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Biomedical subjects

Y Wanibuchi

Publications and source records attributed to Y Wanibuchi.

At least 91 records · Page 5Linked to original sources
PubMed1990

[Long-term results of coronary artery bypass grafting: comparison of angiographic evaluation of internal thoracic artery and saphenous vein grafts].

The long term (10 to 15 years) results of coronary artery bypass grafting (CABG) were studied in 20 patients. The duration of follow-up was ranged from 130 to 170 months with mean 146.4 months. Ten out of 20 patients underwent coronary angiography (CAG), which disclosed that the late patency of saphenous vein (SV) grafts was 68.8% (11/16), but 54.5% (6/11) of patent SV grafts showed atherosclerotic changes such as irregularity and localized narrowing. On the other hand, internal thoracic artery (ITA) grafts were all patent without any atherosclerotic luminal changes. We recognized that ITA grafts were superior to SV grafts from an angiographic standpoint of view in the long term in Japan.

Adult↗
PubMed1990

[Valve replacement in infective endocarditis with mycotic aneurysm].

We successfully performed craniotomy and mitral valve replacement on a patient with bacterial endocarditis and ruptured intracranial aneurysm. A 15-year-old woman with fever and heart murmur was admitted to another hospital. Infective endocarditis and mitral valve regurgitation was diagnosed and treated with antibiotics. About one month after admission the patient suddenly showed severe headache and hemiparesis. Brain CT demonstrated intracerebral and subarachnoidal hemorrhage. The patient was unconscious when transferred to Mitsui Memorial Hospital where cerebral angiography showed anterior cerebral aneurysm and echocardiography showed mitral valve vegetation. We judged the necessary mitral valve replacement could be delayed until the aneurysm had been stabilized. We therefore began treatment using a different antibiotic but, in spite of this, 10 days later the aneurysm had enlarged dramatically. As conservative treatment was ineffective, a clipping operation was done to prevent re-rupture at the time of mitral valve replacement which could not be delayed much longer. 10 days later, cerebral 4 vessel study was done which showed no abnormality. Mitral valve replacement was then done and the patient was discharged in good health 64 days after the valve replacement.

Adolescent↗
PubMed1990

[A successful repair of post-infarction left ventricular free wall rupture].

Left ventricular free wall rupture secondary to acute myocardial infarction is almost invariably fatal. This report is the case presentation of a successful repair of left ventricular free wall rupture. A 55-year-old man, with a diagnosis of acute infero-lateral myocardial infarction, was transferred from another hospital to our CCU having recurrent chest pain on the fourth day after infarction. Shortly after admission, he lost his consciousness and fell into cardiogenic shock. Echocardiography showed a large pericardial fluid. He was immediately transferred to the operating room with the diagnosis of the heart rupture. After opening the pericardium containing 200 cc of blood, cardiac tamponade was relieved. The posterolateral portion of the left ventricle was found to be bluishly discolored, with a 8 mm-long tear of epicardium. Using cardiopulmonary bypass, the tear was closed with Teflon-reinforced sutures. The post-operative course was uneventful.

Aged↗
PubMed1990

[Valve prostheses of mitral position in children].

Twenty children less than 15 years old of age who had undergone mitral (left-sided atrioventricular) valve replacement before August 1983 have been followed up until October 1988. Fourteen biological valves (B-group) and seventeen mechanical valves (M-group) were used in them. Preoperative conditions had been similar between B- and M-groups. For the B-group, there were one operative death and two late deaths. For the M-group there were no operative death and three late deaths. An actuarial survival rate at ten years was 53.5 +/- 23.3% for the B-group and 85.7 +/- 9.4% for the M-group (not significant). All biological valves were calcified and failed in 27 to 89 months. Three mechanical valves caused thrombosis. There was no other complication for both groups. An event free rate was 0% at eight years for the B-group, however it was 70.6 +/- 11.0% at ten years for the M-group (p less than 0.025). Our data indicates that the mechanical valve is more suitable than the biological valve for children.

Bioprosthesis↗
PubMed1990

[Noncardiac surgery in patients with ischemic heart disease].

