Biomedical subjects

T Togo

Publications and source records attributed to T Togo.

At least 37 records · Page 2Linked to original sources

PubMed1995

[Systemic-pulmonary artery shunt using Golaski graft: trial for measurement of the shunt flow].

For the systemic-pulmonary artery shunt operation, the modified Blalock-Taussig shunt was the first choice for procedure in our institution. Since 1990, Golaski knitted Dacron graft (4 or 5 mm in diameter) was used for the prosthesis. Ex-vivo flow calibration of the electromagnetic flow meter (Nihon Koden, MFV-3100) to Golaski graft showed good correlation between the real flow and value measured by the electromagnetic flow meter. Shunt flow was measured in the consecutive clinical fifteen cases. The shunt flow per body surface area of the patient who required additional shunt operation was 721 ml/min/m2 and one patient in whom the congestive heart failure developed after the shunt operation, had the shunt flow of 3,022 ml/min/m2. The adequate shunt flow in these cases was ranged from 745 to 2,820 ml/min/m2 (mean +/- 1 SD, 1,490 +/- 587.8). Therefore we performed the systemic-pulmonary artery shunt operation using Golaski graft to get the shunt flow of 1,000 ml/min/m2 (approximately a third of cardiac index) for the guide of good results.

Blood Flow Velocity↗

PubMed1994

Aortic arch aneurysm repair using selective cerebral perfusion.

Seventy-seven patients underwent aortic arch aneurysm repair using selective cerebral perfusion from January 1987 to August 1992. Early and long-term results and preoperative and postoperative cerebral function were evaluated. Cerebral function was assessed by the mini mental state-Himeji test and the Wechsler adult intelligence scale. Thirty-six patients had true aneurysms, and 41 had dissection. Hospital mortality for true and dissecting aneurysms was 19.4% and 7.3%, respectively. The 5-year actuarial survival rates for true and dissecting aneurysms were 59.0% and 65.3%, respectively (not significant). There were no significant differences in test scores before or after operation. Repair or replacement of the aortic arch using selective cerebral perfusion is a safe procedure with acceptable hospital mortality.

Aortic Dissection↗

PubMed1994

Late results after correction of ventricular septal defect with severe pulmonary hypertension.

Fifty-eight patients with ventricular septal defect (VSD) associated with severe pulmonary hypertension (Pp/Ps > or = 0.90) were repaired between 1971 and 1992. Their preoperative Pp/Ps, Rp/Rs and Rp were 0.98 +/- 0.06, 2.37 +/- 1.20 and 4.81 +/- 3.06 units.m2, respectively. Late results were analyzed in 56 operative survivors. The age at the time of operation ranged from 2 months to 32 years (average 4.1 years) and the postoperative follow-up period ranged from 1 month to 20 years (average 5.5 years). Eighty-two percent of the patients were in New York Heart Association functional class I, 15% were in class II and 3% in class III. The postoperative Pp/Ps and Rp/Rs significantly decreased to 0.41 +/- 0.13 (p < 0.001) and 0.25 +/- 0.16 (p < 0.001), respectively. There were significant differences in Rp/Rs and Rp between the patients operated on before (Group 1) and after 2 years of age (Group 2). Rp/Rs and Rp in Group 1 were 0.17 +/- 0.06 and 2.52 +/- 0.65 units.m2, whereas 0.31 +/- 0.19 (p < 0.05) and 4.26 +/- 1.88 units.m2 (p < 0.05) in Group 2, respectively. One patient died 14 months after VSD closure due to respiratory failure. It is concluded that a patient with VSD associated with severe but reversible pulmonary hypertension should be surgically corrected before 2 years of age.

Adolescent↗

PubMed1994

[Staged operation for aneurysm of the entire aorta: report of four cases].

