Application of ventricular assist systems for end-stage cardiomyopathy patients as a bridge to heart transplant or recovery.
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Adolescent↗
Biomedical subjects
Y Sasako
Publications and source records attributed to Y Sasako.
[A case report of emergent CABG after left main trunk occlusion as complication of direct PTCA].
A 38-years-old man was transferred to our hospital because of cardiogenic shock following acute left main trunk (LMT) occlusion as a complication of direct percutaneous transluminal coronary angioplasty (PTCA), and then underwent emergent coronary artery bypass grafting. We successed his life salvage, but he suffers from very severe heart failure following extensive myocardial infarction. Though acute LMT occlusion as a complication of PTCA is rare, a proper treatment has to be started as soon as possible if it occurs. We must make the systems of support for the emergencies among the surrounding hospitals.
Adult↗
[Maze procedure for a lone atrial fibrillation].
Between 1992. 2 and 1997. 12, the maze procedure for lone fibrillation or flutter (lone af) was performed in 8 patients including 2 patients with a sustained atrial fibrillation, 5 patients with a paroxysmal atrial fibrillation and 1 patient with a sustained atrial flutter. All patients had suffered from a drug resistance lone af which induced sever symptom that is the dyspnea, palpitation and fatigue. Therefore patients requested to receive the maze procedure, and they agreed with the informed concent. After the maze operation, the normal sinus rhythm was recovered in 7 of 8 patients (87.5%). In only 1 patient, a paroxysmal atrial fibrillation remained but his symptoms improved after surgery. So this operation is a good choice of a treatment for a drug resistance lone af.
Adult↗
Maze procedure for atrial fibrillation associated with atrial septal defect.
BACKGROUND: Atrial fibrillation (AF) is a relatively common complication in elderly patients with an atrial septal defect (ASD). However, use of the simultaneous maze procedure for AF associated with ASD remains controversial. We examined the efficacy and risk of the use of the maze procedure in these patients. METHODS AND RESULTS: Between March 1992 and April 1997, 26 patients underwent the maze procedure as a concomitant operation with ASD closure (maze group). Kosakai's modified maze procedure was performed in 17 patients, the modified Cox maze II or III procedure was performed in 6, and the restrictive right-sided maze procedure was performed in 3. The mean +/- SD age at surgery was 58.2 +/- 9.1 years. The mean +/- SD duration of AF was 7.8 +/- 8.5 years. The mean +/- SD left atrial dimension was 47 +/- 9 mm, and 24 patients (92%) had a larger-than-normal (> 35 mm) left atrium. The mean +/- SD follow-up period was 2.7 +/- 1.7 years. There were no hospital or late deaths. There was no thromboembolic episode in the late follow-up period. Sinus rhythm was regained in all patients who underwent conventional the right- and left-sided maze procedure except for 1 patient. However, 3 patients who underwent the restrictive right-sided maze procedure showed a return to AF rhythm. The atrial A wave was detected with the use of pulsed Doppler study in all patients who had a restored sinus rhythm. During the same period, 45 patients who were > 40 years old and without AF underwent only ASD closure (control group). The incidence of reopening the chest for bleeding was significantly (P = 0.046) higher in the maze group (12%) than in the control group (0%). Paroxysmal AF more frequently (P = 0.023) occurred in the control group (18%) than in the maze group (0%). CONCLUSIONS: These results suggest that the standard maze procedure should be considered in patients with AF associated with ASD. The restrictive right-sided maze procedure was not reliable, probably due to preoperative enlargement of the left atrium.
Aged↗
[Surgical treatment for mitral regurgitation associated with secundum atrial septal defect].
