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1.
Kyobu Geka ; 58(8 Suppl): 659-62, 2005 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-16097614

RESUMO

Population of elderly people is increasing and aortic valve disease due to degeneration with aging process, especially aortic stenosis (AS) is increasing in elderly patients. With development and great use of non-invasive diagnostic techniques, particularly echocardiography, the diagnosis and evaluation of aortic valve disease are even safer in these patients. Aortic valve replacement (AVR) is effective treatment for symptomatic AS, however, generally has a higher risk in elderly patients, especially 80 years and over patients. Several reports demonstrated acceptable operative mortality and morbidity in elderly patients. We performed AVR or AVR with other cardiac surgical procedures in 16 cases of 80 years and over patients from 1998 to 2004, and there were no operative or hospital death. Therefore, AVR in 80 years and over patients could be acceptable surgical treatment and age alone is not contraindication.


Assuntos
Estenose da Valva Aórtica/cirurgia , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico , Feminino , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Masculino , Cuidados Pós-Operatórios , Resultado do Tratamento
2.
Kyobu Geka ; 55(9): 754-7, 2002 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-12174618

RESUMO

A 59-year-old women was referred to our hospital due to severe dyspnea and shock status 12 days after intracranial hematoma evacuation for the hypertensive right putaminal hemorrhage. Transthoracic echocardiography revealed right ventricular dilatation and floating structures in the right atrium. Transesophageal echocardiography demonstrated a large, snake-like structure crossing her foramen ovale of the interatrial septum, and impending paradoxical embolism was diagnosed. She did not receive any anticoagulation and surgery due to recent cerebral hemorrhage. Follow-up TEE showed complete disappearance of the thrombus in the atrium two weeks after the onset. Phlebogram of deep vein demonstrated several thrombus in her leg. She underwent placement of inferior vena cava filter and was discharged from our hospital without any symptom of paradoxical embolism.


Assuntos
Embolia Paradoxal/etiologia , Comunicação Interatrial/complicações , Ecocardiografia Transesofagiana , Embolia Paradoxal/diagnóstico por imagem , Feminino , Átrios do Coração , Humanos , Pessoa de Meia-Idade , Embolia Pulmonar/complicações
3.
Artif Organs ; 24(12): 953-8, 2000 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-11121975

RESUMO

In this study, we analyzed the extent and pattern of regression of left ventricular (LV) hypertrophy after aortic valve replacement in patients with aortic stenosis (AS) and compared the results with those of another group of patients with aortic regurgitation (AR). Seventy patients who underwent isolated aortic valve replacement were divided into 2 groups. Group 1 was comprised of 29 patients who underwent aortic valve replacement for aortic stenosis, and Group 2 of 41 patients who underwent aortic valve replacement for aortic regurgitation. A third group of 10 healthy subjects served as a healthy control group. Echocardiographic studies were done before the operation and 5 years postoperatively. At follow-up, a significant reduction in the left ventricular mass was found in both groups, but it remained significantly greater than in the healthy control group. The ratio of LV wall thickness to radius (th/r) in Group 1 decreased significantly, and at follow-up it was within the normal value. In Group 2, the th/r ratio increased, and at follow-up it was within the normal value. After aortic valve replacement, the wall thickness remained significantly greater than normal for patients with AS, and the chamber radius remained significantly greater than normal for patients with AR. For these reasons, LV hypertrophy still existed in both groups at postoperative follow-up. The actuarial survival rate was 85.3% at 16 years for Group 1 and 83.4% at 18 years for Group 2. There was no significant difference in the long-term survival rates between the 2 groups. Actuarial freedom from valve-related events was 91.9% at 16 years for Group 1 and 82% at 18 years for Group 2. There was no significant difference in the valve-related event free curves between groups. After 5 years of follow-up, th/r reached normal for both groups, indicating remodeling of the LV geometry after aortic valve replacement.


