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Biomedical subjects

S Eguchi

Publications and source records attributed to S Eguchi.

At least 271 records · Page 15Linked to original sources
PubMed1989

[Comparative analysis of mechanical and biological prosthetic valves after isolated valve replacement--cooperative study on total 1281 patients].

A total of 1281 patients (594 aortic and 687 mitral) received 734 mechanical valves (320 Björk-Shiley, 283 SJM and 131 Omniscience) and 547 biological (259 ionescu-Shiley, 227 Hancock, and 61 Carpentier-Edwards) were analyzed for postoperative valve dysfunction and thromboembolism. The actuarial survival rates (free from late cardiac deaths and valve-related deaths) were 88.6% (11 years) for mechanical mitral and 86.0% (11 years) for biological mitral valves, and 91.7% (16 years) and 88.5% (12 years), for mechanical and biological aortic valves, respectively. There were no significant differences among these groups. Actuarial rates of freedom from valve-related events were 88.7% (11 years) and 51.7%, for mechanical and biological mitral valves, respectively. There was significant difference between the two types of valves in over 7 years after surgery. In contrast, there were no significant differences between mechanical and biological aortic valves. Actuarial rates of freedom from valve dysfunction were 97.6% (11 years) for mechanical and 56.5% (12 years) for biological mitral valves. The net 12 year results showed no significant differences between the two types of mitral prosthetic valves, but a significantly increased rate of valve dysfunction in the biological mitral valves compared with the mechanical in over 6 years of the study. Concerning AVR, there were no significant differences in the incidence of valve dysfunction between mechanical and biological aortic valves. Actuarial rates of freedom thromboembolism were 92.3% (11 years) and 93.8% (11 years) for mechanical and biological mitral valves, respectively. There were no significant differences between the two types of mitral prosthetic valves.(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Valve↗
PubMed1989

[Effects of cardioplegic solutions on coronary artery and myocardium--comparison of the glucose-insulin-potassium solution and the St. Thomas' Hospital cardioplegic solution].

Effects of two cardioplegic solutions on coronary artery and myocardium were experimentally investigated in three types of preparations. In the isolated perfused guinea pig heart, infusion of Glucose-Insulin-Potassium (GIK) solution (37 degrees C) caused contraction of coronary artery, whereas the St. Thomas' Hospital cardioplegic solution (37 degrees C) produced vasodilation. At the end of 30 minutes reperfusion after continuous infusion of cardioplegic solution, the St. Thomas' Hospital cardioplegic solution produced a greater recovery of cardiac function than GIK solution. In the isolated pig coronary artery, vasoconstriction caused by high potassium content was diminished by addition of magnesium in concentration dependent manner. In the electrophysiological examination, the membrane potential of the guinea pig papillary muscle was recorded by means of conventional glass microelectrodes. Though GIK solution produced greater depolarization of resting membrane potential than the St. Thomas' Hospital cardioplegic solution, effects of the two different cardioplegic solution was not so different after reperfusion of Tyrode solution. The St. Thomas' Hospital cardioplegic solution resulted in greater recovery of contracting activity after reperfusion than GIK solution. These data suggest that GIK solution causes coronary vasoconstriction and has deleterious effects on myocardium and that the St. Thomas' Hospital cardioplegic solution has a vasodilating action and produced a greater myocardial protection than GIK solution.

Animals↗
PubMed1989

[Scimitar syndrome with left pulmonary hypertension and right pulmonary artery stenosis in childhood--report of a case of successful surgical repair].

An one-year old child with Scimitar syndrome (anomalous drainage of the right pulmonary vein to inferior vena cava with right lung hypoplasia) associated with left side pulmonary hypertension and right pulmonary artery stenosis underwent surgical repair. The anomalous pulmonary vein was anastomosed to right atrium with 10 mm PTFE graft interposition and drained to left atrium through equine pericardial intra-atrial baffle. The stenotic portion of right pulmonary artery was enlarged with porcine pericardial patch. To our knowledge, this is the first successful surgical case of Scimitar syndrome with pulmonary hypertension in childhood reported in literature. A repair of anomalous pulmonary venous drainage to inferior vena cava in childhood is difficult, and a meticulous selection of surgical procedure is necessary.

Blood Vessel Prosthesis↗
PubMed1989

[A case of congenital diaphragmatic hernia due to left central tendon defect in pregnancy].

