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Biomedical subjects

S Aoyagi

Publications and source records attributed to S Aoyagi.

At least 253 records · Page 14Linked to original sources
PubMed1989

[Bioprosthetic valvular dysfunction in mitral position: three cases of commissural detachment].

Three cases of commissural detachment in Carpentier-Edwards (C-E) porcine xenografts are reported. All patients had undergone mitral valve replacement (MVR) with C-E porcine xenograft for rheumatic mitral valvular disease 6 to 10 years ago and developed congestive heart failure gradually that required replacement of C-E porcine xenograft. The removed C-E porcine xenografts showed commissural detachments and showed no cusp teaps or cusp perforations. On the basis of the results of our 120 patients with porcine xenograft in the mitral position, we emphasize that the incidence of prosthetic valve dysfunction due to primary tissue failure increases rapidly after the sixth postoperative year.

Adult↗
PubMed1989

[Late results of mitral valve replacement with porcine bioprosthesis].

Forty one long-term survivors over 10 years after isolated mitral valve replacement (MVR) were analysed. At first operation, MVR was performed with the porcine bioprosthesis in all 41. However, 28 porcine bioprostheses in 27 patients were replaced with St. Jude Medical (SJM) prosthesis at second or third operation. These 41 survivors were followed from 10 to 13 years (mean 12.0 years). Cumulative duration of follow-up is 490.9 patient-years. Thrombo-embolic accident occurred in 4 patients and the linearized incidence of postoperative systemic thrombo-embolism is 0.8% per patient-year. Twenty nine reoperations were necessary in 27 patients: in 23 because of valve dysfunction due to primary tissue failure, in 2 because of left atrial thrombosis, in 1 because of valve endocarditis, in 1 because of perivalvular leak. Actuarial freedom from valve dysfunction is 35.0% at 13 years. Degeneration of the cusp of the porcine bioprosthesis remains the chief cause of valve failure leading to reoperation and may represent a major problem.

Adult↗
PubMed1988

The surgical treatment of aortic regurgitation secondary to aortitis.

We describe the operative and perioperative management of 11 patients with aortic regurgitation due to aortitis. All patients required aortic valve replacement because of severely uncoapted cusps secondary to dilatation of the ascending aorta. The right coronary ostium was narrowed in 5 patients and consequently necessitated a smaller coronary tip for the administration of cardioplegic solution. To implant the prosthetic valve, pledgeted 2-0 Tevdek sutures were placed through the aortic valve annulus either from the ventricular side or from outside the aortic wall. Steroids were administered to 4 patients preoperatively and 8 patients postoperatively. Postoperative dehiscence of the prosthesis was seen in 1 of the 3 patients not given any steriods. We conclude that it is important to arrest the inflammatory reaction before operation and if the aortic valve must be replaced, to reinforce the implanted prosthesis with pledgeted sutures. Also, we suggest the possible importance of steroid therapy.

Adult↗
PubMed1988

[Valve replacement in infective endocarditis with mycotic cerebral aneurysm. Report of a case with successful operation].

A 49 year-old woman was hospitalized with headache and left-sided weakness. Computed tomographic scan and carotid angiogram revealed mycotic aneurysms of the bilateral middle cerebral artery with intracranial bleeding. Although all blood cultures were sterile, her physical examination suspected mitral regurgitation due to infective endocarditis and mycotic cerebral aneurysms. Severe congestive heart failure developed immediately after successful clipping for ruptured mycotic aneurysm of the right middle cerebral artery and then mitral valve replacement with prosthetic valve was performed 3 months after craniotomy. At operation, infective endocarditis on the mitral valve was confirmed. Her postoperative course was uneventful and the second craniotomy for aneurysm of the left middle cerebral artery has been planning.

Aneurysm, Infected↗
PubMed1988

[Cardiac valve surgery in the elderly].

Cardiac valve surgery was performed in 54 patients over the age of 60 between January 1982 and December 1986. This included 24 mitral, 23 aortic, 7 multiple valve surgery and 2 thrombectomies and 1 leakage repair of the aortic prosthetic valves. We reviewed these cases comparing with 60 younger patients under the age of 59 with particular emphasis on preoperative state, operative mortality, postoperative course and late results. In older patients, lower renal function and fewer red blood cell count than younger patients were revealed preoperatively. Postoperatively, tendency to have low cardiac output syndrome and have much more complications such as acute renal failure, respiratory insufficiency and psychosis were seen in older patients. There were 7 hospital deaths and 1 late death in older patients, but in 6 of 7 hospital deaths, the causes of deaths were non-cardiac. Clinical improvement was quite satisfactory in older patients equally to younger patients. So it was concluded that age alone should not be regarded as a contraindication to surgical treatment in older patients.

Acute Kidney Injury↗
PubMed1987

[Surgery of the patients on anticoagulants following prosthetic valve replacement].

The surgical operations including 5 cholecystectomies, gastrectomy, and graft implantation for abdominal aortic aneurysm were performed on 7 patients 2 to 98 months after valve replacement. Sodium warfarin was routinely used in an amount to reduce the prothrombin activity in a range of 20-30% normal by thrombotest. In all cases, anticoagulants were reduced in doses gradually in the period of 4 to 15 days proceeding to the operation. Heparin therapy was instituted for the prevention of thromboembolism, when prothrombin activity recovered to 50% normal by thrombotest, in 5 of 7 cases. Heparin therapy was interrupted just prior to operations and it was reinstituted soon after operations in 6 cases. Heparin therapy was maintained by continuous intravenous infusion to produce ACT of 130 to 150 seconds. Heparin therapy was stopped when prothrombin activity reached a therapeutic level with sodium warfarin. There were two episodes of hemorrhage required blood transfusion, observed in patients receiving heparin therapy, but there was no thromboembolism. We believe that our method which minimizes the nonanticoagulated time appears safe and effective in patients with prosthetic heart valves who require noncardiac operations.

Anticoagulants↗