Between September 1989 and May 1994, 3 patients with aortic dissection and one with atherosclerotic total aortic aneurysm associated with annuloaortic ectasia underwent successful staged operation for aneurysm of the entire aorta and aortic regurgitation. A composite graft was used for total aortic root replacement. Carbrol and Piehler techniques, Carrel patch and saphenous vein grafting were employed for coronary artery reconstruction. En bloc arch reconstruction was performed in one patient and three vessels graft replacement in 3 patients under hypothermic separate cerebral perfusion. Combined antegrade with retrograde oxygenated crystalloid cardioplegia and terminal warm blood cardioplegia were used for myocardial protection during prolonged aortic cross clamping in a simultaneous total aortic root and arch replacement. Elephant trunk was used at the distal arch anastomosis in 3 patients and useful for following thoracoabdominal surgery. In 3 patients, separate perfusion of upper and lower body technique with moderate hypothermia was employed and seemed to be useful in the patients who require extensive thoracoabdominal replacement to prevent spinal cord injury. All patients had no major complications and have been well.

Adult↗

PubMed1994

[Insertion of prosthetic tricuspid valve two years after the tricuspid valvulectomy].

A case of a 14-year-old boy who underwent a prosthetic tricuspid valve insertion two years after the tricuspid valvulectomy due to intractable right-sided active endocarditis is presented. At the initial operation, the tricuspid valve was thoroughly resected because of marked destruction and attachment of vegetations, and a concomitant ventricular septal defect was directly closed. When a prosthetic valve was placed in the tricuspid portion, a semicircular Dacron patch was attached to the right side of the interventricular septum in a fashion of up-chord and down-arc to cover the bundle of His. The straight edge of the patch was located near the AV node and was not sutured to the tricuspid valve annulus. A 31 mm of CarboMedics prosthetic valve was sutured to the tricuspid valve annulus and to the free edge of the patch at the position near the AV node to prevent AV block. Postoperative course was uneventful and ECG showed regular sinus rhythm.

Child↗

PubMed1994

Tricuspid valve myxoma in a child with coronary artery occlusion and aneurysms.

The case of a 13-year-old boy with a tricuspid valve myxoma and coronary artery occlusion and aneurysms suspected to be caused by Kawasaki's disease is presented. Simultaneous extirpation of the myxoma and coronary artery bypass grafting to the left anterior descending artery using the left internal mammary artery was performed. His postoperative course was satisfactory. Coronary artery bypass grafting in a child is also discussed.

Adolescent↗

PubMed1994

[Comparison of the late hemodynamics following corrective surgery of congenital heart diseases: ventricular septal defect, tetralogy of Fallot, Mustard operation and Fontan operation].

Late hemodynamics following corrective surgery for congenital heart diseases were evaluated in 65 patients. The patients were divided into 4 groups due to the operative procedures including closure of ventricular septal defect (VSD group = 15 patients), repair of tetralogy of Fallot (TOF group = 20), Mustard operation (Mustard group = 19) and Fontan operation (Fontan group = 11). The postoperative period was 3.8 +/- 3.8, 1.0 +/- 0.1, 5.7 +/- 4.3 and 3.2 +/- 4.9 years in VSD, TOF, Mustard and Fontan groups, respectively. Postoperative pulmonary to systemic arterial pressure ratio in VSD group significantly decreased to 0.38 +/- 0.13 from the preoperative value of 0.97 +/- 0.04. Pulmonary vascular resistance (Rp) in VSD group significantly decreased from 4.88 +/- 2.40 to 2.56 +/- 0.75 U.m2 and Rp in Fontan group significantly increased from 1.63 +/- 0.70 to 3.66 +/- 0.47 U.m2 postoperatively. Postoperative cardiac indices in VSD, TOF, Mustard and Fontan groups were 4.30 +/- 1.34, 4.28 +/- 0.72, 3.83 +/- 1.38 and 3.48 +/- 1.38 l/min/m2, respectively, without significant differences. Ejection fraction (EF) of the systemic ventricle (left ventricle) in VSD, TOF and Fontan groups were 0.66 +/- 0.06, 0.65 +/- 0.07 and 0.63 +/- 0.08, respectively. In Mustard group, EF of the systemic ventricle (right ventricle) was 0.56 +/- 0.12 and significantly less than left ventricular EF in the other 3 groups. The hemodynamic characteristics after these operative procedures should be considered for patient management.

Cardiac Surgical Procedures↗

PubMed1994

[Autologous vs bovine pericardial valved patch for widening of the right ventricular outflow tract of tetralogy of Fallot].

