Biomedical subjects

Yoshiaki Saji

Publications and source records attributed to Yoshiaki Saji.

10 recordsLinked to original sources

PubMed2007

Successful aortic valve replacement for Heyde syndrome with confirmed hematologic recovery.

Aortic valve stenosis can be complicated by recurrent gastrointestinal bleeding, particularly that due to angiodysplasia, also called Heyde syndrome. Recently, acquired type 2A von Willebrand disease, which is characterized by the loss of the large multimer of von Willebrand factor by the shear stress of aortic valve stenosis, was reported to be associated with this hemorrhagic syndrome. A 78-year-old woman, with severe aortic stenosis, presented with advanced anemia due to recurrent gastrointestinal bleeding and was diagnosed Heyde syndrome. By perioperative supplementation of von Willebrand factor and factor VIII, aortic valve replacement was safely performed without gastrointestinal bleeding. After the operation, the multimer of von Willebrand factor was normalized and thereafter no gastrointestinal bleeding occurred. This case reports the successful aortic valve replacement for Heyde syndrome, with confirmed hematologic recovery.

Aged↗

PubMed2006

A combination of omental flap and growth factor therapy induces arteriogenesis and increases myocardial perfusion in chronic myocardial ischemia: evolving concept of biologic coronary artery bypass grafting.

OBJECTIVE: The purpose of this study was to evaluate the therapeutic efficacy of the combined growth factor therapy with an omental flap in a rabbit model of chronic myocardial ischemia. METHODS: Chronic ischemia was created in rabbits by placing a constrictor on the left circumflex artery. Four weeks later the animals were divided into 3 groups: group FG, in which a gelatin hydrogel sheet incorporating 100 microg of basic fibroblast growth factor was placed over the left circumflex region followed by covering with the omental flap including the intact gastroepiploic artery; group F, in which only the basic fibroblast growth factor sheet was placed; and group N, in which no treatment was done. RESULTS: Cine magnetic resonance imaging analysis showed a greater percentage wall thickening in the left circumflex region in group FG than in other groups (group FG, 49.2% +/- 4.5%; group F, 41.2% +/- 3.8%; group N, 32.1% +/- 2.5%, P =.035, group FG vs group F). A colored microsphere assay showed higher perfusion in the left circumflex region in group FG than in group F. Perfusion in the left circumflex region was decreased after clamping the gastroepiploic artery pedicle in group FG (before clamping, 2.83 +/- 0.72 mL x min(-1) x g(-1); after clamping, 1.93 +/- 0.59 mL x min(-1) x g(-1); P < .01). In vivo angiography via gastroepiploic artery showed direct "to-and-fro" visible collaterals between the gastroepiploic and occluded left circumflex coronary arteries in group FG. CONCLUSION: The combined growth factor therapy with an omental flap induced arteriogenesis and provided additional perfusion via the gastroepiploic artery to ameliorate regional dysfunction in the chronically ischemic myocardium.

Animals↗

PubMed2006

Intermediate type atrioventricular septal defect in the elderly.

A 65-year-old woman with intermediate type atrioventricular septal defect had been undiagnosed until initial presentation with congestive heart failure. She underwent surgery when the ventricular septal defect was found to be restrictive. The atrioventricular valve was similar to the common atrioventricular valve, but was connected to the crest of the ventricular septal defect. Surgery included direct closure of the ventricular septal defect, repair of the cleft in the atrioventricular valve, and ostium primum closure. Postoperative echocardiography indicated successful heart repair. We present a review of rare intermediate type atrioventricular septal defect in the elderly, and we discuss the surgical issues in this case.

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PubMed2006

A novel atrial volume reduction technique to enhance the Cox maze procedure: initial results.

