Biomedical subjects

Y Wanibuchi

Publications and source records attributed to Y Wanibuchi.

At least 73 records · Page 4Linked to original sources

PubMed1991

Central nervous system damage following surgery using cardiopulmonary bypass--a retrospective analysis of 1386 cases.

In order to determine the incidence and risk of central nervous system damage (CNSD) which accompanies cardiovascular surgery, a retrospective analysis was carried out on 1386 patients who received surgery utilizing cardiopulmonary bypass. CNSD occurred in 32 of the 1386 patients, the total incidence being 2.3 per cent. The major risk factors which led to a high incidence of CNSD were found to be reoperation, thrombus in the left atrium (TLA) and calcification of the ascending aorta (Cal aAo). In the primary surgical series, CNSD was found in only 29 of 1350 patients (2.2 per cent), however, of a total 36 patients who underwent reoperation, 3 (8.3 per cent) patients developed CNSD (p less than 0.05). In a surgical series done on 562 patients with mitral valve disease, the prevalence of CNSD was much higher in patients who suffered TLA than in those who did not, being 4/85 cases (4.7 per cent) vs 11/477 cases (2.3 per cent), respectively. Moreover, a significantly higher incidence of CNSD was noted in patients with Cal aAo, occurring in 6/10 cases (60 per cent) with Cal aAo vs 4/333 cases (1.2 per cent) without Cal aAo (p less than 0.001). The results of this study showed that patients with CNSD, who had received coronary artery bypass surgery and aortic arch replacement tended to follow a poor clinical course, suggesting that atheromatous plaque embolization may be the leading cause of the poor prognosis following CNSD in patients having undergone cardiopulmonary bypass.

Adult↗

PubMed1991

Intraoperative coronary angiography using fluorescein.

Intraoperative coronary angiography using fluorescein was applied to evaluate the patency of saphenous vein grafts just after completion of the distal anastomosis. By this technique, the area of the revascularized myocardium was well estimated in real time. This intraoperative direct-vision examination gives us more timely and precise information during coronary artery bypass grafting.

Anastomosis, Surgical↗

PubMed1991

Doppler miniprobe to measure arterial graft flow in coronary artery bypass grafting.

Using a 5 X 5-mm ultrasonographic Doppler miniprobe, the flow volume of arterial grafts (internal thoracic artery and gastroepiploic artery) was measured four times during the course of coronary artery bypass grafting. Graft flow just before sternal closure was almost equivalent to that in the preoperative phase when the anastomosis was optimal. Use of the Doppler miniprobe facilitated evaluation of the arterial graft flow pattern easily and quickly. We conclude that the Doppler miniprobe can provide helpful information for the evaluation of results of coronary artery bypass grafting in real time without necessitating any additional procedures.

Coronary Artery Bypass↗

PubMed1991

The role of medical treatment of distal type aortic dissection.

We analyzed the short-term and long-term outcome of 42 patients with distal type aortic dissection. Twenty-eight patients underwent intensive medical therapy within two weeks after the onset of pain (acute dissection). The remaining 14 patients had chronic dissection. The goals of medical treatment were to control blood pressure and to attain a negative C-reactive protein test result. Hospital survival rate in the patients with acute dissection was 96% (27/28). In-hospital complications included changes in mental status, renal dysfunction, bradycardia, orthostatic hypotension, and liver dysfunction, all of which were managed medically. Three of these patients underwent surgical therapy in the chronic phase and were discharged uneventfully. Fifteen (62.5%) of the 24 medically treated patients were discharged with negative C-reactive protein tests. Spontaneous resolution of a dissection was demonstrated by radiological examinations in 8 cases. Five-year survival rates in 24 medically treated patients was 93%. Hospital survival rate in the patients with chronic dissection was 100% (14/14). The rigorous control of blood pressure in the acute phase, and subsequent meticulous evaluation of the dissection by radiological tests and C-reactive protein test provides acceptable short-term and long-term outcomes of patients with acute distal dissection without the need for emergency surgical intervention.

Adult↗

PubMed1991

Comparative study between the gastroepiploic and the internal thoracic artery as a coronary bypass graft. Size, flow, patency, histology.