Assuntos
Insuficiência da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Adulto , Idoso , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/complicações , Insuficiência da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/mortalidade , Ecocardiografia , Feminino , Seguimentos , Humanos , Hipertrofia Ventricular Esquerda/etiologia , Hipertrofia Ventricular Esquerda/mortalidade , Masculino , Pessoa de Meia-Idade , Taxa de Sobrevida
4.
Circulation ; 102(19 Suppl 3): III319-25, 2000 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-11082408

RESUMO

BACKGROUND: Ca(2+) overload plays an important role in the pathogenesis of cardioplegic ischemia-reperfusion injury. The standard technique to control Ca(2+) overload has been to reduce Ca(2+) in the cardioplegic solution (CP). Recent reports suggest that Na(+)/H(+) exchange inhibitors can also prevent Ca(2+) overload. We compared 4 crystalloid CPs that might minimize Ca(2+) overload in comparison with standard Mg(2+)-containing CP: (1) low Ca(2+) CP (0.25 mmol/L), (2) citrate CP/normal Mg(2+) (1 mmol/L Mg(2+)), (3) citrate CP/high Mg(2+) (9 mmol/L Mg(2+)), and (4) the addition of the Na(+)/H(+) exchange inhibitor HOE-642 (Cariporide). We also tested the effect of citrate titration in vitro on the level of free Ca(2+) and Mg(2+) in CPs. METHODS AND RESULTS: Isolated working rat heart preparations were perfused with oxygenated Krebs-Henseleit buffer and subjected to 60 minutes of 37 degrees C arrest and reperfusion with CPs with different Ca(2+) concentrations. Cardiac performance, including aortic flow (AF), was measured before and after ischemia. Myocardial high-energy phosphates were measured after reperfusion. The in vitro addition of citrate to CP (2%, 21 mmol/L) produced parallel reductions in Mg(2+) and Ca(2+). Because only Ca(2+) was required to be low, the further addition of Mg(2+) increased free Mg(2+), but the highest level achieved was 9 mmol/L. Citrate CP significantly impaired postischemic function (AF 58.3+/-2. 5% without citrate versus 41.6+/-3% for citrate with normal Mg(2+), P:<0.05, versus 22.4+/-6.2% for citrate with high Mg(2+), P:<0.05). Low-Ca(2+) CP (0.25 mmol/L Ca(2+)) significantly improved the recovery of postischemic function in comparison with standard CP (1.0 mmol/L Ca(2+)) (AF 47.6+/-1.7% versus 58.3+/-2.5%, P:<0.05). The addition of HOE-642 (1 micromol/L) to CP significantly improved postischemia function (47.6+/-1.7% without HOE-642 versus 62.4+/-1. 7% with HOE-642, P:<0.05). Postischemia cardiac high-energy phosphate levels were unaffected by Ca(2+) manipulation. CONCLUSIONS: (1) A lowered Ca(2+) concentration in CP is beneficial in Mg(2+)-containing cardioplegia. (2) The use of citrate to chelate Ca(2+) is detrimental in the crystalloid-perfused isolated working rat heart, especially with high Mg(2+). (3) The mechanism of citrate action is complex, and its use limits precise simultaneous control of Ca(2+) and Mg(2+). (4) HOE-642 in CP is as efficacious in preservation of the ischemic myocardium as is the direct reduction in Ca(2+).


Assuntos
Cálcio/metabolismo , Soluções Cardioplégicas/metabolismo , Ácido Cítrico/metabolismo , Magnésio/metabolismo , Traumatismo por Reperfusão/prevenção & controle , Trocadores de Sódio-Hidrogênio/antagonistas & inibidores , Difosfato de Adenosina/metabolismo , Trifosfato de Adenosina/metabolismo , Animais , Soluções Cardioplégicas/química , Ácido Cítrico/farmacologia , Guanidinas/farmacologia , Coração/efeitos dos fármacos , Testes de Função Cardíaca/efeitos dos fármacos , Técnicas In Vitro , Ácido Láctico/metabolismo , Magnésio/farmacologia , Masculino , Miocárdio/metabolismo , Fosfocreatina/metabolismo , Ratos , Ratos Sprague-Dawley , Sulfonas/farmacologia , Titulometria
5.
J Cardiovasc Surg (Torino) ; 38(5): 479-85, 1997 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-9358805

