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T Yagihara

Publications and source records attributed to T Yagihara.

At least 127 records · Page 7Linked to original sources
PubMed1991

[Aorto-coronary bypass surgery for children with Kawasaki disease].

The results of aorto-coronary bypass surgery in 28 children with coronary artery lesions due to Kawasaki disease were evaluated. Ages at surgery ranged from one to 17 years, and the intervals from disease onset to surgery ranged from 2 months to 16.8 years. All patients were followed by selective coronary arteriography, thallium myocardial imaging, ECG at rest, and the Master double step and treadmill exercise tests. The surgical outcomes were analyzed by comparing the results of pre-operative examinations with those of one month, one year, and more than 3 year post-operative examinations. At one month, one year, and more than 3 year post-operative examinations, the incidences of patency of internal mammary artery graft (IMAG) were 29/30 (97%), 25/29 (86%), and 7/8 (88%), and those of patency of saphenous vein graft (SVG) were 6/7 (86%), 6/9 (67%), and 3/7 (43%), respectively. Three patients out of 4 who showed occlusion of their IMAGs within one year after surgery, and one deceased case apparently had problems related to the surgical procedures, such as the timing of surgery, reconstruction of the main trunk of coronary artery and the site of anastomoses between aneurysms. Pre-operative, one month, and one year post-operative thallium myocardial imagings were compared to examine the changes of regional myocardial ischemia in 24 children, and 28 IMAGs and 8 SVGs were evaluated. In the 28 IMAGs, 14/28 (50%) showed improvement of the myocardial ischemia, and 2/28 (7%) showed deterioration at one month follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Aortocoronary bypass surgery for coronary arterial lesions resulting from Kawasaki disease.

To establish the indications for aortocoronary bypass surgery on coronary artery lesions caused by Kawasaki disease, we analyzed surgical outcome in 26 patients. Ages at operation ranged from 1 to 17 years. All patients were followed up with selective coronary arteriography, thallium myocardial imaging, electrocardiography at rest, and the Master "two-step" and treadmill exercise tests for coronary insufficiency. Surgical outcome was analyzed by comparing results of patient examinations made preoperatively with those both at 1 month and 1 year postoperatively. One month after the operation, 25 (93%) of 27 internal mammary artery grafts and 6 (86%) of 7 saphenous vein grafts were patent; 1 year after the operation, 19 (86%) of 22 internal mammary artery grafts and 6 (67%) of 9 saphenous vein grafts were patent. By comparing the preoperative findings of myocardial imaging with those obtained 1 month after surgery, we found that 17 (68%) of 25 showed improvement and 3 (12%) of 25 were worse. At 1 year, 6 (29%) of 21 showed further improvement than at 1 month, suggesting increased development of the coronary bed after internal mammary artery graft anastomosis. Thus an internal mammary artery graft has proved to be satisfactory in the management of children with coronary artery obstruction caused by Kawasaki disease; it appears that both the quality of life and the life expectancy of those patients can be improved by the surgery.

Adolescent↗
PubMed1990

[Surgical therapy of congenital aortic valvular stenosis in neonates and infants].

The preoperative evaluation, surgical course, and early follow-up results of 5 infants less than 4 months of age who underwent aortic valvotomy for severe valvular stenosis between 1983 and 1985 were reviewed to determine the early prognosis of these neonates. Two of the 5 patients had been used respiratory support due to severe congestive heart failure and dyspnea. Emergency aortic valvotomy was performed in all during cardio-pulmonary bypass which achieve maximal relief of the stenosis without significant causing aortic insufficiency. There was a single operative death and there was one late death at 2 months after surgery who was regarded to have a extensive endocardial fibroelastosis. The other three patients have had a favorable early prognosis during mean follow-up period of 1.78 (0.4-3.8) years. They had been followed by means of two-dimensional and doppler echocardiography, which inferred that the aortic pressure gradient had been kept under 41 mmHg and which indicated that there were no LV enlargement to prove significant aortic valve insufficiency. These results indicate that early infants with severe valvular stenosis can undergo sufficient valvotomy safely and have a favorable early prognosis.