Ninety-two gastroepiploic artery (GEA) and 322 internal thoracic artery (ITA) grafts which underwent postoperative angiography (0.5-24 postoperative months, mean 2.0 months) were compared. The sites of GEA anastomosis were 5 left anterior descending, 3 diagonal, 16 circumflex and 68 right coronary arteries and for ITA grafts, 241 left anterior descending, 40 diagonal, 36 circumflex and 5 right coronary arteries. Patency rates were 96% (88/92) of GEA and 98% (314/322) of ITA, respectively. No focal stenosis in the graft trunk was found in both GEA and ITA except occasional spasm in GEA. Six (6%) GEAs were opacified via the superior mesenteric artery. Mean diameter of grafts just proximal to the anastomosis measured by angiogram was 2.3 mm in GEA and 1.9 mm in ITA (P less than 0.01). Free flow after intraluminal papaverine injection was 90.6 ml/min (50-300 ml/min) in 48 GEAs and 81.3 ml/min (50-150 ml/min) in 98 ITAs. Histology showed normal to mild intimal sclerotic changes in 58 of 63 (92%) GEAs and in 94 of 95 (99%) ITAs. From these results, we concluded that GEA is a suitable conduit and good long term patency similar to ITA grafting can be expected in coronary artery bypass grafting.

Arteries↗

PubMed1991

[Acute pulmonary thromboembolism after coronary artery bypass grafting].

The cases of acute pulmonary thromboembolism after coronary artery bypass surgery have been rarely reported in Japan. We, however, experienced 2 cases of them and lost them against intensive therapy. In Mitsui Memorial Hospital, 6 cases of pulmonary thromboembolism had been diagnosed in 1990 (0.074% in admission patients), four of the cases had occurred following surgical procedures. Its manifestations are deceivingly nonspecific and are difficult to distinguish perioperative myocardial infarction, pericardial tamponade, and pneumothorax, especially in postoperative states. We would like to emphasize that acute pulmonary thromboembolism is getting important problems also in Japan.

Acute Disease↗

PubMed1991

[Surgical treatment of PDA in the elderly patient accompanied with aneurysm of the main pulmonary artery].

A case of the elder PDA with aneurysm of the main pulmonary artery is reported. The patient was a 59-year-old female who had been suffering from severe heart failure. The PDA was closed directly from inside of the pulmonary artery using balloon catheter under usual cardiopulmonary bypass with limited circulatory arrest, and the aneurysm was repaired by aneurysmorrhaphy. The postoperative course was uneventful and she was discharged after 34 postoperative days. The pathological finding of the aneurysm of the main pulmonary artery is a cystic mucoid degeneration like a finding of Marfan syndrome. The etiology of the aneurysm of the main pulmonary artery seems to be extended Ao-PA shunt besides somewhat congenital change of the pulmonary artery.

Aneurysm↗

PubMed1991

[The surgical treatment of aortic regurgitation with aneurysm of the ascending aorta].

The surgical treatment of the aortic regurgitation with aneurysm of ascending aorta has been considered by Wheat, Bentall and Cabrol as improved combined techniques. 24 cases of the aortic regurgitation with aneurysm of ascending aorta that had been operated in Mitsui Memorial Hospital from November 1975 to August 1990 were examined their late results with the classification of 3 types of operative techniques (aortic valve replacement alone, Bentall's procedure, and Cabrol's procedure). 5 cases of them with aortic valve replacement alone were elected by their aortic angiographic findings, were not significant differences in their late results in the other cases with Bentall's or Cabrol's procedures. So we considered that treatment of the ascending aortic aneurysm with aortic regurgitation would not be necessary to operate with the combined techniques, but their selection of the indication would be limited in the cases that were not widened in aortic ring diameter in their preoperative angiography, and not complicated the systemic diseases such as Marfan's syndrome.

Adult↗

PubMed1991

[The perioperative management of dialysis for patients undergoing coronary artery bypass surgery with chronic renal failure].

Several methods of dialysis have been employed to maintain the perioperative water-electrolyte balance caused by the disorders with chronic renal failure. We have experienced 13 cases of coronary artery bypass surgery with chronic renal failure, and employed hemodialysis (HD) in 5 cases, hemodialysis with extracorporeal ultrafiltration method (HD + ECUM) in 5 cases, continuous ambulatory peritoneal dialysis (CAPD) in 3 cases for perioperative management. The perioperative changes of the circulatory blood volume and the fluid-balance, were assumed by positive reaction with varied over 60 mmHg in systolic blood pressure or demanded over double dose of catecholamines in each observed terms until the next day of the patients extubated. The cases with HD or HD + ECUM have changed the blood pressure more frequently (HD cases = 21%, HD + ECUM cases = 19%) than the cases with CAPD (CAPD cases = 3%). We conclude that the each methods are available to manage perioperative dialysis to undergo coronary artery bypass grafting should be employed with some techniques, CAPD will be the most favorable method to maintain the fluid balance stably for patients with severe compromised cardiac function.

