1.A Case of Off-Pump Coronary Artery Bypass Grafting for Coronary Aneurysm after Drug-Eluting Stent Implantation
Masahiro Ueno ; Hironori Inoue ; Keisuke Yamamoto ; Yasuo Morishita
Japanese Journal of Cardiovascular Surgery 2015;44(4):224-227
A 77-year-old woman underwent percutaneous coronary intervention (PCI) for chronic total occlusion of the left anterior descending artery using a drug-eluting stent (DES). Re-stenosis, stent fracture, and aneurysm were found on follow-up coronary angiography (CAG), and thus implantation of multiple DESs was required. Surgery was indicated because CAG 48 months after first DES implantation revealed enlargement of the aneurysm with other new lesions. She successfully underwent off-pump coronary artery bypass grafting and resection of the aneurysm.
2.Reoperation for Aortic St. Jude Medical Valves in Six Cases.
Takeshi Shichijo ; Osamu Oba ; Keizou Yunoki ; Masahiro Inoue
Japanese Journal of Cardiovascular Surgery 2001;30(1):19-22
From 1982 to March 1999, 276 St. Jude Medical prostheses were implanted in aortic position. Of the 276 patients, 6 (2.2%) required redo aortic valve replacement due to aortic stenosis. The peak velocity measured by continuous-wave Doppler echocardiography ranged from 3.5 to 5.4m/sec with mean of 4.55m/sec. Aortic stenosis was attributable to pannus formation in 3 patients, valve thrombosis in 1 patient, and prosthesis-patient mismatch in 2 patients. The prostheses of patients with pannus formation were implanted in valve orientation parallel to the septum. It is therefore considered that the St. Jude Medical prosthesis should be implanted perpendicular to the septum in the aortic position and that careful follow-up observation of the patients should be made, particularly with echocardiography.
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.Aortic Valve Replacement in a 92-Year-Old Woman
Kunio Gan ; Noboru Wakita ; Masahiro Sakata ; Kyouzou Inoue
Japanese Journal of Cardiovascular Surgery 2003;32(6):382-384
A case of aortic valve replacement in a 92-year-old woman is reported. Severe aortic valve stenosis was pointed out when she suffered from congestive heart failure (CHF). After medical treatment for CHF, she complained of leg edema even with only mild exercise. Aortic valve replacement was performed, because her general condition and her left ventricular contraction on UCG were good. Her postoperative course was good except for a transient rapid atrial fibrillation. We think that surgery should not be withheld on the basis of age alone.
6.A Case of Hemolytic Anemia Caused by a Kinked Graft after Operation for Aortic Dissection
Masahiro Ueno ; Hironori Inoue ; Keisuke Yamamoto ; Yasuo Morishita
Japanese Journal of Cardiovascular Surgery 2015;44(5):275-278
A 62-year-old woman was referred to our hospital for treatment of hemolytic anemia 10 years after total arch replacement for acute aortic dissection. The cause of hemolysis was confirmed to be mechanical damage of red blood cells at the kinked graft. Because aortic valve regurgitation and occlusion of the left subclavian artery were also found, resection of the kinked graft, aortic valve replacement and reconstruction of the left subclavian artery were carried out concomitantly at reoperation. Her postoperative course was uneventful, and hemolysis resolved soon after the operation.
7.An Operated Case of Cardiac Compression by Chronic Expanding Hematoma in the Pericardial Cavity after Cardiac Surgery
Masahiro Dohi ; Tomoya Inoue ; Taiji Watanabe ; Osamu Sakai ; Akiyuki Takahashi ; Yuichirou Murayama ; Masamichi Nakajima
Japanese Journal of Cardiovascular Surgery 2009;38(2):130-134
A rare surgical case of chronic expanding hematoma in the pericardial cavity is reported. A 78-year-old man had undergone coronary artery bypass grafting 2 years previously. He had suffered from general malaise, increasing shortness of breath and systemic edema from 18 months after the operation. Echocardiography revealed an intrapericardial mass compressing the cardiac chambers resulting in insufficiency of the ventricular expansion. Under extracardiopulmonary bypass and cardiac beating, resection of the mass and additional coronary artery surgery were implemented. The mass was encapsulated with thick fibrous membrane containing old degenerated coagula the bacterial culture of which was negative and was histopathologically diagnosed as chronic expanding hematoma. The patient's postoperative course was uneventful and symptoms with cardiac failure were relieved. There has been no recurrence for more than 18 months.
8.Mitral Valve Replacement in a Patient with a Patent Internal Thoracic Artery Graft after Coronary Artery Bypass Grafting.
Masahiro Aiba ; Yoshiaki Matsuo ; Koji Moriyasu ; Atsubumi Murakami ; Makoto Yamada ; Kouichi Inoue ; Toshihiro Takaba
Japanese Journal of Cardiovascular Surgery 1997;26(2):124-127
A 63-year-old woman underwent coronary artery bypass grafting and mitral annuloplasty 4 years previously. She was readmitted owing to heart failure. Cardiac catheterization revealed worsened mitral regurgitation, although the internal thoracic artery (ITA) graft had good patency. Reoperation was performed by median resternotomy and continuous retrograde cardioplegia without clamping the ITA graft. The mitral valve had a perforation in the anterior leaflet, and was replaced by a 29mm Carbo-Medicus valve. The patient was discharged with transient myocardial ischemia. Although median resternotomy and continuous retrograde cardioplegia at reoperation provided on excellent view and myocardial protection, myocardial ischemia in the region perfused by the ITA graft may occur when the ITA graft cannot be clamped during continuous retrograde cardioplegia.
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.A retrospective study of delays in diagnosis andtreatment for malignant spinal cord compression
Chieko Kudo ; Tomohiko Niitani ; Hitoshi Wada ; Yuko Sato ; Sonoko Ichikawa ; Masahiro Inoue ; Katuo Sugiyama
Palliative Care Research 2015;10(3):305-309
The objective of our study was to examine delays between onset of symptoms and treatment for malignant spinal cord compression (MSCC) and to investigate outcomes of neurological function. We performed a retrospective study of clinical records for 25 patients who had been diagnosed with MSCC at a regional center hospital. Thirteen patients had a history of malignancy at the onset of MSCC and 12 patients had no history. For most patients, pain was the first symptom of MSCC. Pain preceded neurologic symptoms by approximately 2 months. The median delays from onset of symptoms of MSCC to treatment were 49 days for all patients, 79 days for those without a history of malignancy and 41.5 days for those with a history of malignancy. It took 39 days from onset to consultation at the hospital, 7 days from consultation to diagnosis and 11 days from diagnosis to treatment. Neurological status was not exacerbated in 8 of 9 patients who had no other neurologic dysfunction at the time of treatment, while only 4 of 10 patients who had deterioration of motor or sensory function at the time of treatment showed improvement in neurological status. In conclusion, there were many delays in all processes from onset to treatment for MSCC and these delays resulted in poor outcome of neurological function.