Aortic Valve↗
PubMed1990

[Extended direct anastomosis for coarctation of the aorta and interruption of the aortic arch].

Between March, 1986 and May, 1988, extended direct anastomosis was performed for coarctation of the aorta (CoA) (5 infants) and interruption of the aortic arch (IAA) (3 infants). The aortic arch was hypoplastic in 3 patients. The incision was made in the inferior aspect of the aortic arch proximal to the origin of the carotid or brachiocephalic artery, which was then anastomosed to the descending aorta. Pulmonary artery banding was placed in 4 patients with associated complex cardiac anomalies. Aortic cross-clamp time was 19-54 minutes (mean 41 minutes). Pressure gradient between upper and lower extremity was 0-10 mmHg (mean 4 mmHg). There were no operative deaths and no neurologic complications. The peak flow velocity at the site of aortic reconstruction measured by Doppler echocardiographic study after surgery was 1.2-2.5 m/sec (mean 1.7 m/sec). This procedure has the advantages of leaving the subclavian artery intact and no aortic shelf tissue. And it can be applied in IAA or CoA with hypoplastic aortic arch.

Aorta, Thoracic↗
PubMed1990

Early and midterm results of the arterial switch operation for transposition of the great arteries in Japan.

A total of 267 infants and children who underwent the arterial switch operation for transposition of the great arteries in the 6 years before Jan. 1, 1988 in six main Japanese institutions were entered into this review. The current status of patients surviving more than 1 year after the operation were evaluated along with early operative results. One hundred forty-six patients had an intact ventricular septum, 103 had a significant ventricular septal defect, and 18 had so-called Taussig-Bing anomaly of the transposition type. Eighteen patients were less than 28 days of age, 73 were 1 to 5 months of age, and 176 were older than 6 months of age at the time of operation. The overall mortality rate was 35% in the first 3 years and 12% in the more recent 3 years. There was a significant difference between the overall mortality rate of primary and two-stage repair (22% versus 10%, p = 0.047) in patients with intact ventricular septum. The overall mortality rate in patients with type B or C coronary arteries of Yacoub, and Radley-Smith's classification was significantly higher than that of other types of arteries (86% versus 18%, p = 0.0001). A total of 156 patients survived more than 1 year after the operation, and 44 children (28%) were noted to have supravalvular pulmonary stenosis (greater than 20 mm Hg). This complication was more common in patients operated on in the newborn period. Trivial or mild aortic regurgitation was noted in 29 patients (19%) and was more common in patients with two-stage than with primary repair (24% versus 14%). Aortic regurgitation was significantly more prevalent in patients in whom coronary arteries were implanted into slits or U-shaped defects than in those whose arteries were implanted into punched-out holes made on the pulmonary root (28% versus 8%, p = 0.049). Normal sinus rhythm was present in 97% of 154 patients and left ventricular ejection fraction was within the normal range in 97% of 115 patients at catheterization 1 to 5 months after the operation.

Aortic Valve Insufficiency↗
PubMed1989

[External conduit repair with "valved pericardial roll"].

External conduit repair was performed in 20 patients with "valved pericardial roll (VPR)" made of own pericardium (one case) or porcine pericardium (19 cases). Intraoperative measurement of peak pressure gradients across the valve ranged from 0 to 8 mmHg (mean 1), and that from the pulmonary ventricle to the pulmonary artery ranged from 0 to 38 mmHg (mean 20). Re-evaluation of 7 patients one year after surgery shows no increase in the pressure gradient except the first case, in which VPR was made of own pericardium. In pulsed Doppler echocardiographic study, no regurgitation was found in 4 patients, mild in 6, moderate in 4, severe in 1. VPR is functioning well with longest follow up at 16 months.

