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T Yagihara

Publications and source records attributed to T Yagihara.

At least 19 recordsLinked to original sources
PubMed2004

Restrictive ventilatory impairment and arterial oxygenation characterize rest and exercise ventilation in patients after fontan operation.

The objective of this study was evaluate the relationships between abnormal pulmonary circulation, lung function, and respiratory response during exercise in Fontan patients. Pulmonary function and cardiopulmonary exercise tests were performed in 101 Fontan patients and 122 controls. A small vital capacity (VC) with a high residual volume-to-total lung capacity ratio and a slight but significant low arterial saturation with hypocapnia were observed in Fontan patients. The number of surgical procedures determined VC. Total cavopulmonary connection, fenestration, higher pulmonary arterial wedge pressure, and smaller VC were independent determinants of low arterial saturation, which was the only determinant of hypocapnia. Arterial saturation decreased during exercise and resting arterial saturation correlated with that at peak exercise. Improvement in dead space ventilation was less in Fontan patients and was independently determined by resting arterial saturation. A steeper minute ventilation-carbon dioxide production slope was determined by resting arterial saturation, arterial carbon dioxide tension, and peak oxygen uptake. In Fontan patients, in addition to dead space ventilation, surgery-related reduced VC, the type of repair, and high pulmonary arterial wedge pressure cause arterial desaturation with subsequent hypocapnia, resulting in accelerated inefficient ventilation at rest and during exercise.

Adolescent↗
PubMed2003

[Less invasive establishment of the Fontan circulation in terms of earlier farewell to a cyanotic circulation].

To promote further improvement of surgical results in the longer terms after the Fontan procedure, we have paid attention to age at operation. Establishment of a non-cyanotic circulation at younger stage, for example around 1 year of age, could have potential advantages in postoperative cardiac performance and functional status. In order to commence the Fontan circulation safe and sound, in turn, the surgical intervention ought to be arranged in a less invasive fashion. In this respect, we introduced off-pump Fontan procedure. Since April 1996, 77 patients have undergone the off-pump Fontan procedure. Its less invasive nature was demonstrated in terms of inflammatory reaction immediately after the operation. Further devices are being sought. These include an alternative off-pump procedure even without a temporary bypass for drainage through the inferior caval vein, which has been thus far applied in 14 patients. This option proved to provide readily an excellent surgical field when an extracardiac conduit is to be anastomosed to the orifice of the inferior caval vein. Another device can be a cordial preparation of the extracardiac channel at the time of the bidirectional Glenn procedure when the staged approach is chosen.

Age Factors↗
PubMed2002

[Aortic valve-sparing root reconstruction in Marfan syndrome].

The outcome of aortic valve-sparing root reconstruction in Marfan syndrome was reviewed. Thirteen patients with Marfan syndrome underwent aortic valve-sparing root reconstruction for annuloaortic ectasia or aortic root dissection between 1994 and 1999. The grade of preoperative aortic regurgitation was I in 4, II in 2, III in 5, IV in 2 patients. The procedures of aortic valve-sparing were reimplantation in 7 and remodeling in 5 patients. There was no hospital and late death. Recurrence of aortic regurgitation greater than moderate grade developed in 1 patient immediately after the surgery and in the other 4 patients in the late stage. One patient of them required aortic valve replacement for it. Aortic valve-sparing root reconstruction is applicable in Marfan patients, although the indication should be cautious. Close observation is needed for recurrence of aortic regurgitation.

Adult↗
PubMed2002

[Aortic dissection in pregnant woman with the Marfan syndrome].

In patients with Marfan syndrome, pregnancy is associated with a potential higher risk of aortic dissection. To determine the incidence and characteristics of aortic dissection in pregnancy, clinical courses of 8 patients with Marfan syndrome were reviewed. Aortic dissection occurred in 3 patients, one of whom had developed rapid dilatation of the ascending aorta during pregnancy. The patient underwent Bentall operation subsequent to cesarean section and simple hysterectomy. All patients tolerated pregnancy well, with favorable maternal and fetal outcomes. Follow-up echocardiography showed no apparent worsening of cardiovascular status attributable to pregnancy such as aortic dilatation and aortic regurgitation except for one patient. Dilatation of the ascending aorta during pregnancy is considered to be an important predictor for aortic dissection. Close observation should be mandatory in such patients. In patients with serious cardiovascular involvement such as acute aortic dissection, cesarean section is preferable for delivery. To prevent hemorrhagic complications under systemic heparinization, simultaneous hysterectomy should be considered as one option.

