2.One Case of Mitral Valve Plasty via Right 7th Intercostal Thoracotomy in a Patient Who Underwent Right Lower and Middle Lobe Resections of the Right Lung
Shinichiro Ikeda ; Hideo Yoshida ; Keiji Yunoki ; Kunikazu Hisamochi
Japanese Journal of Cardiovascular Surgery 2015;44(1):33-36
An 80-year-old woman underwent lower and middle lobe resections of right lung in 1990 and 1998 because of lung cancers. There was no recurrence. In 2009, she presented with exertional dyspnea, and echocardiography showed grade III mitral regurgitation (MR). We diagnosed with congestive heart failure caused by MR. Her chest CT showed her mediastinum was shifted to the right and her heart was in the right thoracic cavity. We performed mitral valve plasty via right 7th intercostal thoracotomy. Post-operative respiratory condition was stable and she was extubated on the first postoperative day. Post-operative UCG showed trivial MR. She was discharged on the 14th day.
3.Clinical Evaluation and Comparison of the ATS Medical Open Pivot Prosthetic Valve and St. Jude's Medical Prosthetic Valve in the Aortic Position.
Teiji Jinno ; Mamoru Tago ; Hideo Yoshida ; Masataka Yamane
Japanese Journal of Cardiovascular Surgery 2002;31(3):183-186
The valvular function after aortic valve replacement was examined using Doppler echocardiography and changes in serum lactate dehydrogenase (LDH) and free hemoglobin levels were assessed. Data for the ATS Medical open pivot prosthetic valve were compared with those of the St. Jude's Medical prosthetic (SJM) valve, a similar bileaflet valve. These have been used in the past 5 years. There were 23 patients with ATS valves (13 men and 10 women, with a mean age of 60.4±13.8 years) and 16 patients with SJM valves (10 men and 6 women, with a mean age of 61.4±8.7 years). The left ventricular diastolic diameter index (LVDdI), left ventricular systolic diameter index (LVDsI), % fractional shortening (%FS) and left ventricular mass index (LVMI) were determined by echocardiography. The peak pressure gradients of the aortic prosthetic valves were calculated by a simplified Bernoulli equation. Postoperative LVDdI, LVDsI and LVMI were not significantly different in the ATS group and the SJM group. However, the %FS of the ATS group was significantly higher than that of the SJM group with aortic stenosis. The pressure gradients at the aortic prosthetic valve position were not significantly different between ATS and SJM valve in the 19-mm, 21-mm and 23-mm size. Postoperative improvement or recovery of the serum LDH level was observed significantly more frequently in the ATS group than the SJM group (p<0.005). The free hemoglobin level of the ATS group was also lower than that of the SJM group (p<0.005). We demonstrated satisfactory valvular function of the ATS valve compared with the SJM valve. Postoperative improvement of hemolysis was observed significantly more frequently and more rapidly in the ATS valves.
4.Operation with Cardiopulmonary Bypass Using Heparin and Nafamostat Mesilate for a Patient with Protamine Allergy
Hideki Morita ; Hideo Yoshida ; Teiji Jinno ; Mamoru Tago ; Masataka Yamane
Japanese Journal of Cardiovascular Surgery 2004;33(2):140-142
A 77-year-old woman was given general anesthesia for an ascending aortic aneurysm operation and went into anaphylactic shock. The operation was canceled. Vecuronium, pancuronium, protamine and famotidine revealed positive prick test reactions. Ascending aortic replacement underwent under minimum dose of heparin for cardiopulmonary bypass (CPB). Heparin was injected immediately before CPB (2.5mg/kg) and nafamostat mesilate was injected continuously during CPB (2mg/kg/h). The ACT value was over 1, 400sec during CPB. However, protamine was not used after CPB. The operation time was 4h and 30min. CPB time was 1h and 26min. After the patient returned to the ICU, bleeding from the chest drainage tubes increased temporarily. The bleeding decreased gradually after administration of FFP and MAP.
5.A Case of Primary Right Atrium Angiosarcoma Involving Cardiac Tamponade
Susumu Oozawa ; Kunikazu Hisamochi ; Hideo Yoshida ; Keiji Yunoki ; Osamu Oba
Japanese Journal of Cardiovascular Surgery 2005;34(5):382-385
Primary cardiac angiosarcoma is very rare and its prognosis was reported to be very poor (average survival period 7 months). A 46-year-old woman with angiosarcoma was admitted for recurrent symptoms of cardiac tamponade. Surgical excision of the tumor was performed 5 months after initial presentation and irradiation therapy was added. Thereafter, immunotherapy, and transcatheter arterial embolization were performed for liver metastasis. Despite this multidisciplinary therapy, she passed away 355 days after surgery. In our report, we described our multidisciplinary approach to this highly malignant tumor and the treatment strategy was discussed.
