1.Renal Transplantation in a Patient with Uremic Cardiomyopathy Resulting in Marked Improvement of Cardiac Function
Taisuke Nakayama ; Hirotsugu Kurobe ; Takaki Hori ; Kazuma Maisawa ; Hiroshi Ishitoya ; Hitoshi Sogabe ; Itsuo Katoh ; Tetsuya Kitagawa
Japanese Journal of Cardiovascular Surgery 2009;38(2):160-164
A 71-year-old man who had been on peritoneal dialysis for 6 years was referred to our hospital for renal transplantation from a living donor. Preoperative echocardiography revealed diffuse severe hypokinesis, a left ventricular ejection fraction (LVEF) of 25%, and a pedicled floating mass in the right atrium. He had not exhibited positive symptoms of active endocarditis or metastatic malignant tumor, and the causes of cardiomyopathy seemed to be uremic and/or ischemic factors. Renal transplantation was postponed, and the extirpation of the mass in the right atrium was scheduled. LVEF improved to 48% 2 months following the induction of hemodialysis before the cardiac operation. Pathohistological findings of the extirpated intra-atrial mass showed sphachelus and fibrotic thrombus, which meant asymptomatic healed infective endocarditis. He recovered uneventfully, and underwent a living renal transplantation from living donor 5 months after the cardiac operation. LVEF further improved better to 56%, and his performance status was remarkably improved. These results imply that renal transplantation and hemodialysis in peritoneal dialysis patients with uremic cardiomyopathy can achive improvement of cardiac function and enable a safe cardiac operation.
2.Mitral Valve Replacement for Recurrent and Multiple Cerebral Embolisms Caused by Mitral Annular Calcification
Mikio Sugano ; Tatsuo Motoki ; Hirotsugu Kurobe ; Homare Yoshida ; Taisuke Nakayama ; Hajime Kinoshita ; Tamotsu Kanbara ; Eiki Fujimoto ; Takashi Kitaichi ; Tetsuya Kitagawa
Japanese Journal of Cardiovascular Surgery 2012;41(6):299-303
A 69-year-old woman had syncope and aphasia. Magnetic resonance imaging showed multiple cerebral infarctions in both hemispheres. Cardiogenic embolisms were suspected, but no arrhythmic causes were shown. Transesophageal echocardiography revealed a highly calcified mitral annulus (MAC) with a rough intraluminal surface and mild mitral regurgitation, but no thrombus or tumor in the left heart system. However, recurrent multiple cerebral embolisms occurred in spite of strict anticoagulation therapy. We speculated that spontaneous rupture of the MAC was the cause of the scattered cerebral embolisms, and we therefore planned to remove the MAC as safely as possible and to endothelialize the deficit of MAC with autologous pericardium. Operative findings revealed that the MAC in P2-P3 had ruptured longitudinally and the ostium of the left atrium was connected to the ostium of the left ventricle as an inter-atrioventricular tunnel beneath the posterior mitral annulus with a fragile calcified wall. The finding suggested that calcified particles that had peeled away from the MAC by normal heart beating resulted in the cerebral infarctions. Therefore, she underwent resection of the MAC and mitral valve replacement with reinforcement of the decalcified posterior mitral annulus between the posterior left ventricular wall and the left atrial wall using autologous pericardium, which enabled both appropriate insertion of a mechanical prosthetic valve and endothelial continuity covering the surface of the residual MAC. No systemic embolism has occurred for two and a half years after surgery. This is the first case report of cerebral embolism caused by a spontaneously ruptured MAC.
3.Successful Repair of a Traumatic Aortic Isthmus Pseudoaneurysm Concomitant with Right Diaphragmatic Hernia
Taisuke Nakayama ; Masashi Kano ; Shingo Isshiki ; Takashi Tominaga ; Hiroshi Ishitoya ; Katsuhiko Hiratani ; Takahiro Sawada ; Hirotsugu Kurobe ; Tetsuya Kitagawa ; Takaki Hori
Japanese Journal of Cardiovascular Surgery 2011;40(3):94-97
A 24-year-old woman underwent successful repair of a traumatic pseudoaneurysm of the aortic isthmus concomitant with right diaphragmatic hernia which developed after a traffic accident, and the steering wheel of the crashed car was considered responsible for both lesions. Due to the right diaphragmatic hernia, she could breathe mainly with the left lung only. The aortic isthmus aneurysm was considered to be a pseudoaneurysm, and because of the potential risk of rupture, we performed urgent aortic surgery. Prior to a left thoracotomy, we anastomosed an 8-mm prosthetic graft to the right axillary artery. When the left lung was collapsed in order to perform a femoro-femoral bypass, the SpO2 level of her right index finger and her cerebral rSO2 markedly decreased. Therefore, we administered additional perfusion via the right axillary artery, which provided sufficient oxygen to the upper body and brain. The patient underwent Marlex mesh reinforcement of the right diaphragmatic hernia 30 days after grafting, and is doing well 1 year postoperatively.
4.How to Develop Human Resources in Cardiovascular Surgery : Investigation about the Gap between Ideal and Reality No.12
Koki ETO ; Yuichiro KISHIMOTO ; Hiromi WADA ; Hiromi ARASE ; Hiroyuki KURAZUMI ; Yuzi KODAMA ; Sayako NAKAGAWA ; Taisuke NAKAYAMA
Japanese Journal of Cardiovascular Surgery 2019;48(4):4-U1-4-U3
We investigated the training system of a young cardiovascular surgeon in Japan. We presented the result of surveillance at the 49th Annual Meeting of the Japanese Society for Cardiovascular Surgery 2019, and report here the summary.
5.1.How Can We Promote Work Style Reforms of Cardiovascular Surgeons ?
Hiromi WADA ; Hiroki ARASE ; Yoshinori INOUE ; Koki ETO ; Yuichiro KISHIMOTO ; Yusuke KINUGASA ; Hiroshi KURAZUMI ; Hiroshi KODAMA ; Sayako NAKAGAWA ; Taisuke NAKAYAMA ; Kenji NAMIGUCHI ; Akira FUJITA ; Hiromu HORIE
Japanese Journal of Cardiovascular Surgery 2020;49(1):1-U1-1-U4
The work style of doctors gets attention within the Work Style Reforms that have been fully implemented since 2019. Now, we conducted a questionnaire survey at 10 institutions in Chugoku and Shikoku region and reviewed the latest work style of cardiovascular surgeons in comparison with other departments.