Adult↗

PubMed1991

[A simultaneous operation of CABG and bilateral femoropopliteal bypass: report of a successful case].

A 62-year-old man with both coronary artery disease and leg ischemia was successfully treated with a combined revascularization procedure. Coronary artery bypass grafting (CABG) was carried out using in situ left internal thoracic artery and right gastroepiploic artery grafts, and bilateral femoropopliteal bypass grafting were performed reversed saphenous vein grafts simultaneously. The patient recovered well and experienced neither angina nor intermittent claudication.

Coronary Artery Bypass↗

PubMed1991

Does use of gastroepiploic artery graft increase surgical risk?

Seventy patients in whom the gastroepiploic artery was used for coronary artery bypass grafting were compared with 70 patients in whom the gastroepiploic artery was not used. Mean age was 56.8 years in the group in which this artery was used and 61.8 years in the group in which it was not (p less than 0.001). All other preoperative characteristics including number of women, extent of coronary artery disease, previous myocardial infarction, unstable angina, and preoperative left ventricular function were not significantly different between the two groups. An internal mammary artery graft was concomitantly used in 68 patients (97%) of the group with a gastroepiploic artery graft and in 61 patients (87%) without such a graft. The mean number of distal anastomoses was 3.3 and 3.4, aortic crossclamp time was 65.3 +/- 19.9 minutes and 54.0 +/- 20.1 minutes, and cardiopulmonary bypass time was 114.8 +/- 23.6 minutes and 112.9 +/- 25.0 minutes, respectively, in the groups with and without a gastroepiploic artery graft. Only aortic crossclamp time was significantly (p less than 0.05) longer in the group with a gastroepiploic artery graft. There were two (2.9%) early deaths and two (2.9%) new Q-wave infarctions in both groups. Intraaortic balloon pumping was required in five patients (7.1%) in the group with a gastroepiploic artery graft and in three patients (4.3%) without this graft. Postoperative complications were similar and rare in both groups. Intraoperative endoscopic laser Doppler study demonstrated no significant change of gastric mucosal blood flow before and after division of the gastroepiploic artery. We concluded that there is no additional risk in the use of the gastroepiploic artery for coronary bypass grafting, and a favorable outcome can be expected.

Adult↗

PubMed1991

[Late results of TVSI for Ebstein's anomaly].

For 10 adult cases of Ebstein's anomaly, tricuspid valve supraannular imposition (TVSI) without excision of native tricuspid valve were performed and its late results (6 mo. to 11.5 y, mean 6.8 years) were investigated. All cases showed the severe low output syndrome after the surgery. But the postoperative recovery of the cardiac function was smooth and there was no early death nor A-V block. Both the A-V conduction and the RV subvalvular structures were preserved in TVSI and it contributed to the postoperative good contractility of RV. In two cases, the serious postoperative ventricular tachycardia or ventricular fibrillation were experienced, one case required open cardiac massage and 6 hours long assist circulation in the other. In late stage, one patient died 9 years after the TVSI from the failure of the bioprosthetic mitral valve which had been implanted simultaneously, and the other 9 survivors returned to the class I of NYHA classification. LVDd and DS obtained by echocardiography showed significant enlargement; 29 +/- 4.5 mm and 19 +/- 4.1 mm before operation to 42 +/- 3.1 mm and 29 +/- 5.8 mm in late stage respectively. EF showed the tendency of slight decrease from the preoperative supernormal value to the normal range. RVD showed significant decrease after the surgery (58 +/- 4.2 mm to 37 +/- 4.1 mm). Bioprosthetic valve failure in tricuspid position was not experienced. PAC or PVC were seen quite often and 8 of 9 cases received medication for arrhythmia even in late stage.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1991

[Simultaneous operations of coronary artery bypass grafting (CABG) using right gastroepiploic artery (rt. GEA) and cholecystectomy for silent gallstone detected preoperatively: a report of two cases].

We report two cases simultaneously operated on CABG using rt. GEA and cholecystectomy for silent gallstone detected by routine preoperative examinations. We prefer that two different procedures are performed simultaneously even if gallstone is asymptomatic, for about 50% of silent gallstone is said to become symptomatic within further five years in the literature and the pedicle of rt. GEA may be troublesome during cholecystectomy.

Aged↗

PubMed1991

[A case experienced a difficulty in removing a catheter of IABP because of coagula formed in the balloon].

This is a report of a rare complication of intraaortic balloon pumping (IABP). A 71-year-old woman with ischemic heart disease and severe atherosclerosis had experienced a difficulty in removing the catheter of IABP because of coagula formed in the balloon and treated surgically by arteriotomy. The coagula was formed from blood entering into the balloon through a pin hole, which was most likely suspected to be made during insertion procedure or coronary angiography and percutaneous transluminal coronary angioplasty (PTCA) procedure done under IABP.