RESUMO

The purpose of this report is to describe the clinical characteristics and surgical technique for splanchnic artery aneurysms. Over the past 10 years we have surgically resected 8 cases of splanchnic artery aneurysms including 2 cases involving the superior mesenteric artery, 3 involving the renal artery, 1 involving the hepatic artery and 2 involving the splenic artery. Diagnosis was established preoperatively in all patients by splanchnic angiography. Surgical treatment for splanchnic artery aneurysms is indicated in any symptomatic patient, in all symptomatic patients with suspected renal aneurysmal expansion and in patients who have renal aneurysms occurring with functionally important renal stenosis, usually associated with hypertension, in all patients with surgical accessible hepatic artery aneurysms, in all patients who have superior mesenteric artery aneurysms having a high tendency to rupture, and in all patients with an asymptomatic splenic artery aneurysms 1.5 cm or larger in diameter. Although splanchnic artery aneurysms are uncommon and asymptomatic, we recommend that splanchnic arteries should be treated surgically because of their tendency to rupture or organ failure.


Assuntos
Aneurisma/diagnóstico por imagem , Aneurisma/cirurgia , Vísceras/irrigação sanguínea , Adulto , Feminino , Artéria Hepática/diagnóstico por imagem , Artéria Hepática/cirurgia , Humanos , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Mesentérica Superior/cirurgia , Pessoa de Meia-Idade , Radiografia , Artéria Renal/diagnóstico por imagem , Artéria Renal/cirurgia , Artéria Esplênica/diagnóstico por imagem , Artéria Esplênica/cirurgia
6.
Nihon Kyobu Geka Gakkai Zasshi ; 45(4): 655-60, 1997 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-9155144

RESUMO

Ruptured fusiform descending thoracic aortic aneurysms due to aortitis syndrome are rare. A 29-year-old woman was readmitted to our hospital with a chief complaint of back pain and shock, and diagnosed as having rupture of a descending thoracic aortic aneurysm. She had a past history of aortitis syndrome beginning eight years ago. On chest CT examination earlier a year, the descending thoracic aortic aneurysm was 4.5 cm in diameter, and calcification we observed in the aortic wall. An inflammatory reaction had been controlled by steroid therapy and her blood pressure had been controlled by vasodilator drugs. Emergent graft replacement of a descending aortic aneurysm was successfully performed under a femoro-femoral bypass using a centrifugal pump and membrane oxygenerator, and Cell Sver. Although in the literature surgical treatment is indicated only if there is a symptomatic or enlarging aneurysm especially of saccular type and no operation is justified for an aortic aneurysm showing marked calcification, we concluded that aggressive surgical treatment was necessary for this fusiform aneurysm due to aortitis syndrome.


Assuntos
Aneurisma da Aorta Torácica/etiologia , Síndromes do Arco Aórtico/complicações , Ruptura Aórtica/etiologia , Adulto , Aneurisma da Aorta Torácica/cirurgia , Ruptura Aórtica/cirurgia , Prótese Vascular , Feminino , Humanos
7.
Kyobu Geka ; 50(3): 256-9, 1997 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-9121036

RESUMO

A 48-year-old man was readmitted to our hospital with a chief complaint of left anterior chest mass. He had a past history of thymo-thymomectomy six years earlier. On chest CT examination, multiple tumor shadows were noted within the left thoracic cavity. All visible tumors were resected. His postoperative course was favorable, and no signs of recurrence have been recognized on CT to date (three years and six months postoperatively). However, in view of the possible recurrence of the present disease after a long period, strict observation of the course of the disease is necessary.