We reviewed 25 patients who underwent a mitral valvuloplasty, from 1984 to 1996, for mitral regurgitation (MR) associated with atrial septal defect (ASD). Mean grade of MR was 2.3 +/- 0.7. The locations of mitral valve lesion were as follows; Postero-medial side of the anterior leaflet (AML) (11 patients: 44%), posteromedial side to center of the AML (7 patients: 28%), whole of the AML (5 patients: 20%), center of the AML (1 patient: 4%), posteromedial side of the posterior leaflet (PML) (1 patient: 4%). In summary, the mitral valve lesion was located in the AML in 96% patients and were seen in the postero-medial side of 96% patients. Mitral valve repair was performed as follows; chordae shortening only (3 patients: 12%), chordae shortening + Kay's annuloplasty (9 patients: 36%), Kay's anuloplasty (10 patients: 40%), using artificial chordae only (1 patient: 4%), using artificial chordae + Kay's annuloplasty (1 patient: 4%), using artificial chordae + ring annuloplasty (1 patient: 4%). In 24 patients, the grade of MR was less than 2/4 in the early postoperative period. In one patient, the grade of 3/4 MR was still remained. Reoperation were required in 2 patients, because of gradual increase of MR, 9 years and 10 years after the initial operation, respectively. In another patient, the grade 3/4 MR recurrently occurred at 6 months after the operation. He has been well maintained medically. In all 4 patients who had more than the grade 3/4 MR postoperatively, the annuloplasty was performed with Kay's method and the cause of MR was poor coaptation around the center of the AML. The mitral valve lesion associated with ASD seemed to be the dislocation of the AML which cause the discrepancy of the coaptation zone between both leaflets, without any prominent prolapse and chordae elongation. We put a particular emphasis on that the mitral valve repair should be performed with the recognition of the etiology of the mitral valve lesion. Especially, if the lesion extends around the center of the AML, sufficient coaptation area of both leaflets at the center of the AML should be obtained by anuloplasty.
Adult↗
Improved success rate of the maze procedure in mitral valve disease by new criteria for patients' selection.
OBJECTIVE: We have carried out the maze procedure for atrial fibrillation (AF) as a combined operation with mitral valve surgery in a consecutive fashion until December 1994 (period 1). Therefore, the success rate in sinus rhythm conversion remained unsatisfactory. We have selected the patients according to arbitrarily decided new criteria since January 1995 (period 2), and examined the results prospectively. METHODS: Between May 1992 and February 1997, we carried out the maze procedure in 220 patients as a combined operation with mitral valve surgery. During period 2, we carried out the maze procedure in 63 cases who satisfied all the new criteria (voltage of f-wave in V1 lead > 0.1 mV, cardiothoracic ratio (CTR) < 70%, LA dimension < 70 mm), and 37 patients out of these criteria. Success was defined as sinus rhythm restoration without sick sinus syndrome. RESULTS: There were 4 hospital deaths (1.8%) and 4 late deaths (1.8%). Success rate was significantly (P = 0.0089) higher in period 2 (82%) than in period 1 (65%). Success rate was significantly higher in patients within criteria than out of criteria both in period 1, period 2, and total (77 versus 48%, P = 0.018; 90 versus 66%, P = 0.004, and 83 versus 55%, P = 0.0001). CONCLUSION: The maze procedure is highly reliable when combined with mitral valve surgery if patients are selected properly.
Adult↗
Survival using percutaneous cardiopulmonary support after acute myocardial infarction due to occlusion of the left main coronary artery--a report of two cases.
Two cases of acute myocardial infarction due to an occlusion of the left main coronary artery (LMCA) are presented. Their cardiogenic shock was successfully treated with percutaneous cardiopulmonary support (PCPS), in addition to reperfusion therapy and an intraaortic balloon pump. The 2 patients were able to be weaned from PCPS and discharged from hospital. It is suggested that the early use of PCPS may be life-saving in patients with myocardial infarction due to the occlusion of the LMCA who have progressed to cardiogenic shock.
Acute Disease↗
[Indications for and limitations of minimally invasive cardiac surgery with the lower ministernotomy approach].
