Biomedical subjects

S Aoyagi

Publications and source records attributed to S Aoyagi.

At least 235 records · Page 13Linked to original sources

PubMed1991

[A case report of atrial septal defect with quadricuspid pulmonary valve].

We reported the successful case of valvuloplasty on the quadriscuspid pulmonary valve which had pulmonary regurgitation. A 38-year-old woman was admitted with the complaint of palpitation. Atrial septal defect and pulmonary regurgitation were revealed preoperatively by the cardiac catheterization and doppler echocardiography. The malcoaptation of the pulmonary valve and pulmonary dilatation were diagnosed in echocardiography. At operation, the pulmonary valve was found quadricuspid and each cusp was same in size. The patient underwent the valvuloplasty on the abnormal cusps and the remarkable improvement of the coaptation was examined postoperatively. The patient had good clinical course for three years after operation.

Adult↗

PubMed1990

[Late postoperative results after repair of tetralogy of Fallot].

Two hundred and eighty two survivors after complete correction of tetralogy of Fallot were analyzed in late follow up periods. The method of the reconstruction of right ventricular outflow tract was non-transannular path (NTAP) in 110 patients and transannular patch in 172. In the group of TAP, pulmonary regurgitation occurred in all and the cardio-thoracic ratio was larger than the ratio in the group of NTAP (p less than 0.05). Postoperative ECG at rest showed complete right bundle branch block (CRBBB) in 224 patients and 6 of them showed sudden death in their follow up period. However, there were no sudden deaths in 41 patients without CRBBB. The rate of reoperation after intracardiac repair was 4.25% and the causes were residual pulmonary stenosis and residual ventricular septal defect, and there were no significant differences of the reoperation rate between NTAP-group and TAP-group.

Adolescent↗

PubMed1990

[Report of two operated cases with erythrocyte antibody].

Two operated cases with erythrocyte antibodies were reported. In the first case who required the second open heart operation for mitral stenosis, delayed hemolytic transfusion reaction by erythrocyte antibodies was recognized. The direct and indirect Coombs' tests were negative and the erythrocyte antibodies were not detected preoperatively. Massive blood transfusion during perioperative period precipitated secondary immunoreaction and reproduction of antibodies. An anti-c antibody and anti-E antibody were detected by the serologic studies on the 11th and 16th postoperative day. In the second case, stenotic mitral valve was replaced without homologous blood transfusion, because anti-C antibody was detected preoperatively. We believe that open heart operations without blood transfusion should be done, whenever possible, it should be kept in mind that delayed hemolytic transfusion reaction by erythrocyte antibody may occur after blood transfusion.

Coombs Test↗

PubMed1990

[Valve thrombosis of St. Jude Medical prosthesis; report of three cases].

Three cases with valve thrombosis of St. Jude Medical prosthesis (SJM valve) are reported. Incidence of valve thrombosis of SJM valve was 0.15%/patient-year. Cineradiography was useful to make the diagnosis. SJM valves were implanted with the hinges anatomically oriented in mitral position, and in both aortic and tricuspid positions with the leaflet opening parallel to the ventricular septum. Therefore, we recommend that SJM valve should be placed with the hinge antianatomically oriented in mitral position, and in both aortic and tricuspid positions with the leaflet opening to be perpendicular to the interventricular septum, respectively.

Adult↗

PubMed1990

[Four operated cases of traumatic tricuspid regurgitation].

Four cases of tricuspid regurgitation due to nonpenetrating chest trauma are presented. From five to twenty five years after the initial blunt chest trauma, they were admitted because of dyspnea or palpitation on exertion. In all cases echocardiogram showed severe tricuspid regurgitation and enlarged right atrium and ventricle. Cardiac catheterization revealed increased right atrial pressure with high v wave. At operation, their tricuspid valves or chordae tendineae were revealed ruptured without other valvular injury. Ruptured chordae tendineae of the anterior leaflet were in three cases and their valves were replaced with mechanical prosthesis. Tear of the anterior leaflet was in one case and it was sutured directly, but mild tricuspid regurgitation was left after the operation. Twenty cases have been reported in Japan up to date and fifteen of them have surgical treatment; tricuspid valve replacement (TVR) is performed in 10 cases, tricuspid valvuloplasty (TVP) is in 3 cases, suture of ruptured chordae tendineae is in 2 cases. Five cases are treated medically. How to diagnose and how to treat them are discussed. And, in the conclusion, we consider that the surgical treatment is recommended for the case of traumatic tricuspid regurgitation with uncontrollable heart failure.

Adult↗

PubMed1990

[Selection of a prosthetic valve for mitral valve replacement].