Assuntos
Miastenia Gravis/complicações , Neoplasias Torácicas/secundário , Neoplasias Torácicas/cirurgia , Timoma/secundário , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Timectomia , Neoplasias do Timo/patologia
8.
Kyobu Geka ; 49(9): 733-7, 1996 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-8741453

RESUMO

During a 20-year period, 364 patients underwent coronary artery bypass grafting (CABG) for the treatment of ischemic heart disease. Among these patients, 28 underwent emergency surgery. The reasons for performing emergency CABG were unstable angina in 15 patients, impending myocardial infarction in 12 patients, and congestive heart failure in 1 patient. Eleven patients died postoperatively. Eight variables were examined by univariate analysis for their influence on the occurrence of a hospital death. IABP and acute coronary occlusion were found to be predictors of hospital death and previous myocardial infarction was a predictor of hospital survival. Seventeen patients were followed up for 12 years. There was no cardiac death and actuarial survival at 12 years was 63%. The 14 survivors are now in NYHA functional class I or II. Although the operative mortality rate is high after emergency CABG, the patient's prognosis is good.


Assuntos
Ponte de Artéria Coronária , Emergências , Isquemia Miocárdica/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Balão Intra-Aórtico , Masculino , Infarto do Miocárdio , Isquemia Miocárdica/mortalidade , Prognóstico , Fatores de Risco , Taxa de Sobrevida , Fatores de Tempo
9.
Jpn Heart J ; 37(4): 447-53, 1996 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-8890758

RESUMO

During a 20-year period, 364 patients underwent coronary artery bypass grafting (CABG) for the treatment of ischemic heart disease. Among these patients, 28 underwent emergency surgery. The reasons for performing emergency CABG were unstable angina in 15 patients, impending myocardial infarction in 12 patients and congestive heart failure in 1 patient. Eleven patients died postoperatively. Eight variables were examined by univariate analysis for their influence on the occurrence of a hospital death. Lack of a history of myocardial infarction, intraaortic balloon pumping (IABP) and acute coronary occlusion were all found to be predictors of hospital death. Seventeen patients were followed up for 12 years. There was no cardiac death and actuarial survival at 12 years was 63%. The 14 survivors are now in NYHA functional class I or II. Although the operative mortality rate is high after emergency CABG, a fair prognosis can be expected if the patients survive surgery.


Assuntos
Ponte de Artéria Coronária/mortalidade , Doença das Coronárias/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Angina Instável/cirurgia , Doença das Coronárias/mortalidade , Emergências , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/cirurgia , Prognóstico , Taxa de Sobrevida , Resultado do Tratamento
10.
Kyobu Geka ; 49(8 Suppl): 621-4, 1996 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-8741431

RESUMO

Underlying cardiac lesions in 39 adult cases with infective endocarditis were studied. 18 cases (46%) of the patients had no evidence of preexisting cardiac disease and infection frequently involved aortic valve. The patients without preexisting cardiac disease and 4 patients with an intracardiac substitute including pacemaker lead and aortic valve prosthesis required a surgery during an active infective endocarditis. All cases of active infective endocarditis accompanied with rheumatic valvular disease underwent surgery after a suppression of active inflammation by medical treatment.


Assuntos
Valva Aórtica , Endocardite Bacteriana/etiologia , Valva Mitral , Adulto , Idoso , Valva Aórtica/cirurgia , Endocardite Bacteriana/cirurgia , Feminino , Doenças das Valvas Cardíacas/complicações , Próteses Valvulares Cardíacas , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/cirurgia , Prognóstico
11.
Kyobu Geka ; 49(5): 376-9, 1996 May.
Artigo em Japonês | MEDLINE | ID: mdl-8992040

RESUMO

We experienced a case of 47-year-old man who suffered swallowed fish bone-induced esophageal perforation with purulent mediastinitis and underwent direct suture closure of the perforation and reinforcement with a pedicled parietal pleura four days after the onset. Postoperative esophageal suture insufficiency was occured and reoperation was performed two months after the first operation. The esophageal fistula was plugged with a pedicled omental graft successfully. The postoperative course of the patient was uneventful and he discharged 45 days after the second operation. A reinforcement by pedicled omental graft for esophageal rupture accompanied with mediastinitis was considered to be a useful procedure.