Autologous or glutaraldehyde treated bovine pericardial valved patch was utilized for widening of the right ventricular outflow tract in 20 patients with tetralogy of Fallot (autologous pericardium group in 10 patients and bovine pericardium group in 10). Pericardial valve function of the both materials was evaluated by postoperative cardiac catheterization performed 1 year after the operation. There were no significant differences in pulmonary arterial and right ventricular pressures, and right ventricular ejection fraction and end-diastolic volume between the 2 groups. Pulmonary angiogram in the autologous pericardium group patients demonstrated the pulmonary regurgitation (PR) of grade 1 in 5 patients, grade 2 in 4 and grade 3 in 1. On the other hand, 1, 3 and 6 patients in the bovine pericardium group demonstrated no-PR, grade 1 PR and grade 2 PR, respectively. It was concluded that there were no significant differences between autologous and glutaraldehyde treated bovine pericardium as a material of valved patch for widening of the right ventricular outflow tract of tetralogy of Fallot.

Bioprosthesis↗

PubMed1993

Cardiac dilatation after cardiopulmonary bypass: ceramic plate technique for sternal splinting.

Intraoperative sternal closure after cardiopulmonary bypass in patients with cardiac dilatation and dysfunction may cause fatal deterioration of their hemodynamics. To avoid this complication, a ceramic plate made from methyl methacrylate was used for sternal splinting. This simple splint can avoid chest wall compression to the overdilated heart, maintaining stable hemodynamics after cardiopulmonary bypass without postoperative respiratory complications or mediastinal infection.

Bone Cements↗

PubMed1993

Unusual electrocardiographic findings associated with type A Wolff-Parkinson-White syndrome.

A 50-year-old woman with Wolff-Parkinson-White (WPW) syndrome presented with unusual electrocardiographic (ECG) findings following the termination of paroxysmal supraventricular tachycardia. The ECG showed three different QRS complexes and irregular R-R intervals. These QRS complexes consisted of: (1) narrow QRS; (2) wide QRS with delta wave; and (3) wide QRS with left bundle branch block (LBBB). The mechanisms of these findings, revealed by electrophysiological study, were: (1) intermittent anterograde left-sided accessory pathway conduction; (2) rate-dependent ipsilateral LBBB; and (3) intermittent retrogradely conducted atrial echoes that occurred due to intraventricular conduction delay resulting from LBBB. Cases of WPW syndrome with these unusual ECG findings, which were clearly interpreted by electrophysiological study, are rare.

Bundle-Branch Block↗

PubMed1992

Hemodynamic effects of oral amiodarone on left ventricular function before and after global ischemia.

We evaluated the hemodynamic effects of amiodarone on left ventricular (LV) function after global ischemia. Amiodarone was administered orally at 15 mg/kg/day for an average of 28 days to a group of 10 dogs. The concentration of amiodarone in serum and LV myocardium was 0.40 +/- 0.24 micrograms/ml and 44 +/- 27.0 micrograms/g, respectively. This experimental group and a control group of 10 dogs each underwent 120 min of aortic cross-clamping with cold crystalloid cardioplegia resulting in an average myocardial temperature of 15 degrees C. LV function measurements by pulse-transit sonomicrometry and Millar solid-state micromanometers were processed by a minicomputer. Compared to the nontreated control group, oral amiodarone for 28 days produced depression of LV contractility which was reflected by lower slope of the end-systolic pressure-volume relation (Evmax), percentage shortening of segment length, left ventricular pressure-segment length loop area, and slope of the end-systolic pressure-segment length relation (Esmax). After ischemia, percentage recovery of LV global function (Evmax and mean velocity of circumferential fiber shortening) and regional function (Esmax) was significantly better in the amiodarone group than in the control group. We conclude that oral amiodarone for 28 days results in a depression of LV contractility but the combination of amiodarone and ischemia does not act synergistically to further depress postischemic LV function.

Administration, Oral↗

PubMed1992

Late results after repair of complete atrioventricular canal.