The early and the late results of mitral valve replacement were retrospectively evaluated to delineate the concept of selection of the prosthetic valve for the mitral position. The mitral valve was replaced with porcine bioprosthesis (P-B) in 102 patients and with St. Jude Medical prosthesis (SJM) in 341 patients between 1975 and 1987. Operative mortality was 5.3% for the SJM and 8.8% for the P-B group (N.S.). Cumulative duration of follow up was 1479.8 patient-years for the SJM and 888.9 patient-years for the P-B group. Actuarial survival rate was 90% for the SJM at 9 years and 81%, 76% for the P-B group at 10 and 13 years (N.S.). Freedom from valve-related death was 94% for the SJM at 9 years and 94% for the P-B at 13 years (N.S.). Thrombo-embolic complications occurred at an incidence of 0.47%/patient-years (p-y) for the SJM and 0.67%/p-y for the P-B group (N.S.). Freedom from prosthetic valve dysfunction due to primary tissue failure (PTE) lowered rapidly after the seventh postoperative year from 88% to 35% in the P-B group. Prosthetic valve dysfunction free rate was significantly lower in the P-B group compared with the SJM between the seventh post operative year and ninth postoperative year (p less than 0.01). From this analysis, we believe that the SJM prosthesis is suitable cardiac valve prosthesis to the mitral position.

Adolescent↗

PubMed1990

[Left atrial thrombosis after mitral valve replacement].

Thrombosis of the left atrium is a rare but troublesome complication of the mitral valve replacement (MVR). In our series of MVR, seven patients had thrombus formation of the left atrium late after MVR. These seven cases (LAT group) are compared with 53 cases (no LAT group), who are picked up randomly and have no thrombus of the left atrium after MVR, concerning to some risk factors. And the result is that the left atrial volume shows a significant difference between two groups among the risk factors. We consider that the cases with enlarged left atrium have a high risk of thrombus formation after MVR and so they also need a plication of the left atrium at the primary operation.

Adult↗

PubMed1990

[Surgical treatment of massive pulmonary embolism--the time of the operation and its effectiveness].

The records of 6 patients undergoing pulmonary embolectomy for massive pulmonary embolism (MPE) at Kurume University Hospital during 17 years were reviewed to determine the management of surgery. The patients consisted of 2 men and 4 women. The patients' ages ranged from 29 to 68 years (mean age, 49.3 years). The records showed that one patient died of brain death after operation and the others survived. All the patients complained of chest pain, anterior chest discomfort and dyspnea. Sudden syncope was observed in 2 patients. Artificial mechanical ventilation was performed preoperatively on 3 patients. Right ventricular load was demonstrated on electrocardiograms and ultrasonograms. Pulmonary angiograms were attempted on two patients and one of them had cardiac arrest during this examination. MPE was suspected by perfusion defect of 50% to 80% of pulmonary vasculature demonstrated on lung perfusion scintigram in 4 patients. Open pulmonary embolectomy with cardiopulmonary bypass (CPB) was performed on all patients using crystalloid cardioplegia and topical cooling. Intraoperative pulmonary angiograms were performed in 4 patients to prevent residual thromboemboli. Since most thromboemboli originate below the level of the vena cava, acute double ligation of the vena cava just below the renal vein was performed to control recurrent embolism. Oral anticoagulant, warfarin, was administered for 3 months after embolectomy as prophylaxis against postoperative recurrent embolism. It is our opinion that an aggressive attitude toward pulmonary embolectomy on CPB is necessary to save lives of MPE patients. This surgical procedure is very easy and safe.

Adult↗

PubMed1990

[Surgical treatment of supravalvular aortic stenosis].

Five surgically treated cases of supravalvular aortic stenosis were reported. Preoperative cardiac catheterization revealed marked left ventricular-aortic pressure gradient ranged from 20 to 180 mmHg (median, 80.2 mmHg) and retrograde aortogram showed localized (hourglass type) supravalvular aortic stenosis in all cases. A traditional diamond shaped patch aortoplasty was used to relieve supravalvular aortic stenosis in 1 case and an extended aortoplasty was used in last 4 cases. Pressure gradients were almost disappeared postoperatively with good surgical result. The extended aortoplasty is considered to be more reasonable than the traditional aortoplasty in relieving constriction symmetrically and restoring normal relationship of the aortic valve cusps and coronary ostia. The operative indication and selection of the operative procedures for supravalvular aortic stenosis were briefly discussed.

Adolescent↗

PubMed1989

[Clinical study of the effect to myocardial protection with crystalloid cardioplegic solution during open heart surgery in infants under age 3 months].

