1.Prosthetic Valve Replacement in Corrected Transposition with Severe Tricuspid Valve Dysfunction
Yoshihiro Ko ; Yuzuru Nakamura ; Michio Yoshitake ; Takahiro Inoue
Japanese Journal of Cardiovascular Surgery 2005;34(1):70-73
Tricuspid valve regurgitation, which is a main complication of corrected transposition of the great arteries (C-TGA), greatly influences prognosis like atrioventricular block, but there are many differing openions concerning the treatment of this condition childhood. In 2 cases of C-TGA (S. L. L.) without other cardiac anomalies, we performed tricuspid valve replacement for severe valve dysfunction.
2.A Case of Aortopulmonary Window after Balloon Angioplasty for Bifurcation Pulmonary Stenosis Based on the Jatene Procedure
Ken Nakamura ; Kiyozou Morita ; Yoshihiro Ko ; Katsushi Kinouchi ; Kazuhiro Hashimoto
Japanese Journal of Cardiovascular Surgery 2006;35(4):205-209
A 6-month-old baby boy had undergone the Jatene procedure at 4 days. Four months later, catheter intervention (balloon angioplasty) was performed because of severe stenosis at the bifurcation of the pulmonary arteries. Twenty days later, several episodes of cyanosis occurred and he was readmitted. The existence of shunt flow between the sinus of valsalva and the pulmonary bifurcation was detected by echocardiography and examination by 16-row MDCT revealed 2 holes at this site. Under a diagnosis of aortopulmonary (AP) window, the patient was placed on cardiopulmonary bypass and the pulmonary artery was opened after aortic clamping. There was a ridge between the bifurcation of the pulmonary arteries. After removing it, 2 holes were visualized that resembled the findings on 16-row MDCT. These holes were closed with Xenomedica patches and the main pulmonary artery was also extended with a Xenomedica patch. AP window is a rare complication after balloon angioplasty for pulmonary stenosis, but we must take great care to prevent this complication.
3.Reconcideration of Shang-han Lun
Kazuhiro MAKIZUMI ; Shuji KOTAKA ; Huang HUANG ; Yoshihiro FUKUTA ; Kensuke NAKAMURA
Kampo Medicine 2008;59(2):193-230
4.Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery with a Specific Left Coronary Artery Route
Yoshihiro Ko ; Koji Nomura ; Takayuki Abe ; Toshiyuki Hoshina ; Yuzuru Nakamura
Japanese Journal of Cardiovascular Surgery 2012;41(5):253-256
We surgically treated a case of anomalous origin of the left coronary artery from the pulmonary artery with the specific route of the left coronary artery in a 17-month-old boy. He had suffered persistent cough and poor weight gain since the age of 4 months. An ultrasound cardiography, at the age of 16 months, revealed retrograde blood flow of the left coronary artery into the main pulmonary artery. Moreover, a chest computed tomography showed an anomalous left coronary artery arising from the bifurcation of the right pulmonary artery and winding in contact on the posterior aortic wall. Though the anomalous left coronary artery shared adventitia with the aortic wall we were able to separate the coronary artery from the aorta, and the patient underwent direct transplantation of the left coronary artery. The postoperative course was uneventful and recovery was rapid.
5.A Case of Secondary Adrenal Insufficiency Due to Isolated ACTH Deficiency That Manifested Orthostatic Hypotension after Administration of Tamsulosin Hydrochloride
Daisuke SAKAGUCHI ; Manabu HAYAKAWA ; Yukihito NAKAMURA ; Masato EDAMOTO ; Yoshihiro ISHII
An Official Journal of the Japan Primary Care Association 2023;46(2):62-66
6.A Case of Large Anastomotic Pseudoaneurysms at Both Sites Following Prosthetic Graft Replacement between Aorta and Left External Iliac Artery.
Shinji Takano ; Kanji Kawachi ; Yoshihiro Hamada ; Tatsuhiro Nakata ; Hiroyuki Kikkawa ; Nobuo Tsunooka ; Yoshitsugu Nakamura
Japanese Journal of Cardiovascular Surgery 2002;31(5):341-343
A 84-year-old man was admitted with an abdominal tumor. Prosthetic graft replacement between the aorta and the left external iliac artery was performed 17 years previously. CT scan and angiography showed a large anastomotic pseudoaneurysms at the sites of proximal and distal anastomosis. A Y graft prosthesis replacement was performed. The size of the proximal anastomotic pseudoaneurysm was 7×6×5cm, and that of the distal anastomotic pseudoaneurysm was 15×10×10cm. They resulted from cutting at anastomosis. Large anastomotic pseudoaneurysms at both sites is rare.
7.A Re-Expanding Descending Thoracic Aortic Aneurysm after Stent-Grafting.