Twenty-five patients with complete atrioventricular canal including 10 Down's syndrome patients repaired since 1972 were analyzed with respect to their physical activities, hemodynamics, ECG, reoperation and late mortality. Follow-up period ranged from 1 to 17 years with an average of 7.0 years. There was 1 late death. Actuarial survival rate was 0.86 +/- 0.13 (mean +/- S.D.) at 12 years. Fourteen patients (70%) of 20 evaluated were in New York Heart Association functional class I, and 4 (20%) were in class II and 2 (10%) in class III. In 23 patients without pulmonary stenosis, preoperative values of peak pulmonary to systemic pressure ratio (Pp/Ps) and pulmonary to systemic arterial resistance ratio (Rp/Rs) were 0.64 +/- 0.28 and 0.36 +/- 0.31, respectively. Postoperative Pp/Ps and Rp/Rs significantly decreased to 0.37 +/- 0.14 and to 0.20 +/- 0.14, respectively. In Down patients, postoperative Pp/Ps, Rp/Rs and pulmonary arterial resistance were significantly greater than in non-Down patients (0.50 +/- 0.07 vs. 0.25 +/- 0.05, 0.30 +/- 0.13 vs. 0.10 +/- 0.03 and 4.4 +/- 1.8 vs. 1.8 +/- 0.6 units.m2, respectively). Complete heart block developed in 1 patient postoperatively. Sick sinus syndrome was observed in 3 patients, transient Mobitz II A-V block in 2, ventricular premature contractions of Lown's Grade II in 1 and atrial fibrillation in 1. Five patients demonstrated severe mitral regurgitation equal to or more than Grade III and 2 of them underwent mitral valve regurgitation equal to or more than Grade III and 2 of them underwent mitral valve replacement 6 months and 12 years after the initial operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1992

Remarkable improvement of activity by CAPD in a hemodialysis patient with a pseudotumor of the craniocervical junction.

Pseudotumor of the craniocervical junction and destructive spondyloarthropathy (DSA) are the most serious forms of dialysis amyloidosis (DAA). Pain and paralysis due to these lesions significantly impair activity of a patients' daily life (ADL). CAPD improved ADL of a 54 year-old male patient complicated with various forms of DAA after 17 years of hemodialysis (HD) treatment. He was first diagnosed as having carpal tunnel syndrome 12 years after initiation of hemodialysis followed by dialysis shoulders(12 years), trigger fingers(12 years), bone cysts(15 years), tendon ruptures(17 years), DSA and a pseudotumor of the craniocervical junction(17 years). Magnetic resonance imaging (MRI) taken in May 1989 revealed a pseudotumor of the craniocervical junction, which was 30 mm in diameter, located in front of partially destroyed C1 and C2. Neck pain and muscle weakness rendered him bed ridden. Six months after switching to CAPD with administration of prednisolone, neck pain disappeared. He recovered the muscle power by physical rehabilitation. At last it became possible for him to perform the CAPD procedure by himself and drive a car to the hospital as an out patient. In such cases of pseudotumors of the craniocervical junction, CAPD is one of the best methods for relieving the pain and muscle weakness.

Activities of Daily Living↗

PubMed1992

[Surgical repair of coarctation of the aorta during infancy].

Fourty-six infants less than 1 year of age underwent repair of coarctation of the aorta in our institution between 1972 and 1991. Pathologic types and numbers of patients were simple coarctation (Group 1) in 7 patients, with ventricular septal defects (Group 2) in 22 patients and with complex cardiac anomalies (Group 3) with 17 patients. A patent ductus arteriosus was present in 43 of these patients. Operative technique used were resection and end-to-end anastomosis (RETE) in 30 patients, subclavian flap angioplasty (SFA) in 15 and Blalock-Park operation in one patient. RETE procedures were employed from 1972 until 1980 and SFA procedures were employed between 1981 and 1985. After 1986 RETE procedures were employed again. The operative mortality rates were 0% (0/7) in Group 1, 9.1% (2/22) in Group 2 and 82.3% (14/17) in Group 3. The high mortality rate in Group 3 are thought to be related to severe associated cardiac anomalies. There were no significant differences in the operative mortality and recurrent coarctation rates between RETE and SFA procedures in Group 1 and 2. In patient with a large associated intracardiac shunt (Group 2 and 3) banding of the main pulmonary artery (PAB) was performed with coarctectomy simultaneously. In Group 2 VSD closure and debanding could be done a few months later with excellent results, but in Group 3 primary repair of cardiac anomalies may be worth to try since results of coarctectomy with palliative procedures in these group of patients were poor.(ABSTRACT TRUNCATED AT 250 WORDS)

Anastomosis, Surgical↗

PubMed1992

[Outbreaks of asthma attack and meteorological parameters--comparison between two areas].