Aged↗

PubMed1990

Postoperative angiographic evaluation of gastroepiploic artery grafts: technical considerations and short-term patency.

Follow-up angiography was performed in 37 patients with right gastroepiploic artery (GEA) grafts at 27 +/- 32 days postoperatively. By the femoral approach, a 5F cobra or twist catheter was advanced selectively into the gastroduodenal artery (GDA) over a plastic-coated guidewire. In 29 patients, the GDA was successfully catheterized, and the GEA grafts were clearly visualized by the injection of 3-7 ml of contrast medium. GDA catheterization was unsuccessful in 8 patients, but in 4 of them the grafts were well visualized when 15-20 ml of contrast was injected. In the other 4 patients, visualization of the GEA grafts was poor, but the distal portions were outlined by retrograde perfusion from the native right coronary arteries. A total of 34 GEA grafts were patent (92%), and the diameters of these grafts were adequate when compared with respective recipient coronary arteries (2.8 +/- 0.9 and 2.3 +/- 0.6 mm, respectively; P less than .05). No complications were noted except for transient vasospasm (3 patients) in the GEA, hepatic artery, or both, which was relieved by the intra-arterial injection of isosorbide dinitrate (2.5 mg). Thus, the over-the-wire technique allows simple and safe GDA catheterization, which is essential for obtaining good visualization of GEA grafts.

Adult↗

PubMed1990

[A case of CABG in a patient with chronic idiopathic thrombocytopenic purpura].

This is a report of the management of a patient with chronic idiopathic thrombocytopenic purpura (ITP) and ischemic heart disease. High-dose transvenous gamma-globulin therapy (400 mg/kg/day for five days) was started five days prior to operation, yielding an increase in platelet count from 5.8 X 10(4)/mm3 to 12.8 X 10(4)/mm3. Platelet transfusion was used at the end of cardiopulmonary bypass and on the first postoperative day. There were no problems with hemostasis during the operative procedure and the postoperative course was uneventful. We prefer high-dose transvenous gamma-globulin therapy for ITP prior to open heart surgery as a treatment of choice.

Aged↗

PubMed1990

[Coronary artery bypass grafting with combined arterial grafts].

Coronary artery bypass grafting with combined arterial graft using the left internal mammary artery (IMA), right IMA, and the right gastroepiploic artery (GEA) was performed in 45 patients with saphenous vein graft (SVG) (29 patients) or without SVG (16 patients) from February 1989 to October 1989. The left IMA was used in all patients, the right IMA was used in 9 patients, and the GEA was used in 43 patients. Perioperative myocardial infarction was noted in two patients who had hospital deaths. Reopening the chest for postoperative bleeding was performed in two patients, and the cerebral accident was noted in one patient. Fourteen patients were operated on without the requirement for blood transfusion. Studied within 3 postoperative months, all arterial grafts were patent though the patency was 97.7% (43/44) in SVG. It is concluded that the combined arterial graft utilizing the IMAs and GEA can be used safely and effectively.

Adult↗

PubMed1990

[Medical treatment of type III dissecting aortic aneurysms: influence of the shape of the false lumen assessed by X-ray CT as a factor in the long-term prognosis].

The future needs of surgical repair for type III dissecting aneurysms among medically-treated patients were estimated according to the influence of the shapes of false lumina assessed by contrast-enhanced CT scans and by the level of blood pressure control at the time of discharge on the long-term prognoses. Thirty-six patients, 30 males and six females, whose mean age was 61 years, underwent enhanced CT scans at their discharge. Events, including deaths and dissection-related surgery were analyzed by a nonparametric actuarial method of Kaplan and Meier. The changes in CT findings were also studied in 33 patients who underwent follow-up CT scans within a mean interval of 3.5 years. 1. Systolic blood pressure was maintained below 140 mmHg (good control group) in 15 patients, and above 140 mmHg (poor control group) in 18 controls. There were no significant differences between the two groups for event-free survival rates. 2. The shapes of false lumina assessed by enhanced CT scans at the time of discharge were categorized in three types; 21 patients (group A) without false lumina of the aorta, or with a small crescentic false lumen in the thoracic aorta (type a), six patients (group B) with intimal flaps and two contrast-material-filled lumina in the thoracic aorta (type b), and nine patients (group C) with expanded false lumina or a false lumen whose margin was convex towards a true lumen in the thoracic aorta (type c).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