1.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.
2.A Case of Infrarenal Aneurysms Abdominal Aneurysm Associated with Bilateral Internal Iliac Artery Aneurysms.
Koji Nakanishi ; Osamu Oba ; Takeshi Shichijo ; Mikizo Nakai ; Keiji Yunoki
Japanese Journal of Cardiovascular Surgery 2001;30(4):197-199
Ischemic colitis is a serious complication of abdominal aortic surgery. Patients with bilateral internal iliac aneurysm have a high risk of ischemic colitis after operation. A 72-year-old man had infrarenal abdominal aneurysm, bilateral common and internal iliac aneurysm and an occluded right internal iliac artery. We examined the flow of the superior rectal artery during operation by transanal Doppler, and intramucosal pH of the sigmoid colon by a tonometer after operation. The flow of the superior rectal artery did not change after clamping of the left common iliac artery, clamp of the infrarenal aorta. He underwent uneventful abdominal aortic aneurysmectomy, Y-grafting and exclusion of bilateral internal iliac aneurysms. The intramucosal pH of the sigmoid colon returned to the normal range 25h after surgery. He had no complications after surgery. Transanal Doppler examination was essential for the successful prevention of postoperative colonic ischemia, and intestinal intramural pH by tonometry was an early reliable marker of the absence of ischemic colitis.
3.Long-term Results of the St. Jude Medical Valve in the Tricuspid Position.
Takeshi Shichijo ; Osamu Oba ; Keiji Yunoki ; Masahiro Inoue
Japanese Journal of Cardiovascular Surgery 2001;30(6):277-279
From 1983 to 1999, 12 St. Jude Medical prostheses were implanted in the tricuspid position. Mean patient age at the time of operation was 40±19 (6 to 62) years. Seven patients were female and five were male. There were no hospital deaths but three late deaths. The cumulative survival rate was 100% at 5 years, 80% at 10 years and 60% at 15 years. Four patients required redo tricuspid valve replacement because of a thrombosed valve. The reoperation-free rate was 100% at 5 years, 78% at 10 years and 29% at 15 years. The data illustrated that patients who underwent tricuspid valve replacement with the St. Jude Medical valve should receive strict anticoagulation therapy.
4.A Successful Surgical Treatment of Distal Arch Aneurysm with Papillary Fibroelastoma in the Left Ventricle.
Masahiro Inoue ; Osamu Oba ; Takeshi Shichijo ; Keiji Yunoki
Japanese Journal of Cardiovascular Surgery 2002;31(2):128-131
Papillary fibroelastoma is a relatively rare cardiac tumor. A report is presented on a 64-year-old man who was admitted to our institute with dyspnea. Distal arch aneurysm was detected by chest computed tomography and aortography. Preoperative transesophageal echocardiography revealed a tumor 9×5mm in size in the ventricular septum of the left ventricular outflow tract. Total arch replacement and tumor resection were performed. The pathohistological diagnosis of the tumor was papillary fibroelastoma. The postoperative course was uneventful and echocardiography conducted one year postoperatively revealed no recurrence.
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.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.
8.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.
9.Two Successful Surgical Treatment for Primary Aortoenteric Fistula.
Masahiro Inoue ; Osamu Oba ; Takeshi Shichijyo ; Mikizo Nakai ; Sadahiko Arai ; Keiji Yunoki ; Noriyuki Tokunaga
Japanese Journal of Cardiovascular Surgery 2001;30(1):29-32
Between January 1991 and December 1998, we performed two successful procedures to repair abdominal aortic aneurysm with primary aortoenteric fistula. We had 197 surgical repair proceduers of aortic aneurysm during the same period. Incidence of primary aortoenteric fistula in abdominal aortic aneurysm was 1% in our institute. We performed primary closure of the fistula and removal of the possibily infected aneurysmal wall followed by anatomical grafting. We utilized omental wrapping for prophylaxis of potential graft infection. We achieved excellent surgical results in both patients by this approach.
10.Tricuspid Valve Endocarditis Complicated Disseminated Intravascular Coagulation (DIC) before an Operation
Daisuke Futagami ; Hideo Yoshida ; Hironori Ebishima ; Nobuyuki Tokunaga ; Keiji Yunoki ; Kunikazu Hisamochi ; Osamu Oba
Japanese Journal of Cardiovascular Surgery 2007;36(2):85-87
Right-sided infective endocarditis (IE) accounts for 5% to 10% of all IE. Compared with left-sided IE, antibiotic treatment is effective in about 70% of cases. The timing of surgical treatment for right-sided IE is therefor controversial. A 26-year-old woman had suffered from tricuspid valve endocarditis with DIC. There was no evidence of any previous cardiac event or dental treatment. Echocardiography showed a large vegetation attached to the anterior leaflet of tricuspid valve with moderate tricuspid regurgitation. We removed the vegetation with a part of the anterior leaflet and performed tricuspid valvuloplasty and annuloplasty. The patient had an uneventful postoperative course and received intravenous antibiotic treatment for a further 4 weeks.