6.Right Pulmonary Artery Communication to a Left Atrium
Toshihiko Suzuki ; Kunikazu Hisamochi ; Hideo Yoshida ; Keiji Yunoki ; Yasufumi Fujita ; Atsushi Tateishi ; Tomoya Inoue
Japanese Journal of Cardiovascular Surgery 2015;44(3):141-143
PA-LA communication is a rare congenital heart disease consisting of direct communication between a branch of the PA and LA through an aneurysmal structure. This disease reveals the central cyanosis with clubbed fingers and surgical repair is needed when symptoms are apparent. Computed tomography is highly recommended for definitive diagnosis. Angiographic catheterization is also recommended to support the diagnosis and decide on the treatment. PA-LA communication is categorized into 4 types. Two types do not need cardiopulmonary bypass (CPB) when treated surgically, but the others need CPB. A 16-year-old girl with clubbed fingers was found to have PA-LA communication by 3DCT. She underwent surgery and was discharged in good condition. The surgical procedure was done through median sternotomy without CPB. The anomalous aneurysmal fistula was doubly ligated. No communication was found after ligation by TEE.
7.A Case of Mitral Valve Re-replacement Combined with Idiopathic Thrombocytopenic Purpura.
Hideo YOSHIDA ; Kenji SANGAWA ; Yutaka SAKAKIBARA ; Kohtaroh SUEHIRO ; Masahiro OKADA ; Takeshi SHICHIJOH ; Osamu OHBA
Japanese Journal of Cardiovascular Surgery 1993;22(4):372-375
Cardiac surgery associated with idiopathic thrombocytopenic purpura (ITP) is rare, and only 10 cases have been reported in the literature. In this report, we described the successful surgical management of a patient with ITP, diabetes mellitus and malfunction of mitral bioprosthetic valve. A 62-year-old male, who underwent mitral valve replacement (MVR) by means of a Carpentier-Edwards valve prosthesis and CABG ten years ago, developed malfunction of mitral prosthetic valve. The preoperative platelet count was 52, 000/mm3 and PA-IgG elevated markedly. The diagnosis of ITP was based on findings of bone marrow examinations. Thrombocytopenia was treated by steroids for 4 weeks and large dose γ-globulin (20g/day) for 5 days preoperatively, but platelet count did not increase. Platelet rich plasma (PRP) was transfused prior to cardiopulmonary bypass (CPB) and fresh blood was added to the priming material of CPB. Re-MVR was performed by means of mechanical valve prosthesis. After operation, large doses of γ-globulin and transfusion of PRP were performed for 3 days, and the postoperative course was uneventful. Other reports in addition to this study reveal that cases of cardiac surgery associated with ITP should be initially controlled preoperatively with steroids or high-dose γ-globulin, and if these treatments are harmful or ineffective, splenectomy should be considered.
8.Total Arch and Descending Aortic Replacement for a Kommerell Diverticulum and Right-Sided Aortic Arch with Aberrant Left Subclavian Artery
Shigeru Hattori ; Keiji Yunoki ; Naoya Sakoda ; Atsushi Tateishi ; Yasufumi Fujita ; Kunikazu Hisamochi ; Hideo Yoshida
Japanese Journal of Cardiovascular Surgery 2015;44(5):279-282
A 74-year-old woman was referred to our unit with a chief complaint of dysphagia. Enhanced CT showed a Kommerell diverticulum with a maximum diameter of 46 mm, associated with a right-sided aortic arch and aberrant left subclavian artery. We performed two-staged operations : left subclavian-common carotid artery bypass followed by total arch, and descending aortic replacement by an antero-lateral thoracotomy with partial sternotomy (ALPS). The postoperative course was uneventful. Total arch and descending aortic replacement for a Kommerell diverticulum by an ALPS approach is rare. ALPS approach for Kommerell diverticulum achieves safe surgery with good exposure.
9.Aortic Valve Replacement in a Patient with Essential Thrombocythemia
Akihisa Furuta ; Akito Imai ; Tomoya Inoue ; Toshihiko Suzuki ; Keiji Yunoki ; Kunikazu Hisamochi ; Hideo Yoshida
Japanese Journal of Cardiovascular Surgery 2014;43(2):49-52
Essential thrombocythemia (ET) is an uncommon type of myeloproliferative disorder, characterized by both thrombotic and hemorrhagic diatheses. No clear guidelines exist for the pre- or post-operative management of patients with ET undergoing cardiac surgery. Here, we present a rare case of a patient with essential thrombocythemia and severe aortic stenosis, who needed an aortic valve replacement on cardiopulmonary bypass and who suffered no complications.
10.A Case of One-Stage Operation for Brachiocephalic Aneurysm and Aortic Regurgitation Associated with Aortitis Syndrome
Hideki Morita ; Hideo Yoshida ; Toru Morimoto ; Teiji Jinno ; Mamoru Tago ; Masataka Yamane
Japanese Journal of Cardiovascular Surgery 2004;33(5):348-351
A 31-year-old woman had an aneurysm of the brachiocephalic artery and aortic regurgitation due to aortitis syndrome. As C-reactive protein (CRP) levels were high (27.5mg/dl), steroid therapy was initiated. After CRP became negative, the brachiocephalic aneurysm was repaired using a GELWEAVE® Y-graft, and the aortic valve was replaced with an ATS® mechanical valve. Regional cerebral oxygenation (rSO2) was monitored during the operative period. The level of rSO2 did not change during the period when the brachiocephalic artery was clamped, resulting in no cerebral damage after the operation. Homer's syndrome appeared after the operation but the symptoms gradually improved spontaneously. A mechanical valve was chosen because the patient did not want to undergo a reoperation. No cerebrovascular event occurred after the operation and the patient was discharged on the 28th postoperative day.