Adult↗
PubMed2001

Influence of ventricular morphology on aerobic exercise capacity in patients after the Fontan operation.

OBJECTIVES: This study investigated the influences of ventricular morphology, hemodynamics and clinical findings on exercise capacity in patients after the Fontan operation. BACKGROUND: Determinants of exercise capacity after the Fontan operation remain unclear. METHODS: Peak oxygen uptake (PVo2) was determined in 105 patients by exercise test and compared to hemodynamics and clinical findings. Patients were divided into three groups based on ventricular morphology: those with a right ventricle (group RV), a biventricle (group BV) and a left ventricle (group LV). RESULTS: Ten patients with atrioventricular valve regurgitation (AVVR) or hypoxia exhibited a low PVo2. After excluding these patients, although PVo2 did not correlate with hemodynamics, except ventricular ejection fraction (p < 0.02), it correlated with age at the Fontan operation and exercise test (p < 0.002). The PVo2 was higher in group LV (63+/-9%) than in groups RV (55+/-9%) and BV (55+/-12%) (p < 0.01), while an inverse correlation between PVo2 and age at operation was demonstrated only in group RV (p < 0.05). Groups RV or BV and age at exercise test were associated with a lower PVo2, whereas group LV was an independent predictor of a higher PVo2 (p < 0.01). During 4.2 years of follow-up, a decrease in peak heart rate was related to a decrease in PVo2 (p < 0.05). The PVo2 decreased in group RV (p < 0.01). CONCLUSIONS: In addition to AVVR, hypoxia, and heart rate response, ventricular morphology is related to exercise capacity. Early Fontan operation may be beneficial in terms of exercise capacity, especially in the group RV patients.

Adolescent↗
PubMed2001

Stent implantation for aortic coarctation complicating the Norwood operation in a 48-day-old baby.

A female infant developed severe aortic coarctation 42 days after a Norwood operation. Balloon dilatation was ineffective due to rapid recoil of the narrowing, but stent implantation completely abolished coarctation. Although the patient died because of low systemic output with high pulmonary flow 62 days after stent implantation, an autopsy showed that the implanted stent was widely patent without any restenosis. Transcatheter stent implantation should be considered for coarctation in selected situations even in early infancy.

Aortic Coarctation↗
PubMed2001

Congenital diverticulum of the left ventricle.

We present a case of a congenital left ventricular diverticulum of fibrous type that was surgically repaired. Considering the potential risks such as rupture, systemic thromboembolism, and arrhythmia, an early surgical intervention should be employed for this rare abnormality even in a child without clinical symptoms.

Child↗
PubMed2001

Tricuspid valve replacement with bioprostheses: long-term results and causes of valve dysfunction.

BACKGROUND: Although the clinical performance of bioprostheses after valve replacement in the aortic and mitral position has been reported, little is known of the performance of tricuspid bioprostheses. The mechanism of bioprosthetic valve dysfunction after tricuspid valve replacement (TVR) is not clear. METHODS: We reviewed 98 cases of TVR with bioprostheses. To clarify the causes of valve dysfunction, pathologic examination of the explanted valve at the reoperation was performed. RESULTS: Actuarial survival at 18 years was 68.7% +/- 5.8%. There were 12 redo TVRs. In six of the 12 cases, isolated redo TVR was performed. In the other cases, concomitant cardiac procedures were performed. The causes of prosthetic valve dysfunction were pannus formation on the cusps of the right ventricle side (four cases), native valve attachment (two cases), pannus formation + native valve attachment (two cases), sclerotic change (one case), pannus formation + sclerotic change (one case), and native valve attachment + valve infection (one case). Freedom from reoperation, structural valve deterioration, and nonstructural dysfunction at 18 years was 62.7% +/- 10.7%, 96.0% +/- 2.9%, and 76.7% +/- 8.3%, respectively. CONCLUSIONS: In our 18 years of experience, although the survival after TVR with bioprostheses is acceptable, the reoperation free rate is not satisfactory. Pannus formation on the cusps of the ventricular side seems to be a serious problem that causes bioprosthetic dysfunction in the tricuspid position.

Adolescent↗
PubMed2001

Renewal of the Fontan circulation with concomitant surgical intervention for atrial arrhythmia.