The correlation between patient visits and meteorological parameters were analyzed regarding asthmatic children who visited the outpatient emergency clinics at Teikyo University Hospital in Tokyo and Ogaki Municipal Hospital in Gifu, during the two years of 1986 and 1987. The yearly climatological changes are quite similar in both areas. Moreover, variations in the number of patient visits were also remarkably similar in both areas. High temperatures and high vapor pressure significantly correlated with increased numbers of visits in both areas. High humidity and high barometric pressure had some correlation with increased numbers of visits in both areas. As for wind direction, northerly synoptic winds had a significant correlation with increased numbers of visits in Tokyo, while contrarily, southerly winds produced the same effect in Ogaki. Precipitation and cloud density showed no correlation with the number of patient visits in either area.

Asthma↗

PubMed1991

Growth of tracheal anastomoses: advantage of absorbable interrupted sutures.

Growth of the trachea after complete transection and anastomosis was studied in four groups of 1-month-old New Zealand white rabbits. The trachea was transected at the fifth cartilaginous ring and then anastomosed with continuous 6-0 polypropylene (Prolene) (group 1), interrupted 6-0 polypropylene (group 2), continuous 6-0 polydioxanone (PDS) (group 3), or interrupted 6-0 PDS (group 4). The animals were followed up for 90 to 103 days (mean follow-up, 95 days). At the time the animals were killed, body weight had increased 125% (1.2 to 2.7 +/- 0.18 kg). Growth of the trachea was assessed at the time of death. Results from this study suggest that growth of a tracheal anastomosis is retarded in a growing animal model. The degree of resultant stenosis was significantly less when an absorbable suture material (PDS) and an interrupted suturing technique were used.

Anastomosis, Surgical↗

PubMed1991

[Treatment of aneurysms of the aortic arch].

Graft replacement therapy was employed in the treatment of 28 patients with aneurysms involving the aortic arch. Of the 28 patients, 14 had true aneurysms, 13 dissecting aneurysms, and 1 pseudoaneurysm. The operative mortality was 75% (6 of 8 patients) between 1979 and 1986, whereas it was 10% (2 of 20 patients) between 1987 and 1989. Temporary or permanent bypass with vascular graft or heparin coated tube were used in 10 patients (7 patients in the early period, 3 patients in the later period). In this group, 50% hospital mortality occurred. Cardiopulmonary bypass and separate cerebral circulation were used in 16 patients (1 case in the early period, 15 patients in the later period). Thirteen of 16 patients survived this technique. In 2 patients, both in later period, profound hypothermia and circulatory arrest were used. Two patients survived without neurological deficit. Operative mortality decreased since 1987 by the change of bypass technique and operative procedures.

Adult↗

PubMed1990

Long-term results after repair of tetralogy of Fallot.

One hundred sixty-six patients with tetralogy of Fallot including 15 pulmonary atresia repaired since 1971 were analyzed with respect to their physical activities, school or social life, hemodynamics, ECG, reoperation and late mortality. Follow-up period ranged from 1 to 19 years with an average of 9.1. There were 9 late deaths including 4 sudden deaths. Actuarial survival rates at 5 and 13 years were 96.4% and 90.5%, respectively. Eighty-five patients (72.0%) of 118 replied were in NYHA functional class I, 31 (26.3%) in class II and 2 (1.7%) in class III. Thirteen patients (7.8%) demonstrated right ventricular/left ventricular systolic pressure ratio over 0.80 because of inadequate relief of the pulmonary stenosis or obstruction, hypoplasia of the pulmonary artery or external conduit stenosis. Although the left ventricular ejection fraction was maintained at the normal range (0.65 +/- 0.09), that of the right ventricle was below the normal level (0.52 +/- 0.09). Two patients developed complete heart block postoperatively and underwent pacemaker implantations. Complete right bundle branch block was observed in 85 patients including 6 with left axis deviation. Most of the patients after correction of tetralogy of Fallot are in satisfactory conditions. However, some patients have limitations in school or social life because of residual lesions or postoperative complications. It is important to consider the proper operative procedures to avoid these problems.

Adolescent↗