabdominal and iliac artery aneurysms associated with severe visceral artery occlusive diseases--a redo operation for thoracoabdominal aortic aneurysm after infrarenal abdominal aortic aneurysm repair].

Abdominal aortic aneurysms can now be successfully repaired with low mortality and few early complications. On the other hand, the cases that required operations for recurrent aneurysms have been increased during long term follow-up period. In such cases, there are many difficulties for operative procedures compared to their first operations and many risk factors. A case of successful operation for the thoracoabdominal aortic aneurysm associated with severe stenotic lesions of the visceral arteries and descending thoracic aneurysm and left common iliac artery aneurysm are reported. A 74-year-old man who underwent operation for infrarenal abdominal aortic aneurysm and left nephrectomy 7 years and 9 months ago at our institution developed an aneurysm just above the proximal anastomosis with severe stenotic lesions of the visceral arteries. At the same time, descending thoracic aortic aneurysm and left common iliac artery aneurysm were associated. And he had ischemic heart disease. Under selective perfusion of the visceral arteries, graft replacement of these aneurysms and reconstruction of superior mesenteric artery and right renal artery were done. The patient had good post operative course and started oral feeding at 3 post operation day. He returned to his occupation and is doing well with no trouble one and half year after operation.

Aged↗
PubMed1997

Operative results of thoracoabdominal repair for chronic type B aortic dissection.

From January 1991 to May 1994, we have operated on 15 cases of Type B aortic dissection. In 10 of these patients, thoracoabdominal repair was performed. According to Crawford's classification, 2 patients fell into Type I, 6 patients into Type II, and 2 patients into Type III. The aneurysms were exposed through a left thoracotomy extending into the retroperitoneum with the hemidiaphragm divided circumferentially. The operations were performed under femoro-femoral partial cardiopulmonary bypass. In 6 of these cases selective perfusion of the visceral branches was used. The celiac axis was reconstructed in 10 patients, superior mesenteric artery in 9, right renal artery in 7, left renal artery in 6. Abdominal vessels were reconstructed by the "inclusion" technique described by Crawford in 2 patients, by "beveling" the distal prosthetic end in 6 and by the "interposition" technique in 4 patients. Vessels arising from the false lumen were reconstructed by the "interposition" technique. To prevent paraplegia, the evoked spinal cord potentials by direct stimulation of the cord (ESPs-dsc) were monitored perioperatively and the aneurysms were repaired sequentially in segments. In all patients except 2 with Crawford type III aneurysms, spinal cord ischemia was detected by ESPs-dsc. In 7 of these patients, 2 to 8 pairs of intercostal/lumbar arteries (I/L aa.) that arose from the "responsible" aortic segment were reconstructed. Reconstruction techniques included the "inclusion" technique in 2 patients, the "beveling" technique in 1, the "interposition" technique in 1 and the "on lay grafting" technique in 3 patients. One hospital death occurred in a patient who had chronic renal insufficiency and liver cirrhosis preoperatively. Spinal cord injury occurred in 5 patients, including 4 paraparesis and 1 delayed-onset paraplegia. In 2 of these patients, responsible I/L aa., were not reconstructed correctly despite ESPs changes, and injury might have been prevented if reconstruction of the "responsible" arteries had been performed. Thoracoabdominal repair for chronic Type B aortic dissection could be performed safely with an acceptable mortality rate. Spinal cord injury remains an unsolved problem.

Aortic Dissection↗
PubMed1997

The reliability of evoked spinal cord potentials elicited by direct stimulation of the cord as a monitor of spinal cord ischemia during temporary occlusion of the thoracic aorta.

Paraplegia is a severe and disastrous complication of operations on the thoracic aorta. For preventing this complication, we employed evoked spinal cord potentials elicited by direct stimulation of the cord (ESPs-dsc) during operations on 83 patients with various aortic lesions (37 dissecting and 46 cases of nondissecting aneurysms, 35 descending and 48 thoracoabdominal aortic aneurysms). All of the patients had some form of circulatory adjunct during aortic cross-clamping. Of the 83 patients, three had "immediate" paraparesis and five had "immediate" paraplegia, whereas three other patients had "delayed" paraplegia. During operation, four types of ESPs-dsc response pattern were observed: (1) no change (n = 57), (2) change with return (n = 15), (3) change with inconsistent return (n = 6), (4) change without return (n = 5). "Delayed" paraplegia occurred in two patients with "no change" and "change with return" response (3%), "immediate" paralysis occurred in three and "delayed" paraplegia occurred in one of those with "change with inconsistent return" response (67%), and all of those with "change with inconsistent return" response (67%), and all of those with "change without return" response developed "immediate" paraplegia (100%). We conclude that intraoperative monitoring of spinal cord function utilizing ESPs-dsc is a good indicator of spinal cord ischemia and we can improve the outcome according to its changes.

Aorta, Thoracic↗
PubMed1997

Mycotic aneurysm of the bilateral tibioperoneal trunks associated with bacterial endocarditis: a case report.

Since antibiotics have been widely used in the treatment of bacterial endocarditis, mycotic aneurysms caused by septic emboli have become extremely rare. We report the case of a 34-year-old man who had mycotic aneurysms in the tibioperoneal trunks of both legs six weeks after he had a mitral valve replacement due to Streptococcus viridans endocarditis. Color Doppler sonography was used to diagnose pseudoaneurysms in both legs. Surgical treatment included the closures of the orifices of both aneurysms in both legs and arterial reconstructions were not required. In the literature, however, the location of mycotic aneurysms in peripheral arteries related to endocarditis were usually reported to be in the upper extremities or femoral arteries. Thus, we present the extremely rare case of mycotic aneurysms because the aneurysms occurred in the infrapopliteal vessel and developed in both legs.