We investigated the effect to myocardial protection with crystalloid cardioplegic solution (Kurume solution I (S-I)) during open heart surgery in 21 infants less than 3 months old. The mortality was 28.6% (6 cases) including 2 patients having peroperative severe acidosis or shock. It was suggested that about half of them died of inadequate myocardial preservation. Comparing factors in the deaths with the survivors, there were significant differences between them in extracorporeal circulation time (ECCT) (196.7 +/- 50.1 min versus 133.2 +/- 45.8 min, p less than 0.01) and aortic-cross clamping time (ACCT) (120.0 +/- 45.8 min versus 78.3 +/- 30.5 min, p less than 0.05). In survivors, 86.7% of them required the effective dose (more than 6 micrograms/kg/min) of catecholamine and 33.3% presented low cardiac output syndrome (with the dose of more than 10 micrograms/kg/min and more than for 48 hours). The incidence of LOS was related to ECCT and ACCT. Thus it seemed that infant was more susceptible than older patient to the effects of ECC and the operation was carried out safely with ECCT less than 150 minutes and ACCT under age 3 months, it is necessary to use the cardioplegic solution fitting immature myocardium and to design operative technique and assist device for open heart surgery to shorten ECCT and ACCT.

Cardiac Surgical Procedures↗

PubMed1989

[Operative results of tricuspid valve replacement with St. Jude Medical prosthesis].

Since 1974, 14 patients underwent tricuspid valve replacement (TVR) with prosthetic heart valves. Hardy's operation was undergone in 2 patients with Ebstein's anomaly and mitral valve surgery or multiple valve surgery were undergone in 9 patients with rheumatic valvular disease, concomitantly. Four types of prosthetic heart valves were used in the tricuspid position, i.e. 2 Starr-Edwards prostheses, 1 Hancock xenograft, 1 Björk-Shiley prosthesis and 12 st. Jude Medical prostheses. The operative mortality rate was 14.3% (2/14) and 2 hospital deaths were due to low cardiac output syndrome. Twelve survivors have been followed with a maximum follow-up of 13 years and the mean of 4.7 years. There were 3 late deaths due to congestive heart failure and prosthetic valve endocarditis (PVE) of the aortic Björk-Shiley prosthesis. There was 1 PVE of the tricuspid Starr-Edwards prosthesis and 1 thrombosis of the tricuspid Björk-Shiley prosthesis, but no thrombosis and no other valve-related complications of SJM prostheses in the tricuspid position. The post-operative NYHA function class improved satisfactorily in 9 survivors. Judging from our relatively satisfactory post-operative results in TVR cases using SJM prostheses, SJM prosthesis in the tricuspid position is one of advisable prosthesis to get satisfactory hemodynamic improvement post-operatively.

Adult↗

PubMed1989

[A case report of double orifice mitral valve (DOMV) associated with incomplete endocardial cushion defect (ECD)].

A case of DOMV associated with incomplete ECD in a 17-year old girl is presented. Preoperatively, the mitral valve was suspected to have two orifice divided by the bridging tissue with sector echocardiography. DOMV is very rare congenital malformation, and 25 cases of DOMV are reported in Japan. Two of them were diagnosed as DOMV preoperatively with sector echocardiography. Sector echocardiography is useful to diagnose DOMV and to know the shape of it preoperatively.

Adolescent↗

PubMed1989

[Four successfully operated cases of ball thrombus in the left atrium].

The authors report four cases of the left atrial ball thrombus associated with mitral stenosis. Three of four which had floating ball thrombus in the left atrium presented with syncopal attacks and systemic embolism. Echocardiography was the most effective method for preoperative diagnosis of ball thrombus in the left atrium and mitralstenosis. After having accurate diagnosis of ball thrombus in the left atrium by echocardiogram, all of cases were treated urgently with removal of the thrombus and mitral valve replacement or mitral commissurotomy. During operation, the head down position and slight right lateral position had been maintained to prevent the impaction of the ball thrombus into mitral valve orifice and the immediate cardiopulmonary bypass by ascending aortic, superior and inferior venous cannulation were placed through midsternal splitting incision. Because of high frequency of peripheral embolism and sudden death, left atrial ball thrombus should be recommended to be removed urgently.

Aged↗

PubMed1989

[A case report of successful surgical treatment of fungal endocarditis].

A successfully treated case of fungal endocarditis for native aortic and mitral valves was reported. A 56-year-old male was admitted with high fever, dyspnea on exertion and oliguria. Infective endocarditis, urinary tract infection and acute renal failure were most suspected by findings of physical examination and urinalysis, but repeated blood cultures were sterile. In the course of treatment for urinary tract infection, high fever and leucocytosis recurred and then blood cultures were positive for Candida parapsilosis. Despite intensive antifungal therapy, blood cultures were consistently positive for Candida parapsilosis. Echocardiogram showed vegetation on the aortic and mitral valve. Aortic and mitral valve replacements with prosthetic heart valves were carried out on April, 1986. Cultures of the vegetation on the mitral valve revealed Candida parapsilosis. Intensive administration of antifungal drug was done postoperatively. Postoperative course was uneventful and he was discharged in excellent condition on the 84th postoperative day. During follow-up period of 1 year, the patient has been doing very well and there were no sign of recurrence of fungal infections.