From January 1983 to December 1988, 4679 patients with operated under general anesthesia in our institute: 161 patients involved suspected ischemic heart disease (IHD patients) by history or electrocardiogram. Eight of 161 patients (5.0%) experienced fatal or life-threatening cardiac complications. On the other hand, only two non-IHD patients (0.03%) experienced complications. IHD patients had a significantly higher incidence of complications compared with non-IHD patients. Forty-five IHD patients had not undergone coronary cineangiogram (CAG) before noncardiac operations and six of them (13.8%) experienced complications. They had a significantly higher incidence of complications compared with other IHD-patients who had received CAG. Fifty-five IHD patients who had already been treated by coronary bypass grafting (CABG) or by percutaneous transluminal angioplasty experienced only one complication. We conclude that CAG should be more actively performed for IHD patients because prior CABG or PTCA is suspected to decrease cardiac complications in IHD patients. However, IHD patients must be managed as carefully as possible.

Aged↗
PubMed1990

[Investigation of primary tissue failure in mitral bioprostheses].

A study was conducted on 118 Hancock (HX) porcine valves, 251 Carpentier-Edwards (CE) porcine valves, and the biological valves in children used in the mitral position. Twenty-three HX valves, twenty-seven CE valves, and all valves except one operative death in children were diagnosed as primary tissue failure (PTF). Freedom from PTF for HX valves was 70.1 +/- 6.0% at ten years and for CE valves was 45.7 +/- 17.0% at ten years, although for children it was calculated 0% at eight years (significantly poor results compared with adults). No relation was found between the degree of calcified cusps and the duration of PTF valves used. The ruptures and calcifications of the cusps were most commonly observed in commissure. The peeled off commissures were characteristic in CE valves. Three adults and two children died without reoperation caused by calcified stenotic valves. Since the risk of reoperation was higher in NYHA functional class four, we recommend earlier elective reoperation.

Adult↗
PubMed1990

[A case of bioprosthetic mitral valvular dysfunction due to pannus-formation].

A case of bioprosthetic mitral valvular dysfunction accompanied by mitral stenosis due to pannus is reported. A 69-year-old woman, whose mitral valve had been replaced with a Hancock bioprosthetic valve in June 1979, underwent the second mitral valve replacement in September 1988 because of valvular dysfunction. The ring and cusps of this Hancock valve was partially covered with hard and milky white pannus which resulted in mitral stenosis. The tear of cusp was observed at the point of contact with pannus, which resulted in mitral regurgitation. Histologically, pannus was consisted of two-layered structure, fibrin and collagen fiber, which demonstrated this over-growth was based on thrombus. Main causes of bioprosthetic valve dysfunction are calcification and tear of cusps. But, valvular dysfunction due to pannus-formation described in this case has been experienced very rarely.

Aged↗
PubMed1989

[Long-term results of mechanical valves in aortic position and biological valves in mitral and tricuspid positions].

The long-term results of patients undergoing aortic valve replacement (AVR) with a mechanical valve (AM), mitral valve replacement with a biological valve (MB), and tricuspid valve replacement (TVR) with a biological valve (TB) operated upon from 1977 to 1988 were retrospectively analysed. A total of 899 patients received 1117 valves (381 AM, 633 TB, 103 TB) with a follow-up 3778 patient-years and 4582 valve-years. A significant incidence of thromboembolism, hemorrhage, and endocarditis was not found among AVR, MVR, TVR, or multiple valve replacement. We found a significantly decreased incidence of survival rate in multiple valve replacement compared with AVR or MVR, and a significantly increased incidence of reoperation in MB compared with AM and TB. We use AM and TB in any adult patients as a first choice. However, we prefer a mechanical valve in the mitral position except in patients over 65 years old, who have a short life expectancy, in whom anticoagulation is thought to be difficult, and who desire a biological valve.

Adolescent↗
PubMed1989

[A case of traumatic tricuspid regurgitation].

Tricuspid regurgitation due to nonpenetrating trauma occurred in a 60-year-old male patient who had received chest trauma in a motorcycle accident. He was admitted because of shortness of breath and palpitation on exertion. On admission physical examinations revealed pulsated and dilated jugular veins, hepatomegaly, and systolic murmur. The chest X-ray film showed an enlarged heart and electrocardiograms revealed complete right bundle branch block. Echocardiography demonstrated systolic prolapse of the tricuspid anterior leaflet into the right atrium. Right atrial v wave pressure was 20 mmHg. Tricuspid valve replacement with a Carpentier-Edwards 33 mm using super interpose method was performed successfully 13 years after the trauma. At operation, it was found that the chordae tendineae of the anterior leaflet was ruptured.