Assuntos
Perfuração Esofágica/cirurgia , Peixes , Corpos Estranhos/complicações , Mediastinite/cirurgia , Omento/transplante , Animais , Perfuração Esofágica/etiologia , Humanos , Masculino , Mediastinite/etiologia , Pessoa de Meia-Idade , Reoperação
12.
Nihon Kyobu Geka Gakkai Zasshi ; 44(2): 130-7, 1996 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-8717259

RESUMO

Although the protective effects of the calcium antagonists on ischemic and reperfused myocardium have been investigated, there have been only a few reports regarding their efficacy in relation to the degree of ischemic myocardium. This study was undertaken to investigate the efficacy of diltiazem, a calcium antagonist, in relation to the degree of ischemic myocardial injury in an isolated working rat heart. Three different models of ischemic injury were designed; Group A: 30 min global ischemia with a single dose infusion of St. Thomas' cardioplegic solution (STS), Group B: 60 min global ischemia with multidose infusion (every 30 min) of STS and Group C: 60 min global ischemia with multidose infusion (every 15 min) of STS. These groups received only STS, while Groups A-D, B-D and C-D (the treated groups) received the same solution with diltiazem (0.5 mumol/l). The recovery of post-ischemic cardiac function and the CPK leakage during reperfusion were evaluated, and the two groups were compared. For 30 min global ischemia, the addition of diltiazem to STS significantly improved the percentage recovery ratio of aortic flow (63.2 +/- 8.6% vs 79.9 +/- 5.9%, control vs. diltiazem, p < 0.01) and reduced CPK leakage during reperfusion (87.5 +/- 35.8 IU/20 min/g dry wt vs. 41.7 +/- 14.5 IU/20 min/g dry wt, control vs. diltiazem, p < 0.05). However, no differences in the post-ischemic functional recovery and CPK leakage were noted between the groups for 60 min global ischemia. In conclusion, for myocardial preservation, the addition of diltizaem to St. Thomas' cardioplegic solution was less effective for the 60 min global ischemia. Regarding severe myocardial ischemia, it was suggested that, inhibitation or suppression of calcium channel by diltizaem might insufficient to obtain additional protection of the St. Thomas' cardioplegic solution. Therefore, it would be necessary to control calcium entry through another pathway during ischemia and reperfusion.


Assuntos
Bloqueadores dos Canais de Cálcio/uso terapêutico , Soluções Cardioplégicas/administração & dosagem , Diltiazem/uso terapêutico , Parada Cardíaca Induzida , Isquemia Miocárdica/tratamento farmacológico , Reperfusão Miocárdica , Animais , Bicarbonatos/administração & dosagem , Cloreto de Cálcio/administração & dosagem , Glucose/administração & dosagem , Técnicas In Vitro , Magnésio/administração & dosagem , Masculino , Modelos Cardiovasculares , Cloreto de Potássio/administração & dosagem , Ratos , Ratos Wistar , Cloreto de Sódio/administração & dosagem , Trometamina/administração & dosagem
13.
Kyobu Geka ; 49(2): 155-8, 1996 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-8691687

RESUMO

Total anomalous pulmonary venous drainage (TAPVD) is a rare congenital cardiac anomaly. It occurs in only 1.5% of children born with congenital heart defects. But, it is one of the most common lesions necessitating intracardiac operation in the neonatal period. We have experienced a 33-year-old man with supracardiac type TAPVD who was operated upon successfully. Cardiac catheterization showed 0.35 in Pp/Ps, 3.33 in Qp/Qs and 0.11 in Rp/Rs. The left to right shunt ratio was 77%, while the right to left shunt ratio was 23%. The operation was composed of anastomosis between the left atrium and the common pulmonary vein, patch closure of the atrial septal defect, ligation of the vertical vein and tricuspid annuloplasty. The posterior approach was adopted in anastomosis between the left atrium and the common pulmonary vein. The association of a normal pulmonary vascular resistance, a large interatrial communication and absence of a pulmonary venous obstruction was considered as factors of a favorable result.