The chief benefits of small skin incisions are reduced patient discomfort, accelerated recovery, and cosmetic satisfaction without compromising the quality of surgery. Since April 1997, the lower ministernotomy approach without femoral cannulation has been performed in 43 patients in the authors' institutions. The indications for this approach were initial single valve surgery and secundum-type atrial septal defect. Cases of aortic valve regurgitation that could be repaired, and aortic stenosis that necessitated annular enlargement were excluded. Among patients with mitral valve disease, those with chronic atrial fibrillation were excluded frpm undergoing the Maze procedure and those reguiring chordal reconstruction for anterior leaflet were also excluded. Mitral valve repair for mitral regurgitation was performed in 8 patients, and open mitral commissurotomy in 2. Mitral valve replacement was performed in 3 patients and aortic valve replacement in 13. Closure of an atrial septal defect was carried out in 18 cases. An approximately 10-cm median skin incision was made, and a ministernotomy with a lower semitransverse division (inverted L-shape) was carried out. Cardiopulmonary bypass was initiated with ascending aortic cannulation and right-angled venous cannulae in the superior and inferior vena cava for mitral valve disease. Single venous cannulae from the right atrial appendage was used for aortic valve disease. Surgery was performed with mild hypothermia and intermittent tepid blood cardioplegia with diltiazem. A rigid 30-degree angle scope held by a videoscope holder with a flexible arm was used for mitral valve surgery. There were one hospital death due to perioperative myocardial infarction and pulmonary embolism. There was one reopening for bleeding which resulted in methicillin-resistant Staphylococcus aureus mediastinitis. However, the patients was discharged after rectal muscle flap repair. There was one reoperation for mitral valve repair due to hemolysis. The improvement of surgical instruments and materials will further facilitate this procedure.
Adult↗
[Experience of weaning from left ventricular assist system in an acutely-ill patient with dilated cardiomyopathy and severe left ventricular dysfunction: a case report].
A 21-year-old man with dilated cardiomyopathy recovered from terminal heart failure with the long-term use of the left ventricular assist system (LVAS). His heart failure was refractory to maximum medical therapy including beta-blockade and intravenous catecholamines. Application of LVAS restored renal and hepatic function and even cardiac function. Left ventricular size decreased from 79 to 57 mm, and cardiac index increased from 1.6 to 2.2 l/min/m2. After 6 weeks of LVAS application, he could walk in the ward and could start exercise on a bicycle ergometer 3 months after. Ninety-five days after implantation, the LVAS could be removed. His general condition remained good and stable for more than a year after the removal of the LVAS. Timely application of LVAS seems to be one of the most important factors for successful circulatory support. Detailed criteria for LVAS application are not established yet.
Adult↗
[Surgical treatment for prosthetic valve endocarditis].
From April 1993 to May 1997, 21 patients underwent surgical treatment for prosthetic valve endocarditis (PVE). There were 13 males and eight females aged from 46 to 79 years old (mean 62 years). There were four cases of early PVE (onset of PVE within 60 days from previous valve replacement), and 17 cases of late PVE (after 60 days). The predominant organisms were Staphylococcus epidermidis (eight cases), Staphylococcus aureus (two cases), MRSA (one case), streptococcal species (three cases), Candida (two cases), Pseudomonas cepacia (one case) and Enterococcus (one case). The predominant organisms were identified in 16 of 20 cases by preoperative blood culture, and in 11 of 20 cases by intraoperative tissue culture, and in 19 cases in all. There were four cases of preoperative cerebral complications, and three cases resurged. The hospital mortality rate was 24% (five patients). Reoperation was required in four patients for recurrence of PVE. Autopsy was performed in four of five patients. Intramyocardial abscess was detected in three patients. Earlier diagnosis and earlier surgical treatment could prevent emboli due to vegetations, which might cause catastrophic results, and could achieve better outcomes. Identification of the predominant organisms, especially from operative tissue cultures, is required.
Aged↗
Surgical management of Behçet's aortitis: a report of eight patients.
BACKGROUND: Behçet's aortitis is one of the most severe manifestations of Behçet's disease. However, there have been few reports of this rare entity. This article we describe our experience with surgical treatment of Behçet's aortitis in 8 patients. METHODS: From May 1978 to February 1995, we operated on 8 patients with Behçet's aortitis. All patients were followed up for a total of 54.4 patient-years (mean, 6.8 years). RESULTS: There were no operative deaths, but 1 patient died in the hospital of ventricular fibrillation. Another death occurred as a result of pseudoaneurysm rupture 10 months after operation. Fourteen operations were performed on eight patients: a second operation was performed on four patients, and a third operation was performed on two patients. The translocated Bentall procedure, a modified Bentall procedure, was performed six times. One patient required a second operation for graft detachment, but the others have done well without further surgical intervention. Aortic valve replacement was performed six times, and three reoperations were needed after aortic valve replacement. CONCLUSIONS: The translocated Bentall procedure may be effective for Behçet's aortitis, but further investigation is necessary.