A twenty-seven-year-old 25 weeks gestation female was admitted with recurrent symptoms of nausea, vomiting and epigastric pain. She was diagnosed as left diaphragmatic hernia by chest X-ray film, CT and esophago-gastrography. During operation, a left central tendon defect was observed, and was 3.5 cm in diameter. The margin of the defect was smooth and round. It was associated with diaphragmatic eventration. The small intestine and transverse colon were herniated into the left thoracic cavity. The central tendon defect was closed with direct mattress sutures and was reinforced by overlap-technique of the diaphragm. To our knowledge, this type of defect has not been described previously in Japan. Diaphragmatic hernia in pregnancy is very rare, and presents abdominal pain, vomiting and dyspnea. Usually the diagnosis is achieved by chest X-ray film. However, esophago-gastrography should be added, if the diagnosis could not be confirmed by chest X-ray film. Conservative management is reported to bring high mortality, therefore, prompt surgical repair is advisable.

Adult↗
PubMed1989

[Angioplasty of the left main coronary artery--report of a case with left main coronary stenosis and aortic valve stenosis].

A 58-year-old woman was admitted to our hospital suffering from repeated chest pain. Selective coronary angiography (CAG) showed severely stenotic lesion in the left main coronary artery. There was no additional lesion in the left anterior descending and circumflex arteries. Aortography showed severe calcification in the aortic valve. The aortic was incised and divided completely at the aortic root 1 cm distal to the aortic valve. The incision was then extended toward the opening of the left coronary artery. An atheromatous plague was found and resected at the ostium. A saphenous vein patch was used to enlarge the internal diameter of the artery. The aortic valve was replaced using #21 SJM prosthetic valve. The patient recovered the surgery well, and anginal attacks have disappeared. Postoperative coronary angiograms revealed no stenotic lesion in the left main coronary artery.

Aortic Valve Stenosis↗
PubMed1989

[Myocardial infarctectomy in the acute stage].

Seven patients with ventricular septal perforation or left ventricular free-wall rupture underwent myocardial resection in the acute stage of myocardial infarction. One of them received direct closure of the left ventricle, and the others replacement of myocardium with a Dacron prosthesis. One patient died of cardiac failure 5 days after surgery, and 4 in the late-stage between 2 months and 4 years. The following conclusions are obtained in our patients: 1. Echocardiography is very important for the diagnosis of cardiac free-wall rupture and determination of emergency surgery. 2. An intra-aortic balloon should be inserted in patients with VSP as soon as possible. If general state of the patients had been improved by the procedure, surgery might be withheld until the recovery, otherwise emergency surgery should be considered. 3. Myocardial replacement with a prosthesis seems to be useful when the left ventricular cavity is predicted to be small after resection of the myocardium. 4. The development of assisted circulation would improve a survival rate after the surgery. 5. Systemic managements are also important because the patients sometimes become fatal by non-cardiac complications even if they have survived from circulatory failure.

Aged↗
PubMed1989

[Complement activation during cardiopulmonary bypass: mechanism and prevention].

The mechanism of complement activation during cardiopulmonary bypass was studied for the prevention. In ten patients undergoing open-heart procedures, the serum levels of complement fractions (C3, C4, and C3 activator) were measured by a single radial immune diffusion method. In four of ten patients, the plasma levels of C3a, C4a, and C5a fractions were studied by the radioimmunoassay 2 antibodies method. The serum levels of C3, C4, and C3 activator decreased after cardiopulmonary bypass. The plasma levels of C3a, C4a, and C5a increased after bypass. The lower level of C3 activator shows that C3 activator was not excessively produced during cardiopulmonary bypass. Therefore it can be thought that much C4b2a from classical pathway as well as C3a over-production localizing extra-corporeal circuits and little inhibitors on alternative pathway resulted in increased complement activation. The prevention should be done from these etiologies.

Adult↗
PubMed1989

Functional and metabolic protection of the neonatal myocardium from ischemia. Insufficient protection by cardioplegia.

The effects of ischemia and cardiac arrest by cardioplegia on the mechanical function and energy metabolism of the ventricular myocardium of the neonatal guinea pig were investigated in the isolated perfused heart preparation and compared with these effects in the adult guinea pig. Whereas reperfusion after ischemia resulted in better recovery of mechanical function and a higher adenosine triphosphase content in the neonatal myocardium than in the adult, recovery from cardiac arrest induced by St. Thomas' Hospital cardioplegic solution was not as good in the neonatal myocardium as in the adult. Contracture developed in the neonatal myocardium on administration of the cardioplegic solution, but did not in the adult. This was considered to be the reason that the protective effect of the cardioplegic solution was inferior in the neonatal myocardium to that in the adult.

