1.Supra-annular Flangeless Mitral Valve Replacement for Mitral Regurgitation Caused by Mitral Annular Calcification.
Kazuya Akiyama ; Jun Hirota ; Yoshitaka Shiina ; Akihiko Ohkado
Japanese Journal of Cardiovascular Surgery 1996;25(2):143-146
A 51-year-old woman with a 12-year history of chronic hemodialysis and secondary hyperparathyroidism suffered dyspnea induced by massive mitral regurgitation due to severe circular mitral annular calcification. Her anterior mitral leaflet was resected and successfully replaced with a 25mm SJM valve in the supra-annular position. The posterior leaflet was heavily calcified and adhered to the left ventricle. The flangeless prosthesis was directly implanted into the left atrial wall on the calcified annulus. Postoperative cine fluoroscopy and echocardiography showed good hemodynamic performance of the prosthesis without perivalvular leakage. In cases of mitral annular calcification due to chronic renal failure, the SJM valve is a more suitable valve prosthesis for replacement of the mitral valve in the supra-annular position. Supra-annular mitral valve replacement without a flange may give superior valve-performance compared to valves with a flange considering thrombogenicity and left ventricular function. However, we may still have to consider the indication of a supra-annular mitral valve replacement with a flange in cases with wide mitral annular calcification in the giant left atrium.
2.Quality of Life of the Patients with Tetralogy of Fallot Corrected under Simple Deep Hypothermia More than 20 Years Ago.
Yoshitaka Shiina ; Kazuaki Ishihara ; Kouhei Kawazoe ; Katsuhiro Niitu ; Koutarou Oyama
Japanese Journal of Cardiovascular Surgery 2001;30(3):126-128
From October, 1960, to December, 1976, a total of 167 patients with the tetralogy of Fallot (TOF) underwent corrective repair under simple deep hypothermia at Iwate Medical University. In 59 out of 167 patients the address or telephone number were identified. Fifty-four patients, consisting of 25 males and 29 females, were investigated by written questionnaire or telephone interview. They were followed for 20-35 years. The mean (±SD) age at operation was 5.3± 4.2 years old (range 6 months to 19 years). Reoperations were successfully performed on two patients with residual shunts. Among these, 43 patients (80%) were in NYHA class I, and 11 patients (20%) were class II. None of the patients were in class III or IV. Medication was not prescribed except in one patient. Twenty-eight patients (52%) married and gave birth to 34 children, none of whom had congenital heart disease. A total of 51 (94%) patients were employed, or were housewives. In conclusion, most patients were considered to have a good quality of life long after repair of TOF under simple deep hypothermia.
3.Two Cases of Eearly Operations for Papillary Muscle Rupture Complicating Acute Myocardial Infarction.
Iichiro Itoh ; Kunihiko Abe ; Yoshitaka Shiina ; Satoru Chiba ; Kouhei Kawazoe ; Katuhiro Niitu
Japanese Journal of Cardiovascular Surgery 1994;23(3):205-208
Two cases who underwent emergency operation for papillary muscle rupture complicating acute myocardial infarction were presented. The first case was a 75-year-old female who had suffered myocardial infarction 26 days previously. Operation was performed on the 2nd day after onset of mitral insufficiency. The posterior papillary muscle was partially ruptured and the mitral valve was replaced with a mechanical prosthesis (SJM 25mm). The second case was a 76-year-old female who had suffered myocardial infarction 10 days previously. Emergency operation was performed on the 4th day after onset of mitral insufficiency. The posterior papillary muscle was completely ruptured. Mitral valve replacement with a mechanical prosthesis (Omnicarbon 25mm) was performed. In both cases, recovery from cardiogenic shock was not possible preoperatively even with pharmacologic and circulatory support, but the postoperative courses were uneventful in both cases. We recommend immediate surgical intervention for mitral insufficiency in patients with severe grade regurgitation and cardiogenic shock following acute myocardial infarction.
4.A Case of Ruptured Aortic Aneurysm Presenting as a Closing Aortic Dissection on Chest CT.
Akihiko Ohkado ; Takayuki Nakajima ; Yoshitaka Shiina ; Jun Hirota ; Yasuhiro Kainuma ; Kazuya Akiyama
Japanese Journal of Cardiovascular Surgery 1995;24(6):377-379
A 68-year-old male was admitted as an emergency case because of two severe back pain episodes in one week. Chest X-ray showed a marked prominence of the aortic knob. A remarkable bulging of the distal aortic arch and a crescentic low density area along the descending aorta on enhanced chest CT suggested a closing aortic dissection. Operation revealed extensive collapse of the very fragile intima of the aneurysmal wall and extraluminal hematoma along the descending aorta due to bleeding from the ruptured site. The ruptured aneurysm of this type should be accurately differentiated from the DeBakey type III closing aortic dissection which can be followed up medically.