BACKGROUND: Atrial arrhythmia remains one of the major complications in the longer term after the Fontan procedure. METHODS: Conversion to total cavopulmonary connection was carried out concomitantly with surgical intervention for atrial arrhythmia in 4 patients undergoing the Fontan procedure by atriopulmonary connection and having continual atrial fibrillation or flutter in the longer term after the initial procedure. RESULTS: The surgical intervention restored sinus rhythm. Transient atrial fibrillation occasionally occurred after the reoperation in 1 patient in whom duration of preoperative arrhythmic period had been 6 years, and defibrillation was needed twice. In the other 3 patients, no episodes of paroxysmal arrhythmia have been noted. Subsequent to renewal of the Fontan circulation, cardiac index increased, with systemic venous pressure decreasing. All 4 patients are currently doing well with their functional status of New York Heart Association functional class I. CONCLUSIONS: Combination of conversion to total cavopulmonary connection and concomitant surgical intervention for atrial arrhythmia is effective, when used appropriately and in a timely manner in patients with atrial arrhythmia in the longer term after the initial Fontan procedure by atriopulmonary connection.

Arrhythmias, Cardiac↗
PubMed2001

Modification of bicaval anastomosis technique for orthotopic heart transplantation.

A modified bicaval anastomosis technique was utilized for 4 consecutive patients undergoing heart transplantation. Instead of transecting the superior and inferior vena cavae, a strip of the posterior right atrial wall was left undivided as a bridge connecting the superior and inferior vena cavae. This minor modification perfectly prevented shrinkage and retraction of the caval tissue, thus providing easier anastomotic orientation and better estimation of the appropriate tissue length that fits well, particularly when a small donor heart was available.

Adolescent↗
PubMed2001

Extended unroofing procedure for creation of a new ostium for anomalous left coronary artery.

A modified procedure to create an alternative ostium for the left coronary artery was successfully carried out in a patient having anomalous origin of the left coronary artery from the right coronary sinus of the aorta. The proximal portion of the artery had an intramural course. The newly constructed orifice was widely patent and functioning well 44 months later, without episodes of myocardial ischemia or aortic regurgitation.

Adolescent↗
PubMed2001

Double inlet right ventricle versus other types of double or common inlet ventricle: its clinical characteristics with reference to the Fontan procedure.

OBJECTIVE: To determine the clinical features in patients with double inlet right ventricle (DIRV) and separate atrioventricular (AV) valves in terms of the Fontan procedure. METHODS: Surgical procedures were carried out in 31 patients with this rare malformation. Their clinical characteristics were compared with similar features in 45 patients with double inlet left ventricle (DILV), 93 with common inlet right ventricle (CIRV), and 20 with common inlet left ventricle (CILV). RESULTS: Pulmonary atresia with the right and the left pulmonary arteries being confluent was seen in 58% of patients with DIRV, and pulmonary atresia with non-confluent pulmonary arteries in 15% (P=0.0001). The incidence of these findings was significantly higher when compared with DILV (P=0.0001). Reflecting these morphologic features, constructions of systemic-to-pulmonary shunts and extensive plasty to the pulmonary arteries were more frequently needed in patients with DIRV than in the others (P=0.04, 0.0001). The AV valves have become moderately or severely regurgitant in three with DIRV (10%). The Fontan procedure has thus been employed in 21 with DIRV (64%), this incidence being significantly higher than that seen in the CIRV (37%) group (P=0.01). Survival rate of 95% at 10 years in this group was as excellent as that in the DILV group, and obviously better than that in either CIRV or CILV (P=0.002). CONCLUSIONS: Although multiple palliative procedures might be frequently needed to maintain pulmonary perfusion, the Fontan circulation can be justifiably established in patients with DIRV, and regurgitation across the AV valves was not very common.

Child↗
PubMed2001

Continuous systemic perfusion improves outcome in one stage repair of obstructed aortic arch and associated cardiac malformation.

OBJECTIVE: To determine whether continuous systemic perfusion is of effective use when establishing primary repair of the aortic obstruction and associated cardiac malformations. METHODS: Since 1991, 56 infants have undergone reconstruction of interrupted (in 28) or coarctated (in 28) aorta, concomitantly with closure of ventricular septal defects in 37, and repair of other malformations in the remaining 19. Of these, total circulatory arrest (30+/-11 min) was employed in 23. In another 21 patients, perfusion was maintained for the carotid arteries with the descending aorta cross-clamped (31+/-15 min). The bodily organs were perfused throughout the operative procedures by placing dual aortic cannulae in the remaining 12 patients. RESULTS: The postoperative courses were less eventful in the non-circulatory arrest group than other groups of patients undergoing total or partial circulatory arrest, although these groups were operated in different time periods, and consequently, a general progress might be one reason for improvements in the surgical outcomes. All patients undergoing no circulatory arrest survived the primary repair, could have the sternum primarily closed, and had no episodes of cerebral bleeding. Prolonged tracheal intubation was needed just in one patient of this group. The amount of urine output during cardiopulmonary bypass was significantly greater in the non-circulatory arrest group than in the others. The maximal concentrations of urinary beta-microglobulin, serous creatinine, creatine phosphokinase, and glutamic oxaloacetic transaminase were lower in this setting. CONCLUSIONS: Continuous systemic perfusion was considered less invasive when concomitantly repairing the obstructed aorta and intracardiac malformations.

