1.A Case of Extensive Cerebral Infarction Associated with Acute Aortic Dissection Responding to External Decompression and Mild Brain Hypothermia
Manabu Noguchi ; Ryuuichiro Shibata ; Miyoko Iwamatsu
Japanese Journal of Cardiovascular Surgery 2003;32(3):148-151
A 56-year-old Japanese woman underwent hemi-arch replacement with selective cerebral perfusion for acute aortic dissection of DeBakey type I. A postoperative computed tomographic scan of the brain showed extensive infarction of the right hemisphere, a midline shift, and right uncal herniation. The patient received right fronto-temporo-parietal craniectomy and external decompression followed by mild brain hypothermia, targeting a rectal temperature of 34°C. Despite residual left hemiparesis, she became alert and successfully recovered. She was discharged 147 days after the operation. We conclude that external decompression with mild brain hypothermia was therapeutically useful, with no major complications, for the treatment of extensive cerebral infarction associated with acute aortic dissection.
2.A Case of Acute Renal Failure Following Abdominal Aortic Surgery
Manabu Shiraishi ; Atsushi Yamaguchi ; Ken-ichirou Noguchi ; Hideo Adachi
Japanese Journal of Cardiovascular Surgery 2011;40(5):255-258
A 75-year-old man received a diagnosis of an abdominal aneurysm and underwent abdominal aortic replacement. His left internal iliac artery was sacrificed because of the difficulty of reconstruction. Rhabdomyolysis of the left gluteus muscle resulted in acute renal failure (ARF) postoperatively. Continuous hemodiafiltration (CHDF) was performed from postoperative day (POD) 1 through POD 10 for the management of his ARF. During CHDF, the maximum value of serum creatinine was 5.10 mg/dl and it returned to the normal range of 1.10 mg/dl on POD 20. We conclude that the early deployment of CHDF was effective in rhabdomyolysis-induced ARF.
3.Resection of Myxoma in the Acute Phase of Hemorrhagic Cerebral Infarction
Hideya Tanaka ; Kojiro Furukawa ; Hiroyuki Morokuma ; Ryo Noguchi ; Manabu Itoh ; Keiji Kamohara ; Shigeki Morita
Japanese Journal of Cardiovascular Surgery 2015;44(2):79-81
Early surgical resection for cardiac myxoma is necessary because it may frequently cause cerebral infarction. However the optimal surgical timing for the disease is controversial because the acute phase of infarction may induce intracranial hemorrhage. An 82-year-old woman referred to our hospital because of unconsciousness and right hemiparesis. MRI showed infarction in the left middle cerebral artery area and UCG revealed a left atrial mass. The fourth day after the onset, brain CT showed hemorrhagic infarction and MRI showed new infarction. There was no enlargement of the hemorrhagic focus on brain CT and the patient underwent surgery on the fifth day after the onset. The postoperative course was uneventful. Despite the existence of hemorrhagic infarction, open heart surgery may save patients with cerebrovascular event.
4.Treatment for Ischemic Heart Disease as a Comorbidity of Leriche Syndrome
Manabu Shiraishi ; Atsushi Yamaguchi ; Koichi Yuri ; Kazunari Nemoto ; Kazuhiro Naito ; Kenichiro Noguchi ; Hideo Adachi
Japanese Journal of Cardiovascular Surgery 2011;40(3):86-88
The aim of this study was to clarify the comorbidities of patients with Leriche syndrome and ischemic heart disease. We enrolled 26 patients with Leriche syndrome and who had undergone preoperative coronary angiography were enrolled. The comorbidities of diabetes, hypertension, and coronary artery disease developed in more than half of Leriche patients with Leriche syndrome. Marked coronary artery disease was diagnosed in 14 patients, 7 of whom underwent coronary artery bypass surgery. The Revascularization procedures performed in patients with Leriche syndrome were anatomical aortofemoral bypass in 15 and an extra-anatomical axillofemoral bypass in 9. In 2 cases of extra-anatomical bypass, occlusion developed in the long-term.
