Biomedical subjects
Publications and source records attributed to T Ujiie.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
BACKGROUND: While partial left ventriculectomy (PLV) improves left ventricular energetic efficiency, concomitant reduction in mitral regurgitation may improve ventricular function. METHODS: Two hundred ninety-five patients undergoing lateral ventricular wall excision between the papillary muscles (lateral PLV) and 101 patients with an additional excision of papillary muscles and mitral valve replacement (extended PLV) were compared with 65 patients undergoing excision of anterior wall or ventricular aneurysm (anterior PLV). RESULTS: All patients had reduced functional capacity, New York Heart Association (NYHA) Class III to IV (3.62+/-0.49). Etiologies were cardiomyopathy (37.3%), coronary artery disease (32.3%), valvular disease (19.7%), Chagas' disease (7.8%), and others (2.8%). Patients undergoing lateral and extended PLV had cardiomyopathy as the primary cause of heart failure, while a majority of anterior PLV patients had ischemic disease. Associated procedures included mitral valvuloplasty or replacement (lateral PLV 67%, extended PLV 100%, anterior PLV 40%) and tricuspid annuloplasty (67%, 76%, 28%, respectively.) In each group after surgery, end-systolic dimension decreased more than end-diastolic dimension despite reduced mitral regurgitation. Although extended PLV resulted in greater volume reduction and less mitral regurgitation, these patients had delayed recovery and poor survival. Patients with valvular disease had the most advanced myocardial hypertrophy with the best survival, while those with Chagas' disease had more severe myocarditis, interstitial fibrosis, and the poorest survival. CONCLUSION: Lateral PLV improved hemodynamics and functional capacity as much as aneurysmectomy by reducing ventricular volume and mitral regurgitation. Inclusion and exclusion criteria have to be sought to make PLV safer and more effective.
BACKGROUND: Although incidence of ventricular arrhythmias after partial left ventriculectomy (PLV) has been reported, there are no studies comparing incidence before and after PLV. Although operative scars may give rise to arrhythmias, improved energetic efficiency after PLV may decrease their incidence. METHODS: Pre- and postoperative ventricular arrhythmias were monitored by Holter ECG and analyzed in 17 patients undergoing PLV in Curitiba, Brazil. RESULTS: Although total 24-hour heart beat (THB) increased significantly (p = 0.018), ventricular premature contractions (VPCs) decreased markedly (p = 0.036), excluding one patient dying in low cardiac output (LOS) who had terminal arrhythmias increased multifold. In the remaining 16 patients, VPC pairs were also reduced significantly on the average (p = 0.038). In contrast, ventricular tachycardia (VT; more than three consecutive VPCs) disappeared in five patients, decreased in two patients, and newly occurred in four patients, with five patients showing no change; one of them developed a prolonged VT, successfully reversed by external cardioversion. CONCLUSIONS: Despite notable significant increase in THB immediately after PLV, PVC and PVC pairs were significantly decreased in contrast to VT, which disappeared in some patients and newly occurred in other patients, remaining constant on the average. Sustained VT occurring in a patient with all other arrhythmias suppressed may suggest a unique electrophysiological substrate, may justify prophylactic use of amiodarone or an implantable cardioverter-defibrillator, and may underscore the importance of further and extended studies.
The Indiana pouch procedure was used on 34 bladder cancer patients. The Heinecke-Mikulicz reconfiguration was carried out, involving the conventional hand-sewn and the absorbable GIA stapled methods with the continence mechanism of a staple-tapered efferent limb. The tunnelled tenial anti-refluxing implantation of ureters was performed. The stapled pouch construction saved approximately 1 h of operating time and reduced by 18% the overall loss of blood. There were 3 complications (wound infection/dehiscence in two, leakage from the enteric anastomosis in one, and acute renal failure in one) within 30 days postoperatively. As a late complication, ureter implantation stricture was experienced in two and pouch stone formation in five. No significant difference in the incidence of stone formation was evident between the hand-sewn and the stapled pouches, nor was any difference of pouch volume and catheterization interval. All patients had acceptable continence. These data demonstrated that the Indiana pouch is a reliable procedure with an acceptable complication rate. The pouch construction using the stapled method, which simplified the procedure, is more convenient than the one using the hand-sewn technique.