Adult↗
Superior approach to the left main coronary artery for surgical angioplasty.
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Aged↗
Resection of a large, high-flow arteriovenous malformation during hypotension and hypothermia induced by a percutaneous cardiopulmonary support system. Case report.
The key to successful surgical resection of cerebral arteriovenous malformations (AVMs) is control of bleeding and cerebral swelling. Induced hypotension is one of the most valuable means of achieving this control. The authors introduced induced hypotension with mild hypothermia by using a percutaneous cardiopulmonary support system (PCPS) to resect a large, high-flow AVM. The efficacy and technical points of this method are discussed. The PCPS, whose entire intraluminal surface was coated with heparin, was established through a transfemoral route. During resection of the AVM, a mean arterial blood pressure of 60 mm Hg and a mean body temperature of 30 degrees C were easily maintained by regulating the flow rate of the PCPS and by blood cooling. The activated coagulation time was maintained at approximately 250 seconds with a minimum systemic administration of heparin. The authors report the case of a 30-year-old woman who presented with intraventricular hemorrhage and was diagnosed as having a large, high-flow AVM located in the left sylvian fissure. The AVM was fed by the left middle, posterior, and anterior cerebral arteries and drained by the many cortical ascending veins and the basal vein. The patient underwent surgery after hypotension and hypothermia had been induced via the PCPS method. Induced hypotension decreased the tension of the nidus and made its dissection easier. The AVM was totally resected and no hemostatic difficulties were encountered. On the basis of the authors' experience, they suggest that hypotension and hypothermia induced by using the PCPS is a powerful tool for the successful resection of large, high-flow AVMs.
Adult↗
Huge aneurysm of the sinus of Valsalva following infective endocarditis in Behçet's disease.
A huge aneurysm of the sinus of Valsalva with conduction disturbance as a consequence of infective endocarditis in Behçet's disease is reported. The aneurysm extended not only into the ventricular septum but also to the right atrium and ventricle, with a complicated cavity formation. We speculate that complete atrioventricular block occurred due to an enlargement of the aneurysm into the ventricular septum, leading to a direct conduction system injury. Preoperative echocardiography and aortography were insufficient to recognize the extent of the lesion; subsequent operative examination revealed the true size. At operation, it is important to understand the lesion dimensions fully in order that appropriate surgical procedures be performed.
Aortic Aneurysm↗
[Aortic valve replacement with stentless porcine aortic valve].
The Toronto stentless porcine valve (TSPV) is a stentless porcine aortic valve, preserved with glutaraldehyde solution, which has been designed to maintain natural laminar blood flow and improve hemodynamic performance and enhance durability. Aortic valve replacement with TSPV was performed in seven patients. The reason for this indication was advanced age (65 years or more) in six patients and connective tissue disease in another patient. One patient required reoperation because of prosthetic valve endocarditis 4 months after implantation. There were no other valve-related complications. Echocardiographic examination of prosthetic valve function one month after surgery showed no aortic regurgitation in any patient. Transprosthetic gradient was 15.1 +/- 5.0 mmHg. Technical know-how is required for the implantation. The hemodynamic characteristics of the TSPV were excellent. Further follow-up is required to determine durability, but further extensive indication of this valve is expected as a bioprosthesis.
Adult↗
Choice of replacement valve in the elderly.