Chordae Tendineae↗
PubMed1989

[A thoracic aortic aneurysm with respiratory failure caused by the mechanisms of stenosis of the left bronchus and ipsilateral pulmonary artery--report of a case and review of the literature].

Clinical symptoms of thoracic aortic aneurysm vary widely from symptoms resulting from its rupture to those due to compression of surrounding organs. Furthermore, the onset of symptoms is frequently followed by a fatal outcome unless emergency measures are taken. We have recently experienced a patient who developed respiratory insufficiency caused by an aneurysm of the descending thoracic aorta compressing the left primary bronchus and the right pulmonary artery, the former causing ventilatory failure in the left lung and the latter interfering with blood flow in the right lung. The patient underwent emergency prosthetic graft replacement and showed temporary symptom improvement. However, a postoperative complication of esophageal perforation due to ischemic necrosis occurred and eventually caused acute empyema followed by death. The patient was a 48-year-old male who presented with symptoms similar to bronchial asthma. Angiographic examination (iv-DSA) revealed compression of right pulmonary artery by an aneurysm of the descending thoracic aorta. Bronchoscopic findings included extramural stenosis of the left bronchus accompanied by arterial pulsation. As an emergency measure, artificial blood vessel replacement of the descending thoracic aorta was performed. However, the patient developed postoperative acute empyema and died on the 19th postoperative day. Autopsy revealed ischemic necrosis on the esophageal wall where the aneurysmal lesion had touched before operation. This seems to have formed a perforation into the left thoracic cavity and ultimately to have caused acute empyema. Since we believe that the pathogenesis and clinical course observed in this patient is rather rare, the case is reported in accompanied by relevant data from the literature.

Aorta, Thoracic↗
PubMed1989

[Long-term results of the 19 mm low-profile bileaflet valve prosthesis in the small aortic anulus].

Between April, 1979, and November, 1986, 20 patients underwent aortic valve replacement (AVR) in the small aortic anulus with either 19 mm St. Jude Medical valve prosthesis or 19 mm Duro-Medics valve prosthesis, which are relatively new, low-profile bileaflet valve prostheses. There were two male and 18 female patients ranging from 35 to 69 years old (mean, 54.7 years). Average body surface area was 1.37 +/- 0.11 m2 (range 1.20 to 1.55 m2). One patient died of arrhythmia at 22 postoperative day. The 19 survivors have been followed up for as long as 61 months (mean, 31.2 months). There were two late complications, cerebral infarctions, and event free ratio was 0.85 at five years. All long-term survivors were in New York Heart Association Functional Class I (15 patients) and Class II (three patients). Preoperative and postoperative echocardiograms demonstrated significant decreases in mean left ventricular end-diastolic diameter (LVDd) (48.9 +/- 8.3 mm vs 42.2 +/- 5.7 mm; p less than 0.01) and in left ventricular end-systolic diameter (LVDs) (32.2 +/- 8.2 mm vs 25.7 +/- 4.9 mm; p less than 0.01). Mean left ventricular wall thickness was decreased to 24.5 +/- 3.7 mm from 25.8 +/- 6.4 mm. The average peak systolic gradient at rest with Doppler ultrasound was 26.0 +/- 9.3 mmHg (range nine to 36 mmHg). Though transprosthetic gradient did occur in patients who received 19 mm low-profile bileaflet valves in narrow aortic roots, progressive prosthetic stenosis was not observed and small aortic prostheses provide acceptable palliation for long-term results clinically.

Adult↗
PubMed1989

[Report of 108 patients with valvular heart disease who underwent re-operations through repeated median sternotomy incision].