Adolescent↗
PubMed1989

[Follow-up study of coronary artery bypass grafting after Kawasaki disease--early and late postoperative evaluation].

In our hospital, 22 patients with severe coronary arterial lesion after Kawasaki disease underwent coronary artery bypass grafting (CABG) since 1982. The age of the cases at surgery ranged from 1 year to 19 years. Mean age was 8.3 years. Fifteen cases were bypassed using internal mammary artery (IMA) and 5 cases using IMA and autologous saphenous vein (SVG). Two cases were bypassed using only SVG. They have been examined until now by catheterization, by Treadmill test, and by Tl-201 myocardial imaging, around 1 month (Study 1) and around 1 year (Study 2) after surgery for the evaluation of results of CABG. One patient died from acute myocardial infarction 3 months after surgery and one patient shows return of anginal attack due to graft stenosis. Other patients are almost uneventful. In the study 1,20 (100%) IMA were patent, and 7 (88%) SVG were patent. In the study 2, 11 (92%) IMA and 6 (67%) SVG remained patent. Development of left anterior descending artery distal to IMA anastomosis was shown in 8 cases in the study 2. On the follow-up study with TI-201 myocardial imaging, disappearance or decrease of perfusion defect was seen in 7 cases (59%) in the study 1 and 9 cases (75%) in the study 2. On the Treadmill test, disappearance or improvement of ischemic change was seen in 15 cases (88%) in the study 1 and 10 cases (84%) in the study 2. These results suggest that IMA is more preferable for than SVG for young children who has an indication of CABG after Kawasaki disease.

Adolescent↗
PubMed1989

[Anomalous origin of the left anterior descending coronary artery from the pulmonary artery associated with other anomalies: a case report].

A two-month-old boy with anomalous origin of the left anterior descending coronary artery (AOLAD), aortic stenosis (AS), coarctation of the aorta (CoA) and patent ductus arteriosus (PDA) is reported. Tachypnea was observed since birth. When he arrived at our hospital, congestive heart failure, cyanosis of his lower extremities and weak femoral pulses were observed. Radiography revealed cardiomegaly and pulmonary congestion. ECG showed low voltage in all leads, ST elevation in leads II, aVF, V5,6 and abnormal Q waves in V5,6. The tentative diagnosis by two-dimensional echocardiography (2DE) was AS, CoA, PDA, pulmonary hypertension and pericardial effusion. The abnormal coronary artery was visualized as originating from the left anterior wall of the pulmonary artery, coursing between the pulmonary artery and left atrial appendage. A definitive diagnosis of AOLAD were made by angiography. Aortic reconstruction using an artificial graft for CoA and PDA ligation was performed first. He died of myocardial infarction while waiting for his second operation for AOLAD and AS. Autopsy confirmed the aforementioned diagnoses as well as old and recent infarction of the myocardium. AOLAD is a rare congenital malformation, only six cases of which have been reported. Moreover, AOLAD complicated by other anomalies had not been previously reported. This is the first such reported case.

Abnormalities, Multiple↗
PubMed1988

[A new surgical method for the creation of atrial septal defects].

For the creation of atrial septal defect (ASD), we have developed a new method (Method I) using modified Harken blade for the closed commissurotomy, in which the membranous septum of the fossa ovalis was incised in case of patent foramen ovale (PFO). When there was no or very narrow PFO, we applied Schuster's procedure to create defect in the muscular and membranous septum, however, it was sometimes found the bridging of remnant of membranous septum was left. So that, we have applied the Method I to cut it off (Method II). Up to date, eleven patients were operated with the Method I, and three patients with the Method II. As the results, nearly no pressure gradient between right and left atrium was detected postoperatively. In two cases, sufficiently created ASDs were confirmed at radical surgery. Because of the safety and reliability, our new procedures appear to be more advantageous in comparing to conventional Blalock-Hanlon or other procedures.

Child, Preschool↗