OBJECTIVE: Large left atrial diameter is reported to be a predictor for recurrent atrial fibrillation after the Cox maze procedure, and left atrial diameter by itself influences the chance of sinus rhythm recovery, as well as maintenance of sinus rhythm. However, additional cut-and-sew procedures to decrease left atrial diameter extend operative time and can cause bleeding. Thus we developed a no-bleeding, faster, and therefore less invasive left atrial volume reduction technique to enhance the Cox maze procedure. METHODS: The modified Cox maze III procedure with cryoablation or the left atrial maze procedure in association with mitral valve surgery was performed in 80 patients with atrial fibrillation and enlarged left atria (> or =60 mm). Among them, 44 patients had the concomitant volume reduction technique (VR group); continuous horizontal mattress sutures for left atrial plication were placed on the left atrial wall along the pulmonary vein isolation line. Cryoablation was applied to the suture line so that the plicated left atrium is anatomically and electrically isolated. Another 36 patients did not have the volume reduction technique (control group). RESULTS: The VR group had preoperative left atrial diameters similar to those of the control group (67.1 +/- 7.8 vs 64.5 +/- 6.7 mm) and a longer preoperative duration of atrial fibrillation (14.1 +/- 5.4 vs 9.5 +/- 5.1 years, P < .05) but had smaller postoperative left atrial diameters (47.6 +/- 6.3 vs 62.1 +/- 7.9 mm, P < .01). There were no differences in mean crossclamp/bypass time and chest tube drainage for 12 hours between the groups. Twelve months after surgical intervention, the sinus rhythm recovery rate of the VR group was better than that of the control group (90% vs 69%, P < .05). CONCLUSIONS: Even in patients with long-standing atrial fibrillation and an enlarged left atrium, maze procedures concomitant with the novel left atrial volume reduction technique improved the sinus rhythm recovery rate without increasing complications. Although further study with a larger number of patients and a longer follow-up period is needed, this safe and thus far potent technique that catheter-based ablation cannot copy might extend indication of the Cox maze procedure for patients with tough atrial fibrillation.

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PubMed2004

Atrial septal defect with borderline pulmonary vascular disease: surgery and long-term oral prostacyclin therapy for recalcitrant pulmonary hypertension.

The hemodynamic determination of operability in atrial septal defect (ASD) with severe pulmonary hypertension is problematic. Therefore, we perform an open lung biopsy prior to the corrective surgery in cases with pulmonary vascular resistance greater than 8 units x m2 and/or pulmonary arterial peak pressure greater than 70 mmHg. We present 4 cases showing occlusion of more than 70% of the small pulmonary arteries and arterioles by musculoelastosis, thromboembolism and mixed-type (musculoelastosis and plexogenic arteriopathy) which was considered borderline in terms of operability. After complete closure of the ASD and postoperative long-term oral prostacyclin (PGI2) therapy, pulmonary artery peak pressure decreased from 110-72 (mean 84) to 105-45 (mean 74) mmHg immediately after operation and 65-40 (mean 57) mmHg after PGI2 therapy. The New York Heart Association functional status of the patients improved from class II-III to class I with oral PGI2 only. Our cases demonstrate that despite more than 70% occlusion of the small pulmonary arteries and arterioles, surgery and long-term PGI2 therapy can reduce pulmonary artery pressure and improve the quality of life.

Adolescent↗

PubMed2003

Coronary artery bypass grafting without cardiopulmonary bypass: a five-year experience.