Adenosine Triphosphate↗
PubMed1989

Difference in the mechanical response to a cardioplegic solution observed between the neonatal and the adult guinea pig myocardium.

We attempted in two types of preparations to delinate the difference in responses to St. Thomas' Hospital cardioplegic solution between the neonatal and the adult guinea pig myocardium. Isolated guinea pig hearts were perfused with Langendorff's method and the tension of the papillary muscle of the right ventricle was recorded. Continuous infusion of St. Thomas' Hospital cardioplegic solution (37 degrees C) for 30 minutes resulted in a significantly higher elevation of the resting tension (development of contracture) in the neonatal myocardium than in the adult. The recovery of normal contractile tension after the resumption of perfusion with normal Krebs-Ringer bicarbonate solution was smaller in the neonate with increases in the myocardial water and calcium contents. The membrane potential of the papillary muscle preparation was recorded by means of conventional glass microelectrodes. There was no significant difference in the control values of the resting membrane potential and in the degree of depolarization during exposure to St. Thomas' Hospital cardioplegic solution between the neonate and the adult. Thus the greater elevation of the resting tension produced in the neonatal myocardium by St. Thomas' Hospital cardioplegic solution was not due to a greater depolarization of the surface membrane.

Aging↗
PubMed1989

[Late clinical results of prosthetic valve replacement undergone more than ten years ago].

We evaluated late clinical results of 207 hospital survivors, who underwent prosthetic valve replacement from Dec. 1965 to May 1979 for acquired valvular heart diseases. The study group consisted of 134 patients with MVR (46 S-E non cloth covered (SENM), 56 S-E cloth covered (SECM), 16 Björk-Shiley (BSM), 16 Carpentier-Edwads (CEM)), 47 with AVR (21 S-E non cloth covered (SENA), 15 S-E cloth covered (SECA), 11 Björk-Shiley (BSA)) and 26 with combined aortic and mitral valve replacement using S-E non cloth and/or cloth covered ball valves. Actuarial analysis (Kaplan-Meier) revealed ten year survival rate was 85.1 +/- 5.6% in SENM, 77.1 +/- 5.8% in SECM, 85.7 +/- 9.4% in BSM, 77.8 +/- 11.4% in CEM, 79.2 +/- 9.3% in SENA, 71.8 +/- 12.0% in SECA, 90.9 +/- 8.7% in BSA and 53.1 +/- 10.4% in combined valve replacement group. Survival rate of combined valve replacement group was significantly lower than other groups (p < 0.05). Also, ten year reoperation free rate was 100% in BSM and BSA, 87.1 +/- 5.4% in SENM, 91.3 +/- 4.2% in SECM, 61.5 +/- 13.5% in CEM, 90.2 +/- 6.6% in SENA and 77.1 +/- 11.7% in SECA. Reoperation free rate of CEM group was significantly lower than other mitral groups (p < 0.05). Immature cardiac protection during anoxic arrest and unestablished anticoagulant therapy for implanted prosthetic valves in those days might increased mortality and morbidity in S-E groups.

Actuarial Analysis↗
PubMed1989

[Combined valvular and coronary artery surgery].

Combined valvular and coronary surgery were performed on 9 patients between 1973 and 1986. Valve replacements were consist of 5 AVR (including 1 translocated AVR and 1 Bentall operation), 2 MVR and 2 double valve replacement. Coronary surgery were of 6 aorto-coronary bypass using great saphenous veins, 1 innominate artery-coronary bypass using a Dacron prosthesis, 1 punch-out of coronary ostium and 1 dilatation of the left coronary ostium with a vein patch. Retrograde infusion of cardioplegic solution from the coronary sinus were done in patients with coronary ostial stenoses. One emergency case with acute cardiac failure died immediately after operation, and one with double valve and one with mitral valve replacement died of hepatic failure and multiple organ failure respectively within 1 year after surgery. Combined valvular and coronary surgery are necessary for patients with both diseases. Although the results of double valve replacement were not satisfactory, they would be improved using intra-aortic balloon pump and ventricular assist devices actively.

Adult↗
PubMed1988

Inferior vena caval obstruction: transvenous instrumental membranotomy.