5.Postoperative Atrial Fibrillation Following Off-pump Coronary Artery Bypass Grafting
Manabu Shiraishi ; Atsushi Yamaguchi ; Koichi Yuri ; Kazunari Nemoto ; Kazuhiro Naito ; Kenichiro Noguchi ; Hideo Adachi
Japanese Journal of Cardiovascular Surgery 2011;40(5):227-230
It has been demonstrated that atrial fibrillation (AF) frequently occurs after coronary artery bypass grafting (CABG) and may cause cerebral infarction. The purpose of this research is to clarify the risk factors of AF in patients who underwent off-pump CABG (OPCABG). In this study, 142 patients (111 men and 31 women) were enrolled with an average age of 67 years old (range, 33-83). According to multivariate analysis, age and the preoperative peak early (E)/late (A) diastolic velocities ratio (E/A) were the independent predictors of postoperative AF. Patients who suffered from postoperative AF required a significantly longer hospital stay.
6.A Case of Perioperative Coronary Artery Spasm in Initial and Redo Open-Heart Surgery.
Ryuichiro Shibata ; Masatake Takagi ; Naotaka Miyagawa ; Hiroshi Hashiyada ; Manabu Noguchi ; Seiichi Tada ; Toshiyasu Kugimiya
Japanese Journal of Cardiovascular Surgery 1997;26(4):271-274
A patient developed perioperative coronary artery spasms (CAS) twice, in initial and redo open heart operations for mitral stenosis. CAS was shown by sudden ST segment elevation, hypotension, bradycardia, and decreased cardiac output. The patient, a female, had the first CAS attack in the ICU following open mitral commissurotomy at the age of 48. The Second CAS attack occurred during redo surgery for mitral valve replacement at age of 56. Preoperative coronary angiography before both operations did not indicate significant organic lesions. Intraaortic balloon pumping in conjunction with intravenous nitroglycerin and norepinephrine were effective to treat CAS in this case.
7.Less Invasive Aortic Valve Replacement Following Coronary Artery Bypass Grafting Using the Internal Thoracic Artery: Usefulness of Balloon Occlusion of the Internal Thoracic Artery Graft
Shiro Hazama ; Kiyoyuki Eishi ; Manabu Noguchi ; Tsuneo Ariyoshi ; Hideaki Takai ; Tomohiro Odate ; Seiji Matsukuma
Japanese Journal of Cardiovascular Surgery 2005;34(1):67-69
When performing aortic valve replacement (AVR) in patients with a past history of coronary artery bypass grafting (CABG) using the internal thoracic artery (ITA), the patent ITA graft needs to be detached from the surrounding tissue and occluded to properly protect the myocardium. However, detaching the ITA graft from the surrounding tissue takes time, and caution must be exercised to avoid damaging the graft. Two patients with a past history of CABG using the ITA were scheduled to undergo AVR. To simplify AVR, a balloon was placed preoperatively, and was inflated during aortic occlusion to occlude the ITA graft. The myocardium was adequately protected in this manner. Furthermore, since adhesion detachment was limited to around the ascending aorta, operative duration was short and bleeding volume was low. Balloon occlusion of the ITA graft appears to be useful in reducing the invasiveness of AVR in patients with a past history of CABG.
8.Randomized Controlled Trial on "Cardiac Cycle: The First Step" Blinding the Students and the Rater
Yumiko ABE ; Janet DOMAN ; Daigo HAYASHI ; Nagisa KAMIOKA ; Manabu KOMORI ; Naoki MARUYAMA ; Kunio MIYAZAKI ; Kengo NOGUCHI ; Atsushi OHYA ; Naoyuki OKABE ; Hirotaka ONISHI ; Masato SHIBUYA ; Kazusa WADA ; Tomohiro YAMAMOTO
Medical Education 2004;35(1):17-23
“Cardiac Cycle: The First Step, ” which discretely, non-ambiguously, and accurately presents basic essential information on the cardiac cycle, was compared with conventional material in terms of educational efficiency. Twenty-six first-year medical students were randomly assigned to either material. The conventional group was presented with a standard textbook with a typical figure and text. The students were blinded as to the origin of the materials. After self-study, the same quiz (30 two-item choice questions asking basic essential information) was given to both groups and was scored by a blinded rater. The number of correct answers was 25.7±3.7 (mean±SD) in the conventional group and 29.4±1.1 in the ‘first-step group’(p<0.01).