Alanine Transaminase↗
PubMed2001

Anatomic biventricular repair by intraatrial and intraventricular re-routing in patients with left isomerism.

OBJECTIVE: To determine the efficacy of anatomic biventricular repair by a combination of intraatrial and intraventricular re-routing in patients with isomerism of the left atrial appendages. METHODS: Anatomic biventricular repair by means of combined intraratrial and intraventricular re-routing was achieved in 5 of the 63 patients with left isomerism in whom we attempted a definitive surgical procedure. The inferior caval vein was interrupted in 3. The Mustard procedure was chosen for intraatrial redirection of blood in 4, and the Senning procedure in the other. Intraventricular re-routing was carried out via a right ventriculotomy in all patients, using an external conduit to reconstruct the morphologically right ventricular outflow tract. RESULTS: One patient died one month after the procedure because of low cardiac output and bronchial bleeding. Obstruction across the superior caval venous channel occurred after the Senning procedure in this particular patient, related to the interrupted inferior caval vein draining via the azygous vein. The other 4 patients are currently doing well. Postoperative catheterization showed excellent cardiac performance, with no obstruction across the venous channels or the ventricular outflow tracts in these 4. No episode of significant arrhythmia has been noted, all patients having a regular atrial rhythm, although the P wave vector was unusual in each patient. Reoperation has been needed thus far in one patient, 128 months after the initial repair, because of obstruction of the external conduit. CONCLUSION: With precise recognition of the morphologic features, a combination of intraatrial and intraventricular re-routing can successfully be established in patients with isomeric left atrial appendages, with functional results in the intermediate term being reasonable.

Atrial Appendage↗
PubMed2001

Coagulation profile, hepatic function, and hemodynamics following Fontan-type operations.

We analyzed retrospectively the relationship between coagulation profile, and either hepatic function or hemodynamics, in patients who had undergone a Fontan-type procedure, comparing them, first, with a control group of 12 patients without significant hemodynamic abnormality, and, second, with a group of 14 patients who had not undergone a Fontan procedure, but whose mean right atrial pressure exceeded 8 mmHg. Follow-up catheterization had been performed in all 30 patients submitted to the Fontan-type operation. Prothrombin time, and factor XIII, were significantly lower in those who had undergone the Fontan procedure than in the other groups. Those submitted to the Fontan operation also had lower levels of protein C than controls, and their levels of plasminogen were lower than the patients with high right atrial pressure. Both aspartate aminotransferase and alanine aminotransferase were higher in those undergoing the Fontan procedure than in the other groups, while gamma-glutamyltranspeptidase in these patients was higher than in the control group. Mean right atrial pressure was highest in those undergoing the Fontan procedure, while cardiac index was lowest. Prothrombin time was correlated to some extent with aspartate aminotransferase, mean right atrial pressure, and cardiac index. Protein C correlated with both aspartate aminotransferase and mean right atrial pressure, while factor XIII correlated with alanine aminotransferase, mean right atrial pressure, and cardiac index. Aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyltranspeptidase, parameters of hepatic function, correlated significantly with mean right atrial pressure. In those who had undergone the Fontan procedure, decreased synthesis of pro-and anti-coagulant factors is a risk factor for both thrombosis and bleeding. Abnormal hemodynamics, in the absence of a right sided pumping chamber, may predispose to subclinical hepatic dysfunction, leading to selective disturbances of protein synthesis.

Adolescent↗
PubMed2001

Biventricular repair in a patient having double outlet right ventricle with unusual straddling of the mitral valve.

The authors achieved biventricular repair in a 1-year-old boy having double outlet right ventricle and unusual straddling of the mitral valve. There was a substantial abnormal muscular bar present within the right ventricle, and some of the tendinous cords of the mitral valve were attached to this structure. Preoperative echocardiography was particularly informative in enabling the surgeon to arrange the optional operative procedures. The postoperative course was smooth and uneventful.

Double Outlet Right Ventricle↗