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Biomedical subjects

Setsuo Kuraoka

Publications and source records attributed to Setsuo Kuraoka.

7 recordsLinked to original sources

Intermediate type atrioventricular septal defect in the elderly.

A 65-year-old woman with intermediate type atrioventricular septal defect had been undiagnosed until initial presentation with congestive heart failure. She underwent surgery when the ventricular septal defect was found to be restrictive. The atrioventricular valve was similar to the common atrioventricular valve, but was connected to the crest of the ventricular septal defect. Surgery included direct closure of the ventricular septal defect, repair of the cleft in the atrioventricular valve, and ostium primum closure. Postoperative echocardiography indicated successful heart repair. We present a review of rare intermediate type atrioventricular septal defect in the elderly, and we discuss the surgical issues in this case.

Aged↗

Ruptured aneurysm of the subclavian artery in a patient with von Recklinghausen's disease.

A vascular manifestation of von Recklinghausen's disease is rare, but may be fatal if it is disrupted. A 39-year-old male with von Recklinghausen's disease presented with a large and tender bruise extending from his left neck to his left shoulder and arm. Computerized axial tomography revealed a ruptured aneurysm of the left subclavian artery. The patient underwent emergency surgery to exclude the aneurysm, and cross-over bypass grafting of both subclavian arteries was performed. We present a brief review of vascular maintestation of von Recklinghausen's disease, as well as a discussion regarding the strategy for treating this rare presentation.

Adult↗

Mitral valve re-replacement for impaired bioprosthesis after 19 years in a patient undergoing steroid treatment.

A 59-year-old man underwent closed mitral commissurotomy for mitral stenosis at the age of 19 years, and mitral valve replacement (MVR) with a Hancock standard bioprosthesis and tricuspid annuloplasty at the age of 40 years. Two years after the second operation, the patient developed human T-lymphotropic virus type-1 infection, manifesting as myelopathy/tropical spastic paraparesis, and has required steroid therapy for 17 years. He was well for 18 years after the MVR, but has recently developed severe congestive heart failure, orthopnea and enlarged liver. Doppler echocardiography showed severe transvalvular regurgitation of the prosthesis and tricuspid valve. The patient underwent re-MVR with a 27 mm St. Jude Medical prosthesis, and tricuspid annuloplasty. The surgery was well tolerated, without any significant infectious complication. Some tears and perforations were found in the leaflets of the explanted bioprosthesis, but soft X-ray analysis showed minimal calcification. Mild changes and longer durability of the bioprosthesis may be related to the long-term use of steroid therapy.

Adrenal Cortex Hormones↗

Aortic valve replacement in a woman with osteogenesis imperfecta.

The mortality rate in cardiac surgery patients with heritable generalized connective tissue disorders, such as Marfan s syndrome and osteogenesis imperfecta, is high due to tissue friability. We describe a successful open heart surgery for repair of aortic regurgitation in a woman with osteogenesis imperfecta (OI). Although tissue friability caused no problems during surgery in this case, it should be kept in mind when operating on patients with OI.

Aortic Valve↗

Ross procedure for aortic insufficiency due to doubly committed subarterial ventricular septal defect in adults.

A 52-year-old female, with aortic insufficiency due to doubly committed subarterial ventricular septal defect (VSD) underwent a successful surgical repair by the Ross procedure. Preoperatively, she developed congestive heart failure because of less compliance to oral medication, raising concerns regarding life-threatening thromboembolism if she undergoes mechanical valve replacement. Despite the pulmonary autograft being defective, there were no difficulties in completing the surgery. The defect of pulmonary autograft and the VSD was closed by an expanded polytetrafluoroethylene patch. She tolerated the procedure well and now enjoys improved quality of life. We present a discussion of the indication of Ross procedure in the rare presentation of congenital heart disease, as well as several issues raised in this case.

Aortic Valve↗

Posttraumatic tricuspid insufficiency successfully repaired by conventional technique.

A 22-year-old man developed exertional dyspnea 2 years after blunt chest trauma due to a horse kick. Preoperative echocardiography showed severe tricuspid insufficiency (TI) caused by chordal rupture and prolapse of the anterior leaflet. A novel repair technique, the "clover technique," was applied, but was unsuccessful in this case. The valve was then repaired successfully using conventional techniques, that is, insertion of an artificial chordae, plication of the prolapsing leaflet, and DeVega's annuloplasty. We present here a brief review of posttraumatic TI, and discuss effective and less expensive techniques for repair.

Adult↗