Assuntos
Veias Pulmonares/anormalidades , Veias Pulmonares/cirurgia , Adulto , Anastomose Cirúrgica/métodos , Átrios do Coração/cirurgia , Humanos , Masculino , Valva Tricúspide/cirurgia
14.
Artif Organs ; 20(2): 152-5, 1996 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-8712961

RESUMO

A totally implantable motor-driven left ventricular assist device (LVAD) has been developed and tested. The performance of this LVAD was tested in a mock circulatory system. This pump provided 8 L/min of output against a mean afterload of 120 mm Hg with a filling pressure of 20 mm Hg when the pump was operated in the fill/empty mode. The right and left pumps were tested in a mock loop. The right pump afterload was kept in the range from 23-32 mm Hg. With increase in the left pump afterload, the pump power output varied from 1.64 to 2.37 W. The instantaneous motor power input varied from 22.6 to 30.6 W with the total system efficiency ranging from 6.7 to 9.4%. To date, 4 in vivo studies have been conducted for up to 12 h. Two animals survived 12 and 10 h, respectively. Termination was due to bleeding in 1 animal, vent tube obstruction in 1, and respiratory failure in 2. All animals died of technical failure. Another experiment is to be undertaken, and a newly designed cannula is now being manufactured.


Assuntos
Coração Auxiliar/normas , Músculos Abdominais , Animais , Materiais Biocompatíveis , Débito Cardíaco/fisiologia , Ponte Cardiopulmonar , Cateterismo , Técnicas In Vitro , Fluxo Pulsátil/fisiologia , Ovinos
15.
Kyobu Geka ; 48(12): 1002-5, 1995 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-8538098

RESUMO

A case of rare thymic squamous cell carcinoma was reported. A 46-year-old female was admitted to our hospital because of an abnormal shadow on chest X-ray. Chest CT showed anterior mediastinal tumor and histological diagnosis of squamous cell carcinoma was made by needle biopsy under CT guide. Esophagus and lung were no abnormal findings, we thought the primary region was thymus. On mid-sternotomy, anterior mediastinal tumor was resected with thymus, right phrenic nerve and pericardium, however it was not direct invasion to heart, great vessels, lung and chest wall. Resection of peripheral fatty tissue and dissection of mediastinal lymph nodes as much as possible, it was not capsular invasion and mediastinal lymph nodes metastasis and complete curative resection was able to perform. Additional radiation therapy was done, post-operative course was uneventful.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias do Timo/cirurgia , Carcinoma de Células Escamosas/secundário , Terapia Combinada , Feminino , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Neoplasias do Timo/patologia
16.
Kyobu Geka ; 48(3): 236-8, 1995 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-7534839

RESUMO

A 20-year-old man was admitted to our hospital because of an abnormal shadow on chest X-ray Laboratory data revealed a high serum alpha-fetoprotein (AFP) and LDH level. Percutaneous needle biopsy of the tumor suggested primary mediastinal germ cell tumor. Curative resection was performed after three courses of combination chemotherapy (cis-platinum, VP-16, bleomycin and adriamycin). A post-operative histological examination of the mass revealed total necrosis. Post-operative course was uneventful, and he has been free of recurrence for the last six months.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Germinoma/cirurgia , Neoplasias do Mediastino/cirurgia , Adulto , Bleomicina/administração & dosagem , Cisplatino/administração & dosagem , Terapia Combinada , Doxorrubicina/administração & dosagem , Etoposídeo/administração & dosagem , Germinoma/tratamento farmacológico , Humanos , Masculino , Neoplasias do Mediastino/tratamento farmacológico
17.
Kyobu Geka ; 47(8): 684-7, 1994 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-7967290