Adult↗
PubMed1996

[Dissection of the interventricular septum with aorto-left ventricular communication due to infective endocarditis--report of a rare case].

Dissection of the interventricular septum is an uncommon manifestation, which is rarely associated with infective endocarditis, aneurysm of sinus of Valsalva and thoracic trauma. We report a 34-year-old male case with aorto-left ventricular communication due to infective endocarditis. The patient had chief complaints of dyspnea on exertion and precordial discomfort. Preoperative laboratory data showed normal white blood cell counts, a slightly elevated CRP, and negative blood culture in bacterial examinations. Echocardiogram revealed progressive dissection of the interventricular septum and stenosis of the left ventricular outflow tract. Disturbance of conduction including progressive atrioventricular block and bundle branch block were found in the electrocardiogram. The dissection extended over 2 x 2 x 2.5 cm in diameter, with an entry located at the basis of the right coronary cusp and reentry communicated to the left ventricle. Operative procedures included the aortic valve replacement with prosthetic valve due to severe inflammation, in addition to resection of the dissecting cavity. Pathological examination of the resected tissue accorded with infective endocarditis in active phase, showing necrosis, small cell infiltration and microabscess. However, a bacterial colony was not found in the surgical specimen. Postoperative course was uneventful and the patient was discharged in satisfactory conditions.

Adult↗
PubMed1996

[A case of redo operation for ascending aortic aneurysm after modified Bentall operation for Marfan syndrome associated with type A acute dissecting aortic aneurysm].

A 37-year-old man who had undergone modified Bentall operation in December 1986 had redo operation for ascending aortic aneurysm. Initial operation, in other institute, included aortic root replacement using composite graft and reconstruction of coronary arteries. Left coronary ostium was directly anastomosed to composite graft while a saphenous vein was grafted between composite graft and right coronary artery concomitant with closing right coronary ostium. In addition, composite graft was wrapped with native aortic wall and Cabrol trick was carried out. In December 1994, this patient required redo operation for a 90 mm size of ascending aotric aneurysm which had been used for wrapping in the initial operation. The findings at reoperation revealed patent Cabrol trick, occluded saphenous vein graft, dehiscent proximal anastomosis of saphenous vein graft and partial dehiscence of distal anastomosis of composite graft. The repairs included new saphenous vein grafting to right coronary artery and re-anastomosis of distal site of composite graft. Cabrol trick was closed and composite graft was not wrapped. His post-operative course was excellent and post-operative scintigram indicated ameriolation of inferior wall ischemia.

Acute Disease↗
PubMed1996

[Subtotal aortic replacement in a patient with Marfan's syndrome--replacement of the ascending aorta and entire aortic arch for acute type I aortic dissection 4 years after the thoracoabdominal replacement].

We report a patient with Marfan's syndrome who underwent replacement of the ascending aorta and the entire aortic arch for acute type I aortic dissection 4 years after the thoracoabdominal replacement. As a result, she underwent subtotal aortic replacement from the ascending aorta to the bilateral common iliac arteries in three stages. A 48-years-old female was admitted to our service because of acute heart failure and cardiogenic shock caused by acute DeBakey type I aortic dissection. She had undergone replacement of the descending thoracic aorta at the age of 44 and replacement of the remaining thoracoabdominal aorta with reimplantation of the four major abdominal branches at the age of 46 for a chronic expanding DeBakey type IIIb dissecting aneurysm. She successfully underwent replacement of the ascending aorta and the entire aortic arch with an aortic prosthesis provided with four branch grafts for reconstruction of the arch vessels. Considering the high incidence of new aortic lesion, extensive aortic replacement and careful postoperative follow-up are necessary in patients with Marfan's syndrome.

Aortic Dissection↗
PubMed1996

[Successful surgical repair of acute DeBakey type I aortic dissection complicated by acute occlusion of the suprarenal abdominal aorta].

We reported a case of acute DeBakey type I aortic dissection presented with occlusion of the suprarenal abdominal aorta, who was successfully treated by simultaneous graft replacement of the ascending aorta and total aortic arch. The patient was a 68-year-old man who complained of chest pain and symptoms of acute arterial occlusion of bilateral lower extremities, and who had consciousness disturbance due to stroke caused by aortic dissection. He underwent simultaneous graft replacement of the ascending aorta and total aortic arch under selective cerebral perfusion during an emergent operation. For reconstruction of the arch vessels, we used three separate grafts that were connected to the aortic prosthesis before use. Although postoperative course was complicated by myonephropathic metabolic syndrome, the patient subsequently recovered and was discharged on foot. Early vascular reconstruction and appropriate management of reperfusion injury are extremely important in the setting of malperfusion phenomena complicating acute aortic dissection.

Aged↗
PubMed1996

[Evolution and recent trends in patient selection and reconstruction method for chronic aortic dissection].

Evolution and recent trends in patient selection and reconstruction method for chronic aortic dissection are reported. Although patient selection and reconstruction method for chronic type A aortic dissection are essentially identical with those for acute type A aortic dissection, chronic dissection frequently necessitates extended reconstruction of the aortic arch. Aortic valve-sparing operation is increasingly applied for associated aortic regurgitation. In chronic type B aortic dissection, operation is indicated when the diameter exceeds 5 cm, if it is symptomatic (i.e. those accompanied with pain or malperfusion of the vital organ), or when it is enlarging rapidly. Operative treatment includes resection of the intimal tear and replacement of the dilated segment. With the advance in diagnosis, methods of organ protection and operative techniques, operative results for chronic aortic dissection had been improving, despite the fact that these complex lesion frequently requires extensive aortic reconstruction with reimplantation of the major aortic branches. Spinal cord protection in extensive thoracoabdominal reconstruction for type B aortic dissection remains an unsolved problem.

Aortic Dissection↗