Aortic Valve↗

PubMed1989

[A case report of aortitis syndrome with massive aortic regurgitation (AR), and ostial stenosis of the right coronary artery].

A 55-year-old female with massive aortic regurgitation and ostial stenosis of the right coronary artery due to aortitis syndrome was reported. The patient was admitted to the hospital with anterior chest pain and dyspnea on exertion. Retrograde aortogram showed massive aortic regurgitation and selective coronary angiogram revealed ostial stenosis of the right coronary artery. She was treated with aorto-coronary bypass (A-C bypass) and aortic valve replacement (AVR) with St. Jude Medical prosthetic valve. At operation, ostial stenosis of the right coronary artery due to aortitis syndrome was confirmed. Aortic valve replacement with a prosthetic valve and saphenous vein grafting to the distal right coronary artery were performed. Steroid therapy was started immediately after the operation. She recovered well and no complications was recognized after the operation.

Aortic Arch Syndromes↗

PubMed1989

[Operation methods and results in repeated open heart surgery for acquired valvular disease].

Fifty-six patients who underwent repeated open heart surgery for acquired valvular disease are presented. Their mean ages were 48 years and mean interval between initial and second operation were 6 years. Preoperative functional status (NYHA) were class II in 11, class III in 40 and class IV in 5. The indications for repeated open heart surgery were mitral re-stenosis in eight, mitral and aortic regurgitation after valvuloplasty in 26, artificial valve failure in 32, perivalvular leakage in 2, left atrial thrombus formation in 1 and aggravation of rheumatic changes of non-operated other valves in 3. Dissection of adhesive tissue around the heart was limited to the aortic root for prevention of cardiac injuries and minimizing bleeding. In all cases, myocardial protection was achieved with intermittent infusion of cold crystalloid cardioplegic solution with topical myocardial cooling during single period of aortic clamping. Adequate left ventricular hypothermic protection was obtained by cold physiological saline that was filled in left pleural cavity. Postoperative low cardiac output syndrome was developed in only 2. Three patients (5.4%) died of left ventricular rupture and of multiple organ failure within thirty days and 4 patients (7.1%) died of prosthetic valve endocarditis, cerebral bleeding and sudden death in late follow-up periods. These results suggested that the operative mortality and morbidity for repeated valve surgery with the aid of cardiopulmonary bypass was not different from that for initial valve surgery. So we believe that repeated open heart surgery for acquired valvular disease should be done prior to deterioration of patient's clinical condition.

Adult↗

PubMed1989

[Cineradiographical significance for diagnosis and treatment of thrombosed Björk-Shiley prosthesis in the aortic position].

In the periods between February 1973 and December 1987, 377 Björk-Shiley valve prostheses have been implanted in the aortic position in our institute. The maximum opening angle of the prosthesis have been cineradiographically measured in 30 cases. The maximum opening angle of the convexo-concave valve having an opening angle of 60 degree (CC 60) was measured as 58.8 +/- 1.9 degree and that of the monostrut valve having an opening angle of 70 degree was 69.4 +/- 2.1 degree. During this period we have experienced 6 cases of thrombosed Björk-Shiley prosthesis. They have shown restriction of the opening from 26 to 58.9 degree and restriction of the closing from 9.2 to 41.8 degree. Thrombolytic treatment was successful in case with thrombosed Björk-Shiley prosthesis which showed restriction of the opening angle on cineradiogram. 4 cases with restriction of the closing angle on cineradiogram were treated operative thrombectomy. Three of them have had uneventful reoperative course in the follow up period of 8 years. We believe that cineradiography is very useful for not only diagnosis but also decision of management for thrombosed Björk-Shiley prosthesis in the aortic position.

Adolescent↗

PubMed1989

[Case reports of fistula formation between aortic pseudo-aneurysms and atria after Bentall's operation].

Fistula between aortic pseudo-aneurysm and atrium occurred in two patients ten or thirteen years after initial Bentall's operation. Their chief complaints were edema of lower extremity, oliguria and dyspnea. Because the pseudo-aneurysm and fistula was suspected by continuous murmur and echocardiogram, cardiac catheterization and aortography were performed to make accurate diagnosis. In these cases, both the fistula and the leakage at the site of initial anastomosis were repaired as soon as the diagnosis was made. To our knowledge, there have been no such reports of aortic pseudo-aneurysm penetrating into the atrium after Bentall's operation.

Adult↗