Nobuo Tsunooka ; Kanji Kawachi ; Yoshihiro Hamada ; Tatsuhiro Nakata ; Yoshitsugu Nakamura ; Katsutoshi Miyauchi ; Hiroshi Imagawa
Japanese Journal of Cardiovascular Surgery 2003;32(1):38-40
A descending thoracoaortic aneurysm excluded by stent-grafting had expanded during a period of one and a half years. There was no endoleakage but there was shortening of the stent-landing on both proximal and distal sides. Aneurysm seemed to be pressed by blood pressure through the graft in TEE. The aneurysm was replaced by an artificial graft through a left heart bypass. Because ESP diminished during the operation, VIth intercostal arteries were reconstructed immediately, and CSF drainage was performed. Following this procedure there was no paraplegia.
8.A Case of Mycotic Aneurysm of the Pulmonary Artery with Pulmonary Artery Fistula following Pulmonary Artery Banding
Yoshihiro Ko ; Kiyozo Morita ; Yoko Matsumura ; Katsushi Kinouchi ; Ken Nakamura ; Kazuhiro Hashimoto
Japanese Journal of Cardiovascular Surgery 2006;35(5):292-294
A 9-month-old boy who had been given a diagnosis of double outlet right ventricle (DORY), partial anomalous pulmonary venous return (PAPVR), ventricular septal defect (VSD), pulmonary hypertension (PH) and polysplenia with azygos connection, underwent pulmonary artery banding at the age of 6 months. At 2 months after surgery, a chest computed tomogram revealed a main pulmonary artery aneurysm and a main pulmonary artery-right pulmonary artery fistula caused by bacterial endocarditis due to a methicillin-resistant Staphylococcus epidermidis. We performed pulmonary arterioplasty and re-pulmonary artery banding for acute aggravation of cardiac insufficiency and obtained good results. This is an extremely rare case that was treated infectious pulmonary artery aneurysm and fistula after pulmonary artery banding.
9.Modified Konno Operation for Aortic Valve Regurgitation after Arterial Switch Operation
Ken Nakamura ; Kiyozou Morita ; Yoshihiro Ko ; Katsushi Kinouchi ; Kazuhiro Hashimoto ; Hiromi Kurosawa
Japanese Journal of Cardiovascular Surgery 2007;36(2):72-75
We describe a case of postoperative aortic valve regurgitation (AR) after arterial awitch operation (ASO) successfully managed by the modified Konno procedure. A 4-year-old girl with complete transposition of the great arteries (TGA, Type II) had undergone the ASO (LeCompte maneuver) at 10 days of age. Because of progression of moderate AR 4 years after ASO, the modified Konno procedure with aortic valve replacement (SJM 21mm) was successfully performed. She remains in good clinical condition at the last follow-up at 5 years.
10.Combined Coronary Artery Bypass Grafting, Abdominal Aortic Repair and Aortic Valve Replacement in a Case with Porcelain Aorta.
Kanji Kawachi ; Tatsuhiro Nakata ; Yoshihiro Hamada ; Shinji Takano ; Nobuo Tsunooka ; Yoshitsugu Nakamura ; Atsushi Horiuchi ; Katsutoshi Miyauchi ; Yuuji Watanabe
Japanese Journal of Cardiovascular Surgery 2002;31(5):344-346
A 73-year-old woman was admitted to undergo three simultaneous operations: aortic valve replacement (AVR), coronary artery bypass grafting (CABG) and abdominal aortic aneurysm repair. She had previously undergone percutaneous catheter intervention in the left coronary anterior descending artery. Computed tomography revealed an abdominal aortic aneurysm 5cm in diameter. Aortic valve stenosis (AS) was shown with a pressure gradient of 60mmHg, and 90% stenosis of the distal right coronary artery was also shown. CT scan and aortography revealed porcelain ascending aorta. The patient underwent simultaneous operations because of severe AS, coronary artery disease and abdominal aortic aneurysm. An aortic cannula was placed in a position higher in the ascending aorta with no calcification. Cardiopulmonary bypass was started using a two-staged venous cannula through the right atrium. At first, AVR was performed with cardioplegic solution and ice slush. Because it was difficult to inject the cardioplegic solution into the coronary artery selectively due to the calcified orifice of coronary artery, we closed it immediately by removing the calcified intima of the porcelain aorta after completion of AVR. The second cardioplegic solution was injected through the ascending aorta. Next, CABG to RCA was performed using the right gastroepiploic artery without anastomosis to the ascending aorta. Cardiac surgery was first performed, followed by abdominal aortic aneurysm repair after discontinuation of cardiopulmonary bypass. The patient was extubated the next day and stayed for two days in the intensive care unit. She is very well now one year after the operation.