Five transvenous instrumental membranotomies were performed in four patients with membranous obstruction of the hepatic segment of the inferior vena cava. Membranotomy was done with a specially designed instrument similar to a Tubbs' dilator, which was inserted through femoral or the right internal jugular veins. Pressure gradients across the membrane disappeared after membranotomy and the release of the stenosis was confirmed by angiography and ultrasonography. One patient needed a second membranotomy because of recurrent stenosis 7 years after the initial procedure.

Adult↗
PubMed1988

Electrophysiologic study of patients with ventricular dysrhythmias during long-term follow-up after repair of tetralogy of Fallot.

We performed an electrophysiologic study (EPS) in 8 patients who had received corrective surgery for tetralogy of Fallot. The mean age was 30 years. An average of 15 years had elapsed after corrective surgery. Two patients had episodes of syncope. ECG showed normal sinus rhythm in 7 patients and atrial fibrillation in 1, and all had complete right bundle branch block. All patients had ventricular premature beats of grade 3 or higher of Lown's classification. Overdrive suppression test was performed in 6 patients. Corrected sinus node recovery time (CSNRT) ranged from 230 msec to 510 msec. Wenckebach block of atrioventricular nodal conduction occurred at rates of 130 to 170 bpm during atrial pacing. The H-V interval was prolonged to 60 msec in 1 patient, but was below 55 msec in the others. Programmed stimulation induced ventricular tachycardia (VT) in 3 patients, nonsustained VT in 2 and sustained VT in 1. In 2 of 3 patients, delayed potential or fragmentations were recorded in the outflow tract of the right ventricle. During the follow-up period of 20 months, 2 patients died suddenly. Their CSNRTs and H-V intervals were normal. Ventricular tachyarrhythmia seems to be important as a cause of late sudden death after repair of tetralogy of Fallot.

Adolescent↗
PubMed1988

[Aorto-caval fistula complicated by a DeBakey IIIb-type dissecting aortic aneurysm: report of a case].

The patient, male and 70 years of age, was suspected of having a ruptured abdominal aortic aneurysm during the laparotomy, and referred to our department. After admission it was found that a ruptured abdominal aortic aneurysm complicated with dissecting aneurysm. Urgent surgical intervention should have been scheduled but an initial conservative control was necessary because of impaired hepato-renal function and hemorrhagic gastroduodenal ulcer. Meanwhile, pleural effusion, edema in lower extremities and abdominal continuous vascular murmur appeared, and cardiac failure symptoms gradually aggravated. The formation of arteriovenous fistula was suspected. Aortography revealed the DeBakey IIIb type dissecting aortic aneurysm complicating an abdominal aneurysmal rupture with the fistula formation to inferior caval vein. Neither enlargement nor progress of a thoracic aortic aneurysm were observed by CT scanning examination and the closure of fistula and Y grafting were performed successfully. So far, only one case of a ruptured abdominal aortic aneurysm forming the aorto-caval fistula and complicating dissecting aortic aneurysm was reported in Japan, and, to the best of our knowledge, this is the first case treated successfully.

Aged↗
PubMed1988

[Morphological characteristics of the left ventricle with volume-and pressure-overload in valvular heart diseases].

There are some cases in which pump function of the left ventricle (LV) is not sufficiently improved despite of successful operation, especially in advanced hypertrophy. The impaired pump function is believed to result from irreversible myocardial damage. Thus, the present study is designed to make clear the histopathological changes of the LV muscle in hypertrophied hearts. Fifty-six patients with volume-overloaded hearts (27 with AR, 24 with MR, and 4 with AR and MR) and 10 patients with AS were examined. Cardiac muscle specimens for histological examination were obtained from the LV anterior wall. In volume-overloaded hearts, the muscle cell diameters were correlated with both LV dimension (LVDd and LVDs) and LV volume index (LVEDVI and LVESVI). The progress of interstitial fibrosis was correlated with LV volume index. Five of the 9 patients with massive myocardial hypertrophy (in all cases, muscle cell diameter was greater than 30 microns) did not show any improvement in histological figure after operation and displayed persistent postoperative LV dilatation. Patients with either LVDd greater than 75mm and LVDs greater than 55mm or LVEDVI greater than 200ml/m2 and LVESVI greater than 100ml/m2, whose hearts showed massive myocardial hypertrophy and severe fibrosis, tended to have postoperative cardiac dysfunction. In pressure-overloaded hearts, the muscle cell diameters were correlated with LVPWTh and LVESVI. Noteworthily, fibrosis and degeneration of muscle fibers were slight as compared with advanced myocardial hypertrophy.

Cardiomyopathy, Hypertrophic↗