The current drive to practice less invasive surgery is changing surgical practice towards safer and simpler procedures. The practice of coronary artery bypass grafting (CABG) on a beating heart without cardiopulmonary bypass (CPB), off-pump CABG or OPCAB, has been gaining great attention as an alternative approach to conventional CABG. Since the first adoption of OPCAB in 1997 at our department, 181 patients have undergone OPCAB. OPCAB was indicated for patients who were possibly at risk for CPB, i.e., those who were elderly, who had a history of cerebrovascular disease, whose ascending aorta was severely atherosclerotic with calcification, whose respiratory function was compromised, or whose renal function was compromised. A patient with a concomitant malignant neoplastic disorder was also a candidate for OPCAB because of the possible deleterious effect of CPB on the immune system. More recently, when the coronary anatomy was suitable for OPCAB, even in younger or less risky patients, OPCAB was indicated. The OPCAB procedure was performed through a median sternotomy in 146 patients (80.6%), a left thoracotomy in 27 (14.9%), a subxiphoid approach in 6 and a combined one in 2. One hundred and eleven patients (61.3%) received 1 or 2 grafts (Group I) and 70 (38.7%) received 3 or more grafts (Group II). The number of grafted vessels in Group II patients was 3 to 5 with a mean of 3.44. The mean operative time was 163 minutes in Group I and 209.5 minutes in Group II. The frequency of the use of arterial grafts such as LITA, RITA and RA was significantly higher in Group II than in Group I. Death occurred in 3 patients with acute coronary syndrome who had to undergo urgent surgery. Angiographic examination was performed within 3 months, postoperatively, in 98 patients (54.1%) revealing the overall patency rate of each graft: LITA82/83 (98.8%), RITA 33/33 (100%), GEA 15/16 (93.8%), RA 20/20 (100%), and SVG 15/16 (93.8%). We conclude that, in light of our 5-year experience, off-pump CABG on a beating heart can be safely and effectively performed, with acceptable angiographic results even in patients with multi-vessel coronary disease requiring multiple revascularization. This procedure enables us to perform successful coronary bypass surgery for those who otherwise would not have been candidates for conventional CABG.

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PubMed2003

Application of off-pump coronary artery bypass grafting for patients with acute coronary syndrome requiring emergency surgery.

Off-pump coronary artery bypass grafting (OPCAB) has become a more applicable procedure, even in patients with multi-vessel disease. However, the role of OPCAB for patients with acute coronary syndrome (ACS) requiring emergency revascularization has not been established yet. We reviewed our results of emergency coronary artery bypass grafting (CABG) for patients with ACS. Seventy-two patients with ACS who underwent emergency CABG were studied. Twenty-five underwent OPCAB and 47 on-pump CABG. OPCAB was mainly indicated for patients who were possibly at risk for cardiopulmonary bypass. When the coronary anatomy was suitable in younger or less risky patients, OPCAB was performed. Patients with multi-vessel disease or with a critical left main trunk lesion were not excluded from OPCAB. The mean number of grafted vessels was 2.6 per patient in the OPCAB group, and 3.8 per patient in the on-pump group (p<0.0001). However, none of the patients in either group required postoperative catheter intervention. Mean operative time was 195 minutes in the OPCAB group and 286 minutes in the on-pump group (p<0.0001). There were three postoperative deaths in the OPCAB group and four in the on-pump group. Multivariate logistic regression analysis revealed that preoperative cardiogenic shock was the only significant predictor for postoperative death (odds ratio, 7.33). The selection of the on-pump procedure or OPCAB did not correlate with operative death. Thus, we conclude that OPCAB can be performed safely and effectively in selected patients with ACS requiring emergency coronary revascularization.

Aged↗

PubMed2003

Subclavian artery reconstruction in patients undergoing coronary artery bypass grafting.

The presence of occlusive disease of the subclavian artery (SCA) proximal to the origin of the internal thoracic artery (ITA) influences the operative strategy and the outcome of coronary artery bypass grafting (CABG). Of 780 patients who underwent CABG, concomitant SCA occlusive lesions were reconstructed in 13 patients (nine males, four females). The affected SCAs were left-sided in 11 patients, and right-sided and bilateral in one, each. An aortoaxillary bypass utilizing an 8-mm PTFE graft was constructed in nine patients and a carotid-subclavian (C-S) transposition in two, simultaneously with CABG. Percutaneous balloon angioplasty with a stent was performed in two patients prior to CABG. With follow-up periods ranging from 4 to 8.4 years (mean, 6.3 years), aortoaxillary bypass grafts were patent in all patients. Other reconstructive procedures, including a C-S transposition and balloon angioplasty, were performed safely and effectively in off-pump CABG patients. In six patients, the left internal thoracic artery (LITA) could be used as a graft to the coronary artery after SCA reconstruction. Aortoaxillary bypass using an 8-mm PTFE graft is a safe and effective way for simultaneous subclavian reconstruction in patients undergoing CABG. Mid-term patency of the graft is satisfactory. The LITA can be used as a graft to the coronary arteries in selected patients. Preoperative brachial angiography is mandatory in these patients.