RESUMO

Between 1975 and 1993, 16 of 95 patients who received open mitral commissurotomy for mitral stenosis required reoperation for recurrent mitral lesions with a mean duration of 11 years after the initial operation at Kawasaki Medical School Hospital. The mitral lesions necessitating reoperation involved restenosis in eight, stenoinsufficiency in six and regurgitation in two. In 13 patients, mitral commissure was well separated, and the mitral restenosis and regurgitation were caused by progressions of valvular and subvalvular lesions. Significant tricuspid valve regurgitation was also seen in nine patients, and in seven out of eight patients who were in NYHA functional class III or IV, tricuspid regurgitation of grade 3 was observed. The combined tricuspid regurgitation aggravated the patient's symptoms and became a major risk factor of the reoperation after open mitral commissurotomy.


Assuntos
Cateterismo , Estenose da Valva Mitral/terapia , Valva Mitral , Feminino , Humanos , Masculino , Insuficiência da Valva Mitral/complicações , Estenose da Valva Mitral/complicações , Recidiva , Reoperação , Insuficiência da Valva Tricúspide/complicações
18.
Kyobu Geka ; 47(6): 470-3, 1994 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-8207888

RESUMO

The case of a 56-year-old man who underwent mitral valve replacement due to HOCM complicated by IE and MR is reported. Preoperative 2D echocardiographic assessment of the mitral valve revealed systole anterior motion (SAM) and vegetation, and color flow Doppler echocardiographic examination revealed severe mitral regurgitation. The left ventricular out-flow tract gradient decreased from 140 mmHg preoperatively to 60 mmHg postoperatively. Mitral valve replacement should be considered in patients with associated IE and severe MR.


Assuntos
Cardiomiopatia Hipertrófica/cirurgia , Endocardite Bacteriana/complicações , Insuficiência da Valva Mitral/cirurgia , Infecções Estreptocócicas/complicações , Streptococcus sanguis , Cardiomiopatia Hipertrófica/complicações , Próteses Valvulares Cardíacas , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/cirurgia
19.
Nihon Kyobu Geka Gakkai Zasshi ; 42(1): 78-82, 1994 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-8308387

RESUMO

A 54-year-old man with an acute retrograde type I dissecting aneurysm of the aorta underwent three operations for four years. The first operation was by the Collins method, the second was a graft replacement of the descending aorta, and the third involved a graft replacement of the ascending aorta and aortic arch, revascularization of the aortic branches and replacement of the aortic valve. In operations on acute retrograde type I dissecting aneurysms of the aorta, the methods of Koster or Collins are in appropriate in cases where sufficient entry treatment is impossible, and graft replacement of the ascending aorta at least is considered to be necessary.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Dissecção Aórtica/cirurgia , Doença Aguda , Prótese Vascular , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação
20.
Nihon Kyobu Geka Gakkai Zasshi ; 41(6): 957-61, 1993 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-8336046

RESUMO

Between January 1975 and July 1992, coronary artery reoperation was performed in 16 of 333 patients who had undergone primary bypass grafting. The interval between the operations ranged from 2 to 147 months. Reoperation was done within one year in two patients, within one to five years in five patients and after more than five years in nine patients. The mean number of bypass grafts was 2.31 per patient in the first operation and 1.75 in the reoperation. The main reasons for the reoperation were an occlusion of the graft in 12 cases and both graft occlusion and new coronary artery disease in 3 cases. In one other case, an emergency right coronary bypass graft done for an acute occlusion during PTCA to an area of right coronary artery stenosis 13 months after two bypass graftings to the LAD and circumflex coronary artery. Fourteen cases had vein graft disease bypassed to the LAD or new coronary artery disease in the LAD and required reoperations of the LAD. In the case with a recurrence of myocardial ischemia after coronary bypass surgery and with bypass grafts to the LAD that were patent, there were no cases requiring reoperation. These findings demonstrate that patency of the grafts to the LAD is an important factor for reoperation after myocardial revascularization surgery.


Assuntos
Ponte de Artéria Coronária , Fatores Etários , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Fatores de Tempo , Grau de Desobstrução Vascular
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