108 patients who underwent redo median sternotomy between January 1975 and April 1988 were studied to determine factors affecting risk of cardiac reoperations. (1) Seventeen of 108 patients died, yielding an overall mortality of 15.7%. (2) Preoperative diagnosis had a significant correlation with mortality, which was higher with prosthetic valve endocarditis (50.0%) than with all other indications for reoperation. (3) Operative mortality was related to pre-reoperation functional class: 8.7% for New York Heart Association (NYHA) class II, 9.8% for class III and 27.8% for class IV. (4) Based on the degree of urgency, elective reoperation had a mortality of 5.4%, while emergency procedures carried a mortality of 61.5%. (5) Cardiac catheterization information was available in 53 patients. The pulmonary artery pressure was higher in the died group. There were no significant differences in pulmonary capillary wedge pressure and cardiac index between the survived and died. (6) Operation time, aortic cross clamp time and pump run were significantly longer in the died than in the survived group. The died had more blood loss during operative procedure. To decrease operative mortality, technical improvement and increased experience were necessary for surgeons. We prefer to free entirely pericardial adhesion to facilitate mobilization and evacuate air, and to make intra-cardiac procedure more easier and safety. Furthermore early reoperation before irreversible deterioration occurs was necessary since myocardial function was found to be a major determinant of surgical results.

Adult↗
PubMed1989

[Biological versus mechanical valves in the mitral position].

The long-term late results of isolated mitral valve replacement before April 1981 were retrospectively evaluated in 54 patients receiving a Hancock valve (HX) with a total follow-up of 424 patient-years (py) and 37 patients receiving a Björk-Shiley valve (BS) with a total follow-up of 366 py. There was no significant difference in regard to preoperative age, cardiothoracic ratio, electrocardiogram, or New York Heart Association functional class between the two groups. All of the BS group and 43 of the HX patients received long-term anticoagulant therapy. No significant difference was notable between the two groups in hospital mortality. Actuarial survival rate excluding hospital deaths was 75.5 +/- 6.7% for the HX group, and 80.8 +/- 7.1% for the BS group at ten years (not significant). There was no significant difference between the two groups in overall incidence of thromboembolism (HX 1.4% py, BS 1.9% py), anticoagulant related bleeding (HX 0.5% py, BS 0.8% py), or endocarditis (HX 0.5% py, BS 0.3% py). Actuarial freedom from reoperation at ten years was 69.6 +/- 8.1% for the HX group, and 93.5 +/- 4.4% for the BS group (p less than 0.01). Event free survival excluding hospital deaths at ten years was 49.2 +/- 8.1% for the HX group, 70.6 +/- 8.3% for the BS group (p less than 0.05). We prefer a mechanical prosthesis except in patients over 65 years old, who have a short life expectancy, in whom anticoagulation is thought to be difficult, and who hope a biological valve.

Adult↗
PubMed1989

[A case of ruptured aneurysm of the profunda femoris artery treated successfully by transcatheter embolization].

A 55-year-old man with ruptured aneurysm of the profunda femoris artery was treated successfully by transcatheter embolization. The selective angiography of profunda femoris artery following embolization disclosed that the aneurysm was occluded completely on both its distal and proximal sites, and blood flow was preserved just proximal to the aneurysm. We concluded that this new, less invasive method of transcatheter embolization in a patient with aneurysm of the profunda femoris artery may be a treatment of choice.

Aneurysm↗
PubMed1988

Early and late results of valvular surgery in the elderly.

From January, 1979 to June, 1986, 70 consecutive elderly patients (30 males and 40 females) age 65 years or older underwent open heart surgery for valvular heart diseases at Mitsui Memorial Hospital in Tokyo. Seventeen patients (24.3%) were septuagenarians. Porcine bioprosthesis (Carpentier-Edwards) was inserted for the mitral and the tricuspid position, and mechanical valve (Björk-Shiley or Duromedics) for the aortic position. Every patients received an anticoagulant (warfarin) postoperatively all through the follow-up period. The mean duration of follow-up was 43 months and the cumulative follow-up was 195 patient-years. Fifteen patients died in hospital after operation, giving an operative mortality rate of 21.4%. Cardiac death occurred in only 5 and the other 10 patients died of other causes such as sepsis, cerebrovascular accident, and agranulocytosis, showing that these patients were already in an advanced stage of cardiac failure. Late death occurred in 5 patients, but there was no clear-cut cardiac death documented. The actuarial survival rates at 3 years and 5 years were 71.6% and 65.9% for all patients, and 90.5% and 83.3% for early survivors. The functional and symptomatic improvement of 49 late survivors was remarkable. Thirty-eight patients (77.6%) are now NYHA class I and II. The incidence of thromboembolic and hemorrhagic episodes was fairly low--2% and 3% per patient year, respectively. Although the operative mortality is rather high in this study, it is clear that the surgical management of elderly patients with life-threatening valvular lesions results in substantial functional improvement and good prognosis in surviving patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