Aged↗

PubMed2002

Efficacy of intraoperative mapping to optimize the surgical ablation of atrial fibrillation in cardiac surgery.

BACKGROUND: Observation during open heart surgery in patients with chronic atrial fibrillation (AF) showed that the activation sequence of the left atrium was regular and that of the right atrium chaotic in most patients. We speculate that the left atrium plays a role as an important electrical driving chamber for AF and by mapping pre-operatively, optimal sites for the cryoablation can be determined to minimize the extensiveness of the cryolesions. METHODS: Forty patients who underwent cardiac surgery and cryoablation guided by epicardial mapping data to eliminate AF originating from the left atrium were included in this study. RESULTS: Sustained reentrant movement or repetitive firing from foci located in the right atrium was never observed. Foci or reentry circuits located in the left atrium were clearly identified in 11 cases. Nine of the 11 cases resumed sinus rhythm by placing cryolesions at these sites. Two cases needed a pacemaker implantation. The exact site had not been identified in the 29 remaining cases. In these 29 cases a left atrial posterior longitudinal linear cryoablation was placed. Sinus rhythm resumed in 22 cases. Six cases still remained in AF and a pacemaker was implanted in 1 case. Ultimately, in this series of operations sinus rhythm was resumed in 31 of 40 cases; AF remained in 6 of them and pacemaker implantation was required in 3 cases. CONCLUSIONS: Mapping was useful to distinguish the two etiologies of the AF to facilitate optimal placement of the cryolesions. Sustained reentrant movement or repetitive firing from foci located in the right atrium was never observed and the left atrium played an important role as the electrical driving chamber for AF.

Adult↗

PubMed2002

Evolution of staged approach for Fontan operation.

BACKGROUND: During the early development of the Fontan operation, a number of physiologic and anatomical limits were proposed as selection criteria, and two criteria, pulmonary vascular resistance and ventricular function, have been important in predicting surgical outcome. The use of the bidirectional cavo pulmonary shunt as a staging procedure performed to control the pulmonary blood flow adequately and reduce ventricular volume over load has resulted in marked improvements in the early and late Fontan procedure results. METHODS AND RESULTS: At our hospital we perform systemic pulmonary shunt or pulmonary artery banding in patients if pulmonary blood flow can not be controlled adequately in the neonatal period and then perform bidirectional cavo pulmonary shunt six months afterwards. During this operation we also performed simultaneous surgical repair for pulmonary artery distortion, anomalies of pulmonary venous connection, restriction of bulboventricular foramen and atrioventricular valve regurgitation. To determine the efficacy of this staged approach in avoiding increases in pulmonary vascular resistance and impaired ventricular function, surgical results were investigated. From February 1995 to May 2001, eighteen patients with cardiac morphology unsuitable for biventricular repair were admitted to our hospital. Twenty-six palliative procedures, were performed including seven pulmonary artery banding, three systemic pulmonary shunt, thirteen bidirectional cavo pulmonary shunt, one original Glenn procedure, four repair of coarctation of the aorta, two total anomalous pulmonary venous connection repair, one mitral valve plasty, and two patients required Damus-Kaye-Stansel procedure to release restrictive bulboventricular foramen. Fifteen patients underwent a modified Fontan operation (total cavopulmonary connection) after these palliative procedures. The operative mortality rate for these palliative procedures was 3.8% (1/26). The operative mortality rate for Fontan operation was 7.1% (1/14). Three patients awaiting the Fontan operation were considered good candidates for a final operation and no patients in this series were considered unsuitable for Fontan completion. CONCLUSION: Our strategy of staged approach for Fontan procedure offers a good prognosis.

Child↗