BACKGROUND AND AIMS OF THE STUDY: Little comparative information exists on the outcome of the valve replacement with bioprostheses or mechanical valves in the elderly. This study was carried out to make such a comparison. METHODS: Follow up data were examined from 219 patients aged > or = 65 years who underwent aortic and/or mitral valve replacement using bioprosthetic (n = 67) or mechanical valve (n = 152) between April 1979 and December 1993. The mean follow up periods were 6.3 +/- 2.8 years after bioprosthesis and 4.9 +/- 2.1 years after mechanical valve implantation. RESULTS: Although the actuarial rate of structural deterioration was higher in patients with bioprosthetic valves than in those with mechanical valves (58% versus 100% freedom at 10 years after surgery, p < 0.01), no such prosthesis-related difference was seen in the subgroup of patients aged > or = 70 (100% versus 100% at nine years, p = N.S.). The actuarial rate of major bleeding was higher after mechanical valve implantation than after bioprosthetic valve placement (90% versus 100% freedom at 10 years, p < 0.05); this lower rate with bioprosthetic valves was maintained in patients aged > or = 70 (78% versus 100% at nine years, p < 0.05). There were no significant differences in the incidences of thromboembolism and bacterial endocarditis between the two valve types. CONCLUSIONS: Structural degeneration of bioprosthetic devices was a major problem in patients aged 65-70 years, but it was essentially negligible in those aged > or = 70 years. Anticoagulant-related bleeding was a major problem with mechanical valves in both age groups. Therefore, for patients older than 70 years, valve replacement with a bioprosthesis appears to be the method of choice.
Age Factors↗
[Extensive indication of mitral valvuloplasty for non-rheumatic mitral regurgitation and postoperative QOL].
Between January 1993 and June 1996, 108 patients with non-rheumatic mitral regurgitation (MR) underwent surgical treatment. Mitral valvuloplasty (MVP) was performed in 94 patients (87%) and mitral valve replacement (MVR) was performed in 14 patients. The patients were reviewed based on the location of the prolapse, active endocarditis, and re-valvuloplasty. The proportion of MVP patients to the total number of cases was 92%, 96% and 94% for prolapse of the anterior mitral leaflet (MVP: n = 22), the posterior mitral leaflet (n = 47) and of both leaflets (n = 15), respectively; it was 60% and 33% in the patients with active infective endocarditis (n = 3) and in reoperation cases (n = 3). Reoperation was required in 2 patients. Other than reoperation cases, 3/4 grade MR was detected by color Doppler echocardiography in 6 patients although they were asymptomatic. Thromboembolism occurred in 3 patients. The event-free rate at 42 months was 80.4%. Concomitant maze procedure was performed in 36 of 39 patients with atrial fibrillation and normal sinus rhythm was obtained in 25 of the 36 patients. Only 6 patients received warfarin anticoagulation after MVP. In current cases with non-rheumatic MR, the MVP could be performed in 87% of all patients and in 94% of the patients with simple prolapse, regardless of the prolapse area. Concomitant maze procedure might provide a better quality of life after MVP.
Adult↗
Surgical treatment for prolapse of the anterior mitral leaflet.
BACKGROUND AND AIMS OF THE STUDY: Mitral valvuloplasty (MVP) for the prolapse of the anterior mitral leaflet (AML) is more difficult than that for the posterior mitral leaflet. The introduction of artificial chordae (November, 1986) and the concomitant maze operation (November, 1992) were surgical 'turning points' in our 17 years' experience. METHODS: In total, 163 surgical cases of AML prolapse based on the above turning points, and carried out between 1979 and 1996, were reviewed. These included 110 MVP and 53 mitral valve replacements. MVP was performed in only 46% (29/63) of patients before October 1986 (Group I); in 72% (42/58) of patients between November 1986 and October 1992 (Group II); and in 93% (39/42) of patients after November 1992 (Group III). RESULTS: Reoperation was required in nine patients. The reoperation-free rate after MVP was 79% at 17 years in all cases, 82% at 17 years in Group I, 86% at 10 years in Group II and 97% at four years in Group III. Besides reoperation cases, grade 3/4 mitral regurgitation (MR), assessed by color Doppler echocardiography, was detected in seven patients. The event-free (reoperation, MR, thromboembolism) rate was 69% at 17 years in all cases, 78% at 17 years in Group I, 71% at 10 years in Group II and 92% at 4 years in Group III. A concomitant maze operation was performed in 19 of 20 current patients with atrial fibrillation. The percentage of sinus rhythm after operation in Group I, II and III was 53%, 60% and 84%, respectively. CONCLUSIONS: During 17 years' experience, mortality and morbidity after MVP for AML prolapse were satisfactory. With the use of artificial chordae, we have been able to perform MVP in more than 90% of current patients with AML prolapse. Further, a concomitant maze procedure could provide a higher incidence of postoperative sinus rhythm.
Actuarial Analysis↗